Nandys Principles of Forensic Medicine, 3rd Edition PDF

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Apurba :\andy
PRINCIPLES
OF
FORENSIC
MEDICINE
INCLUDING TOXICOLOGY
Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

PRINCIPLES OF
FORENSIC
MEDICINE
INCLUDING TOXICOLOGY
Apurba Nandy MD
Ex-Professor and Head of the Department of Forensic and State Medicine,

North Bengal Medical College, Sushrutanagar, Siliguri;
Medical College, Kolkata, RG Kar Medical College, Kolkata, WB;
Katihar Medical College, Bihar;
Manipal College of Medical Sciences, Pokhra, Nepal
Ex-Principal ofNB Medical College, Siliguri;
Midnapore Medical College, W B;
Katihar Medical College, Bihar
Ex-member of Senate, N B University; Calcutta University
Ex-member ofUG Council, NB University
Board of PG Studies, Calcutta University
Ex-member ofWB Medical Council
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Principles of Forensic Medicine including Toxicology • Apurba Nandy
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f=oreword .. .. .. .... ... .. ..... ........ .. ... ... . ..... .. ....... .... .. ..... : .. ......... ... .. ... ... ... .. .......... ..... ................ .... xvii
Preface to the Third Edition .... .... ........................ .. .... .. .... .. . ....... ............................................. : .. xix
Preface to the First Edition ......... ........................ ... ............. ... .. ....... ................................... .. . xx-xxi
"'\cknowledgemenls ... .... ... ..... ...... ........ ..... ...... ........ .... . .. ... . . .. ... . ............................ .. ........ XXIII
~~. , · . _' Pert - f ~ .,
1. FORENSIC MEDICINE-A BRIEF INTRODUCTION ............................................... ... 1-4
[ Medical Juri~pru_dence and Forensic Medicine; History of Forensic Medicine and Toxicology I
2. LEGAL PROCEDURES IN MEDICOLEGAL CASES .................................................. 5-22
Preliminaries; Investigation of a c;riminal case, Investigation of case of death in a suspicious
l circumstance; Different inquests, Types of offences and cases; Punishment allowed by IPC;
Categories of courts in India; Witness; Evidence; Medical evidence, Dying declaration;
I
l Dying deposition; Attendance in court by a doctor; Trial of a case; Examination in chief;
Cross examination; S~mmary trial, Guidelines for the doctor; Scene of crime-examinati-~n _j
3. LEGAL AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE ............................... 23-88
~Ethics; Etiquette; Different Codes of Ethics, Declaration of G eneva,2 004 ;-Amendment2006;

International code; Doctor's duty; Acts in connection with practice of Western Medicine in
India; Indian Medical Council Act; State Medical Councils; Erasure of name from Council's
register; Rights and privileges of Registered Medical Practitioners; Codes, ethics and duties
etc. of doctors as per MCI; Unethical acts; Professional miscondud (Infamous conduct);
Punishment; Disciplinary action; Form of certificates recommended for leave etc .; Format
for Medical record, Detail of duties, Patients' secrecy; Privileged communication; Fiduciary
t duties; Malpractice and negligence; Burden of proof of negligence; Res-Ipsa loquitur; Civil
and Criminal negligence; Iatrogenic conditions, Medical maloccurrence; Therapeutic mis-
adventure; Corporate negligence, calculated risk, common knowledge; Novus-Actus-
_lntervenins; Duties of the patient; Contributory negligence; Product liabilily; Euthanasia or
I Mercy Killing, Human Experimentation; Codes and declarations; Human Genome Project;
Cloning; Consent; Maintenance of medical records; Laws and statutes for medical practice;
Workmen's Compensation Act; ESI Act; CPA or COPRA; Protection of Human Rights Act;
LAmnesly International; Tr~splan~tion of.....Human organ Act__
vii

~- ·_._ - -
4. IDENTIFICATION OF AN INDIVIDUAL ....................... :....................... ............ .... 89-188
Definition, Data for identification, Race, Ethnicity and morphological features, Different skel-
etal indices, Features of Indians, Identification from Religions. Determination of sex from-
Morphology, from Bones, Sex chromatins, Gonadal biopsy; Concealed sex; ln.tersex or
genderqueer, Hermaphroditism, true, Pseudo- male and female; Klinefelter':; syndrome,
Turner's syndrome, Estimation of age; Teeth- eruption, decaying changes and age, Boide' s
formula, Stacks method of ageing, Matching of teeth; Race, sex, Grouping from teeth bite
marks; Age from ossification of different bones; Age changes at symphyseal surface of pubis;
from scapula, vertebrae, skull bone sutures; Developmental features and age -Intra-uterine,
! extra-uterine, MLI of different ages; Stature of a person- Different formulae; Scar, Keloid,
1 Tattoo marks; Anthropometry, Study offinger prints, Poroscopy, Footprint, Sole print, Lip print,
nail print, Palata-print; Hair- Morphology and Otherfeatures, MLI; Biometric identification,
Hand geometry, Palm vein authenticity; Iris and Retinal scan; Superimposition technique,
Reconstruction of Facial Contour, Sketching of face, Photograph, Clothes, Ornament etc,
Voice, Gait, Trick, Manner, Habit, Handwriting, Signature; Memory, Intelligence; Dog's scent
identification; Study of DNA profile, Methods of PCR technique etc., DNA profile of siblings,
DNA gene card (smart/secure card)
5. IDENTIFICATION FROM TRACE SUBSTANCES AND

THEIR OTHER EVIDENTIAL VALUES ....... .-......................................................... 189-220
Locard's principle, Blood as trace evidence, MLI of blood, Study of source of blood, Naked-
eye examination, Microscopic examination, Spectroscopic examination, chemical (presump-
tive) tests; Confirmatory microchemical (crystal) tests, Species identification from blood (sero-
logical), ring test, antiglobulin consumption tesl, precipitation test in gel, passive haemag-
glutination test, Gel electrophoresis test, ABA card test; Specific identification from blood,
1 Blood group and 1ype, Subgroup of'!\, Tests for ABO group (different tests), Blood group and
1
• disputed paternity and maternity, MN grouping, S5 grouping, Rh Alleles, Kell, Duffy, Lutheran,
Kidd systems, Antigenic factors in serum, Haptoglobin, Gm factor, Red cell enzyme system,
I Exclusion of Paternity and maternity by DNA test, Abnormal Hb., Seminal fluid- examina-
tion, tests for blood group factors, MLI, Tests etc. for Vaginal fluid, Urine, Skin, loath pulp,
Nail, Dandruff
6. DEATH AND POSTMORTEM CHANGES .......................................................... 221-286
Thanatology, Definition of death, Brain death, Suspended animation, Natural and Sudden
death, Modes of death-coma, syncope, asphyxia, Changes after death -Immediate, Early,
Late; Immediate changes, Early changes, Primary relaxation, changes in the eye, Cooling of
the body, Postmortem lividity (staining), Rigor mortis, Cadaveric spasm, Secondary relaxa-
' tion, Decompositi~n (putrefaction), Forensic entomology, Decomposition in water, Mummifi--
cation, Adipocere formation, Rancification, Changes in blood, CSF, Estimation of time of
death; Preservation of dead bodies, Plastination, Old Egyptian way, Disposal of dead bodies
presumption of survivor-ship and death
viii

MEDICOLEGALAUTOPSYAND ARTEFACTS IN POSTMORTEM EXAMINATION,
EXAMINATION OF SCENE OF CRIME .................................. ... ...... ...... ... ....... . 287-314
Examination of scene of crime, procedure of medicolegal autopsy, PM examination proper-

External and internal, Exposure of cranial cavity, Spinal cord, Viscera -preserved, Exhuma-
tion, Examination of mutilated body, Charred (Burnt) body, Skeletal remains, Obscure and
Lnegative autopsy, Postr:nortem artefacts, Examination of dead body at the scene of crim~
8. FORENSIC SCIENCE LABORATORY .............. ................. ... ..... ... ...................... 315-328
r set up of FSL, Chromatography-Column, Paper, Thin layer, Gas; Electrophoresis-Starch

or agar gel, Paper; Spectroscopy or spectrometry-UV, Infra red, Mass, Emission; Atomic
absorption technique, Neutron Activation analysis, X-ray defraction pattern; Microscopes in
Forensic use-spectroscopic, comparative, Fluorescent, Polarising; Polygraph or lie detector
Part-Ill
9. INJURIES-LEGAL CONSIDERATION ............................................ ....... .. ...... ... 329-338
Legal aspects of injury, Offences against human body, Homicide, Murder, Grievous hurt etc,
Different sections of IPC related to offence against human body (some other sections of IPC
related to offence against human body are described in relevant chapters), Injury and murder
- provisions of English law)
10. MECHANICAL INJURIES .................... ............................... ............................. 339-426
rClassifi~ation, Abrasion, Bruise, Laceration, lmcised :ou ndPefence wound, Self-inflicted

I wound, Fabricated wound; Punctured wound; Firearms- shotgun (smooth bored) and rifled,
Long barrelled, Short barelled, Revolver, Pistol, Cartridges, Primers, Gun powders-Smoked,
Non-smoked, Semi-smoked, Projectiles - Pellets, Bullets; Injuries caused by firearms,
Variation of injuries due to various causes, Airgun, Gyrojets, Plastic and Rubber bullet,
IExplosive agents -Injuries caused by them
'---!.,._ _ _ -- - -------------~
11. THERMAL INJURIES ............................................................ .......... ...... .. .. .. ..... 427-450
Exposure to cold- Effect of general exposure, Local exposure, Frostbite, Strench foot, Expo-
sure to heat- effects of General exposure- Heat stroke, Exhaustion, Cramps, Local expo-
sure to dry heat- Burn- Differentclassifications and ~es of injuries, Causes of death, PM
findings, MLI, Postmortem burning, Preternatural burning; Spontaneous combustion of dead
! bodies, Flash burn. Scalds (application of wet or moist heat) effect
12. INJURIES DUE TO ELECTRICITY, LIGHTNING, RADIATION .. .......... .................... 451-464
l
· Death due to electrucution, features of electrocution, causes of death, Joule burn, Judicial
elecliocolioll, Ligliliiillg 011d lightning deaths, Effects of lightning, Recommended precau-
tions against lightning injury, X-ray and radiation injuries- Acute and chronic exposure-
] Intensity, LASER beam injury, Effect of r<:J_~iatic>n, precautionary steps
lx

13. COMMUNICATION AND TRANSPORTATION INJURY ....................................... 465-478
Road injuries-Primary impact injuries, Secondary injuries, Secondary impact injuries-to

pedestrians, occupants of offended vehicle, offending vehicle, Vehicles running in the Same
direction, Opposite direction, Types of vehicles involved; Railway injuries, Different aspects of
. consideration; Aviation accidents-Role of Medical persons, Identification of victims and
l0.her issues
14. REGIONAL INJURIES .... .. .. .. ...................... .. ... .......... ............. ........... ........ ... .... 479-510
Head injury-to bones of head (different fractures), Cerebral concussion, lntracranian haem-l
orrhages, Other injuries to brain, Punch drunk, Head injury and legal responsibility; Injuries
to neck, chest, abdomen, limbs and other parts, fracture of vertebral column, Railway spine,J
lburn_~njury _ _ _ _ __ _
15. M EDICOLEGALASPECTS O FI NJURIES ..................... ............ .......... ................ 511-516
~
act~-;s ~-hich-;nfluence eff~cts ofinjuri;:~ Their heal:ng; Other medicolegal asp~cts, Ex~mi-l
ation and certification of wounds, Model proforma of certificate, Causes of death due to
njuries-delayed and immediate causes
16. VIOLENT ASPHYXIAL DEATHS .. ..... .. .. .... .......... .... ........ .. ................... ............... 517-564
Types, Hanging and its types, Causes of death in hanging, Force of constriction, PM appear-
ance, ligature mark and features, Judicial hanging, MLI, PM hanging; Strangulations, types-
by ligature-PM findings, Throttling or Mannual strangulation-PM findings, Strangulation
by other means-Bansdolla, Garroting, Mugging, features and MLI, Accidental strangula-
tion. Drowning---Jypes-dry, wet, Fresh water, Saltwater, (Type I, IIA, liB) Shallow water drowning,
~
atoms-tests fm, value of; Suffocations-Smothering, Traumatic asphyxia, Choking, Gag-
ng, Overlying, Burking, their causes, PM findings, MLI
- - ---
-----------------------~
- -- . . - -- - . ~ - - ~ ..
. . . .- . . . ~ . . ... - ' - ~ ... ~
17. STARVATION ............. .................... .... .... ...... .. .. ... ........... ... ............. : ............... 565-568
[ Types, Features of, Fatal p~iod; Malnutrition, Featur:s, PM findin_§ls, MLI - =
18. CRIME AND CRUELTY AT HOME ........................ .. ....... ........ ...... ................... .. 569-582
Cruelly and atrocity on children-Different aspects, Features related, MLI, Dealing the prob-
lem, Treatment; Cruelty on wives, Various aspects and issues to be considered; Cruelty on [
1 husband; Cruelly on old and disabled; Cruelty on other members of family ~
19. ' HAZARDS OF BLOOD TRANSFUSION ........ .. ...... .. ...... .. .................................. 583-584
Serological problem, Infection from infected blood or Wrong technique, Transfusion of ex~e~~
volume, Air Embolism, Transfusion of haemolysed blood
- - -- ----- -
20. SOCIAL, MEDICAL, LEGAL AND ETHICAL PROBLEMS WITH AIDS ...................... 585-590
!AIDS-A problem of th~ :·ociety, Medical pr~bl;ms, -R:medy, Lega~·Ethical and Mora~~
[peels

21. FORENSIC PSYCHIATRY ................................................................................ 591-624
I The Forensic psychiatrist, Mental health, Mental illness, Definition of insanity, Causes, Clas-
sification; Illusion, Hallucination, Delusion-Types, MLI, Emotion, Anxiety disorder, perso-
nality, Insomnia, Phobia, Obsessive compulsive disorder, Stress disorder, Post-traumatic stress I
disorder, Impulse, Delirium, Obsession, Somnambulism, Somnolentia (Semisomnolence), Sleep,
Narcolepsy, Panic disorder, Identity disorder, Attention deficit hyperactivity, Agoraphobia,
Claustrophobia, Depersonalisation, Derealization, Abreaction, Disorientation, Ambivalence,
Euphoria, Apathy, Perseveration, Mannerism, Stereotypy, Negativism, Narcoanalysis, Echo-
praxia, Echolalia, Vervigeration, Neologism, Circumstantiality, Distraction, Neurosis, Neu-
1 rasthenia, Psychosis, Lucid interval, Psychopathic disorder, Schizophrenia, Epileptic insanity, I
Bipolar disorder, Hypomania, Mania, Depressive psychosis (Melancholia), Mental retarda-
tion, Dementia, Diagnosis of mental insanity, Observation, Feigned insanity, Insanity and
law, Admission, Detention and Release from a hospital or nursing home, Criminal responsi-
bility, McNaughten rules, Durham and other rules, Legal test, Civil responsibilities, Hypno- 1
tism, Diminished responsibility
J
22. IMPOTENCE, FRIGIDITY, STERILITY, ARTIFICIAL INSEMINATION,

IVF AND CLONING .......................................... .... ................ ................. ....... 625-636
Sexual intercourse, potency, impotence, sterility, Civil and Criminal issues, Causes of impo- ~
tence and sterility, in Males, in Females, Frigidity in women; Sterilisation; Artificial insemina-
r tion, Surrogate mother, In-vitro fertilisation, Cloning
23. VIRGINITY AND DEFLORATION ..................................................................... 637-642

[ Signs of Virginity, Defloration, Extra-genital signs of virginity, Signs of false virginity
24 . PREGNANCY, DELIVERY AND LEGITIMACY ETC. ............................................. 643-658

Pregnancy, Medicolegal aspects, Legal issues, Diagnosis of Pregnancy, Presumptive signs, l
Probable signs, Pregnancy tests- Biological, Serological, Positive signs, Super-faetation,
Super-fecundation, Pseudocyesis, Viability of foetus, Delivery- Signs of recent delivery in the
living and dead, Signs of remote delivefy in the living and dead, Legitimacy and Disputed
Paternity and Maternity, Cloning
25. ABORTION ................................................................................................... 659-670

Types, Spontaneous, Causes of natural abortion, Induced abortion, MTP, Criminal abortion,
Concerned IPC sections, Methods of inducing criminal abortion, Therapeutic abortion, Causes I
of death, Signs of criminal abortion, Postmortem findings, Appearance of foetus in different
intra-uterine ages of Medicolegal importance
26. INFANTICIDE ................................ ............................................................... 671-686

Viability of the foetus, Still born foetus, Dead born foetus (dead birth)- Signs; Signs of live
birth, Hydrostatic test, Histological exam~~ation~f !.::_ngs: Br:aslan's second life test, Infant J
xi

death - Natural causes, Accidental causes, Precipitated Labour, Deliberate killing of an
infant, Acts of omission, Acts of commission; Abandoning of a child, Concealment of birth,
Cot death or Crib death (SIDS)
27. SEXUAL OFFENCES AND SEX PERVERSIO ~ . .. ....................... 687-720

Types, Natural, Ur.tnatural, Definition of Rape, ?u 1s enr Statutory rape, Rape on- Virgin,
Defforated women, Young child, Sleeping or nfo>·ca·eo .1()111an, Complication of rape, Exami-
nation of the- Victim, Accused, Materials preserved Es'ablts ment of relationship between
accused, offence and victim, Impact on the victim , Other- a· ral sex offences not amounting
to rape, Adultery, Incest; Unnatural sex offences - Sodom , · o· - ab'tual passive and active
agents, Habitual passive and active agents, their Examination, Lesoianism or Tribadism, Buc-
cal coitus, Bestiality, Indecent assault, Sexual abuse of children, Immoral trafficking, Pomeg-
raphy, Sex Perversion- Classification, Fetichism, Transvestism, Peeping Tom, Troilism, Sco-
pophilia, Sadism, Bobbitsyndrome, Lust murder, Naturists, Necrophagia, Masochism, Exhi-
bitionis~; Hypersexuality, Satyriasis, Nymphomania, Frotteurism, Necrophilia, Masturbation
Part- VI
28. FORENSIC TOXICOLOGY ..................................................... . 721.744

Definitions, Different Acts and Laws, Sources of poison, Nature, Actions, Factors int uenci - g
Actions, Diagnosis of poisoning in living and in dead, PM findings, Preservation o; viscera
and other materials, Laboratory tests, Chromatography, Treatment- Emesis, Stomach wash-
Contraindication of their use, High colonic lavage, Delaying of absorption of poisons, Use of
antidote- Physical, Chemical, Physiological or Pharmacological, Universal antidote, Chelating
agents, Serological antidote, Symptomatic treatment, Different classifications of poisons
29. CORROSIVE AGENTS ........................................... .. ....................................... 745-760
Sources, Actions, Properties, Signs-symptoms, Fatal dose, Fatal period, Treatment, PM find-
ings, MLI of corrosive mineral (inorganic) acids- Sulphuric acid, Nitric acid, Hydrochloric
acid; Corrosive Organic acids- Oxalic acid, Carbolic acid or Phenol, Acetyl Salicylic acid
or Aspirin, Acetic acid; Corrosive alkalies- Anhydrous ammonia, Ammonium hydroxide,
Hydroxides and Carbonates of Sodium, Potassium and Calcium
30. IRRITANTS: MECHANICAL& NON-METALLIC INORGANIC &

SOME ORGANIC CHEMICAL IRRITANTS ........................................................ 761-772
Mechanical irritants- effects and other aspects of Glass powder or pieces, Chopped Hair,
Stone Pieces, Diamond dust or pieces, Spiky Metallic Pieces; Acute and Chronic White Phos-
phorus poisoning; Poisoning with Halogens, Chlorine, Fluorine, Bromine, Iodine; Camphor,
Phosgene, Phosphine, Nitrous oxide, Ozone, Hydrogen peroxide, Hydrazine, Sulphur diox-
ide, Soaps and Detergents, Smoke
xii

'ETALLIC CHEMICAL IRRITANTS ............................................... ..... ................. 773-798
Acute and Chronic Poisoning with poisonous compounds of Arsenic, Lead, Mercury, Copper,
Iron, Thallium, Zinc, Barium, Potassium, Gold, Bismuth, Tin, Silver
32 ORGANIC CHEMICAL iRRITANTS (INSECTICIDES AND ENVIRONMENTAL) ......... 799-808

Fungicidal, Herbicidal, Insecticidal agents- Organophosphorus compounds-Alkyl and
Aryl compounds, Chlorinated hydrocarbons, Rodenlicidal agents, Carbomates, Aluminium
phosphide, Synthetic Pyrethroids, Paraquat, Dipridyl, Agent orange, Tear gas, Incense smoke,
Ketone bodies
33. VEGETABLE IRRITANTS ................................................................................... 809-822

Abrus Precatorius, Ricinus Communis, Croton Tiglium, Semi carpus Anacardium, Ergot, His-
tamine, Calotropis Gigantea, Calotropis Procera, Plumbago Zeylanica and Rosea, Podo-
phyllum Hexandrum, Anacardium Occidentale, Argimone Mexicana, Crysanthemum
Cinerariaefolium, Eucalyptus Globulus, Cinnamomum Camphora, Cytrulus Colocynth is,
Juniperus Sabina, Colchicum Leutium, Turpentine, Carum Copticum, Cuminum Cyminum,
Cassia Augustifolia, Daffodil, Mango, Eugenia Caryophyllus, Rerula Narthex, Indian Win-
tergreen, Aristolocia Indica, Fern, Loco Weed
34. ANIMAL IRRITANTS ......................................... .............................................. 823-838

Poisonous snakes- Colubridae- King cobra, Cobra, Common Krait, Branded Krait, Poi-
sonous Vipers- Pit viper, Echis viper, Russel viper; Poisonous insects - Cantherides, Scor-
pion, Bees, Wasps, Hornets, Red Ants, Centipedes, Millipedes Brown spider; Gila Monsters,
Poisonous Amphibian like poisonous salmanders, Toads and Frogs, Aquatic animals, Veno-
mous fish like Scorpion fish, load fish, Weever fish; Invertebrate aquatic animals
35. CEREBRAL POISONS ........ ...... ..... ..... ... ..... ........................................... ....... ... 839-880
Somniferous Drugs- Opium (Morphine), Heroin, Codeine, Dihydromorphine, Pethidine,
Nalorphine, Methadon; lnebriants- Ethyl Alcohol, Drunkenness, Methyl Alcohol, Methylated
Spirit, Isopropyl Alcohol; Hypnotics, Barbiturates, Bromides, Chloral Hydrate, Paraldehyde;
Cerebral Stimulants- Amphetamine, Methamphetamine, Dexo-amphetamines, Adrenaline,
Cocaine, Procaine, Butacaine, Dopamine, Camphor, Caffeine, Theophylline, Theobromine,
Formaldehyde, Kerosene; Deliriants -Datura, Atropa Acuminata, Cardiazol, Camellia Sinensis,
Conium Maculatum, Fish-berries, Water Hemlock; Hallucinogens-Cannabis, LSD, Mesca-
line, Nutmeg, Phencyclidine, Hallucinogenic Mushrooms, Autonomic Excitant- Sympathetic
Excitants, Ephedra Gerardoama; Parasympathetic Excitant; Tranquilizers
36. SPINAL POISONS .......................................................................................... 881-884

Strychnine (Strynos Nuxvomica)
37. PERIPHERAL NERVE POISONS ....................................................................... 885-886

Drug which act on p~ripheral nerve ends- Curare toxins
- J
xiii

38. ANAESTHETIC AGENTS ................................................................................. 887-890
1
General anaesthetics, Ether, Chloroform, Fluothane, Cyclopropane, Nitrous oxide, Spinal

anaesthesia; Local anaesthesia, Muscle relaxants
39.
- - - --
CARDIAC POISONS ............ .......................... ................ ................................ 891-902
Hydrocyanic acid and its salts, Aconite, Nicotine (Nicotiana Tabacum) and Lobelia lnflata,
.
r
Quinine, Quinidine, Cinchonine, Cinchonidine, Digitalis, Cerbera Thevefia, Nerium Odorum,
Ipecacuanha, Yew, Glory Flower, Alpinia Galanga
40. ASPHYXIANTS ....... .. ..... .... ... ... .. ....... ... .. ......... .... .... .. ...~...... ... ...... ....... .. ........... 903-908
C lassification, Carbon dioxide, Carbon monoxide, Hydrogen Sulphide, Sulphur dioxide, Phos-
gene, Phosphine
41. FOOD POISONS .... ..... ... ......... .. .............. .. .. ... ................ ... ..... ....... ............... 909-912
Botulin loxin, Mushrooms, Fly Agaric, Destroying angel, Calviceps purpurea, Lathyrus sativa,
Solanine, Aflatoxin, Soyabean, Ptomaines
42. DRUG DEPENDENCE AND ABUSE .............................. ...... .. .... ...................... 913-922
~
Drugs- Definition etc. Types of drug users, Types of abused drugs, Drugs causing- Psycho-
ogical dependence, Physiological dependence, both; Factors related to drug dependence,
Assessment of the problem, Management plan, De-addiction centres, Treatment at home,
Right to use Psychotropic Drugs, Misuse of medicinal drugs
-- -- -- ___J
43. NATIONAL HUMAN RIGHTS COMMISSION'S RECOMMENDATIONS

ON AUTOPSY PROTOCOL .. .... .. ........ ... .... ... .. ......... ........ ................ ..... ... ..... ... 923-942
Model Autopsy Protocol-Introduction, Proposed model aut~psy protocol, Scene investiga-
tion, Autopsy, Model protocol for disinternment and analysis of skeletal remains, Proposed
rmodel skeletal analysis protocol, Procedure to be followed during disinternment,

tion of burial, Laboratory analysis of skeletal remains, Final report, Repository evidence,
Classifi~a
postmortem detection of torture, Comparison of the body with the possible dissidents, Stab
wound chart, Firearm wound chart
~ - ----------------------------------------------
44. APPENDIX .. ... ...... ........ .. ...................................................................... ......... 943-958
[""Fc;'r~ate of first information report to police, lnvestigatio; under section 1 7 4 CrPC, Challan
I~o- be used when a dead body is sentfor examina~ion, PM report formate, Label to be used on
viscera preserved, Formate for leave extension or commutation of leav.e, Report on Medical
Examination of a male subject (for sex offence and estimation of age), Report on Medical
examination of a female subject (for sex offence and estimation of age); Notice of poisoning
or disease, List of notifiable diseases (occupational sources); Form for despatch of viscera/
xiv

exhibit, Nature of crime, List of exhibits sent for examination, Nature of examination required,
Court summons to witness, Age-height-weight chart in growing children, Affidavit, Medical
certificate of cause of death- Form for cause of death, Form for cause and manner of
death, Brain stem death certificate
INDEX ................................................................................... ........ ......... .... 959-l 013
APPENDIX-18 .................................................................................................... l-26
XV

Foreword
Principles of Forensic Medicine by Dr Apurba Nandy is an authentic textbook in the field of Forensic
Medicine and_ is certain to draw interest of the medical students and also those who are professionally
linked with medicolegal services.
This book will serve the purpose of undergraduate medical students to the fullest extent and of the
Postgraduate students of Forensic Medicine to a great extent. It will act as a good referral book for them
who practice medicine, law and are engaged in crucial investigation of criminal cases.
The book palpably attempts to introduce the conception of principles of practice of forensic medicine
to the medical students. Incorporating medicolegal aspects of certain recent issues, it has also altempted
to remove some anomalous conceptions about the applicability of this branch of science in the practical
field.
Dr Nandy, Professor and Head of the Upgraded Department of Forensic and State Medicine and
Vice Principal, Calcutta Medical College, Calcutta, was the Postgraduate student in Forensic Medicine in
SCB Medical College and the MD degree of this College was one among the few others recognised by
MCI earliest. As his guide and teacher during his postgraduation I was convinced that Dr Nandy would
shine as a very successful medicolegist. My assessment was correct. This book is a bright example in
support of my contention.lf the book meets the demand and desire of all related sections it will not only be
a success of the author, it will also give me personal pleasure and satisfaction as Dr Nandy was my first
Postgraduate student, on whom I had great hope.
GP Mohanty
Ex-Professor & Head of the Department of Forensic Medicine and
Toxicology, SCB Medical College. Cuttack, and
Director of Health Services, Govt of Orissa
xvii

The book Principles of Forensic Medicine has established itself among a wide and greater circle of people
in the society who deal or will deal in future, the medicolegal cases, namely teachers and students of
medical colleges, doctors in general, legql practitioners and law-keeping authorities, in spite of the fact
that due to some unavoidable constraints, the book could not be edited for over a decade.
' '
There has been a minor chcmge in the"title of the; boo~ in th~ present edition-at the desire of them
who use it-to meet their requirements. However, this has not changed the n'ature and purpose of the
book.
The present edition is an extensively modified version. In this edition the author has not only tried to
incorporate the recently developed related aspects of medicolegal practice and serve the readers of the
book to meet.their need with the scope and provision?, alongwith limitations, concerning their service to
the society, but also has tried to inculcate a judiciou·s medicolegal vision, thinking capacijy and analytical
mind in them who render such a critical service to the society. In this book, the varying standards of
medicolegal service in our country and other corners of the world have been dealt with for better under-
standing of -the social and cultural conditions prevailing all around to provide the most rational and
desired service . It ccin be expected that the contents of the book will act in the mind of the readers while
dealing with medicolegal matters and the few crucial pertinent issues for solving medicolegal problems,
questions like "What, When, Where, How, Whom, and Who" will always arise in mind. In the present
situation of unrest all around the world, the role of a doctor cannot be underestimated in all_such various
aspects of medicolegal issues.
The students will find some additional help from important issues which have been high-lighted in this
book in red, to cho'?se their required topics.
If this edition of th~ book can· help the readers (even to a meagre extent), the author will derive
immense pleasure and satisfaction for his microscopic contribution for creation of a healthy society for
years to come.
Though I am very much obliged to them who have helped me in various ways, I feel their help was
spontaneous and without-expectation of any thanks in return.
Koikata APURBA NANDY

12.06.2009
xix

Preface to the First Edition
This book is the result of a long-standing desire of the author to present the magnitude of the vast field of
applied Forensic Medicine in the background of the present social structure . It also enumerates the basic
concepts necessary to deal with different medicolegal cases and delineates the scope and extent of knowl-
edge of this field of medicine, so that a doctor can act in the best possible way either by rendering service
himself-as far as possible-or adapting such rational steps as the society gets his best service .
Though Forensic Medicine is complete only when it is based on science and scientific development,
this is not the entire picture, when viewed from the social requirement point of view. Its applied field
changes with the changing pattern of social psychology. When we were undergraduate students of Foren-
sic Medicine, in most cases it was sufficient to know if a case of death was suicidal in nature, though
provision of Section 306 IPC concerning abetment to commit suicide was existent event then. Today, in
most of the suicidal cases, much emphasis is given on the provisions of this Section, whether this Section
is applicable or not. The MIP Act has changed one facet of our social concept. Ouestions of negligence
in hospitals and nursing homes are being raised far more often. More and more young offenders claim
themselves to be juvenile and more and more employees of retiring ages claim wrong entry of their ages
in their official records .
Simultaneous with increased expectation of the society and the investigating authorities from a
medicolegist, the medicolegist has started feeling frustrated as his scope to render service has not ex-
panded in the last 50 years! The availability and use of scientific aids for rendering service by other
medical specialities have inevitably disillusioned the man of Forensic Medicine about the future prospect
of this discipline . On the other side, expectations of investigating authorities and those in the courtroom as
also society as a whole, from the medicolegistis increasing . In other words, the gap between the expecta-
tion and the service rendered increasing. If this trend continues it will be disastrous for this discipline as
well as society .
Most of the medicolegal cases in our country are dealt by fresh young doctors and doctors of other
specialities. They do so with total dissatisfaction as they find themselves ill equipped to deal with the
varying medicolegal cases . Additional problems are there. The doctor has to attend courts, not at all
pleasant places for non-litigants. They deal with affairs of known or unknown criminals, and in many
circumstances the working environments are hellish, if not worse. This book aims to give some indirect
relief in this regard.
In this book certain items have been dealt in more than one chapter. This is because of more than one
medicolegal bearings of those issues in our society and as perceived by a medicolegist.
Certain archaic concepts still governing the service rendered by a medicologist could not be totally
ignored . However, wherever pos-sible, the author has tried to point those fallacie s and remove the old
misconceptions.
Many concepts have been introduced in this book which the doctors practising Forensic Medicine
ordinarily cannot practice . But conception about those topics will be helpful to assess the position from all
XX

ltXi
angles and the enlightened man of science can convey the shortcomings to the investigating machinery as
well as the actual position. It will definitely be in the interest of justice.
Though this book is primarily written for the undergraduates, it will be beneficial tot he postgraduate
students who want to specialise in this field . They would get some idea as to what is the magnitude and
scope of this field and as to what they should learn from different books and by their practical experience.
This book can give an idea to the legal practitioners as to what is expected from a doctor in legal issues.
The investigating authorities who put in much effort in the detection of a case may also get some idea as
to what extent can be expected from whom, particularly from the doctor.
. .
Few topics which have been briefly discussed in this book are not relevant to this part of the world, for
example, some poisonous plants not found in India. These have been incorporated just as an example to
remind the readers that there are innumerable such items which specifically concerns medicolegists of
different parts of the world in addition to the problems common to all.
In the Appendix, different official forms related to medicolegal service have been incorporated.
Lastly, the author expresses his sincere feeling of indebtedness to those victims of crime and cruelty,
social and circumstantial injustice and misconception who paid with their lives or physical and mental well
being, which directly or indirectly benefited the author to improve and enrich his knowledge.
The concept of social justice may change but the concept of human feeling should not ...... '
Calcutta APURBA NANDY

1st January 1995
xxi
In course of preparing this textbook I have received extensive help, cooperation, and appre-
ciation from my departmental colleagues and colleagues of the discipline of Forensic Medi-
cine from both inside West Bengal and outside . Apart from my Departmental colleagues and
colleagues of the discipline, Dr (Mrs) Mita Sen, Sri Aloke Mitra (of The Telegraph), Dr Shiraz
Ahmed and Dr (Mrs) Jyoti Mahapatra and many others earn my gratitude .
xxiii

FORENSIC MEDICINE- 1
A BRIEF INTRODUCTION Chapter
MEDICINE AND LAW

cal practices. Hence, practice of medicine is
guided and guarded by some codes, ethics and
legislations which we learn from Medical Ju-
Forensic Medicine and Medicolegal works are
risprudence. In our country and many oth-
also concern of police and many other inves-
ers, each of the two terms "Forensic Medi-
tigating agencies, laboratories, legal authori-
cine" and "Medical Jurisprudence" are often
ties and court rooms.
used to mean both.
The terms "Forensic Medicine" and
According to the some conception, "Medi-
"Medical Jurisprudence" are used in the prac-
cal Jurisprudence", however is the science
tice of Law and Medicine. These two terms
which deals with the application of medical
are not synonymous.
and surgical knowledge and skill to the prin-
FORENSIC MEDICINE, which is., also ciples and administration of the law. It com-
known as LEGAL MEDICINE, relates to ap- prises of all legal subjects which have a medi-
plication of medical knowledge for di~ensa cal aspect.
tion of justice in a Court ot.Law. Thus, this
The term "Forensic" has come from the
subject teaches a man how to use his knowl-
edge of Anatomy, Physiology, Pathology, Latin word "Forensis", and is related to "fo-
Medicine, Surgery, Gynaecology, etc., to rum" which means a meeting place in ancient
clarifY or solve related legal problems or is- Rome, where disputes used to be discussed
sues. This necessitates examination of vic- relating matter of evidence and testimony in
tims, accused persons, complainants, defend- court of law or governmental proceedings.
ants, respondants and different exhibits, by "Forensic Medicine" interprets and ex-
a medical man in relation to some criminal plains the unexplained aspects of death in
or civil cases. suspicious circumstance or suffering of bod-
MEDICAL .nJRISPRUDENCE means le- ily harm and some such matters related to
gal aspects of practice of medicine. Practi,ce criminal or civil faw cases, by using knowl-
11f medicine occassionally involves certain edge of medicine.
ribks, more so, if the medical practitioner is Both the terms Forensic Medicine and
negligent towards his patient or if he uses Medical Jurisprudence, strictly speaking are
his medical knowledge in unlawful orunethi- branches of medicine and not of law.
2 I PRINCIPLES OF FORENSIC MEDICINE
1 Gradually, a difference between the two come much dependant on the medical sci-
terms Forensic Medicine and Medical Juris- ence. However, use of medical knowledge in
prudence as noted above, has been accepted. legal issues is not new to the present age.
In any case, connection between law and The subject got its importance in Germany
medicine is perceived since long, long before followed by Great Britain and some other Eu-
the existence of the term Medical Jurispru- ropean countries. Workers have traced law-
dence. However, both the terms Forensic medicine relationship from as back as 4000-
Medicine and Medical Jurisprudence is the 3000 B.C., in many comers of the world in-
functioning bridge between medical man in cluding India and China.
one side, and (1) civil and social rights and In Egypt, in around 3000 B.C., the Chief
(2) criminal matters invoh·i ng common men Physician used to be the Chief Justice too.
on the other side.
In the 6th century B.C . , in Rome,
"STATE MEDICINE", Dr Stanford Emer- weightage was given to the assessment of the
sion Chaille (1949), an eminent medical edu- severity of the wound in one side and negli-
cationist recommended the term "State Medi- gence in the treatment of the wounded on
cine" for this branch of medical science. which the other, iffatality resulted after sustaining
was once suggested earlier too (as early as in the wound.
1876). But presently, this term stands almost
In the 5th and 4th century B.C. ,
rejected world-wide. The term actually sig-
Hippocrates (460- 355 B.C.), talked about
nified an elaborate field of practice of Medi-
Medical Ethics and wounds and fatality.
cine including social and legal aspects, which
according to Chaille, ought to be free from In about 200 B.C., in China, hashish was
political implications and machinations. in use as narcotic in surgical procedures.
The term "Forensic Medicine" is popular In ancient Persia, induced abortion was
in England and Scotland and includes, both, considered as a serious offence.
use of medical knowledge in legal practice In 5th and 6th century A.D., Justanian
and legal aspects of practice of medicine. "Le- Code of practice of medicine came into exist-
gal Medicine" is the synonym, popular in ence. Justanian law specified the role of a
France and Germany. In many states of medical man as an expert in certain legal is-
U.S.A "Medical Jurisprudence" is the term sues like malingering, impotence, abortion,
still preferred to others. legitimacy, rape, poisoning, etc.
In India, the term "Forensic Medicine" is Between 12th - 16th century A.D. , Italy
getting more and more popularity. In some and France showed much progress in the use
states of our country like Bihar and Orissa, of medical knowledge for legal purposes .
the subject is named "Forensic Medicine and Sometimes the methods of such medicolegal
Toxicology''. West Bengal, Assam and Manipur practices used to be crude. For example, in
use the term "Forensic and State Medicine". Italy, in nullity of marriage cases on the
ground of impotence, the husband and wife
~r.;-.,-~~-~---:l _. ' . had to prove their ability by attempting and
• '. ~. 't.---..4..:~-- .. - l
performing sexual intercourse, which was
witnessed by doctors and nurses, so that they
In present days, all over the world, dispensa- could give their opinion on the capability of
tion of justice through legal system has be- the partners.

chapter 1: FORENSIC MEDICINE-A BRIEF INTRODUCTION I 3
In China, in 13th century, a manual was Orfila ( 1787 -1853) , Professor of chemis-
prepared to help investigation of death cases . try and legal medicine introduced chemical
fu this century China allowed limited autopsy procedures in Toxicology in the early 19th
(external examination of the dead body) for century in Paris .
the purpose of diagnosis ofthe cause of death.
The historical MeN aughten rule came in
Further, in this century itself a mannual was
existence in 1843.
prepared in China to help investigation of
death. During the 19th century, in Europe and
U.S.A, we had pioneers in many fields of
However, first medicolegal autopsy, in its
Forensic Medicine, namely, Tardieu, John Pa-
real sense of understanding was performed
gan, John Glaister, A.M. Hamilton, Gonzales,
in "Bologna" in Italy, in 1302 by Bartilomio
Vance, Helpern, and others.
De Varignana .
In the 20th century, progress in the proc-
The first medicolegal journal came out in
ess of crime investigation continued with the
Germany in 1482 . In Germany in 1532 it was
advancement in the scientific medicolegal
considered that homicide caused by a person,
practices.
deprived of any understanding capacity should
not be punishable. (McNaugten Rule, page 617 20th century can be considered as the
came in existence more than 300 years later). golden period for medical science and foren-
fu the early part of16th century, medicolegal sic medicine with the progress in study of
autopsy was made obligatory in Germany, in genetics. Though DNA was isolated in 19th
unnatural and suspicious cases of death. century by Friedrich Meischer, during 1920s ,
From 17th century onwards, Europe has PA Levene analysed the components of
been showing continuous progress in the de- DNA, though not without any error. Many
velopment of practice ofForensic Medicine. scientists worked to decipher the structure
of DNA and its replication and hereditary·
Italian physician Fortunato Fedel pub-
transmission. Study ofDNA and application
lished the first book in Forensic Medicine in
1602 . of polymerase chain reaction have revolu-
tionized the field of applied Forensic Medi-
Between 1621 to 1635 the principal phy- cine.
sician of Pope Innocent-X and Pope Alexan-
In the current 21st century, B Medea, B
der-VII, and also an expert in the court of
Brinkman, PM Srieder, J Balazic, MA Dada,
appeal, Rota Romana published seven vol-
umes of documents concerning medicolegal MSL Salgado, S Mesewa, MI Miscan, K Honda
matters. He published two more volumes in and many others are carrying.ahead on the
medicolegal matters iJ11666. These publica- works of our predecessors.
tions were authoritative till the beginning of It is unfortunate that, in our country
19th century. He was considered father of medicolegal investigations are much behind
legal medicine and father ofForensic psychia- the standard followed in developed countries.
try . The educational, administrative, legal
In the eighteenth century, the post ofPro- machinaries and the anomalous and patho-
fessor of Forensic Medicine was first intro- logical social psychology, all have contributed
duced in Europe. to the retarded growth ofthis highly sophis-

ticated technical discipline in our country. We limitations of practical applications of our

are contended and proud with our borrowed theoretical knowledge as much as possible,
knowledge. The present generation of if we sincerely desire to improve the stand-
medicolegists in India, must come out of the ard of medicolegal service in our country.
NOTES

The legal procedure in India is based on the Examples of civil cases-land dispute,
Indian Constitution, the Code of Criminal property dispute, divorce case or compensa-
Procedure, Indian Penal Code, Indian Evi- tion case, etc. These cases are settled in Civil
dence Act and other Acts promulgated for Courts without the provision of punishment
specific purposes, including special Acts. In for any. Compensation or relief to the suf-
medicolegal practices, a medical expert has fered party is allowed.
to extend his service within the frameworks Payment of compensation of any amount
and provisions of these Codes an Acts. is not a punishment, but fine of any amount
The Criminal Procedure Code (CrPC) is a punishment.
deals with the procedure of investigation and Whether it is a civil case or a criminal
trial of offences within the limitation of the case, the role of the medical expert does not
Union territory of India except Jammu and vary much.
Kashmir, N agaland and some other tribal
Investigation in a civil or criminal case-
areas, so far some chapters are concerned.
like elsewhere, our country also has various
The Indian Penal Code (IPC), describes investigating agencies, some are under the
punishments for different enlisted offences control of state governments and some are
and the different types of Courts authorised controlled by the central government, and
to try different types of offences. there are some other autonomous and quasi
autonomous bodies.
The Civil Procedure Code (CPC) deals
with the procedures to dispose of disputes But, as it appears to us that investiga-
between two individuals or two sides; disputes tion of a criminal case is more stringent, here
which do not amount to offences. we will give more weightage on discussion
on the process of investigation of a criminal
A criminal case is tried in a Criminal
case. A doctor in course of participating in
Court and a civil case is tried in a Civil Court.
the investigation of criminal cases will be
Examples of criminal cases -murder, conversant with his role in the investigation
rape, theft, robbery etc. In these cases the of civil cases also, as, so far a doctor is con-
offender or the criminal is liable to be pun- cerned there is nothing much additional to
ished after trial and conviction. deal these cases.
5
Among criminal cases, investigation of a 5. For any other reason, the police officer
case of death of a person in a suspicious cir- considers it expedient to do so,
cumstance is very seriously done and is im- in accordance within the provision oflaw,
portant for the doctor. Hence, we will dis- shall send the dead body to the nearest
cuss the same here.
autopsy centre considering the distance
and chance of putrefaction of the dead
body rendering the possible findings on
the body totally destroyed.
Under this section a District Magistrate,
Subdivisional Magistrate or any other execu-
A coordinated team-work by the police, the tive magistrate empowered in this behalf by
medical expert and the others concerned is the State Government or the District Magis-
necessary for investigation of some criminal trate can also hold the inquest (inquiry).
cases. The process of coordinated investiga-
Under section 176 of CrPC, the nearest
tion is most scrupulously followed in a case
of death in a suspicious circumstance. Hence, magistrate empowered to hold inquest shall
if a medical man knows to play his best role hold inquest in circumstances narrated un-
in such cases then, in other criminal cases der the headings (1) and (2) above under sec-
he can play his role easily. tion 174 CrPC and may also hold inquest in
any other circumstances of death mentioned
under section 174 CrPC instead of or in addi-
tion to the investigation to be held or held. by
a Police officer. Further,
1. Where any person dies or disappears, or
In a case of a death in a suspicious circum- 2. Where rape is alleged to have been com-
stance the procedure of investigation in brief mitted on a woman, in police or any cus-
is held under Section 174 or Section 176 CrPC. tody authorised by the magistrate or
court, a judicial or metropolitan magis-
Under section 174 CrPC police officer so
trate having jurisdiction on the case will
empowered usually holds inquiry or investi-
hold an enquiry in addition to the inves-
gation in any unnatural death, e.g., suicide,
tigation held by police.
homicide or accident by any machinery or
animal etc. and suspicious death and In any case of such police investigation
1. When a woman commits suicide within or inquest by a magistrate he shall send the
seven years of marriage, or body within 24 hours for postmortem exami-
2. In case of death of a woman within 7 nation. If it is not possible to do so then the
years of marriage in any circumstance reason had to be recorded.
raising a reasonable suspicion that some Wherever possible the magistrate should
other person committed an offence in inform the relatives about inquest etc. Sec-
relation to that woman, or tion 176 CrPC ammendment of 2005, has
3. A woman dies within seven years ofher made it mandatory that, in case of death and
marriage and any relative of the woman disappearance of a person or rape of a woman
makes request for enquiry in the matter, while in police custody, a judicial enquiry will
4. There is any doubt regarding the cause be held and in case of death, the body should
of death, be examined within 24 hours.

chapter 2: LEGAL PROCEDURES !N MEDICOLEGAL CASES I 7
postmortem examination at the nearest au-

thorised centre.
Inquest means investigation or inquiry into In sub-section 4 of section 174 CrPC, Dis-
the cause of death, where death has occurred trict Magistrates, Subdivisional Magistrates
in a suspicious circumstance . or other Executive Magistrates specially au-
,.
thorised by the State Government or the Dis-
In different countries and places, differ- trict Magistrate, are empowered to hold in-
ent officials are authorised to hold inquest. quest.
Accordingly, inquest may be held or investi-
Magistrate's Inquest-Section 176 CrPC
gation may be performed by (a) Executive
provides that in case of death in police cus-
Magistrate, (b) Police officer, (c) Coroner and
tody or in case of death of a house-wife within
(d) Medical man. In India, Police inquest (in-
7 years of her marriage, if it is a case of sui-
vestigation) is the most common one.
cide or in case of death of a woman within 7
Police Inquest (Investigation)-A police years of marriage in any circumstance rais-
officer investigates a case of suicide, homi- ing a reasonable suspicion that· some other
cide or accidental death or death in a suspi- person committed an offence in relation to
cious circumstance, as per the provision of such woman, then the nearest Magistrate em-
174 CrPC. Under this section, on being in- powered to hold inquest will do so. Such a
formed about such a death, the officer-in- Magistrate can also hold inquest instead of
charge of a police station or any other police or in addition to an investigation by a police
officer so empowered, should inform about officer. See also Table 2.1 next page.
the incident of death to the nearest Execu-
tive Magistrate who has the authority to hold Coroner's Inquest-This system of in-
inquest and will himself proceed to the place quiry in an unnatural case of death was in-
of death or where the dead body is lying. On troduced in the metropolitan cities of India.
the spot he makes an investigation in pres- It is now effective only in some countries.
ence of two or more respectable persons of Coroner used to be appointed by the State
the locality and forms an opinion about the Government under Coroner's Act, from
apparent cause of death. He notes the inju- amongst legal practitioners of minimum 5
ries present on the body and other relevant years' standing practice or from Metropoli-
findings and the probable weapon or agent tan Magistrates. A Coroner inquires about
used to cause the death. The investigating the cause of death, the extent of the offence
police officer signs the report prepared by him involved in the death and finds out, how, when
and takes the signatures therein of as many and by whom death was caused. Wherever
persons as available or thought necessary. existent he is the Officer in charge of the
He also collects any object or material from "Coroner's Court" of inquiry where he is as-
near and around the spot (where dead body sisted by the members of the Jury, who are
is lying), which may subsequently be used or appointed by the Coroner from the respect-
act as evidence . The report is then sent to able members of the society who are neither
the district or subdivisional Magistrate. When doctors nor legal practitioners. If he passes
no foul play is suspected, the police officer the verdict of commission of an offence and if
can allow disposal of the dead body. In other the suspect can be located, then he issues
circumstances he forwards the dead body for warrant for the arrest of the accused person;

Table 2 1 Differences between Police Inquest (Investigation) and Magistrate/Coroner's l~t
Magistrate/Coroner's Inquest Police lnauest or Investigation

- -
1. Can hold inquest in aII cases of suspicious deaths. Cannot hold inquest in case of death in police custody, jail,
.'
due to police firing or death of housewives within 7 years
of marriage in case she has committed suicide or some
other person committed an offence in relation to her.
2. Magistrate's inquest is in full use only in a part of In use all over India except in these two places.
Kolkata. Nopoliceinquestis held in this part of the
city. Coroner's inquest is present only in some
other country.
3. In holding inquest. members of jury help the Police officer gets help from witnesses.
Coroner. Police officers help both Coroner and
Magistrate.
4. In the process, they need not inform anybody. In the process, the police officer has to inform the nearest
Magistrate about the incident and send a report on his
investigation to the magistrate.
5. They can issue warrant of arrest of the accused. Cannot issue warrant of arrest; but can arrest the accused
in case of a cognizable offence or with a warrant ot arrest
in any case.
6. They can order for exhumation of a dead body. Cannot order for exhumation of a dead body.
7. They can give requisition for analysis of viscera. Cannot do so.
8. Their investigation is considered superior to police This investigation is considered inferior to that of
investigation. Magistrate or Coroner.
Table 2 2· Differences between Coroner's Court and Judicial Magistrate's Court
Coroner's Court Magistrate's Court
1. It is a Court of Inquiry. It is a Court of trial.
2. In the functioning of the Court, presence ot the In the functioning cJ the Court presence of the accused is
accused is not necessary. essential.
3. Cannot punish the accused for commiSSion a the Can punish the accused for commission of the offence
offence inquired upon. under trail, after conviction.
4. Can punish aperson for contempt of the Can punish a person for contempt of Court 01' commission
Coroner's Court. of an offence.

chapter 2: LEGAL PROCEDURES IN MEDICOLEGAL CASES I 9
othetwise he gives an open verdict, and in- expert here gets the scope to inspect the dead
quiry of the case is kept in abeyance. body on the spot at the very onset of the en-
quiry and he thus can drive the process of
A Coroner's Court is a Court of inquiry
and not of trial. Hence the Coroner cannot enquiry more satisfactorily in the right di-
award punishment like a Judicial Magistrate. rection. This system does not exist in India.
But he can take a person to task for contempt Except in special circumstances as mentioned
of the Coroner's Court and can compel the earlier, ordinarily everywhere in our coun-
.- ttendance of a witness in his Court and keep try inquests are held by Police Officers ex-
•. e person under detention till the next rise cept in a part of city ofKolkata, where pres-
of the Court. In course of collecting evidence ently senior police officer not below the rank
of a case, he can summon anybody who de- of Asstt. Commissioner holds inquest in all
poses in his Court as witness under oath. cases of unnatural deaths, where medicole-
gal P.M. examinations may be necessary.
A Coroner in course of holding iitquest
enjoys all the powers of a First Class Magis-
trate. He can hold inquest in any suspicious
case of death.
Jury-Not in India, but in some coun- Offences may be (i) Cognizable offence (ii) Non-
tries, the Jury system of inquiry and trial is cognizable offence. Cognizable offence means
existent. GRAND JURY is the bodyofjurors, an offence enlisted in the First Schedule of
who take part in the process of inquiry of a CrPC, for which or under any other law in
criminal case to fix up the accused. PETIT force for the time being, a police officer can
JURY is the body of jurors who participate in arrest a person or persons without warrant.
trials. Cognizable cases deal with cognizable of-
The assistance of Grand Jury in the mat- fences.
ter of inquiry or investigation of a criminal Offences not enlisted as cognizable are
case to fix up the accused has been abolished non-cognizable offences in which cases for the
for reasons that the opinion of member or arrest of the accused a warrant must be is-
members of Grand Jury may be polluted by sued by an authorised person (e.g. magis-
extraneous source. In our country, though trate).
Jury system of trial no more exists, Section Different types of cases:
166 oflndian evidence Act still has its men-
tion to put question to a witness through or A Criminal cases
by leave of the Judge, which the Judge him- B. Civil cases
self may put and which he considers proper. Criminal cases relate to commission of
crimes. These cases are tried in criminal
courts. Usually the State initiates the case
against the accused. On conviction, the crimi-
nal or the convict is awarded with punish-
ment, allowed for commission of the offence.
In this system, enquiry of a suspicious case Usually the police institutes the case through
of death is done by a medical expert. The the public prosecutor and the accused per-
advantage of this system is that, the medical son is the defendant here.

Criminal cases may be : and imprisonment may be awarded one along

(a) Cognizable case-Relates to a cognizable with or without the other
offence.
(b) Non-cognizable case .
(c) Warrant ~ase -These are cases where
According to the nature of cases we have civil
the offence is punishable with death, life
Courts and criminal Courts We need not dis-
imprisonment or imprisonment for ape-
cuss the Civil Courts.
riod of more than 2 years .
(d) Summ:ms cases are those where maxi- Categories of Criminal Courts
mum punishment allowed is imprison-
Supreme Court. Located at New Delhi, is the
ment up to 2 years.
highest in status. It deals with both Civil and
(e) Police case -It is a case instituted by po- Crirmnal cases. But unlike civil cases, no
lice for trial in a Court. criminal case can be initiated in Supreme
(f) Complaint case- It is a case not instituted Court. It can only consider the criminal ap-
by police or on police report but is initi- peal cases. So, for criminal cases, it has only
ated by an individual or individuals, in a appelate section and no original section. All
Court. appeal cases must come after being dealt by
a High Court Supreme Court can award any
A summons case where punishment al-
punishment provided in the IPC. It can sus-
lowed is more than 6 months may also be
tain or alter the punishment approved or
tried as an warrant case.
awarded by the High Court.
Civil cases-These are cases relating to
High Court: Usually each state has a
disputes between two parties lodged in a Court High Court. But, for some small states, one
of law in their indivi.dual capacities. These High Court covers more than one such small
cases do not relate to offenc•"S or crimes. states. Usually High Courts are located in
These are tried in Civil Courts. The party State capital city or town. But, in some states,
which lodges the complaint is known as com- they are situated in a city or town other than
plainant and the other party is called the re- the capital. Usually, for criminal cases most
spondent. In a civil case there is no provision of the High Courts have now only appelate
of punishment, as no offence has been com- section and no original section. These High
mitted. The dispute is settled in the Court Courts deal only appeal criminal cases. High
justly. When one party has suffered loss, com- Courts can award any punishment provided
pensation or damages is allowed, if the loss by the IPC. It has an additional function re-
can be so compensated. lating to some criminal cases. In a criminal
case, when a lower Court awards a death sen-
. - - - - - -
- -- -
tenCE ·, the High Court has to confinn the sen-
' . ', I
• • I
tence before the sentence is executed, even
' . .
' -
~• - I
t if there is no app~::al against the verdict. For
confirmation of death sentence or where a
Death sentence, life imprisonment, impris- new sentence is given which differs from the
onment for a tenn of some fixed period (both sentence awarded by a session judge, two or
simple and rigorous imprisonment), solitary more than tv.·o judges of the High Court
confinement, fine, forfeiture of property. Fine should sit together and at least two judges

should sign the confirmation of the death tan city there is a Chief Metropolitan Mal;is-
sentence or a new sentence awarded by the trate who has jurisdiction over the Metro-
High Court. This procedure is not necessary politan City. Chief Judicial Magistrates and
while dealing an appeal case. ChiefMetropolitan.Ma¢strates are 1st class
Sessions Court Every state has divisions Magistrates appointed by the High Court.
of Sessions Court for the districts. For met- They have power to award pnnishment of im-
ropolitan cities (population being more than prisonm~nt for up to 7 years.
1 million), there are separate sesswns courts Judicial Magistrates of the 1st class-
independent of the districts to which they They are appointed by the High Court A
belong. In addition to the Sessions Court one Judicial Magistrate of the 1st class can award
or more Additional Sessions Court may be punishment of up to 3 years imprisonment
there in a district, when felt necessary, the and fine ofup toRs. 10,000.00.
location of which is fixed by the State Govt.
A second class Judicial Magistrate is also
in consultation with the. High Court. The
appointed by the High Court and he can
judges of the Sessions and Additional Sessions
Courts are appointed by the High Court. The award punishment of up to 1 year imprison-
punitive or pnnishment awarding power of ment and fine up to Rs. 5,000.00
the Sessions Courts and Additional Sessions In metropolitan cities, there are MetriJ-
Courts are same. politan Magistrates who are appointed by the
A Sessions or Additional Sessions judge High Court and can award pnnishment of up
can award any pnnishment allowed by law. to 3 years imprisonment and/or fine of up to
But a sentence of death ordered by a Ses- Rs. 10,000.00.
sions or an Additional Sessions Court has to Court for Juvenile Offenders: An offence
be confirmed by High Court, with minimum not punishable with death or life imprison-
two judges sitting and signing the verdict. ment, committed by a person who on the date
Assistant Sessions Judge/Court Where of appearance or production before the Court,
necessity demands, for the assistance of Ses- is under the age of 16 years may be tried by a
sions Courts, Assistant Sessions Courts are Chief Judicial Magistrate or by any court spe-
instituted. Such a Court may be located at cially empowered by the Children Act 60 of
the District Head Quarter or at any other 1960. The Court provides for the treatment,
place considered suitable. Assistant Sessions training and rehabilitation of the juvenile
Judges are appomted by the High Court. They offenders.
can award any punishment provided by law Special Judicial Magistrates: On the re-
except death sentence, sentence of life im- quest of Central or State Government, the
prisonment or imprisonment for a period High Court in any local area may confer the
exceeding 10 years. power of a 1st class or 2nd class Judicial Mag-
istrate, on a person who is or was a Govern-
Courts of Magistrates
ment servant, and possesses required quali-
Chief Judicial Magistrate and Chief Metro- fication or experience, in connection with par-
politan Magistrate-In every district there is ti~lar classes of cases. Such appointments
one Chief Judicial Magistrate with jurisdic- of special Judicial Magistrates shall not be at
tion over the whole district. In a Metropoli- a time for a tenn of more than 1 year.

Special Metropolitan Magistrates : The lor. If a person under oath gives false evi-
High Court within the local jurisdiction of a dence in a court oflaw (perjury ), then he may
Metropolitan City, may confer the power of be punished with imprisonment extending up
Metropolitan Magistrate on a person on the to 7 years _In other cases- for giving false evi-
same grounds, in the same manner, as in case dence (other than under oath in a court) a
of a Special Judicial Magistrate, for a term person may be punished with imprisonment
not exceeding 1 year at a time . If necessary, which ·may extend up to 3 years . Giving false
the High Court and the State Govt. may and fabricated evidence in a case where pun-
empower a Special Metropolitan Magistrate ishment allowed is up to death sentence, the
to act in a locality outside the metropolitan person (who gives false evidence), may get
area. life imprisonment . And if death sentence has
been executed then the person who gave false
Public Prosecutor, Addl. Public Prosecu-
evidence may be awarded with death sen-
tor, Asst. Public Prosecutor: They are ap-
tence .
pointed by the Central Govt or State Govt.
for conducting in courts, prosecutions or other
proceedings like appeals.
Evidence means any statement in relation
.. - ··-· . •• . - ·- .... -- - =; •, ~ to a matter or fact under inquiry or a docu-
1'~ • ~ -.
.. . ., .• ~a .... ,..---. ._:-_:: ..__,._~
ment or something, for the inspection of the
Any person can testifY as a witness in a court Court.
of law if the court considers that he is not
Types
prevented from understanding questions, or
from giving rational answers due to tender 1. Oral-Any statement which the court per-
or extreme old age, disease of body or mind mits or requires to be made before it by
or any other cause. a witness in relation to a matter of fact
under inquiry (in the court for trial).
Types 2. Documentary-All documents including
1. Common witness -A common witness electronic records produced for the in-
testifies about what he himselfhas seen, spection of the court (in relation to a case
heard or perceived in relation to a case. under trial by the court).
2. Expert witness -In questions of forming Regarding evidence, some specific terms
an opinion on a point of foreign law, sci- are used in some cercumstances:
ence or art or to identifY handwriting or (a) Primary evidence -When some docu-
finger impression, etc., opinion of a per- mentary evidence is produced before the
son specially skilled in the matter be- court, we call it primary evidence.
comes relevant. Such a person or witness (b) Secondary evidence- This means certified
is called an expert witness. copy, photocopy, counterparts of original
Hostile witness and perjury-A witness documents or oral accounts of a document
who wilfully or with some motive tells lie, given by a person who has seen it.
suppresses facts partly or fully in a Court as (c) Matenal evidence -When some object or
a witness, may be declared a hostile witness . matter (e.g. a weapon of offence) is placed
On declaration of a witness as hostile, he can as evidence of some matter or fact, we
be cross-examined by the same side counsel- say it material evidence.

chapter 2: LEGAL PRO CEDURES IN MEDICO LEGAL CASES I 13
(d) Direct evidence-An evidence is a direct tion that it exists (i.e., existance of a mat-
evidence, when a person who himselfhas ter in question or raised before the
seen, heard or perceived something, gives court).
the statement (as in oral evidence) or (i) Disproved evidence-A fact is said to be
when some matter or object is produced disproved when, after considering the
to prove something (as in material evi- matters before it, the Court either be-
dence). lieves that it does not exist, or cqnsiders
(e) Circumstantial evidence-When some- its non-existence so probable that a pru-
thing at a place or circumstance proves dent '(cautious)' man ought, under the cir-
something indirectly, it is called circum- cumstances of the particular case, to act
stantial or indirect evidence, e.g., when upon the supposition that it does not ex-
the spot where a dead body has been de- ist (i.e., non-existence of a matter in ques-
tected is found to be very much disturbed tion or raised before the court).
it indirectly indicates that there was prob- (j) Not proved--A fact is said be 'not proved'
ably struggle between ~he deceased and when it is neither proved nor disproved.
his assailant.
(k) Conclusive evidence or proof- Any fact
(f) Hearsay evidence-It is an indirect oral declared by Indian Evidence Act to be con-
evidence . Here the person giving the clusive prooffor another, the Court shall,
statement has not himself seen, heard on proof of the fact, regard the other as
or perceived the matter in question but proved, and shall not allow evidence to
has learnt about the matter from some- be given for the purpose of disproving it.
body else who has seen or heard or per-
Corpus Delicti mean!'r-A (dead) body,
ceived the matter in question. Hearsay
findings on which or appearance of which
evidence is not ordinarily accepted by the
suggests that some illegal (criminal) act has
Court. But when the person 'X' who has
occurred (say relating to the death of a per-
seen, heard or perceived the matter in
son).
question is dead or not available then
hearsay evidence may be allowed if a Ordinarily documentary evidences are
statement is given by another person 'Y' required to be subjected to verification in the
who has learnt the matter from 'X' . court by oral evidence. But in certain circum-
(g) Prima facie evidence-Evidence which stances it may not be done so. e.g.,
has some force in it for which it can be 1. Dying declaration (see page 15)-As the
taken in its face value as proof of some person who gave the statement is dead,
matter in question (until it is disproved no question for him to attend the court
by some other evidence), is called Prima subsequently arises. But the Magistrate
facie evidence or the Doctor who records the declara-
(h) Proved evidence-A fact is said to be tion may have to attend the court in con-
proved when, after considering the mat- nection with this.
ters before it, the Court either believes 2. Once some deposition has already been
it to exist, or considers its existence so recorded and accepted as evidence in one
probable that a prudent '(cautious)' man court, it need not be deposed again in any
ought, under the circumstances of the other court in connection with the same
particular case, to act upon the supposi- case. But this does not prevent recall of

the witness in the same Court or when Medical Certificates -When it is a fitness
the section of charge is changed during or ill-health certificate it should include date,
the course of trial or, when the High hour and place of examination; name, sex,
Court in course of dealing with the case age and address of the person concerned; his
orders further enquiry and re-trial. complaints, brief history, physical findings,
3. Chemical Examiner's report need not be laboratory findings, if any; diagnosis; treat-
ordinarily followed by oral evidence ex- ment and further advice; signature of the
cept when either party desires for this. doctor, his qualifications and speciality, if any,
and signature or thumb impression of the
4. Opinion expressed in books/treatise/jour-
patient w1th date along with the statement
nals need not be ordinarily subjected to
from the doctor incorporated on the body of
verification by oral evidence due to rea-
the certificate that the person has signed in
son that the author may not be available
his presence .
due to his death or may not be easily
available without loosing much time or In case of birth certificate I declaration ,
incurring huge expenses when the author particulars of the mother, baby and place and
lives at a very distant place. time of delivery should be given in details.
In case of death certificate , cause, date,
hour and place of death should be mentioned.
If the cause , ' death is not clear, then post-
mortem examination should be advised in the
Medica] evidence may be 1. ORAL , 2. DOCU- certificate. If there is suspicion of any foul
MENTARY (e.g., the medical reports or cer- play, then police should be informed.
tificates, a doctor prepares and issues). Except in a free hospital or, where the
Sometimes the doctor may have to tes- tenn of service dictates otherwise the doctor
tify some material evidence (exhibit), e.g , can demand fees for issuing a medical certifi-
when he recovers some bullet from a dead cate. But in case of a death certificate reali-
body which may go in evidence. sation of fees cannot be a pre-condition of is-
suing a certificate, which can be legally real-
Oral Evidence -For this a doctor has to
ized later.
attend the court when summoned (see page
12). Medicolegal Reports -These are the
Documentary Medical Evidences-These medical reports prepared by the doctor usu-
ally on the requisition from some authorised
are.
person (a Judge, Magistrate or a police of-
1. Medical certificates like, ill-health, fit-
ficer), in connection with some civil or crimi-
ness, birth or death certificates. nal cases. {as mentioned above under docu-
2. '\iedicolegal reports like, injury, post- mentary medical evidences).
mortem, sex offence or age estimation
Medicolegal reports have three parts . The
reports.
FIRST part contains, name, age, sex, address,
3. Dying declaration . religion /caste of the person examined, name
4. Dying deposition This is not essentially of the accompanying and identifying person/
a medical or medicolegal report/docu- policeman, briefhistory of the case as provided
ment. by the police; date, hour and place of exami-

nation, consent for examination (except for noted in their exact forms and expressions re-
autopsy examination), two or three identifica- spectively. If the patient dies with part of the
tion marks of the person examined, person in statement being recorded then the doctor and
whose presence examined (if any), case refer- the witnesses should put their signatures on
ence of the police station. The SECOND part it in that condition. After the declaration is
consists of the observations or findings of the recorded it should be sealed inside a closed
doctor. The TillRD part consists of the opin cover and sent to the nearest Magistrate hav-
ion or inference of the doctor, formed on the ing jurisdiction. No policeman should be
basis of the findings. This is why the doctor is present while the declaration is recorded.
considered both as a common as well as an Dying declaration is given extreme value,
expert witness. For the part he observes, he
because it is believed that a dying person does
is a common witness and for the opinion he
peak a lie. But in the opinion of the au-
forms on his findingJ;: with application of his
thor it should not be given so much force
scientific knowledge and ~xperience, he is an
because that will be an over-simplification of
expert witness.
various complex psychological aspects of hu-
Dying Declaration-This is a statetrr:nt man mind which remains active in many per-
made by a person, who is about to die, relat- sons till the time of death.
ing to the cause or circumstance bearing with
The declaration recorded in improper way
the cause of his impending death. Preferably
will not be given value, e.g., if it is given to a
a magistrate should record it in presence of a
police officer along with an FIR or, if it is not
doctor and two other witnesses. The doctor
the narration of the declarant or, if it is re-
then certifies about the mental soundness of
corded by some one and attested by someone
the person. If there is any chance that the
else when it cannot be proved in the court by
person may die before the arrival of the mag-
istrate and if the doctor is present, then he a competent witness. Otherwise declaration
recorded by any person including a relative
should record the declaration in presence of
two witnesses (preferably two more doctors gets the value as a good evidence, (when there
acting as witnesses, if possible). Here also the is no other dying declaration conflicting or
doctor is to certify about the mental sound- countering each other or is/are inconsistent).
ness of the person If possible, the person In any case, dying declaration is valid with
should write the statement in his own hand- good evidential value only when the person
writing. Ifhe is illiterate or h is condition does dies in consequence to the stated circum-
not permit him to write, then the magistrate stance. Ifthe person survives then the decla-
or the doctor should write it as the patient ration has no value, because in that case the
himself narrates without any prompting. The person will have to attend the court to nar-
matter is then read before the patient who rate the circumstance which was allegedly
after reading it or listening what is exactly going to cause his death. But, still that will
written as his statement puts his signature or have some sort of evidential value, ifhe can-
left thumb impression on it. Then it is signed not attend the Court due to infirmity, being
by the magistrate or doctor and the two wit- not traceable or due to his stay at a distant
nesses. If the patient cannot narrate or speak, place, from where the declarant cannot
then he may be asked questions and his ges- present himself without much delay or cost
tures in response to the questions should be or both.
Dying Deposition-It is a statement by a for trial. For trial of a case in an Additional

dying person about the circumstance leading or Assistant Sessions Court the case shall ei-
to his death, made under oath in presence of ther be made over t o such court by the Ses-
a Magistrate where the accused person or his sions Judge or there should be a directive by
lawyer will be there to cross (question ) him the High Court on the said Court for trial.
on his statement. Here also the doctor has Cognizance of an offence is taken by a
to certify about the mental soundness of th e Magistrate,
person. This type of evidence may not be used
(a) upon rece iving a complaint of an act
in its totality. Also, strictly speaking, it is not
which constitutes such offence;
a documen tary medical evidence .
(b) upon a police report on such facts ;
(c) upon information received from any per-
Table 2.3: Differences between Dying Declaration
son other than a police officer or upon
and Dying Deposition . I his own know ledge that such an offence
Dying Declaration Dying Deposition has been committed.
1. Recorded by a magistrate Always recorded by a Ordinarily, before the commencement of
or a doctor. In circums- magistrate the trial, the charge is read out before the
tances by any other accused person. Ifhe admits guilt of commis-
person. sion of the offence , t h en wit hout going
through the detail process of t rial he is
2. No oath is necessary Oath taking is a must awarded suitable punishment. If the accused
3. Presence of accused or Presence of accused or person does not admit his guilt then trial pro-
his lawyer is not his lawyer is necessary ceeds. But in case of serious offences where
necessary punishment is also very severe, trial of the
case is a must.
4. Inferior to Dying Superior to Dying
After the charge is read out before the
Deposition Declaration
accused, the prosecution side (Complainant)
is asked to present its case. The prosecution
Trial of a Criminal Cas~ -A Magistrate presents evidences and witnesses who are
of the first class or second class who is spe-
'
cially empowered may take cognizance of any
. examined and cross-examined. Then both
prosecution and defence sides place their ar-
offence. Then the case is referred to the Chief guments. The accused may then be asked to
Judicial Magistrate. The Chief Judicial Mag- submit his statement ifhe has any say. After
istrate CCJM) after taking Cognizance of the all these, if the Judge or the Magistrate is
case sends it to a Magistrate of the first class satisfied that the accused person has com-
or second class for trial. Any Magistrat e spe- mitted the offence then he awards suitable
cially empowe r ed by the CJM (e.g., punishment. Ifhe feels that the prosecution
Subdivisional Judicial Magistrate) may act has failed to prove the case against the ac-
similarly on his behalf. For trial of a case in cused person beyond all reasonable doubt
a Sessions Court, the case has to be commit- then he orders acquittal for the accused. If
ted to the Sessions Court by a competent after hearing the prosecution case, the Judge
Magistrate. The public prosecutor is also in- fails to take any decision then he may order
formed after the case is committed to a Court the defen ce (accused) to present its case, be-
chapfer 2: LEGAL PROCEDURES IN MEDICOLEGAL CASES I 17
fore giving the verdict. In any case, if either the witness in the court on a specific date at
party, the prosecution or the defence, is dis- a specific time , to depose (state), as to what
satisfied with the verdict, then any or both he knows in relation to a case under trial in
sides may prefer an appeal before a higher the court. The summons is issued by and
court or bench. For this, the party dissatis- bears the signature of the presiding officer
fied should take leave from the present court (Judge or Magistrate) of the court or any of-
for a reasonable period to seek permission ficer fixed by the High Court ruling. It also
from the higher court for appeal. During this bears the case reference and name of the
period ofleave the execution of the verdict of accused person. It also contains special in-
the present Court will remain suspended. In struction to the witness, if any, for example,
case of death sentence, the verdict has to be if the witness is required to produce any docu-
confirmed by the High Court after scrutiny ment before the court.
of the case by two or more Judges of the High Summons are issued in duplicate. When
Court. If the death sentence is confirmed and served to the witness , he should send one
in case of appeal, if the order of death sen- copy back to the issuing court retaining the
tence is sustained, then the date of execu- other copy with him The returned copy
tion ofthe sentence is fixed up by the origi- should bear his signature authenticating the
nal Court which awarded the death sentence receipt of the other copy.
after giving reasonable time to appeal before
The summons may be served to the wit-
the Supreme Court. If a death sentence is
ness through the police or through somebody
sustained by the Supreme Court after an ap-
from the court or by some other means. For
peal is made there against the sentence, the
Government servants, the summons may be
President oflndia has the capacity to quash
served through the Head of the Department
or commute the sentence to imprisonment
or the Institution where the Government
in which case the death sentence will not be
servant works. It may be served to the wit-
executed, otherwise, the death sentence will
ness at his residence or even to some of his
be executed on the date to be fixed by the
relatives but not to the family servant. If the
Court which has originally awarded the ver-
summons cannot be served in any of these
dict.
ways, then it may be stuck to the wall of his
residence or in any conspicuous place which
should attract the notice of the witness. In
such a case, it is subsequently decided by the
court, whether the court should take as the
summons has been "served" or not. If the wit-
In connection with the medicolegal service ness resides outside the territorial jurisdic-
offered by a doctor in a case, he may have to tion of the court which has summoned him,
attend a court of trial of any category. For then the summons can be served through the
this purpose, the doctor is issued a summons magistrate within whose territorial jurisdic-
by the court. tion the witness resides presently. Summons
can also be served by registered post.
Summons
A doctor who has received the summons
Summons to a witness is a directive or order should attend the court on the specific date
Issued by a court I"Aqmnng the presence of at the specified time, if he is not compelled
rc ~A ,, 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
otherwise. In case he cannot attend the court The Doctor in the Court as a Witness
due to some valid ground then the court
In the Court, the doctor should report his at-
should be informed of the same well in ad-
tendance to the prosecution lawyer, when he
vance. If the doctor receives two summons
is a prosecution witness or to the defence law-
to attend two different courts on the same
yer, when he is a witness for the defence.
day at the same time, then he has to attend
When his tum comes he will stand inside the
one court with intimation to the other about
witness box. There he will first take OATH
the reason ofhis inability to attend that court.
to "speak the truth, the whole truth and noth-
In choosing the court he will attend, he
ing but the truth" This he will solemnly af-
should give priority to criminal Court over
firm or will affirm in the name of the God.
civil Court. When both the summons are ei-
ther from civil or from criminal Courts then Then his EXAMINATION-IN-CHIEF be-
higher Court should be given priority to the gins.
lower one. If the status of both the Courts If he is a prosecution witness his exami-
are same then the Court from which the doc- nation in-chief is conducted by the prosecu-
tor received the summons first, should be at- tion lawyer, i.e., the public prosecutor or his
tended. assistant. The lawyer asks him questions to
Non-attendance of the Court without bring out what he knows about the case. Ac-
valid ground amounts to contempt of court tually, on the basis ofhis report the doctor is
and is punishable by law. In such a case a to narrate his personal knowledge about the
bailable or non-bailable warrantofarrestmay case which may include his findings and opin-
be issued for causing the presence of the wit- ion about what he has examined. During ex-
ness on a fixed date and time. amination-in-chief leading questions (ques-
tions which suggest or give hint about the
Conduct Money answer) cannot be asked, if the opposite (de-
For attending a court, the witness is allowed fimce) lawyer objects to the question. Lead-
conduct money to meet up travelling and ing question (see below) may be asked with
other expenses. For attending a Court in his the permission ofthe Court During this phase
official capacity, a Government medical of- the Court allows questions on matters which
ficer should claim the expenses from his of- are introductory in nature or undisputed or
fice. In other circumstances, in riminal cases, which in the opinion of the Court has already
the witness should place his claim before the been placed before the Court about which the
concerned Court after attending the same. witness has personal know ledge and obser-
In civil cases, the conduct money may be ad- vation and if he is an expert witness then,
vanced to the witness along with the sum- from his observation and know ledge he can
mons. If the advanced money is not sufficient, also draw inference or form an opinion which
then the witness may place additional claim will be helpful for or required by the court
before the Court when he attends the same. for assessment of commission of crime and
In a civil case, the witness may place claim related matters Examples of leading ques-
towards travelling and other expenses before tion - In case ofd~s~;ription of a weapon to be
attending the Court. But in a criiriinal case, given by the witJlE:S$, during examination-in-
he must attend the Court first and then place chief the question to the witness should be
his claim for conduct money. "what was-the t~.of the weapon? "What

was its length" etc. Such questions will not a amination then the opposite lawyer has to
mount to leading questions. For these, the be allowed re-cross-examination on that is-
leading questions can be "Was the weapon a sue.
dagger? Was it 10 inches in length ?"etc. Questwns by the Judge or the Magis-
This type of questions are not ordinarily al- trate-During any stage of his deposition, the
lowed during examination-in-chief. witness may be asked any question by the
Judge or the Magistrate, which he feels nec-
Cross-Examination
essary.
Cross-examination is started by the lawyer If during any stage of examination-in-
of the opposite side, after examination-in- chief, cross-examination or re-examination
chief. The lawyer concerned at this stage try anything incriminating in nature comes out
to get from the witness the facts favourable from the witness that cannot be used against
for his case. Obviously he may try to nullify him in any future case or the witness cannot
the submission of the witness recorded dur- be made accused of an offence on the basis of
ing the examination-in-chief In doing so the such matter.
trustworthyness, efficiency, competence,
memory, intelligence, etc. ofthe witness may Release of the Witness from the Court-
be tested or questioned. The witness has to After his deposition is over, the witness will
answer a question even if it tends to mcrirm- put his signature on the written record of his
nate him for commission of an offence, if the deposition, receive the conduct money, take
question has a beanng with the case pres- court attendance ce1tificate and then with the
ently under trial. No question which is scan- permission of the court he can leave the court.
dalous for the witness or in its form is insult- A witness may be recalled by a trial court,
ing or annoying for him may be allowed by if the High Courtduringdealingand studying
the court, if the question does not have any the case feels reinqtliry and retrial of the case
direct bearing with the case under trial. At by a trial court is necessary or if the charges
this stage leading questions (vide above) may on the accused person or persons are changed
be asked to the witness. There 1s no time during the process or progress of trial.
limit for the cross-examination.
On declaration ofbeing hostile, a witness Summary Trial
may be cross-examined by the lawyer who
Though not at all related with medical evi-
has called him as a witness and as per the
dence, the students are sometimes asked
provision of cross-examinatwn, such a wit-
about this in examination. Hence, it is de-
ness can be asked leading questions also.
scribed here in short for the interest of the
Re-examination students.
If the lawyer who conducted examination-in- A chief Judicial Magistrate, Metropolitan

chief feels that during cross-examination Magistrate and Magistrate of the 1st class spe-
unnecessary confusion has been created or cially empowered by High Court, if thinks,
undue importance has been given on some- may try summarily the "surmnons cases" of
thing, then he re-calls the witness with the the following types:
permission of the court for his re-examina- Theft of articles of valuation of/or money
tion. If any new issue is raised during re-ex- not exceeding Rs. 2,000, receiving retaining,

concealment, disposing of stolen property of preferably should not quote any book. The
valuation not exceeding Rs. 2,000, lurking, lawyer may often read a paragraph from a
house trespassing or house breaking; insult book and ask his opinion on that. Before giv-
to provoke breach of peace, criminal intimi- ing his opinion , the doctor should read the
dation, offence punishable with imprison- paragraph and assess in which context it has
ment for not more than 2 years or fine or been written. If the doctor feels that his an-
both, abetment or attempt to cause any of swer to a specific question does not fully re-
the above offences, when such abetments or veal a fact, then with the permission from
attempts are also offence and cattle trespass. the Court he can volunteer a statement.
Procedure of trial is same as in summons A doctor does not enjoy the privilege of
cases . professional secrecy in the abc:olu· e and tru-
The High Court may confer on any Mag- est sense . Ifhe is asked by the Court any ques-
istrate invested with power of Magistrate of tion, answer to which, in his opinion will re-
the second class, the power to try summarily veal some secret information of his patient,
any offence punishable only wi~h fine or im- he may inform the same to the Court. If the
prisonment for up to 6 months or abetment Court still directs him to answer the question
or attempts to commit such an offence. then he is bound to answer the question.
The Magistrate, iffeels it desirable dur- Examination of a Dead Body at the Scene
ing the course of summary trial may start of Crime
trying the case in usual way as provided in
CrPC. Whenever the concerned doctor is requested
to examine a dead body at the scene of crime,
In case of summary trial punishment
he should do so. This helps to form a clear
should not exceed three months imprison-
idea about the cause of death, nature of death
ment .
and mode of assault. At the scene of crime
Guidelines to a Doctor-witness
the doctor should not touch anything or dis-
turb the surrounding or any evidence. He also
A doctor should be well-conversed with the should not make any premature comment in
subject in connection with which he has been connection with the case. It sometimes so
summoned, and he should attend the Court happens that after conducting the postmor-
with confidence. He should not fumble or tem examination, the autopsy surgeon feels
evade a question or use any superlative word a necessity to visit the place of occurrence of
or exaggerating word. In the witness box he death or where the dead body was found. It
should stand erect, answer the questions should only be done if it is actually neces-
slowly but steadily and !audibly. He should sary, otherwise he may have to face undesir-
answer the questions straight and should not able questions in the Court that his opinion
unnecessarily give descriptive or twisting has at least been in part influenced by what
answers. His deposition should be with ref- was shown to him at the scene of crime, and
erence to his report and he should not try to was not fully based on the scientific interpre-
memorize things in the Court. He should not tation of what he has observed in the dead
go beyond the limit of his know ledge or body. Further, he cannot testify in the Court
expertisation. He should answer the ques- that the scene of crime has not been created
tions from his know ledge or experience and specially for his visit (see also page 302).

between Coroner's Court and Judicial Magistrate's

Court.
• Major Criminal Acts. 1989, Published by Central Law 2. What do you mean by evidence ?What are the types
of Documentary Medical Evidences? Describe them.
agency, Allahabad
(a) Code of criminal procedure, 1973, with amend- 3. Write notes on-la) Summons. (b) Examination-in-
chief, (c) Cross-examination, (d) Re-examination,
ment up to 1988.
(e) Dying declaration, (f) Dying deposition, (g) Medi-
(b) Indian Penal Code, 1866 with amendment up
cal certificates, (h) Medicolegal reports, lil Police in-
to 1988.
quest, OJ Magistrate's inquest/Coroner's inquest,
(c) Indian Evidence Act, 1872. with amendments lk) Witness. OJ Hostile witness, (m) Expert witness.
up to 1986. (n) Conduct money,(o) Medical Examiner's system of
• Code of Criminal Procedure. 1973, (Act No. 2 of 197 4) inquest.
2nd ed. (1976). Lal, Rao and Bagga.
Additional oral questions
• Origin and Progress of Medical Jurisprudence, Chaille
1. What is -Forensic Medicine, Medical Jurisprudence,
S.E. (1949)- Journal of Criminal Law and Criminol-
State Medicine (see answers in chapter 1). Inquest,
ogy V-40, No. 4.
Police inquest, Coroner's inquest, Magistrate's in-
• Gradwohl's Legal Medicine, Edited by F E. Camps, quest, Medical examiner's system of inquiry, Evidence,
1968. Documentary Medical evidence, Dying Declaration,
• Universal's criminal manual 2007, published by Uni- Dying Deposition, Summons. Conduct money, Exami-
versal Law Publishing Co.-Delhi-110033. nation-in-chief, Cross-examination, Re-examination,
Hear-say evidence, Circumstantial evidence, Oath,
Direct evidence, Prima facie evidence, Primary evi-
dence, Secondary evidence, Conclusive evidence?
2. What are - Different types of Courts, Powers of
different Courts, Punishments allowed by Indian law,
Theoretical questions
Leading questions ?
1. What is inquest ? What are its types ? Describe the 3. Under what circumstances - (a) A police officer
Police inquest. Differentiate between police inquest cannot hold an inquest. (b) Documentary evidences
and Magistrate's/Coroner's inquest. Differentiate need not be followed by oral evidence?

NOTES

LEGAL AND ETHICAL
ASPECTS OF PRACTICE 3
Chapter
OF MEDICINE
Note : This is an important chapter for all future 'medical practitioners'. Different "codes
of medical ethics" and 'duties of a registered medical practitioner' presented in
this chapter should not create any confusion. There is no contradiction among
the different codes of 'ethics' and 'duties' of registered medical practitioners. Of
the dtfferent mentionable codes of ethics-'Hippocratic Oath' is the earliest. Code
of ethics were laid down at the international level at Geneva (1948) and London
(1949 J In our country Medical Council of India, the body controlling the medical
profession in India, has also brought out the codes of medical ethics. For exami-
nation purposes, if question is asked about the codes of ethics, then the answer
will depend on which code of ethics is wanted. If the question is nonspecific then
the answer should consist of the theme of all the codes of ethics for doctors.
Medical service being the most humane of others. The society and the State cannot al-
the services to humanity, needs constant im- low this. Both the members of the medical
provement, enrichment and application of profession and the society or for that purpose
mind. A qualified medical practitioner, who the State, must concurrently try to uphold the
is entrusted with the physical and mental respectful position of the profession. Hence,
well-being of his patient must realize his ob- the members of the profession follow certain
ligations to his patient The society also has ethics and etiquettes and the government has
obligations to its members. It has to see that framed certain legislations and Acts concern-
the man (the doctor), on whom it has vested ing the practice of medicine. If a doctor delib-
the duty to safeguard the life and health of erately does any wrong or harm to his patient
the members of the society, does his job with who hopefully surrenders himself to his phy-
responsibility. The medical practitioner must sician for his well-being, then these Acts and
also be aware of his responsibility to the so- legislations come to the rescue of the sufferer
ciety. There are ample scopes for the doctor and the erring doctor is punished. Hence, it is
to misuse his capacity and special position in imperative that, the new medical practitioner
the society for his own interest at the cost of is well conversed with and follow the provi-
23
sions of these legislations regarding his own nesses, that I will carry ou t, according to
rights as well as his duties and obligations to my ability and judgement, this oath and
his patient and the society. this indenture (formal list ofbindings).
ETHICS is the understanding of moral 2. To regard my teacherin this art as equal
values. The CODES OF ETHICS are the rules to my own parents; to make him partner
framed in these lines and on the basis of the in my livelihood; when he is in need of
sense of moral values, to guide the conduct money to share mine with him; to con-
of all concerned. sider his offspring as my own brother ; to
teach them this art if they require to
:MEDICAL ETHICSmeans the moral prin-
learn it, without fee or indenture.
ciples which should guide the members of the
medical profession in course of their practice 3. To impart precept, oral instruction, and
of medicine and their dealings with patients all other learning to my sons, to the sons
and other members of the profession. of my teacher, and to pupils who have
signed the indenture and sworn obedience
The term MEDICAL ETIQUE'ITE is es- to the physicians' law, but to none other.
sentially limited within the mutual relat:i:on-
4. I will use treatment to help the sick ac-
ship among the members of the medical pro-
cording to my ability and judgement, but
fession. It actually means the sense of cour-
I will never use 1t to inJ Ure or (doing)
tesy and mutual respect which should gov-
wrong (to) them.
ern the conduct and relationship among the
members of the medical profession. 5. I will not give poison to anyone though
asked to do, nor will I suggest such a plan.
6. Similarly, I will not give a pessary to a
woman to cause abortion. But with pu-
rity and holiness I will guard my life and
The history of the first use of code of ethic my art.
in the practice of medicine can be traced as 7. I will not 'lSe the knife on sufferers as
back as in the 5th and 4th century B C (some- stone, but as a craft man therein.
time between 460- 377 B.C., the accepted 8. Into whatsoever houses I enter, I will do
life period of the "Father of Medicine", so to help the sick, keeping myself free
Hippocrates). Hippocrates recommended cer- from all intentional wrong-doing and
tain principles for those who choose to prac- harm especially from forn ication \Hth
tise medicine. These principl~s with some woman or 1nan, bond or free.
modifications are accepted by the new prac-
9. Whatsoeve rin the course of practice I see
titioners in the form of oath affirming their
or hear (or even outside my practice in
obligations and proper conduct.
social intercourse) that ought never to be
published abroad, I will not divulge, but
consider such things to be holy secre .
10. Now, ifl keep this oath and break it not,
1. I swear by Apollo the Physician, by may I enjoy honour in my life and art,
Asklepios (AEsculapious) and Health, by among all men for all time; but tr
Panacea (all remedies) and by all the gress and forswear (belie the oath) my-
Gods and Goddesses, making them wit- self, may the opposite befall me.

chapter 3: LEGAL AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE I 25
even under threat, I will not use my

The declaration of Geneva 1948
medical knowledge contrary to the laws
ofhumanity.
The World Medical Association at its third
general Assembly at Geneva in September, 10. I mak., thesr romises solemnly, freely
1948, adapted certain codes of ethics, in the and upon my honour.
form of oath to be taken by all members of
(B) The declaration of Geneva as last
the profession, at the time of entering into
ammended in 2006
medical profession which was ammended by
the World Medical Association in 1968, 1984, At the time of being admitted as a member
1994 and 2006. With change of time, there of the medical profession, 1 cter:larat ion to
has been change in every society. The origi- be made by the physician:
nal declaration of Geneva in 1948 and the last 1. I solemnly pledge to consecrate my life
declaration till now (i.e., of 2006) both are to the P.l iCt: f I n< t, .
given below. These are mo.re or 1 ss ju t 2. I will give to my t a hea'S, the respect
modern versions oftl e "oath of Hippocrates''. and gratitude that is their due.
(A) The original declaration of Geneva 3. I will p aettsP my profession with con-
1948 science and dignity.
4. The "'alth o f m:;. p atiPnt will be my first
At the time of being admitted as a member
consideration.
of the medical profession, the declaratiOn to
be made by the physician: 5. I will respect the secrets that are confided
in me, even after the patient has died.
1. I solemnly pledge myself to consecrate
6. I will maintain by all the means in my
my life to the s n 'icH of humanity.
power, the honour and the noble tr a ::l
2. I will give to my ,•a l -rs th · ·spect tlot\S of the medical profession.
and gratitude which is their due.
7. My e;ue will be my sisters and
3. I will practise my profession with co1 brothers.
science and digni. .
8. I will not p rnut c rsidl:'raun • ; age,
4. The health and l tl of rny patient will be disease or disability, creed, ethnic origin,
my first consideration. gender, nationality, political affiliation,
5. I will respect the secreL which are con- race, sexual orientation, social standing
fided in me. or any other factor to intervene between
6. I will maintain by all the means in my my duty an:! my patient.
power, the honour and the noble tradi- 9. I will maintain the utmost respect for
tions of the medical profession. h uman life.
7. My colleagues will be my brothers. 10. I will not use my medical know ledge to
8. I will not pernut considerations of reli- violate human righl s and CIVIl liberties,
gion, nationality, race, party, politics or even under threat.
social standing to intervene between my 11. I make these promise"' solemnly, freely
duty and my patient. and upon my honour.
9. I will maintain the utmost · espect for In the amendment of 20 6 we essentially
.h uman life from the .mf' o nceptions, find differences in clause , 5, 8 and 9. Clause

10 ofthe amended declaratiom s new and was laid down in the International Code of Medi-
not there in the original declaration of 1948. cal Ethics are as follows :
Addition of the word sister in clause 7 can 1. Doctors' duty to the sick -
just be taken as correction. Of all those dele-
(a) A doctor must always keep in mind
tion of the word '~ife " in clause 4 and the
the importance ofpreserving human
words "from the time of conceptiOn " have
life from the day of conception until
created dissatisfaction in many-more par-
death . Therapeutic abortion may
ticularly so, the deletion of the word 'life' in
only be performed if the conscience
clause 4, the argument being that it gives
ofthe doctors and national laws per-
npresston that a doctor is needed to bother
mit.
for health of the patient but not h1s life . But
in the opinion of the author, these changes (b) A doctor owes to his patient complete
have to be accepted in the present scenario loyalty and all the resources of his
of the world. science. When some examinations
and treatments are beyond his capac-
About ethics in medical practice i_n the
ity, he should summon another doc-
changed social scenario, the British Medical
tor who has the necessary ability.
Council drafted changed codes of medical eth-
ics to match the present society. The B.M. C. (c) A doctor owes to his patient abso-
recommended the proposed changes for use lute secrecy regarding that which
all over the world. The changed codes as in- has been confided to him or what
tended were not only for doctors but also he knows by virtue of the patient's
for nurses and other paramedical staff who confidence on him.
are related with patient care service. The (d) A doctor must give necessary treat-
B.M.C. recommended non-medical persons in- ment in emergency circumstances ,
cluding lawyers in the body of the council. unless he is certain that it can and
The World Medical Council by and large will be given by others.
incorporated the recommended changes in 2. Doctors duty to another doctor -
their amendment though in a different way, (a) A doctor should behave tcwards his
but so far confidentiality of the patient and colleagues in a way which he will
his/her family is concerned, the conditiOnal like to have from them.
disclose of the same as required in the rec- (b) A doctor must not entice away pa-
ommendation did not get any place in the tients from his colleagues.
amended declaration of the World Medical
(c) A doctor must observe principles of
Council.
the Declaration of GBneva approved
The International Code of Medical Ethics, by the World Medical Association.
1949 3. Duties of a doctor in general -
The World Medical Association, in its gen- (a) A doctor must always maintain the
eral Assembly in London in October , 1949 , highest standards of professional
adapted the following cc)de of ethic:: , popular conduct .
as International Code ofMedical Ethics. This (b) A doctor must not allow himself to
dictates the different duties of the doctors be influenced merely by motives of
considered from different angles. The duties profit .

(c) A doctor should consider the follow- British India, came into being as Indian Medi-
ing practices unethical - cal Degrees Act of1919 The purpose of this
(i) Any self-advertisement except Act was to regulate grant of qualification and
such as is expressedly author- title in western medical science and check
ised by the national code of assumption and use of these titles by unquali-
medical ethics. fied persons. Further, the right to confer
medical qualification certificates, degrees, di-
(ii) Participation in any health care
plomas and licences allowing the holders to
system in which the doctor will
practise Western Medical Science was vested
not have professional independ-
on certain authorities specified in the Act.
ence.
Subjects wrongly using these titles are liable
(iii) Receiving money for the serv- to be punished as provided by this Act.
ice to his patient other than
acceptance of proper profes- Indian Medical Council Act of 1933
sional fee·or payment of money
in such circumstances, without This Act was legislated to establish a uniform
the knowledge of the patient. standard for medical education and practice
all over the then British India.
(d) A doctor is not permitted to do any-
thing which can weaken the physi-
Indian Medical Council Act of 1956
cal or mental resistance of a human
being, without strict therapeutic or This Act was promulgated as Act No. 102 of
prophylactic indication, in the inter- 1956, and the Indian Medical Council Act of
est of the patient. 1933 was repealed. The purpose of this Act is
(e) A doctor should be very careful while to regulate practice and training in Medical
publishing his observations or dis- Profession. Its jurisdiction extends to all over
coveries, particularly in respect of a India except the state of Jammu and Kash-
method of treatment which is not mir. This Act provides for the constitution,
recognised by the professional men. composition and fi.1q_ctions of the Medical
Council oflndia.
(f) In case of issuance of a certificate
and when required to give evidence The Medical Council oflndia is composed
he should only mention of what he of members of the profession from different
can verify or prove. levels and from different parts of the country.
Codes of Medical ethics and duties of a doctor as
It has representatives from different univer-
enumerated by Medical Council oflndia have been sities which have undergraduate or postgradu-
mentioned separately in pages 32-35 and 35-39 . ate medical education in their cwTicula. It has
representatives from different State Govern-
ments. Some members are nominated by the
Central Government and one elected mem-
ber from each State Medical Council.
The members of the Council elect a presi-
Indian Medical Degrees Ad of 1919
dent, a vice-president and 7-10 other mem-
The first Central Act concerning practice and bers of an executive committee, from
education in Western Medical Science, for the amongst themselves. The council appoints a

registrar and a secretary for proper function- schedule was provided after amendment
ing of the Council. on application by any concerned medical
institution, after consulting the Indian
Functions of the Indian Medical Council Medical Council.
2. The Indian Medical Council maintains a
1. The Council maintains three schedules. register. The register contains the
The First schedule contains the list of names, addresses, qualifications of all
different medical degrees offered by dif- medical practitioners, who are regit>ttmd
ferent Universities or Institutions inside with any Stat, 'rl 1l ") 1 f i . When a
India, which are recognised by the Coun- medical graduate with a recognised medi-
cil and the Government of India. T'he cal qualification registers himself with
Second schedule contains the list ofmedi- any State Medical Council, his name is
cal degrees conferred outside India and automatically entered in the register of
are recognised by the Medical Council of the Medical Council oflndia. Similarly,
India and the Government oflndia .. The if the name of an already registered medi-
Third schedule has two parts. Part I of cal practitioner is erased or removed from
the Third schedule contains the list of the the register of the concerned State Medi-
medical qualifications conferred by the cal Council then, the name of the medi-
Indian Universities or Institutions but cal practitioner is also automatically re-
not included in the First schedule and moved from the register oflndian Medi-
medical qualifications granted to the citi- cal Council. No additional fee is required
zens oflndia by the medical institutions to be paid and no separate application is
before 15th August, 1947, within the ter- to be submitted for inclusion of the name
ritory of Pakistan and before 1st April of a registered medical practitioner in the
1937, within the territory of Burma-all register of the Medical Council of India.
were to be recognised. Medical qualifica- But a person with reeognised medical
tions granted by a medical institution qualification can directly enroll his name
outside India which were included in Part in t h· · register of Indian Medical Coun-
II of the 3rd schedule would also be rec- cil. In such a case the requisite fees for
ognised, but none who possessed any registration has to be paid. A person can
such qualification should be entitled to practise anywhere in India with recog-
enrolment in any State Medical Register nised qualification, registering his name
unless he/she was a citizen of India and in any of the State Medical Councils.
underwent practical training after obtain- 3. Regulation of the standard of undergradu-
ing the qualification as was necessary by ate and postgraduate medical curricula
the rules and regulations ofthat country and examinations all over the cow1try is
or, he/she underwent practical training another function of the Council. The
as was to be prescribed by the Central Council has an undergraduate and a post-
Government after gazette notification graduate conunittee for this purpose. The
which could amend Part II of the 3rd Council prescribes undergraduate
schedule to include any qualification courses and the criteria which a Medical
therefrom in the 2nd schedule. Recogni- Institute should fulfil for taking up the
tion of any qualification of Part I of 3rd course of study. For both undergraduate

chapter 3: LEGAL AND ETHICAL ASPECTS OF PRACTICE C0F MEDICINE I 29
and postgraduate courses the Council ap- 4. The Council has the authority to recom-
points inspectors who visit the Institu- mend to the Central Government for rec-
tions to inspect if the Institutions have ognition of a foreign degree . It has the
the minimum requisite facilities and authority to enter into negotiation with
whether they follow the prescribed rules its counterpart in any other country for
and regulations of the Medical Council of mutual recognition ofsome medical quali-
India for starting and continuing the par- fications ofboth the countries.
ticular courses which they desire to start 5. Decision on appeal cases where State Medi-
in their Institutions. For undergraduate cal Councils take action against doctors.
course (MBBS) the inspection starts be- When a registered medical practitioner,
fore starting of the course, i.e., for per- being dissatisfied with the disciplinary
mission from the Central Government to action taken against him, appeals before
start the course on the recommendation the Central Government against the pun-
of MCI on the basis of the report of the ishment imposed on him by the State
inspectors, who are s.ent to inspect Medical Council, the Medical Council of
whether the institution which has applied India, on being consulted by the Central
to start MBBS course possesses the re- Government and after going through the
quirements in all respect or not; for theme of the case, gives its recommenda-
MBBS course such visits by MCI inspection to the Central Government which is
tors continue every year till the last ex- binding to the apellant party and the con-
amination of the course ofthe first batch cerned State Medical Council.
of students admitted. During this period 6. For improvement of medical education,
due to non-fulfilment of any of the requi- training and services, the Medical Coun-
sites the continuation of annual admis- cil oflndia can recommended to the Cen-
sion may be disallowed by the council. If tral Government for amendment, change
satisfied till the final examination of the or introduction of new rules and regula-
course, then on recommendation of the tions regarding requirement for teach-
Medical Council oflndia, the Central Gov- ing, and modalities in teaching, training,
ernment recognises the degree. examinations and services in teaching
For any PG course irrespective of 3 years' and training institutions.
degree course or 2 years' diploma course,
minimum two inspections are necessary.
One to be conducted befo~ -getting per-
mission from Central Government to
start the course and the other during Each state of the country has a State Medi-
University examination at the end of the cal Council which is usually located in the
course and if the report is satisfactory, capital city of the state.
the degree or diploma is recognised. Structure of the State Medical Councils-
Whether undergraduate or postgraduate, The State Medical Councils are composed of
once the course is recognised, regular members of medical profession ofthe follow-
annual inspection is not required for per- ing different categories-
mission for admission except in specifi- 1. Medical teachers from different univer-
cally required circumstances. sities of the state, which undertake medi-

30 I PRINCIPLES OF FORENSIC MED-::.I:C::.:.
.:: IN_:::E:.___ _ _ _ _ _ __ _ __ __ _ __ _ _ _ __
cal curriculum, elected by the teachers 2. Disciplinary action on erring registered

of different medical institutions. medical practitioners -If some misdeed
2. Registered medical practitioners , elected or misconduct (professional) of a practi-
by the registered medical practitioners tioner is lbrought to the notice of the
of the state. Council then the Council, after going
3. Some members, nominated by the State through the complaint, if finds a prima
facie case against the doctor, arranges for
Government.
an enquiry on the complaint, usually by
The members of the State Medical Coun- the Penal and Ethical Committee. If the
cil elect a president and a vice-president from doctor admits his fault then he is pun-
among themselves. They also elect mem- ished accordingly as per the provision of
bers of the executive committee , penal and the Council. If the doctor does not admit
ethical committee and such other commit- his fault then a detailed enquiry is held.
tees as are necessary. The Executive Com- The onus to prove the fault of the doctor
mittee appoints a registrar who is filso the lies with the complainant. But in course
secretary of the Council. of enquiry, the Council may summon
both the parties, who may present their
Fundions of State Medical Council cases directly or through representatives.
The Cot'c ril, after hearing both the par-
1. State Medical Council maintains a regis- ties and &uing through other evidences,
ter. An authorised or qualified medical if finds the doctor faulty then he is either
practitioner must have his name regis- reprimanded or warned (if the fault is
tered with the State Medical Council. minor and for the first time) or his name
After obtaining a recognised medical is erased temporarily or permam•ntly (if
qualification, one has to apply before the the offence is a serious one). The action
State Medical Council with payment of a taken is informed to the complaining
requisite fee to get his name entered in party. If the doctor is not formd guilty then
the register of the Council. A registered also it is informed to the complaining
doctor gets his registration number from party. Removal or erasure of the name
the Council. His name, address, qualifi- of a doctor from the register as a discipli-
cations and other particulars are kept in nary action is termed PENAL ERASURE
record in the register. The registered or PROFESSIONAL DEATH SEN-
medical practitioner should always keep TENCE Such an action taken by a State
the Council infonned about change oflns Medical Council on a registered medical
address. As a penal measure, the name practitioner is informed to the Medical
ofthe doctor may at anytime be removed Cormcil oflndia and the name of the doc-
from the register of the Council, either tor is also removed from the register of
temporarily or permanently. the Indian Medical Cormcil. Either party,
Both undergraduate and postgraduate if not satisfied with the decision of the
recognised medical qualifications are to State Medical Cormcil, may appeal before
be entered into register either at the the Govt oflndia, whose decision taken
State Medical Council level or at the In- in consultation with the Medical Council
dian Medical Council. oflndia, 1s final.

chapter 3: LEGAL AND ETHICAL ASPECTS O F PRACTICE OF MEDICINE I 31
Causes of erasure of the name of a While refusing to treat a patient, the prac-
registered medical practitioner titioner should remember that it is not
from the Council's register in conformity with the ethics of his pro-
1. When the information of death of a reg- fession that he refuses relief to a sick
istered medical practitioner is received person on vague ground or in a partisan
by the Council. manner.
2. Penal erasure as described under disci- 2. Right to use title and description of the
plinary action qualifications which he actually possesses
and which are recognised by law or by
3. When a name is entered in the register
any State Medical Council or the Medi-
by mistake or by way of a fraudulant prac-
cal Council oflndia.
tice, the name is removed, when the
matter comes to the notice of the Coun- Appointment in public and local hospi-
cil. tals-The Central Government and dif-
ferent State Governments prov1de that
4. When a registered medical practitioner
an unregistered medical practitioner can-
is not traceable in his address recorded
not be appointed in public and local hos-
with the State Medical Council, his name
pitals.
may be erased from the register. His
name may be re-entered in the register 4. Right to prescribe and dispense medicine
if he applies to the State Council men- to h1s patient-A registered medical prac-
tioning his changed address. titioner can prescribe medicine for the
use of his patient. He may also prepare
and dispense medicine to his own patient.
He should not ordinarily and as a rou-
tine serve the prescription of another
doctor, if it is not an emergency and una-
voidable on the ground of safety of the
A registered medical practitioner enjoys cer- patient.
tain rights and privileges which an unregis- 5. Right to realize fee and other expenses,
tered medical practitioner, though qualified for attending his patient-If a registered
with a medical degree which may even be a medical practitioner has treated his pa-
recognised one, does not enjoy. These rights tient with the prevailing standard of
and privileges can be enumerated as follows: know ledge and reasonable degree of care
1. Right to choose his patient-A regis- and skill then he earns the right to real-
tered medical practitioner is free to ize reasonable fee against his service, ir-
choose his patient. On this basis he may respective ofwhetherthe patient is cured
refuse a patient without showing any or not He is also entitled to realize any
reason. He, however, cannot refuse to other expenses made by him towards his
treat a patient whom he has accepted journey to the patient's residence and to-
to treat, if there is no valid ground for wards the medicine he gave to his patient.
such refusal (see page 65). A registered If the patient or his guardian does not
medical practitioner SHOULD NOT pay the justified claim of the doctor then
REFUSE EMERGENCY treatment re- he may take the help of a court oflaw for
quired by a patient. realisation of the same. The amount of

fee of a practitioner is more a matter of with a Central Government Act titled 'Gt;-
etnv n o of the area and depends on n lit n , >f 1960' Use ofthe
his r a'· f a 1 n e n • and the Red Cross emblem without permission
doctor should not claim disproportionately from the Government of India amounts
high fee from his patient. to violation of the prohibitory Act.
6. ght <v iSSUt: ... ·...... 1< ·,) ( ct! f ndi1 in accord-
1
nPrli< I -These certificates ance with the responsibilities vested on it,
and reports should be prepared true to takes care of medical ethics to be followed in
the findings maintaining all formalities. our country and also is the final authority to
7. ~ tght g f
i. I ' (' of • dictate duties and takes care of any tmethi-
1 e '1' -Registered medical behaviour and misconduct related to the
cal practitioners are accepted as expert profession of a medical practitioner who is
witnesses in professional consideration, either registered with it or with any State
in the Courts of law. Medical Cotmcil. As per the provision of the
8. Right to be e.n.emptea fro.m acting as a relevant Act of the Govt. of India, Medical
• t C01mcil oflndia, every doctor, who seeks reg-
where this system of inquest exists-A istration with MCI or any State Medical Coun-
registered medical practitioner is ex- cil, has to affirm in writing an oath and ac-
empted from acting as a juror during an cept and declare in writing about the norms
inquest. he has to follow in course ofhis medical prac-
tice, including the prohibitory conducts and
9. R.er110val of organs from a de cl d. ~::
the punishment he may be awarded if he fails
ransf .a ion o -A registered
to act in accordance with his declarations.
medical practitioner, maintaining all le-
gal and other related formalities in this
regard, can remove organs from a dead CODES, ETHICS AS ENUMERATED BY
body, if he is working in and for a centre, MEDICAL COUNCIL OF INDtA
approved for this purpose.
10. ight to pemn ~ J1 a •' ti1a i n
A. CODE OF MEDICAL ETHICS
"'&' ancy -lf the registered medical
practitioner has ., p1 l1f · 1 • and
(a) Declaration
experience he can perform M. T.P . in
cases where there is valid ·ud1c • or . It Each applican , at the time of making an ap-
has to be done observing all rules and plication for registration shall be provided
regulations (vide page no. 660) with a copy of the declaration and shall subnllt
11. Right to use the Red Croos .11 lem- ;"l'.o- a ul. 1gnt>d I clarntion as m page no 53.
bod:;- u 1 .d g the registered medical prac- The applicant shall also certify that he/she
titioners the memb s or I e medi- has read and agreed to abide by the same.
rvi"• of the army of a country and
(b) Duties and responsibilities of the
except the 1Cross socie ;~ Ju m6 ar
Physician in general
and during their exercise of humanitar-
ian se 1 • n l'""~'!.!'e can usA tl, Red 1. Ch~ r.t ' of hy"sir"an - (Doctors with
Cross . This prohibition is in accordance qualification ofMBBS or MBBS with post-

chapter 3: LEGAL AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE 1 33
graduate degree/ diploma or with equiva- medical knowh.. rl~c and skill and
lent qualification in any medical disci- should make available to their pa-
pline): tients and colleagues the benefits of
(a) A physician shall uphold the dignity their professional attainments. The
and honout of h k' professi01 . physician should practise methods
of healing founded on scientific ba-
(b) The prime ohje<'t of the medical pro-
sis and should not as. oc1ate profes-
fession is to render service to hu-
siOnally with any one who i 1htes
manitv ; reward or financial gain is
this princtple . The honoured ideals
a subordinate consideration. Who-
of the medical profession imply that
so-ever chooses this profession, as-
the responsibilities of the physician
sumes the obligation to conduct him-
extend not only to individuals but
self in accordance with its ideals. A
also to society.
physician should be an ttpright man ,
instructed in the art ofhealings. He (b) Membership in \1edical Society : For
shall keep himself pure in charac- the advancement of his profession,
ter and be diligent in canng for the a physician should affiliate with as-
·Ick ; he should be modest, sober , sociations and societies of allopathic
should hav patiencf•, be prompt in medical professions and involve ac-
discharging his duty without anxi- tively in the functioning of such bod-
ety; conducting himself with propri- ies.
ety in his profession and in all the (c) A Physician should partieipa1"1i' in pro-
actions of his life. fessional meetings as a part of Con-
(c) r 1 perso!l other than a doctor hav- tinuing Medical Education pro-
ng qualification recognised by Medi- grammes, for at least 30 hout- every
cu l Council of India and registered five years , organized by reputed pro-
with Medical Council oflndia/State fessional academic bodies or any
Medical Council(s) is allowed to prac- other authorized organisation. The
tice Modern syste rn of Medicine or compliance of this requirement shall
Surgerv . A person obtaining qualifi- be informed regularly to Medical
cation in any other system of Medi- Council oflndia or the State Medi-
cine is not allowed to practice Mod- cal Councils as the case may be.
ern system of Medicine in any form. 3. Maintenance ofmedical records :
2 M. "ntaming good medical practice : (a) Every physician shall maintain the
(a) The principal objective of the medi- medical records pertaining to his I
cal profession is to render service her indoor patients for a period of 3
to humanity with full respect for the years from the date of com me rlCE'-
dignityofprofession and man. Phy- ment of the treatment in a standard
sicians should merit the confidence proforma laid down by the Medical
of patients entrusted to their care, Council oflndia (vide page no. 54).
rendering to each a full measure of (b) If any request is made for medtcal
service and devotion. Physicians records by the patient/authorised at-
ould try contmuously o improve tendant or legal authorities, the
"' ' "!1

same may be duly acknowledged and guarding the profession against admission
documents shall be issued within a to it of those who are deficient in moral ·
period of 72 hours. character or education. Physician shall
(c) Registered medical practitioner shall not employ in connection with his pro-
maintain a Register of Medical Cer- fessional practice any attendant who is
tificates giving full details of certifi- neither registered nor enlisted under the
cates issued. When issuing a medi- Medical Acts in force and shall not per-
cal certificate he/she shall always en- mit such persons to attend, treat or per-
ter the identification marks of the form operations upon patients wherever
patient and keep a copy of the cer- professional discretion or skill is re-
tificate. He/She shall not omit to quired.
record the signature and/or thumb- 7. Exposure ofUnethical Conduct: A Physi-
print, address and at least one iden- cian should expose, without fear or fa-
tification mark of the patient on the vour, incompetent or corrupt, dishonest
medical certificates or report. The or unethical conduct of members of the
medical certificate for illness, fitness profession.
and death should be prepared as in 8. Payment of Professional Services: The
page no. 54 and in appendix in pages physician, engaged in the practice of
956, 957 and 958, and wound certifi- medicine shall give priority to the inter-
cate as in page 513. ests of patients. The personal financial
(d) Efforts shall be made to computer- interests of a physician should not con-
ize medical records for quick re- flict with the medical interests of pa-
trieval. tients. A physician should announce his
4. Display of registration numbers: fees before rendering service and not af-
(a) Every physician shall display the reg- ter the operation or treatment is under
istration number accorded to him by way. Remuneration received for such
the State Medical Council I Medical services should be in the form and amount
Council of India in his clinic and in specifically announced to the patient at
all his prescriptions, certificates, the time the service is rendered. It is
money receipts given to his patients. unethical to enter into a contract of "no
(b) Physicians shall display as suffix to
cure no payment". Physician rendering
their names, only recognized medi- service on behalf of the state shall refrain
cal degrees or such certificates/di- from anticipating or accepting any con-
plomas and memberships/honours sideration.
which confer professional knowl- 9. Evasion of Legal Restrictions: The phy-
edge or recognizes any exemplary sician shall observe the laws of the coun-
qualification/achievement. try in regulating the practice of medicine
5. Use ofGeneric names of drugs: Every phy- and shall also not assist others to evade
sician should, as far as possible, prescribe such laws. He should be cooperative in
drugs with generic names and he/she observance and enforcement of sanitary
shall ensure that there is a rational pre- laws and regulations in the interest of
scription and use of drugs. public health. A physician should observe
6. Highest Quality Assurance in patient the provisions of the State Acts like
care: Every physician should aid in safe- Drugs and Cosmetics Act, 1940; Phar-

macy Act, 1948; Narcotic Drugs and Psy- trarily refuse treatment to a pa-
chotropic substances Act, 1985; Medical tient. However, for good reason,
Termination of Pregnancy Act, 1971; when a patient is suffering from an
Transplantation of Human Organ Act, ailment which is not within the
1994; Mental Health Act, 1987; Environ- range of experience of the treating
mental Protection Act, 1986; Pre-natal physician, the physician may refuse
Sex Determination Test Act, 1994; Drugs treatment and refer the patient to
and Magic Remedies (Objectionable Ad- another physician.
vertisement) Act, 1954; Persons with Dis- (b) Medical practitioner having any in-
abilities (Equal Opportunities and Full capacity detrimental to the patient
Participation) Act, 1995 and Bio-Medical or which can affect his performance
Waste (Management and Handling) vis-a-vis the patient is not permit-
Rules, 1998 and such other Acts, Rules, ted to practice his profession.
Regulations made by the Central/State 2. Patience, Delicacy and Secrecy: Patience
Governments or local Administrative and delicacy should characterize the phy-
Bodies or any other relevant ·Act relat- sician. Confidences concerning individual
ing to the protection and promotion of or domestic life entrusted by patients to
public health. a physician and defects in the disposition
B. DUTIES OF PHYSICIANS TO THEIR or character of patients observed during
PATIENTS medical attendance should never be re-
vealed unless their revelation is required
1. Obligations to the Sick: by the laws of the State. Sometimes, how-
(a) Though a physician is not bound to ever, a physician must determine
treat each and every person asking whether his duty to society requires him
his services, he should not only be to employ knowledge, obtained through
ever ready to respond to the calls of confidence as a physician, to protect a
the sick and the injured, but should healthy person against a communicable
also be mindful of the high charac- disease to which he is about to be ex-
ter of his mission and the responsi- posed. In such instance, the physician
bility he discharges in the course of should act as he would wish another to
his professional duties. In his treat- act toward one of his own family in like
ment, he should never forget that circumstances.
the health and the lives of those en- 3. Prognosis : The physician should neither
trusted to his care depend on his exaggerate nor minimize the gravity of a
skill and attention. A physician patient's condition . He should ensure him-
should endeavour to add to the com- self that the patient, his relatives or his
fort of the sick by making his visits responsible friends have such know ledge
at the hour indicated to the patients. of the patient's condition as will serve the
A physician advising a patient to best interests of the patient and the fam-
seek service of another physician is ily.
acceptable. However, in case of 4. The Patient must not be neglected: A phy-
emergency a physician must treat sician is free to choose whom he will
the patient. No physician shall arbi- serve. He should, however, respond to

any request for his assistance in an emer- sician in making themselves available for
gency . Once having undertaken a case, consultations.
the physician should not neglect the pa- 4. Statement to Patient after Consultation :
tient, nor should he withdraw from the
(a) All statements to the patient or his
case without giving adequate notice to the
representatives should take place m
patient and his family. Provisionally or
the presence of the consulting phy~
fully registered medical practitionershall
sicians , except as otherwise agreed.
not willfully commit an act of negligence
The disclosure of the opinion to the
that may deprive his patient or patients
patient or his relatives or friends
from necessary medical care.
shall rest with the medical attend-
5. Engagement for an Obstetric case : When ant.
a physician who has been engaged to at-
(b) Differences of opinion should not be
tend an obstetric case is absent and an-
divulged unnecessarily but when
other is sent for and delivery accom-
there is irreconcilable difference of
plished, the acting physician is ent~tled
opinion the circumstances should be
to his professional fees, but should secure
frankly and impartially explained to
the patient's consent to resign on the
the patient or his relatives or friends.
arrival of the physician engaged.
It would be opened to them to seek
further advice as they desire.
c. DUTIES OF PHYSICIAN IN
CONSULTATION 5. Treatment after Consultat10n: No deci-
sion should restrain the attending physi-
L Unnecessary consultations should be cian from making such subsequent vari-
avoided: ations in the treatment if any unexpected
(a) However in case of serious illness change occur-s , but at the next consulta-
and in doubtful or difficult conditions, tion, reasons for the variations should be
the physician should request consul- discussed/explained. The same privilege,
tation, but under any circumstances with its obligations, belongs to the con-
such consultation should be justifi- sultant when sent for an emergency dur-
able and in the interest of the pa- ing the absence of attending physician.
tient only and not for any other con- The attending physician may prescribe
sideration. medicine at any time for the patient,
(b) Consulting pathologists/radiologists whereas the consultant may prescribe
or askingforanyotherdiagnostic Lab only in case of emergency or as an ex-
investigation should be done judi- pert when called for.
ciously and not in a routine manner. 6. Patients Referred to Specialists: When a
2. Consultation for Patient's Benefit : In patient is referred to a specialist by the
every consultation, the benefit to the attending physician, a case surmnary of
patient is of foremost importance. All the patient should be given to the spe-
physicians engaged in the case should be cialist, who should conunun1cate his opin-
frank with the patient and his attendants. ion in writing to the attending physician
3. Punctuality in Consultation : Utmost 7. Fees and other charges
punctuality should be observed by a phy- (a) A physician shall clearly display his

fee.:; and other charges on the board attend his patients during his temporary
of his chamber and/or the hospitals absence from his practice, professional
he is visiting. Prescription should courtesy requires the acceptance of such
alsomakeclearifthe Physician him- appointment only when he has the ca-
self dispensed any medicine. pacity to discharge the additional respon-
(b) A physician shall write his name and sibility along with his /her other duties.
designation in full along with regis- The physician acting under such an ap-
tration particulars in his prescrip- pointment should give the utmost con-
tion letter-head. sideration to the interests and reputation
ofthe absent physician and all such pa-
Notp : In Grvemment hospital where the
tients should be restored to the care of
patient-load is heavy, the name of
the latter upon his/her return.
tht:> presc ribiug doctor must be writ-
ten below his/her signature. 5. Visiting another Physician's Case: When
it becomes the duty of a physician occu-
D. RESPONSIBILITIES OF PHYSICIANS pying an official position to see and re-
TO EACH OTHER port upon an illness or injury, he should
communicate to the physician in attend-
1. Dependence of Physicians on each other: ance so as to give him an option of being
A physician should consider it as a pleas- present. The medical officer/physician
ure and privilege to render gratuitous
occupying an official position should avoid
service to all phy:o1c1ans and their imme- remarks upon the diagnosis or the treat-
diate family dependants. ment that has been adopted.
2. Conduct in consultation: In consultations,
no insincerity, rivalry or envy should be E. DUTIES OF PHYSICIAN TO THE
indulged in. All due respect should be PUBLIC AND TO THE PARAMEDICAL
ob ·erved towards the physician m-charge PROFESSION
of tht case and no statement or remark 1. Physicians as Citizens: Physicians, as good
be made, which would impair the confi- citizens, possessed of special training
dence reposed in him. For this purpose should disseminate advice on public
no discussion should be carried on in the health issues. They should play their part
presence of the patient or his representa- in enforcing the laws of the community
tives. and in sustaining the institutions that
3. Consultant not to take charge of the case : advance the interests ofhumamty. They
When a physician has been called for con- should particularly co-operate with the
sultation, the Consultantshouldnormally ' authorities in the administration of sani·
not take charge of the case, especially on tary/public health iaws and regulations.
the solicitation of the patient or friends. 2. Public and Community Health: Physi-
The Consultant shall not criticize the cians, especially those engaged in public
referring physician. He/she shall discuss health work, should enlighten the public
the diagnosis treatment plan with there- concerning quarantme regulations and
ferring physician. measures for the prevention of epidemic
4. ppomtment of Substitute: Whenever a and communicable diseases. At all times
physician requests another physician to the physician should notify the consti-

tuted public health authorities of every apparatus or appliance or any com-

case of communicable disease under his mercial product or article with re-
care, in accordance with the laws, rules spect of any property, quality or use
and regulations of the health authorities. thereof or any test, demonstration
When an epidemic occurs, a physician or trial thereof, for use in connec-
should not abandon his duty for fear of tion with his name, signature, or
contacting the disease himself. photograph in any form or manner
of advertising through any mode nor
3. Pharmacists/Nurses: Physicians should
shall he boast of cases, operations,
recognize and promote the practice of dif-
ferent paramedical services such as, phar- cures or remedies or permit the
macy and nursing as professions and publication of report thereof through
should seek their cooperation wherever any mode. A medical practitioner is,
required. however, permitted to make a for-
mal announcement in press regard-
F. UNETHICAL ACTS ing the following:
1. On starting practice
A physician shall not aid or abet or commit
any of the following acts which shall be con- 2. On change of type ofpractice.
strued as unethical: 3. On changing address.
1. Advertising: 4. On temporary absence from
(a) Soliciting of patients directly or in- duty.
directly, by a physician, by a group 5. On resumption of another prac-
ofphysicians or by institutions or or- tice.
ganisations is unethical . A physician 6 On succeeding to anotherprac-
shall not make use of him/her (or tice.
his/ her name) as subject of any form
7. Public declaration of charges.
or manner of advertising or public-
ity through any mode either alone (b) Printing of self photograph, or any
orin conjunction with others , which such material of publicity in the let-
is of such a character as to invite terhead or on signboard of the con-
attention to him or to his profes- sulting room or any such clinical es-
sional position, skill, qualification, tablishment shall be regarded as
achievements, attainments, speciali- acts of self-advertisement and un -
ties, appointments, associations, af- ethical conduct on the part of the
filiations, or honours and/or of such physician . However, printing of
character as would ordinarily result sketches, diagrams, picture of hu-
in his self aggrandisement. A physi- man system shall not be treated as
cian shall not give to any person, unethical .
whether for compensation or other- 2. Patent and Copyrights: A physician may
wise, any approval, recommenda- patent surgical instruments, appliances
tion, endorsement, certificate, re- and medicine or copyright applications,
port or statement with respect of methods and procedures. However, it
any drug, medicine, nostrum rem- shall be unethical if the benefits of such
edy, surgical, or therapeutic article, patents or copyrights are not made avail-

chapter 3: LEGA L AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE I 39
able in situations where the interest of 5. Secret Remedies : The prescribing or dis-
large population is involved. pensing by a physician of secret reme-
3. Running an open shop (Dispensing of dial agents of which he does not know
Drugs and Appliances by Physicians) : A the composition, or the manufacture or
physician should not run an open shop promotion of their use is unethical and
for sale of medicine for dispensing pre- as such prohibited . All the drugs pre-
scription's prescribed by doctors other scribed by a physician should always
carry a proprietary formula and clear
than himself or for sale of medical or sur-
name.
gical appliances. It is not unethical for a
physician to prescribe or supply drugs, 6. Human Rights : The physician shall not
remedies or appliances as long as there aid or abet torture nor shall he be a party
is no exploitation of the patient. Drugs to either infliction of mental or physical
prescribed by a physician or brought from trauma or concealment of torture in-
the market for a ·patient should explic- flicted by some other person or agency
itly state the proprietary formulae as well in clear violation of human rights.
as generic name of the drug. 7. Euthanasia : Practising euthanasia shall
4. Rebates and Commission: constitute unethical conduct. However on
specific occasion, the question of with-
(a) A physician shall not give, solicit, or
drawing supporting devices to sustain
receive nor shall he offer to give,
cardiopulmonary function even after
solicit or receive any gift, gratuity,
brain death, shall be decided only by a
commission or bonus in considera-
team of doctors and not merely by the
tion of or retum for the referring, treating physician alone. A team of doc-
recommending or procuring of any tors shall declare withdrawal of support
patient for medical, surgical or other system. Such team shall consist of the
treatment. A physician shall not, di- doctor in charge of the patient, Chief
rectly or indirectly, participate in or Medical Officer/Medical Officer in charge
be a party to act of division , trans- of the hospital and a doctor nominated
ference, assignment, subordination, by the m-charge of the hospital from the
rebating, splitting or refunding of hospital staff or in accordance with the
any fee for medical, surgical or other provisions of the Transplantation ofHu-
treatment. man Organ Act, 1994 .
(b) Provisions of para shall apply with
equal force to the referring, recom- G. MISCONDUCT (OR PROFESSIONAL
MISCONDUCT :: ALSO TERMED BY
mending of procuring by a physician
SOME AS INFAMOUS CONDUCT)
or any person, specimen or mate-
rial for diagnostic purposes or other Definition -In conpection with a case involv-
study/work. Nothing in this section, ing the General Council of Medical Educa-
however, shall prohibit payment of tion and regulations, the Ld. Judge defined
salaries by a qualified physician to infamous conduct very effectively. On the
other duly qualified person render- basis of this, infamous conduct can be defined
ing medical care under his supervi- as "that act of a medical man done in the
sion. pursuit of his profession, with regard to which

it would be reasonably regarded as disgrace- 4. Adultery or Improper Conduct Abuse of

ful or dishonourable by his professional breth- professional position by committing adul-
ren of good repute and competence". tery or improper conduct with a patient
or by maintaining an improper associa-
The Medical Council oflndiahas prepared
tion with a patient will render a physi-
a list of acts which amounts to professional
cian liable for disciplinary action as pro-
misconduct. It further declares that the list
vided under the Indian Medical Council
should not be considered as an exhaustive one
Act, 1956 or the concerned State Medical
and that circumstances of professional mis-
Council Act.
conduct may and do arise besides those enu-
merated in the list. If any misconduct of a reg- 5. ConvictiOn by Court of Law: Conviction
istered medical practitioner is brought to the by a Court of Law for offences involving
notice of the Medical Council of India or State moral turpitude/Criminal acts.
Medical Council, then upon consideration of 6. Sex Det~r runation Tests: On no account
the complaint against the practitioner, ifhe is sex determination test shall be under-
found guilty then he becomes subjected to dis- taken with the intent to terminate the
ciplinary action which may be a warning no- life of a female foetus developing in her
tice in case of commission of a milder offence. mother's womb, unless there are other
But, m case of serious professional miscon- absolute indications for termination of
duct, the name of the medical practitioner may pregnancy as specified in the Medical
be temporarily or even permanently removed Termination ofPregnancy Act, 1971. Any
from the register of the Council act of termination of pregnancy of nor-
mal female foetus amounting to female
MISCONDUCT foeticide shall be regarded as professional
misconduct on the part of the physician
The following acts of commission or omission
leading to penal erasure besides render-
on the part of a doctor amount to professional
ing him liable to criminal proceedings as
misconduct rendering him/her liable for dis-
per the provisions of this Act.
ciplinary action:
7. S1gn ng Professional Certificates Reports
1. Violation of the Regulations: If he/she
and other Documents: Registered medi-
commits any act in violation of the Regu-
cal practitioners are in certain cases
lations.
bound by law to give, or may from time
2. If he/she does not maintain the medical to time be called upon or requested to
records of his/her indoor patients for a give certificates, notification, reports and
period of three years as per regulation other documents of similar character
and refuses to provide the same within signed by them in their professional ca-
72 hours when the patient or his/her au- pacity for subsequent use in the courts
thorised representative makes a request or for administrative purposes, etc. Such
for it as per the regulation. documents, among others, include the
3. If he/she does not display the registra- ones given at page 54, 55. Any registered
tion number accorded to him/her by the practitioner who is seen to have signed
State Medical Council or the Medical or given under his name and authority
Council oflndia in his clinic, prescriptions any such certificate, notification, report
and certificates, etc. issued by him or vio- or document of a similar character which
lates the provisions of regulation. is untrue, misleading or • , ' , is li-
Contd. page 51
Fig. 3.1: Lady patient: "But Doctor, I shall feel comfortable to be examined in presence of
another lady''
Fig . 3.2 Doctor (Self}: I have failed to convince that patient

that smoking is harmful

Fig. 3.3: I am exhausted. Let me have some rest and nice time now. Let me have some rest
now. Let the remaining patients wait.
Fig. 3.4: Patient party: Doctor I am not sick. I came to you to arrange an appointment for my ailing son.
Doctor: No, No, you are also appearing sick. If you are not healthy, then how can you take care of your son?

Fig. 3.5: Doctor: Sorry, you are carrying for 30 weeks and everything is fine with your health . I don't think I can advice
you for termination of your pregnancy
Fig. 3.6: Doctor: Pregnancy is not a disease. You have nothing to worry. Attend antenatal care unit regularly

Fig. 3.7 Doctor: Sorry, I can't tell you the sex of the baby (foetus) in your womb. USG is giving the
impression that you are carrying for 12 weeks. Everything appears normal. Don't ask me
about the sex of your baby
Fig . 3·8 Assistant: Sir, A good number of patients are waiting.

Doctor: So what? Tell them to wait till I am ready.

F1g . • Doctor: God, bless me. I know, with your blessing I will have a good day.
Fig. 3 10 Patient: Doctor, I am your patient. Keep distance and come to your sense. I am
leaving your centre today itself.

Fig. 3.11: Patient's father: Doctor kindly help me. My son is seriously ill. Plea~:~ ;orne to my residence and see my son.
Doctor: I am exhausted now. If I am to move now then you ha •e to pay me Rs .... as my visit.
Fig . 3.12 : Agent: You have not paid me my share for the last three months. Today I shall not move
empty handed

Fig. 3.13 Doctor: You will get more attention in my nursing home than here in the hospital. How is the
idea to move to my nursing home. I assure you better care there.
Fig. 3.14. Doctor: I feel you are worried. I shall pay optimum attention to your patient. But I can't accept any money for
that as you are supposed to get my service free.

Fig. 3. 5 Doctor to his wife: Sorry, I can't go for any entertainment now.
Wife: But this is a prefixed programme and we have a private life also.
Doctor: I agree, but I can't ignore the serious patients waiting for my help.
Fig. 3.16 . Patient's mother: Doctor please help me. My son is very sick. I have none to help me.
I shall be grateful.
Doctor: Don't worry. Let's go inside and let me listen to your story first. If I am satisfied,
I shall definitely help you.

Fig . 3. 17 Doctor: Follow the prescription carefully as written. Don't hesitate to contact me anytime.
Keep me informed about the progress.
Fig. 3. 8: Doctor: It appears that my people (agents) have shifted their loyalty to Dr........ I must have
to think seriously.
rF M -41
Fig. 3.19: Doctor: My fee, qualification, speciality registration, all are written there
so that all who visit me can have these informations from the chart
Fig. 3.20: Doctor: No need for any investigation· you have malignancy. I shall do
my best. But you also should be ready for any consequence.

chapfet3: LEGAL AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE I 51
able to have his name deleted from the habilitation centre or any type of train-
Register. ing institution, etc. may be advertised in
8. A registered medical practitioner shall the lay press , but such advertisements
not contravene the provisions of the should not contain anything more than
Drugs and Cosmetics Act and regulations the name of the institution, type of pa-
made thereunder. Accordingly, tients admitted, type of training and other
facilities offered and the fees.
(a) Prescribing steroids/psychotropic
drugs when there is no absolute 13. It is improper for a physician to use an
unusually large sign board and write on
medical indication;
it anything other than his name , qualifi-
(b) Selling Schedule 'H' & 'L' drugs and
poisons to the public except to his cations obtained from a University or a
statutory body, titles and name of h1s
patient ,
spec1ality , reg1stration number including
in contravention of the above provisions the name of the State Medical Council
shall constitute gross professional mis- under which registered. The same should
conduct on the part of the physician. be the contents of his prescription papers.
9. Performing or enabling unqualified per- It 1s 1mproper to affix a signboard on a
son to perform an abortion or any illegal chemist's shop orin places where he does
operation for which there is no medical, not reside or work.
surgical or psychological indication. 14. The registered medical practitioner shall
10. A registered medical practitioner shall not disclose the secrets of a patient that
not issue certificates of efficiency in mod- have been learnt in the exercise of his!
em medicine to unqualified or non-medi- her profession except
cal person . (Note: The foregoing does not (a) m a court of law under orders of the
restrict the proper training and instruc- Presiding Judge;
tion of bonafide students, midwives, dis-
(b) in circumstances where there is a
pensers, surgical attendants, or skilled
senous and identified risk to a spe-
mechanical and technical assistants and
cific person and/or community; and
therapy assistants under the personal
supervision of physicians.) (c) notifiable diseases .
11. A physician should not contribute to the In case of communicable/notifiable dis-
lay press articles and give interviews re- eases, concerned public health authori-
garding di:eases and treatments which ties should be infonned immediately.
may have the effect of advertising him- 15. The registered medical practitioner shall
self or soliciting practices; but it is open not refuse on religious grounds alone to
to write in the lay press under his own give assistance in or conduct of sterility,
name on matters of public health, hygi- birth control , circumcision and medical
enic living or to deliver public lectures, termination of pregnancy when there is
give talks on the radio/TV/internet chat medical indication, unless the medical
for the same purpose and send announce- practitioner feels himself/herself incom-
ment of the same to lay press. petent to do so.
12. An institution run by a physician for a 16. Before performing an operation the phy-
particular purpose such as a maternity sician should obtain in writing the con-
home, nursing home, private hospital, re- sent from the husband or wife, parent or

guardian in the case of minor, or the pa- 23. If a physician posted in rural area is found
tient himself as the case may be . In an absent on more than two occasions dur-
operation which may result in sterility, ing inspection by the Head of the District
the consent ofboth husband and wife is Health Authority or the Chairman, Zila
needed. Parishad, the same shall be construed as
17. A registered medical practitioner shall a misconduct, if it is recommended to the
not publish photographs or case reports Medical Council of India/State Medical
ofhis/her patients without their permis- Council by the State Government for ac-
sion , in any medical or Other journal in tion under these Regulations.
a manner by which their identity could 24. If physicians posted in a medical college/
be made out. If the identity is not to be institution as teaching faculty or other-
disclosed, the consent is not needed. wise, they shall remain in hospital/col-
18. In the case of running of a nursing home lege during the assigned duty hours. If
by a physician and employing assistants they are found absent on more than two
to help him/her, the ultimate responsi- occasions during this period, the same
bility rests on the physician . . shall be construed as a misconduct if it is
certified by the Principal/Medical Super-
19. A Physician shall not use touts or agents
intendent and forwarded through the
for procuring patients.
State Government to Medical Council of
20. A Physician shall not claim to be special- India/State Medical Council for action
ist unless he has a special qualification under these Regulations.
in that branch.
21. No act of in vitro fertilisation or artificial H. PUNISHMENT AND DISCIPLINARY
insemination shall be undertaken with- ACTION
out the informed consent of the female 1. It must be clearly understood that the
patient and her spouse as well as the do- instances of offence and of Professional
nor. Such consent shall be obtained in misconduct which are given above do not
writing only after the patient is provided, constitute and are not intended to con-
at her own level of comprehension, with stitute a complete list of the infamous
sufficient information about the purpose, acts which calls for disciplinary action,
methods, risks, inconveniences, disap- and that by issuing this notice the Medi-
pointments of the procedure and possi- cal Council oflndia and or State Medical
ble risks and hazards. Councils are in no way precluded from
22. Research : Clinical drug trials or other re- considering and dealing with any other
search involving patients or volunteers form of professional misconduct on the
as per the guidelines ofiCMR can be un- part of a registered practitioner. Circum-
dertaken, provided ethical considerations stances may and do arise from time to
are borne in mind. Violation of existing time in relation to which there may oc-
ICMR guidelines in this regard shall con- cur questions of professional misconduct
stitute misconduct. Consent taken from which do not come within any of these
the patient for trial of drug or therapy categories. Every care should be taken
which is not as per the guidelines shall that the code is not violated in letter or
also be construed as misconduct. spirit. In such instances as in all others,

the Medical Council oflndia and/or State

Medical Councils have to consider and
decide upon the facts brought before the
Medical Council of India and/or State
Medical Councils. At the time of registration, each applicant shall
2. It is made clear that any complaint with be given a copy of the following declaration by
regard to professional misconduct can be the Registrar concerned and the applicant shall
brought before the appropriate Medical read and agree to abide by the same:
Council for disciplinary action. Upon re- 1. I solemnly pledge myself to consecrate
ceipt of any complaint of professional my life to service of humanity.
misconduct, the appropriate Medical 2. Even under threat, I will not use my medi-
Council would hold an enquiry and give cal knowledge contrary to the laws of
opportunity to the registered medical Humanity.
practitioner to be he~rd in person or by 3. I will maintain utmost respect for human
pleader. If the medical practitioner is life from the time of conception.
found to be guilty of committing profes- 4. I will not permit considerations of reli-
sional misconduct, the appropriate Medi- gion, nationality, race, party, politics, or
cal Council may aw~rd such punishment social standing to intervene between my
as deemed necessary or may direct the duty and my patient.
removal alt.CJgether or for a specified pe- 5. I will practise my profession with con-
riod, from the register of the name of the science and dignity.
delinquent registered practitioner. Dele- 6. The health of my patient will be my first
tion from the Register shall be widely pub- consideration.
licized in local press as well as in the pub- 7. I will respect the secrets which are con-
lications of different Medical Associa- fided in me.
tions/Societies/Bodies. 8. I will give to my teachers the respect and
3. In case the punishment of removal from gratitude which is their due.
the register is for a limited period, the 9. I will maintain by all means in my power,
appropriate Council may also direct that the honour and noble traditions of medi-
the name so removed shall be restored cal profession.
in the register after the expiry of the pe- 10. I will treat my colleagues with all respect
riod for which the name was ordered to and dignity.
be removed. 11. I shall abide by the code of medical eth-
4. Decision on complaint against delinquent ics as enunciated in the Indian Medical
physician shall be taken within a time Council (Professional Conduct, Etiquette
and Ethics) Regulations 2001.
limit of 6 months .
I make these promises solemnly, freely
5. During the pendency of the complaint the
and upon my honour.
appropriate Council may restrain the
physician from performing the procedure Signature 0 0 0 0 0 0
or practice which is under scrutiny. N arne 0 0 0 0 0 0 0 0 0 0
6 Professional incompetence shall be Place 0 0 0 0 0 0
judged by peer group as per guidelines Address 0 0 0 0 0 0 0 0 0
prescribed by Medical Council oflndia. Date 0 0 0 0 0 0 0

FORM OF CERTIFICATE RECOMMENDED FORMAT FOR MEDICAL RECORD

FOR LEAVE OR EXTENSION OR (See regulafion 3.1)
COMMUNICATION OF LEAVE AND FOR
Name ofthe patient:
FITNESS
Age:
Sex:
Signature ofpatientorthumb impression
Address:
(To be filled in by the applicant in the presence of

Occupation:
the Government Medical Attendant, or Medical Prac- Date of 1st visit:
titioner).
Clinical note (summary) of the case:
Identification marks:
Prov· Diagnosis:
1.
Investigations advised with reports:
2.
Diagnosis after investigation:
I, Dr. after careful Advice.
examination of the case certify hereby that
Follow up:
_ _ _ _ whose signature is given
above is (was) suffering from _ _ _ __ Observations:
and I consider that period of absence from
duty of _ _ _ with effect from Date: Signature in full ....... .. ... ..... .
is (was) absolutely necessary for the restora-
Name of Treating Physician
tion ofhis health.
I, Dr. _ _ _ after careful examina-

tion of the case certify hereby that _ __
LIST OF CERTIFICATES, REPORTS,
on restoration of health is now fit to j0in serv-
NOTIFICATIONS ETC. ISSUED BY
ice. DOCTORS FOR THE PURPOSES OF
VARIOUS ACTS/ADMINISTRATIVE
Place _ _ __ Signature ofMedical REQUIREMENTS
attendant
(a) Under the Acts relating to birth, death
Date _ ___ . Registration No. or disposal of the dead.
(b) Under the Acts relating to Lunacy and
(Medical Council oflndm/State
Mental Deficiency and under the Mental
Medical Council of D D D D State) illness Act and the rules made thereun-
der.
Note: The nature and probable duration of
(c) Under the Vaccination Acts and the regu-
the illness should also be specified.
lations made thereunder.
This certificate must be accompanied
by a brief resume of the case giving (d) Under the Factory Acts and the regula-
the nature of the illness. its symp- tions made thereunder.
toms, causes and duration. (e) Under the Education Acts.

f! Under the Public Health Acts and the (a) When the doctor-patient relationship
orders made thereunder. is terminated by a notice from ei-
(g) Under the Workmen's Compensation Act ther side (the doctor or the patient).
and Persons with Disability Act. (b) When another doctor has been con-
(h) Under the Acts and orders relating to the sulted without the knowledge of the
notification of infectious diseases. first doctor.
(i) Under the Employee's State Insurance (c) "When remedies other than what has
Act. been prescribed by the doctor is be-
ing followed.
(j) In connection with sick benefit insurance
and friendly societies. (d) When the advice of the doctor is not
(k) Under the Merchant Shipping Act. properly followed.
(l)
(e) When the doctor is not informed
For procuring/issuing of passports.
about the details of the patient's con-
(m) For excusing attendance in courts of Jus- dition.
tice, in public services;in public offices
(f) When the doctor is not paid his due
or in ordinary employment.
fees for attending the patient.
(n) In connection with Civil and Military mat-
(g) When the doctor himself has fallen
ters.
sick.
(o) In connection with matters under the con-
(h) Temporarily for the period for which
trol of Department of Pensions.
the doctor remains engaged with an
(p) In connection with quarantine rules.
emergency and more serious case.
(q) For procuring driving licence.
(i) When the doctor understands that
the patient is malingering.
Detailed description of some of the duties
concerning general aspects of medical 3. Duty to pay special attention to chil-
practice not mentioned above dren, old and disabled persons-These
subjects being incapable to take care of
1. Duty to maintain up-to-date standard
themselves, the doctor should arrange
knowledge of profession and skill (see also
for their proper care.
page 33)-lt is not expected that all doc-
tors should cure all patients or that all 4. Duties related to investigations-Wher-
should be of very high calibre. But the ever necessary, for proper diagnosis and
doctor should possess standard and up- to know the progress, the doctor should
to-date knowledge. A specialist should, not forget or hesitate to advise for inves-
however, be matchingly efficient to man- tigations like X-ray examination, biopsy,
age a case of his speciality. etc.
2. Details about the duty to attend the pa- 5. Duty to give a proper prescription with
tient-Once the doctor accepts a patient, clear instructions to the patient. The doc-
the doctor-patient relationship gets estab- tor may or may not give medicine to the
lished and the doctor becomes duty-bound patient. But he must give him a prescrip-
to attend the patient as and when neces- tion with proper instructions.
sary, except in the following circum- 6. Duty to issue certificate whenever nec-
stances: essary for the patient. When the patient

needs, the doctor must provide his pa- or injured person is (a) a member of the
tient with sickness or fitness or other armed force; (b) the victim of a wrecked
certificate (see page 54, 55). While issu- ship; (c) a prisoner of war or (d) a citizen
ing death certificate he should be very of an enemy country.
cautious (see page 58 and 59). 12. Duty in relation to consultation-Apart
7. Duty to mform th authority about the from the guidelines for consultation dis-
outbreak of a communicable disease (see cussed in page 36, a doctor should remem-
page 60). ber the following in this regard, as to
when he should consult another profes-
8. Duty to act n. r•o a ce w th the law of
sional colleague -
the Sta t and help the law-keeping au-
thority whenever situation so demands. (a) In cases where the diagnosis re-
If, in course of his practice, a physician mains obscure.
comes to know about the occurrence of a (b) While dealing with a criminal abor-
criminal act, then he should inform the tion or an attempted criminal abor-
police or any other law-keeP.ing author- tion case.
ity about the same. (c) To take decision about termination
9. Duty to inform the patient about the con- of pregnancy case, after 12 weeks
dition of the pat nt and the risk in the and up to 20 weeks of pregnancy.
treatmen , if any. A physician has to be (d) In dealing with a poisoning case.
frank in his expression to the patient or (e) When dealing with a serious crimi-
his guardian about the exact condition of nal case.
the patient and the risk involved in the
(f) When the treatment or the opera-
treatment he requires. To assure a pa-
tion involves risk of life.
tient nothing should at any stage create
any misconception in the patient. Simi- (g) When an operation involves gross
larly, the physician must not have any mutilation or loss of function of a
motive to exaggerate the illness of the body part or organ.
patient. (h) In connection with organ transplan-
10. Duty to take con ent from the patient or tation (see also page 85-86).
his guardian whenever the procedure for 13. Duties in relation to operation cases-
diagnosis or treatment involves ar y n r lt. (a) A surgeon should not delegate his
11. Duty according to the Geneva Conven- duty to operate a patient, to another
tion of 1949-In this convention many doctor.
countries, including India, agreed upon (b) The surgeon should not experiment
that, a doctor should not discnrr inate without valid reason and without
while givmg pnorit~ for treatment of a consent from the patient after he
patient, on any ground o ~her than emer (the patient) is fully informed about
gency medical need of the patient. Race, the nature and necessity of the ex-
nationality, political belief, sex or any periment. See also page 72-76.
other consideration should not influence (c) In all cases of operations the nature
the discretion of the doctor in choosing of the operations and the risk in-
his patient or giving priority to one over volved in each case shou1d be m-
the other, irrespective of whether the sick formed to the patient.

(d) He should be very particular about tion of the patient demands and per-
the site and extent of the operation mits the shift.
(e) He should avail the assistance of (c) To take a detailed historyofthe case
qualified and experienced anaesthet- as to when and how the symptoms
ists only. started; what is the progress;
(f) Properly sterilised instruments whether related to taking of any food
should only be used. or drink; whether the number of
sufferer is more than one; whether
(g) Care should be taken not to leave
any treatment was already given and
any instnnnent or swab inside a body
whether there is any history of pre-
cavity.
vious poisoning.
(h) Proper post-operative care should be
taken. (d) The doctor should himself record full
history of the case, the signs and
(i) Death on operation table should be
symptoms and progress.
followed by P. M. examination.
(e) The doctor should collect and pre-
14. Duties in connection with administration
serve the vomitus, stool, urine,
of anaesthetic agents-
clothes stained with poison or vomi-
(a) The anesthetist should choose the tus, doubtful container with remain-
right agent needed for each particu- ing part of the poison, if any, and if
lar case. necessary blood, for laboratory in-
(b) The patient should be properly pre- vestigations.
medicated when necessary. Neces- (f) The doctor should arrange for a re-
sary investigations should be recom- liable attendant of his own choice,
mended prior to anaesthesia. for the patient.
(c) The anaesthetic agent and the ap- (g) The doctor should inform the police
pliances should be checked before station of the area about the case,
use. irrespective of whether the patient
(d) The anaesthetist should follow up survives or dies and whether it ap-
the condition of the patient till full pears to be a case of suicide or homi-
recovery from anaesthesia. cide or accident.
(e) Death after administration of anaes- (h) If death is apprehended then ar-
thesia should be followed by P. M. rangement for recording dying dec-
examination. laration should be made.
15. Duties in connection with poisoning (i) In case of death, death certificate
cases-In connection with a poisoning should mention about the poisoning
case the doctor must act as follows: or suspected poisoning with recom-
(a) Try to save the life of the patient mendation for post-mortem exami-
and give emergency necessary treat- nation.
ment. 16. Duty to maintain secrecy-The doctor is
(b) If necessary, the patient should be obliged to maintain the secrecy of the
sent to a better hospital, if possible patient which he knows in course of
a government hospital, if the condi- treating and attending the patient except

when he is required by law to divulge the about the nature of the illness of the servant
secrecy of the patient or when the pa- without his consent.
tient has consented for their disclosure. The information about the nature ofill-
The consent may be expressed or implied
ness of a minor, insane or intoxicated patient
consent (see the following few pages).
may be disclosed to the guardian of the pa-
tient. But in case of a mentally sound major
patient, nothing should be disclosed to his
parents or other relatives without his con-
sent.
Except in circumstances of privileged com- While treating a minor inmate of a hos-

munication and except when the patient has tel or a boarding house the doctor may dis-
consented for disclosure, the doctor must not close the necessary information of the patient
disclose the secret informations of.his patient. to the warden or superintendent. But, if the
The doctor is liable for damages ifhe discloses patient is a major, then he cannot do so with-
without a valid ground any such info~ation out the consent of the patient.
which the patient may reasonably claim as In case of treatment of a convict prisoner
secret or confidential. The following exam- of a jail, the matter relating to his illness may
ples may serve as guideline: be conveyed to the jailor or the superintend-
A doctor should not disclose any secret ent of the jail. But, in case of an undertrial
information about his patient or his private prisoner or a person in police custody , this
life, which he learns in course ofhis exami- cannot be done without his consent.
nation, investigation and visiting the house When a person comes to a med1cal man
of the patient, to a third party . for a medical certificate or a report , for pro-
Except in circumstances of public inter- duction to some place, then it may be taken
est , as in case of communicable diseases, the as implied that he has the consent for disclo-
doctor should not disclose the secret infor- sure of all infonnations about his illness to
mation of the patient even to a public or a that place. Hence, in such a situation, disclo-
statutory body . sure of relevant information about the per-
son to the concerned place will not amount
Similarly, without the consent of the pa-
to breach of trust for breaking professional
tient, no information about him or his illness
secrecy. For example, when somebody ap-
or any matter about his family can be dis-
proaches the doctor for medical check-up and
closed, even to his employer , irrespective of
report for the purpose or in connection with
whether he is an employee of a government
a life insurance policy, the doctor should feel
or a private concern.
himselffree to mention all relevant informa-
Without consent , the secret information tions about the person's health, in his report
about the husband or the wife cannot be dis- to the life insurance corporation. But when
closed to the other spouse. the person comes to the doctor for a purpose
In case of domestic servant , even if the other than holding a life insurance policy, e.g.,
master pays the fees of the doctor towards when he comes simply for the purpose of per-
the treatment of the servant, the doctor can- sonal treatment, the doctor should not di-
not disclose any information to the master vulge any information to the life insurance

----------------------------
corporation without the consent of the pa- with which of his patient's Illness he should
tient. send to which authority which will serve the
In case of artificial insemination the do- lawful interest of an individual or the greater
nor and the recipient should not know each interest of the society. Here, only some ex-
other's identity. amples are enumerated. Wherever possible,
the doctor should try to protect the interest
In course ofpathological postmortem ex- of the society by ways other than divulging
amination, the doctor should be cautious that the confidential information about his patient.
he does not disclose any such information It is only when he is convinced that the in-
about the deceased, which may injure his terest of another individual or the society at
reputation. large cannot be protected without divulging
In reporting a case, in any scientific jour- the facts about his patient, he should do so.
nal or otherwise, the doctor should be cau- 1. Information about a patient suffering
tious that the identity ofthe patient is not from sexually transmitted disease-W'1en
disclosed. the doctor fmds that one of his patients,
A doctor, irrespective of whether he acts who is suffering from some sexually
in his private capacity or as government serv- transmitted disease. IS planning to rna. •y .
ant, should respect the secrecies of his pa- he should first advise the patient not to
tients with utmost care. He should be care- marry until he IS cured ofhis disease. If
ful particularly for the fact that, in most cir- the patient does not listen to the advice
cumstances, he is not expected to disclose the of the doctor then the doctor can 1' form
secrets of his patient but in some circum- the person about his illness, whom the
stances he is not only expected to disclose patient is going to marry. Though, in
some information related to some of his pa- general consideration, disclosure of the
tients, but is bound by law to do so. These infi)nnation of the patient suffering from
are the circumstances of privileged commu- veneral disease is a breach of trust m the
nication. professional field, here it is 1 ather the
duty of the doctor to disclose the infor-
mation to the person whom the patient
is going to marry, without bemg cured,
inspite of such prior advice from the doc-
It is a bonafide information to a concerned tor, thus exposing that person to his dis-
person or authority, given by a doctor by vir- ease.
tue ofhis duty to protect the interest of the 2. Information about infectious disease of
community or the society some categories of employees-When a
To be bonafide the infonnation should person, suffering from or IS a carrier of
only be sent to the concerned person or au- some infectious disease which is known
thority, maintaining its confidentiality from to contaminate through food and drink,
all other persons, in all other respects, as is employed in a hotel or a restaurant to
otherwise the doctor may be charged for dis- prepare food or serve food to the custom-
closure ofhis patient's secrecy. In individual ers, then his doctor should first advise
circumstances, the doctor is the best judge him to abstain from working till he is free
to decide which information in connection from the disease or the infective genns.

If he does not listen to the advice of the bomb or firearm or stab injury case), he
doctor then the doctor should inform the should bring the same to the know ledge
employer about the danger from the par- of the law-keeping authority.
ticular employee. 7. Information d1sclosed m the mtHrest of
3. Information about non-infectious dis- thP patient-When the doctor feels that
eases of some specific categories of em- for the interest of the patient and for his
ployees-Persons suffering from defective treatment, his close relative should be
visual aquity or defective colour vision informed about the exact state of the pa-
or such other perceptive or neurogenic tient's illness, he should do so.
defects , if engaged in jobs like driving a 8. Disclosure 1 t th i .t:A:·rest of ·.h« doctor
vehicle or dealing a heavy machine may himself-When a charge of negligence is
be dangerous to himself or others. The brought against the doctor by the patient
treating physician of such a defective per- or when the patient does not p ay the due
son will first advise him to refrain from fe£:s of the doctor, then the doctor can
such work so long the defect per.sists. If disclose the relevant aspects of the pa-
the person does not listen to the advice tient's illness, as his defence against the
of the doctor and continues in the job, charge or to realise his due fees.
which may be hazardous, the doctor 9. Disclosure in a Court vf La in cin:·um-
should inform the employer about the >'tances other than described above, in Sl.
state of his illness and the possible con- no. 8- Though a doctor is not ordinarily
sequence of his continuing in that job. expected to divulge any secret informa-
4. Information about the risk of contami- tion about his patient which he learns in
nation to public in general with infectious course of treating the patient, in a Court
disease at places other than place of em- of Law he does not enjo} the privilege of
ployment-When a person suffering from profe ssional secrecy , as a lawyer does .
a contagious disease takes bath in a pub- Whatever information is required by the
lic bath like a bathing pool, danger is there court, for the interest of justice, the doc-
that the disease will be contaminated to tor is legally bound to narrate the same
many others taking bath in the same pool. before the court as per his knowledge.
If his doctor cannot restrain him from his
habit, then he should inform the care-
taker of the bathing place.
5. Information about outbreak of a commu-
nicable disease-When there is outbreak When doctor-patient relationship is estab-
of a communicable disease, the doctor lished, the doctor simultaneously owes some
must inform the same to the local or state other duties to the patient, apart from the duty
health authority so that appropriate steps related to his proper treatment. The doctor
can be taken by the State authority to enjoys a special position du to the trust of
control the spread of the disease. the patient on him The doctor must not mis-
6 Information about commiss10n of sorr.te use this respectful position of trust. He should
crime-If in course ofhis practice, a doc- keep the following points in his mind:
tor comes
, to know about occurrence of 1. He should n ot hn~e hi pos ~Lion of trust
some crime (e.g., when a doctor treats a and should not take undue financial ad-

vantage from the patient. He should not Criminal Malpractice--As in other crimi-
adapt any undesirable means to extract nal cases, in criminal malpractice by a doc-
money from the patient which is not his tor, he is prosecuted by the State for com-
due. mission of some wrong which comes under
2. He should disclose to the patient or when the purview of the CrPC (criminal procedure
it is difficult to inform the patient, he code). The wrong deed of the doctor is con-
should inform the relative of the patient, sidered as an offence against the community
about the po -~·ible prognosis sequelae or or the State. For this the doctor is liable to
iJrohable compl cntion of the disease and be punished by a law court according to the
then leave it to the patient or his rela- provisions of the IPC (Indian Penal Code).
tive to decide whether the patient should The wrong deeds of a doctor which amounts
be treated by him or consult any other to criminal malpractice are contravention of
doctor elsewhere the provisions of the Drug Act, wilful manipu-
3. As discussed und~r professional secrecy, lation of the medical records, performing
the doctor must honom t hE:: t rust of his criminal abortion, wilful issuance of a medi-
patiE'nt on him and must not disclose his cal certificate in a wrong way, covering a
patient's confidential information to any- criminal act in course of his practice, gross
body except when necessary as detailed and 11ilful negligence of a patient resulting
under 'privileged communication'. in his death or such bodily injury which can-
not be compensated by money.
Criminal negligence-Criminal negli-
MALP.RACltce AND NEGLIGENCE IN gence is a sort of criminal malpractice where
MEDICAL PRACTICE the gross careless or negligent act of the doc-
tor causes serious bodily harm or death of
In medical profession, malpractice may be de- the patient. These are such acts of the doc-
fined as absence of reasonable care and skill tor which show that the doctor is least con-
in a doctor in course of treating his patient cerned about the welfare or safety of his pa-
or his wilful negligence in the treatment of a tient. As the criminal law does not approve
patient, causing some damage, bodily injury and allow any act of a person which may be
or death of the patient. dangerous and harmful to another, these
Definition of negligence-Negligence in types of gross negligent acts on the part of
medical practice may be defined as the omis- the doctor, resulting in irreparable bodily
sion to do something which a reasonably com- harn1 or death of the patient are counted as
petent medical practitioner, guided by the criminal negligence, and the erring doctor is
prevailing standard of medical know ledge and liable to be punished as per CrPC and IPC.
practice and such other considerations, which Civil Malpractice or Civil Negligenc~
ordinarily should regulate the conduct of a These two terms are rather synonymous.
medical man, would do, or doing something Civil Malpractice or Civil Negligence indi-
which such a reasonably competent medical cates such act of negligence (see definition of
man would not do, leading to some harm or negligence given above) on the part of the
damage to the patient. treating physician which causes some suffer-
Medical malpractice may be (a) criminal, ing, harm or damage to the patient and can
(b) civil or (c) ethical. be compensated by paying money and does

not come under the purview of the CrPC and be inferred only because the patient could
IPC and does not demand legal punishment not be cured or because the patient suf-
of the doctor. fered much or for a long period. To decide
Ethical malpractice -This neither on this point, it must be shown by the
amounts to criminal nor to civil negligence plaintiff that the doctor did not execute
The patient may not be directly affected in his duty in accordance with the prevail-
ethical malpractice. These are those acts of ing standard of knowledge, care and skill
breach of ethics of medical practice which, and did not attend the patient or act in
though may or may not amount to negligence, the expected manner.
may lead to debar the physician from medi- 3. Actual damage or harm of the patient is
cal practice, on the decision of Medical Coun- another essential ingredient of negli-
cil. gence on the part of the doctor which
must have resulted from dereliction of
The burden of proof and the ingredients his duty.
of negligence
It may be marked that neither the dam-
The burden of proof of negligence of the doc- age alone, nor the dereliction of duty alone
tor lies on the plaintiff, i.e., the complainant. can be accepted as proof of negligence on the
part of the doctor. Firstly, treatment of a
To prove negligence on the part of the patient by ad 'tor does not guarantee a cure,
doctor the following ingredients must be and harm fru .. 1 a disease may be a natural
present. consequence Secondly, the doctor is the best
1. That, the doctorwas duty-bound to treat judge to decide what extent of attention
the patient and attend him regularly should be paid to which patient. So, in ab-
Here it may be repeated again that treat- sence of any of the two factors, negligence
ment given to a patient in an emergency on the part of the doctor cannot be estab-
circumstance does not make the doctor lished. And question of dereliction of duty
duty-bound to treat the patient, because cannot arise if there was no duty for the doc-
doctor-patient relationship is not estab- tor to attend the patient.
lished on the basis of treatment. given
on emergency requirement alone . Sec- Doctrine of Res ipsa loquitur
ondly, even if the relationship has already Res ipsa loquitur means 'facts speak for them-
been established after the doctor has ac- selves' Ordinarily, the burden to prove neg-
cepted the patient for treatment, he mav ligence of the doctor lies on the plaintiff or
not subsequently attend the patient on the complainant. But when the doctrine of
some valid ground (vide page 55). Res ~psa loqwtur is advocated, the position is
2. That, the doctor did not do his duty to treat reversed. This doctrine is pleaded by the com-
C1e patient properly as is expected from a plainant when the negligence and the dam-
reasonably competent doctor, though the age are quite evident, with the argument that
doctor-patient relationship was already es- the damage could not have been caused but
tablished and the doctor thus had a duty for the negligent act of the person or persons
to the patient. Thus, there has been der- concerned. The doctor being the concerned
eliction of duty on the part of the doctor. or one of the concerned persons has to estab-
Here also, dereliction of duty should not lish that the damage suffered by the patient

was not due to his negligence. This doctrine 1. That, he had no duty to the patient (al-
has often been presented when the damage ready discussed).
resulted from a teamwork where the doctor 2. That, he discharged his duties in accord-
and some other persons were involved. In ancewith the prevailing standard of medi-
such circumstances, the doctor himself be- cal practice.
ing ignorant about the cause of the damage 3. That the patient did not release the doc-
and the person actually responsible, may find tor though the doctor expressed his in-
it difficult to prove his innocence, though he ability to treat the patient and advised
may actually be innocent. him to go to some other doctor.
In a circumstance where a doctor, in his 4. That the patient did not agree for ar-
prescription, wrongfully directs a patient to rangementofconsultation which was felt
take some medicine orally which is exclu- .__;.;sential by the doctor, nor did the pa-
sively for external use, and if the patient suf- tient released him of his duty.
fers following such written directive of the
doctor, the wrong prescription of the doctor 5. That, the damage caused to the patient
will tell for the negligence of the doctor. ~is is not due to his negligence but could be
due to the act of any· other person who
is an example where the doctrine of Res ipsa
also was concerned with his treatment.
loquitur can be applied for establishing the
negligence of the doctor. In another circum- 6. That, the damage was the result of a third
stance, where, during an operation, a swab party who interfered in the treatment
or an instrument is left inside a body cavity, without his knowledge or consent.
the subsequent detection of the material in- 7. That, the patient did not follow his ad-
side the body cavity also acts as Res ipsa lo- vice properly or it was a case of contribu-
quitur, which establishes negligence in the tory negligence (see page 55, 67).
process of the operation. In such circum- 8. That, the damage complained of is an ex-
stances, the doctor may try to show that the pected outcome for the particular type of
job of counting out the swabs, etc. at the clo- the disease the patient suffered from.
sure of the operation is not his job but the
9. That, it was a case of reasonable error of
job of the assisting nurse.
judgement.
But this argument may not be helpful for
10. That, it was a case of therapeutic or di-
the doctor as in many such cases the trial agnostic misadventure (see page 65).
courts have observed that the ultimate re-
sponsibility to complete the operation safely 11. That, it is a case of medical maloccurrence
for the patient lies with the surgeon. It is the (see page 65).
duty of the surgeon to see that his assistants 12. That, the complain should not be enter-
discharge their duties carefully during an tained because it has already been tried
operation. once by a court of law (Res judicata).
13. That, the damage was the result of tak-
Defences of a doctor against charges of
ing some unavoidable risk which was
negligence
taken in good faith in the interest of the
When charged for negligence, a doctor may patient with his or his guardian's con-
plead any or many of the following arguments sent.
as his defence, as applicable in his case. 14. That, the patient persistently insisted on

Table 3 1 Differences between Civil and Criminal Negligences

Ctvil negltgence Crimmal negltgence
-
1. C1v11 negligence does not amount to comm1ss1on of Criminal negligence amounts to commission of an offence.
an offence.
2. Tried 1n a c1vil court. Tried in a criminal court.
3. A dispute between two parties 1n their individual Acase between the sate and the accused doctor.
capacity
--
4. The sufferer party 1s the complainant. The public prosecutor on behalf of the state is the
complainant.
5 It 1s a negligence which causes reparable damage or It causes irreparable damage to the patient.
harm to the patient.
--
6. The magnitude of the negligence does not indicate The magnitude of the negligence is gross, indicating total
gross carelessness by the doctor about the patient's carelessness resulting in severe harm to the patient.
health.
7. The doctor is not punishable. He may have to pay The doctor is punishable with either imprisonment or fine
for or compensate the damage caused by money. or both.
Table 32 Differences between Professional Negligence and Professional Misconduct

Professtonal negligence ProfessiOnal misconduct
----
It concerns duties of a medical man towards his/her It concerns violation of Codes and Ethics of Medical
patient an offence. practices.
---- -------~------------------------------------
2. There should be dereliction of duty 1n the treatment There need not be any dereliction of duty and damage
caus1ng some damage to the patient. to the patient.
3. Charge against the erring doctor 1s brought before a Charge is brought before the State Medical Council.
Court of law.
4 May be pumshed as per Indian Penal Code as in Where applicable, name of the doctor may be erased
other cnm1nal cases or may be liable to pay from the Medical Council's register or he may be
compensation as in other civil cases. served with warning notice and reprimanded.
5 Appeal cases are lodged with the Higher Court. Appeals are made to the Central Government.
the specific line of treatment which has the complaint may not be entertained now.
caused the damage inspite of the doctor's Complaints ofnegligence should be lodged
waming about the risk involved in that within two years, counting from the al-
method of treatment. leged date of causation of the damage.
15 That, the time limit allowed by the law It should be remembered that free treat-
for lodging such a complaint is over and ment of a patient does not absolve a doctor

chapter 3: LEGAL AND ETHICAL ASPEC TS OF PRACTICE OF MEDICINE I 65
·. responsibility towards his patient and An experienced medical practitioner having

does not give him immunity against a negli- standard knowledge should be aware of the
gence charge. usual unexpected and unexplained reactions
with different drugs in different individuals .
Procedure to initiate a charge of negli-
He should be acquainted with the iatrogenic
gence against a doctor-The charge of crimi-
effects, side-effects and contraindications of
nal negligence against the doctor is lodged
different drugs, at least of those used by him.
by the public prosecutor. The charge of civil
Medical maloccurrence is thus not a blank
negligence may be lodged by the sufferer pa-
cheque to be used by the doctor against whom
tient or it may come up when the doctor sues
a charge of negligence has come up.
the patient for non-payment of his fees and
the patient argues that there was no ques- (b) Therapeutic Misadventure
tion of paying the doctor's fees as because
the treatment of the doctor did not benefit 1. Therapeutic misadventure may be truely
him, rather caused some damage to him. due to the therapeutic reasons when no
action or an adverse reaction to a drug is
there, or when the doctor knows that the
r :·: . ·. drug may cause some untoward reaction,
L~fii.' ~> _. :0.~'"' ~ , ' . ., ' ' ~
or its prolonged use may cause some
harm to the patient, but finding no other
These are diseases or conditions arising out
way he uses the drug . This condition, to
of medicinal or therapeutic sources or uses.
a great extent, is similar to medical
Two different types of circumstances are rec-
maloccurrence. It may also be,
ognised, e.g., (a) Medical Maloccurrence, (b)
Therapeutic Misadventure. 2 An instance of diagnostic misadventure ,
where some diagnostic procedure may
(a) Medical Maloccurrence bring hazard to the patient , as in case of
injection of some radio-opaque dye in
Not in all diseases or in all persons , one medi- some special radiological investigation,
cine gives the same or the expected result . laryngoscopy, bronchoscopy or explora-
Bio-physiological actions and reactions to dif- tive laparotomy. It may be,
ferent drugs are different and are extremely 3 Expe.·imental misadventure, where a
variable. Thus, individuals may react differ- person might have been subjected to use
ently to the same drug, in the same dose and of some drug or undergo certain opera
same mode of application. Also, it is to our tive procedure on expenmental basis . In
know ledge that some individuals may be quite case of therapeutic and diagnostic mis-
tolerant to some drugs due to which the usual adventure, the defence of the doctor
dose of the drug may not give the desired stands only if he can show that,
effect. On the other hand some individuals
(i) the steps he took was quite jus-
may be idio-syncratic to some drugs while
tified ,
others are not. These are medical
maloccurrences, which may cause extra suf- (ii) the hazard was quite unexpecte<l and .
fering to the patient and the doctor is not is not known to occur,
actually responsible in these cases~s the (iii) he took reasonable precaution
doctor is not negligent ~n his act. However, against the possible hazaTd· as its
the 1ssue should not be considered so simply . possibility-was known to him or
fF M -'il
(iv) he had no other way but to take the of negligence will not stand aga..mst the doc-
risk of the hazard, though he knew tor, even though the patient might have suf-
its possibility. fered some damage out of the act involving
In case of experimental misadventure, if the risk. The justification of the step involv-
the doctor wants to use this point as a ing the risk and the precautions taken to
defence against a charge of negligence he overcome the risk will act as good defence
must justifY the reason for his experi- for the doctor who is charged for negligence.
mentation and must show that he got a
Common Knowledge
valid consent from the patient or his
guardian, after duly explaining him the The doctor may be charged for a negligent
merits and demerits of the experiment act not involving his technical or specialized
and the risk involved in the act. (see also knowledge and experience, but some act in-
page 77) volving application of common sense only.
Necessity of fluid therapy for a dehydrated
Corporate Negligence ·
patient suffering from gastro-enteritis, is a
The question of corporate negligence arises matter of common sense or common knowl-
in hospitals or nursing homes, where more edge. If a doctor fails to do the needful in such
than one individual at more than one level a case, he is negligent and to prove this the
remain responsible for the well-being of the plaintiff need not show that the doctor did
patient on the basis and terms of their serv- not show reasonable degree of scientific
ices. Thus, not only the treating doctor of the kn~wedge and care and skill as it is a com-
patient but also the hospital administration mon know ledge that such a patient requires
and some other categories of the hospital staff fluid therapy for which the doctor did not take
related with treatment of the patient may be proper step.
charged for negligence due to the damage
suffered by the patient. A doctor may be Novus Actus lntervenins
charged for negligence WI his part,vf duty, a
nurse may be charfed if ~e does not take In case of, intervention by a doctor in a case
care of the patient according to the direction of injury or disease of a person, if complica-
of the doctor and the hospital superintend- tion arises or condition of the subject dete-
ent may be charged if he does not take steps riorates or he or she dies, any of which should
to make the drugs necessary for the patient, have not occurred in natural course of the
available in time. The superintendent will injury or disease even without ;my treat-
not only be responsible for posting of persons ment, then the theory of " N ovus Actus
with desirable qualifications and experiences Intervenins" becomes applicable, i.e., it will
for a specific post but he will also be obliged be taken that the deterioration/complication/
to see that every employee perform his/her death of the subject has occurred due to in-
part of duty to the patient. tervention by the doctor, and in such a case
he will be held responsible.
Calculated Risk
Duties of a Patient
In some cases acceptance of some degree of
risk may be inevitable. If in such cases proper The doctor-patient relationship is not a one
care is taken against the risk then a charge way traffic. In connection with his treatment

chapter 3: LEGAL AND ETHICAL ASPECTS OF PRA.C'T!CE OF MEDICINE I 67
the patient also has certain duties to do. These responsible if the damage complained of is
are--- partly due to his negligence and partly due to
1. The patient should inform the doctor eve- the act of the patient. Contributory negligence
rything about his illness and should not is thus a good defence for the doctor, but only
keep the doctor ignorant of anything re- in civil cases and not in criminal negligence
lated with his illness. cases. In criminal negligence cases the charge
2. He should properly follow the ad vices of framed against the doctor is as per the crimi-
the doctor. nal laws of the country, when the act of the
doctor amounts to some codified crime of the
3. He should not do anything which the doc-
country. If the doctor has conunitted any of-
tor prohibits as a part of the treatment.
fence, then he will be charged up to the ex-
4. He should not follow the advice of any tent ofhis offensive act. In criminal negligence,
other doctor without the knowledge and the negligence is gross and the resultant dam-
consent of the doctor in his charge (he age is also gross. While prescribing a very
can, of G.ourse·, do so if the doctor in charge dangerous drug to his patient the doctor must
of the patient relinquishes the charge or give detail instructions about the method of
if the patient decides not to continue units use and warning against its danger. Ifhe
der the treatment of the first doctor). fails to give proper instruction leading to se-
5. The patient should pay the due fees to vere harm to the patient, then he alone is re-
the doctor. sponsible for the harm caused. If he gives
When a charge of negligence is brought proper instruction which the patient does not
against a doctor, he may plead not re- follow and ~uffe ~the harm, t~n'\he patient
sponsible, for reasons of failure on the
' ,.
alone is fesponsiSI.e mf.
not the doctor.
part of the patient to do any or more, of In connection with contributory negli-
the above-noted duties of the patient. gence two special circumstances need to be
mentioned. 1. If after the negligent act of the
Contributory Negligence
patient himself, the doctor gets time but fails
Sometime the alleged damage suffered by the to take precautionary step against the possi-
patient or the negligent act of the treating phy- ble damage and if damage occurs conse-
sician is related to some undesirable or negli- quently, then the doctor cannot take the plea
gent act of the patient himself. If the patient of contributory negligence to defend himself
would have acted in the way as is expected or in the face of charge of negligence, because,
desirable from a patient, the doctor either after the act of the patient he got clear time
would have not committed the mistake or the and scope to avert the "possible" dama~e
damage would not have been caused to the which he did not do. This theory is termed as
patient. This is contributory negligence. Hence "the last clear chance doctrine" which limits
in contributo1y negligence, there is at least the scope of use of contributory negligence
some contribution by the patient to the dam- as defence by the doctor. 2. In some other
age suffered by him. Accordingly, in these cir- circumstances, it is seen that the patient was
cumstances, the doctor will either be not held negligent only after the damage was caused
responsible at all if the negligent act of the by the negligence of the doctor. The negli-
patient is solely responsible for the damage gence of the patient might aggravate the dam-
he complains or the doctor will be held partly age which could be avoided by the patient.

However, as the negligence of the doctor is Like intern trainee doctors, in case of
responsible for the damage complained of, he trainee nurses also the staff nurse-in-charge
cannot take the plea of the patient's subse- remains responsible for the negligent acts of
quent negligence to defend himself, though the trainee nurses. The superintendent of a
further damage might have not occurred if hospital is not responsible for the negligent
the patient was not negligent. This provision act of any doctor of the hospital if the appoint-
is termed ''the avoidable consequence rule ". ment and posting of the doctor was properly
done by him giving due importance to his
Product Liability qualification and experience on one side and
the nature of duty he is to perform, on the
This means the liability of producer, agent
other.
or seller of medicines, instruments or appli-
ances, the use ofwhich alone has caused some Some precautionary steps recommended
damage or harm to the patient. The burden for registered medical practitioners to
to prove this lies on the plaintiff
avoid a charge of negligence
Vicarious Responsibility 1. The registered medical practitioner must
not guarantee cure of his patient.
This means liability of a person due to the
act of another. In medical practice, this 2. He should keep his professional knowl-
means responsibility of a superior medical edge up-to -date
or paramedical employee for the negligent 3. He should apply due care and skill for
act of his subordinate employees or persons the treatment of the patient.
under training who are expected to work 4. He should take written informed consent
under the guidance of the superior. This (see page 77) in all steps of treatment if
working relationship is also termed these involve any risk or if they are be-
"respondan• supenor", because a superior yond what are routinely followed.
has to answer for the fault of his subordi- 5 It is advisable that consent should be
nate. Thus, an intern doctor, though quali- taken from both husband and wife if ei-
fied, is in practical training under the guid- ther of them 1s going to have a treat-
ance of the unit head of the department and ment which may cause sterility or im-
if he commits some negligent acts which potence
cause some damage to a patient, then for
6. Laboratory investigations should be ad-
his act the unit-in-charge will be answerable
vised whenever necessary to come to a
and responsible. However, this will not be
diagnosis or to confirm a clinical diagno-
so, if the negligence complained of, comes
sis.
under the purview of Doctrine of Common
Knowledge (see page 66). However, to be to- 7. Condition of the patient and the treat-
tally out of danger arising from the comment are to be regularly recorded in de-
plaint, the intern doctor may have to prove tail.
that he has not acted against the advice of 8. He should consult a professional col-
the unit-in-charge, or that his acts in rela- league whenever necessary (see page
tion to the treatment of the patient were 56).
known to the unit-in-charge, or the unit-in-
~
9. The condition of the ·nstruments or
chftrge got. ~me to ~ ~ify his mistake. equipments must be checked before use.

0 Particular attention to be paid on the 23. Due care must be exercised while choos-
ot mediCli e while giving it to a mg an assistant during an operation or
patient for internal use. Special atten- otherwise.
tion should be paid towards the expiry 24. Irrespective of whether the patient re-
date of the medicine, crack in an am- sponds to the treatment or not, the treat-
poule or break of the seal of the con- m en s· ould not be given up un less the
tainer. patient desires it or agrees to it.
11. - s t.1vn s l should be performed be- 25. During any emergency, the patie~1t
fore injecting a drug which is known to ·ho ld not l)f> 1 ft unut €'nded except when
cause allergic reaction or anaphylaxis or there is more emergency of another pa-
if the patient is known to be hypersensi- tient.
tive to a drug of the group to be used.
26. The car aci Ly of a professional colleague
12. Whenever necessary, the patient should and his efficiency should not be publicly
be immun Jst-!d against a disease. cnuci. ed.
13. nJur.y due to assault and pOisoning cases 27. If the doctor .::1 unnble .o attend. the pa-
should be sp€Cia!l.r dealt with. tient due to any cause, then ,,he patient
14. t-.. o meth JG should be tried b ~ onJ the sho 1 d bt: inform0J of the same, . ell in
sk1ll o · field of specialisation of the doc- advance with the advice to arrange for a
tor concerned. substitute.
15. Expe r l ntal trea· ment should be gen- 28. Wheneve • n ce s,lry, the patient should
erally avoided. But if it is necessary then be referred to another centre with avail-
it should be done only with the written ability of better facilities.
consent of the patient or the guardian of
29. F :rru .le pattents should not be examined
the patient. without the presence of another female.
16. The prescription must contain clear in-
30. Provisions of the .T P Act (see page
!':truc·twns to the patient.
660) should be strictly followed.
17. ost-ope rnti c re should be optimum.
31. Dea~h certificate and other medical cer-
18. ' o advtce should be given over tel- tificates should be issued with care.
Ephone .
19. Anaesthesw should be administered by a Medical Indemnity Society and Insurance
qualified and expen .need doctor.
Medical indemnity societies have come up
20. Necessary clinical check up, laboratory
with indemnity (security/protection) msur-
investigations and premedication as re-
ance sch emes, to protect tl,e doctor when he
quired should be done before administra-
is professionally in danger. The policy holder
tion of n ciO thP. ta. (medical practitioner), if gets involved in neg-
21. Ana t.het:t=-t should not leave the patient ligence charge or related litigacy, informs the
b fore the patient's recovery from anaes- society or the insurer without making any
thesia. personal comment on the charge against him.
22. In case of d at ·. of the patient under The insurer or the society defends his case
au sth ros t'1 or on the operation table , an in all respects and according to the scheme
inque 'L. should be recommended. of the insurance may even pay compensation

on his behalf. This type of schemes are going to allow or assist for as painless death of a
to get more importance as medical practice person as possible. This terms are-'mercy
comes under the purview of Consumer's Pro- killing' or physician assisted suicide.
tection Act or C.P.A. or COPRA. In India, like most other countries of the
world, euthanasia has no legal status. Su-
Malingering
preme Court oflndia on 21.3.1996 expressed
Malingering in medical practice means feign- that Euthanasia (mercy killing) is "a matter
ing or pretending some illness or injury with of policy which is within the domain of the
some motive . The motives are divergent in legislature". On the other hand, as the law
nature. It may be with the intention to avoid stands, the practice of euthanasia is a clear
duty, take premature retirement from the act of offence, either a suicide, assistance to
service, to bring a false charge of assault or commit suicide or a murder. It is a case of
poisoning against somebody, to avoid a busi- suicide with or without assistance when a per-
ness contract, to extract compensation, to son terminates his hfe with or without the
avoid attendance in a court or to establish a assistance of another, usually a doctor ; it is
defence (on the ground) of self-protection, a case ofmurderwheu it is practised without
when charged for causing assault or injury the available consent from the person so
to another person. To establish his case the killed. When a doctor kills such a patient ac-
malingerer may inflict certain minor injuries cording to the desire of the patient, a double
on his body or may take some drug to alter legal position arises. From the point of view
the functions of the body system, e.g., to al- of the patient concerned, it is a case of sui-
ter the body temperature, pulse rate, heart cide but the legal position of the doctor con-
function etc. In case of any doubt about the cerned is like that of a murderer, helping the
illness of the person concerned, thorough practice of euthanasia. In U.S.A its practice
clinical examination, necessary laboratory in- is a clear offence theoretically, but generally
vestigations and constant watch by admitting the judgements of different courts during trial
him in a hospital may be needed before giv- of euthanasia cases seem to be liberal. Jack
ing him any treatment or issuing a certifi- Kevorkin a 67 years old pathologist attended
cate in his favour. 27 such suicides in U S A in 1990. He has
been aquitted by 3 Courts. In 1996 two U.S.A
Euthanasia or Mercy Killing Federal Courts upheld this rightoftemunally
ill persons with the help of doctors. Among
Euthanasia or mercy killing is the practice the common people there are opinion in fa-
of killing a person for giving relief from in- vour and against Euthanasia. Supporters ad-
curable pain or suffering or allowing or caus- vances arguments of civil rights of terminally
ing painless death when life has become mean- ill. Opposers say 1t is to eradicate
ingless and disagreeable . inconviniently ill elders. 1996 U.S .A. ,Judge-
The term Euthanasia comes from a Greek ment says-"competent adults have consti-
word "euthanatos" where 'Eu' means good tutional nght to seek help in choosing a dig-
and 'thanatos' means death. This, thus means nified and humane death than reducing to a
a painless death or death with minimum pain. childlike state of helplessness". It makes no
Some other terminologies are ofte'l used with sense that a doctor can pull the plug on life
more or less same meaning or purpose i.e., support systems at a patient's request but he

------- ---
is not allowed to prescribe lethal doses of Religious and Philosophical back-
drugs for them who wanted it. On 1.2.97 one ground-No religion approves euthanasia.
Florida Judge upheld the right of a dying AIDS Philosophers like Aristotle, Plato and
patient to go in for doctor-assisted suicide to Pythagorus favoured euthanasia. Different
end his sufferings. In U.S.A a woman who organisations have moved from time to time
was suffering from total paralysis and related to form public opinion in favour of euthana-
distress, was granted right to terminate her sia and legalise it. Roman Catholics oppose
life and then to try her mother on charge of the right of self-killing.
murder for shooting the daughter on her neck
and causing the paralysis. Though not ap- Methods of Pradice
proved, the legal position of euthanasia in
A Active and Passive Euthanasia- This are
Germany, Sweden, Poland are comparatively in relation or concerning the action of a
liberaL Hitler's Germany made it compulsory doctor.
for them whose life ceased _to be useful, often
(a) Active euthanasia-When euthana-
deliberately selecting wrong persons. Part of
sia is allowed by administration of
Australia had a voluntary Euthanasia law
drugs in absence of which the per-
which was subsequently repealed.
son would have not died immediately
Doctors' Associations' view-Almost all or wi.,hin a short period. In most
the associations or bodies of physicians of the cases this is the physician assisted
world have opined against physician assisted suicide. In these cases no further
euthanasia. For a patient who in hts termi- change of drug is made to survive
nal phase of life suffers from extreme pain , the person.
the recommendation of Australian Medical
(b) Passive euthanasia- When an indi-
Association is to give him pain killer and not vidual is surviving only on life sup-
to kill the patient. porting measures. In this variety
There is not much problem in the life supporting measures are
nonvoluntary euthanasia because the patient withdrawn only; which causes death
is unconscious or in a vegetative state and of the subject without active or di-
death is inevitable in such cases. rect assistance (from a physician).
Ethical contradiction-The Hippocratic B. Voluntary and involuntary euthanasia-
oath and international code of medical ethics This is in relation to or concerning the
pose ethical contradiction for the doctors. role of the patient.
According to the oath and the ethics, the doc- But some suggest that so far the role of
tor is to relieve the pain of his patient in one the patient or suicide is concerned, three
hand, and protect and prolong his life on the varieties of situations are met with
other. The first can be used in favour of the (a) Involuntary- Where the patient
doctrine of euthanasia but the second concerned, has not given his or her
counters the doctrine. American Medical As- consent. In other words decision to
sociation holds it inconsistant with the eth- terminate life of the person lies not
ics of healing. It is also a matter of contradic- on the expressed desire of the per-
tion that advanced medical technology could son , though he or she is in a posi-
or should prolong sufferings tion to give or refuse consent. Here

G
the process of euthanasia is under- This is only legalised in Denmark,

taken on the decision of others-like Switzerland, Netherland and Bel-
close relatives, treating doctors etc. gium. For sometime it was legalised
who find that the life of the patient in some states in U.S.A. like Or-
has become extremely painful and egon, and in some comer of Aus-
purposeless, without any chance of tralia but legal provision did not sus-
survival for long and the life of the tain and the rule had to be reversed.
patient has become distressful and
distateful and also purposeless . Human experimentation
Some consider it equivalent to mur-
In human experimentation, effects of drugs
der.
or agents on human subjects are studied
(b) Non-voluntary euthanasia-In this which may have immediate therapeutic ne-
condition consen· oft] patient can- cessity or may be conducted for the exten-
not be taken, but it is considered sion or expansion of scientific medical know l-
I E:d. Jh t.f t h "ffilnOt n:l\ IV d edge. Accordingly, the experiments may be:
to continue his life without life sus-
1. TheraJJeuti ~When the immediate pur-
taining aids and is living a vegeta-
pose of the experiment is to improve the
tive life who cannot give consent.
condition of a patient who does not re-
Here proxy orcsurrogate consent is
spond to any established medical treat-
often used. (See page 73). It is a less
ment.
debatable process. This process is by
and large legally approved depend- 2. Resea:reh experiment-Here the experi-
ing on the condition of the patient ment is conducted to study the effects of
and process adopted for causing different agents which on the basis of the
death in agoodnumberofcountries. result of the experiment, may be accepted
The recent case of Terry Schiavo in as useful (effective) and usable (safe for
Florida in U.S.A is a bright exam- human consumption). Research experi-
ple. ments are mostly innovative experiments
(c) Voluntary euthanasia wtth assist- concerning drugs or agents which are not
nee fr n , >h., :sici 1. It is also yet in use in medical practice.
highly debatable. The patient may In relation to human experimentation it
persistently insist for assisted sui- is advisable to acknowledge that basic scien-
cide due to depression, with knowl- tific research often requires research on hu-
edge of short period of survivability man subjects to ascertain its mass applica-
due to the suffering disease. Before bility. Innovative therapeutic approach have
helping the patient to commit sui- value in them, but these r!¥}uire considera-
cide a psychiatrist should be con- tions in respect of safety. These scientific
sulted and counselling should be researches often create ethical dilemmas,
tried before helping the person to considering rights of the individual subject
die, is the opinion of some physi- on whom experiment is undertaken. How-
cians and psychiatrists and doctors ever, this problem can to an extent be over-
who do not out right reject the come by use of free voluntary informed con-
proposition of such assisted suicide. sent in which "proxy'' or "surrogate" consent

may also be included to meet up crisis situa- out the knowledge and consent of the pa-
tions, when the patient himself is not in a tients, so that the researchers could deter-
position to understand the nature and neces- mine how lethal or dangerous syphilis was
sity of the experiment he may be subjected for the patients if there were no treatment.
to for his benefit and the step requires to be All these patients died premature deaths from
taken without any delay. " Proxy" or" surro- the complications of syphilis. The list of Se-
gate" consent is not free from ethical ques- cret human experimentation is vast. In 1931
tions and is not at par with the essence of scientist in a famous research Institute in-
norms of consent which should be directly troduced cancer cells in human subjects with-
taken from the person concerned. Though out their knowledge, for investigation of ef-
other ingredients of informed consent may fects of such experiment. The same doctor
be there adequate disclosure of informations worked to ascertain the efficacy of biological
concering (a) diagnosis, (b) nature, (c) pur- warfare agents and effects of radiation expo-
pose, (d) need of the experimental treatment sure, on patients of civilian hospitals and on
proposed, (e) risk involved in such treatment, soldiers. Hundreds of prisoners in an ad-
(f) alternative of the proposed ~reatment and vanced country were regularly subjected to
effect and value of that, all the while neither experiments, (both civilian population as well
can be conveyed directly to the patient nor as military men) with use of different chemi-
the patient can directly convey his consent cal, biological and radiation warfare agents
after full understanding-in " proxy'' or "sur- till the end of 20th century-all secretly with-
rogate" consent. out knowledge and consent of the victims of
The reckless human experimentations experimentation. The position after 1997 is
conducted on the prisoners of 2nd World War not known to this author. Most subjects of
in the concentration camps and even on help- these secret harmful experiments were pa-
less civilians have thrown permanent black tients or healthy innocent people, members
shade on human experimentations. In Aus- of civilian or armed force and not prisoners
tria alone 75000 including 5,000 children who of war (in most cases) unlike "Nazi" experi-
were physically or mentally handicapped were ments which were carried on prisoners of 2nd
killed byway of starvation, exposure and non- world war mainly.
treatment for other ailments to carry on Rules for human experimentation-The
medical research on them. These handi- drug used for the experiment must not be a
capped civilians were chosen for such brutal known harmful agent. There must be scien-
act as they were considered unsuitable in tific justification for experimenting the agent
Hilter's dream-world. Today's most shiver- on human beings. The human experiment
ing and dreadful information is that the brains must be preceded by other experiments in
of these victims are still lying preserved in a the laboratory including experiments on other
museum in Viena. Such type of "inhuman" animals. Experiments should not be con-
human experimentation have also been un- ductedjust to find out a substitute of a medi-
dertaken by an advanced country. The cine without any expectation of greater effi-
"Tuskegee syphilis" study ( 1932-1972) is one cacy or safety. The experiment should be
example in which 200/400 males who were immediately stopped if any untoward symp-
suffering from syphilis were given placebo (no tom starts. The experiment can be under-
drug in the name of drug for treatment) with- taken only with the consent of the person or

his guardian and should be stopped when the 5. Council for International Organisation of
consent is withdrawn . The experiment must Medical Sciences' guidelines for biomedi-
be conducted directly by the medical man who cal research involving human subjects.
has thorough knowledge about the agent to Helsinki convention on human experimenta-
be tested. The spirit of Helsinki Declaration tion in 1964 and its revision in Japan in
should be the basis of such experimentations, 1975.
which dictates the codes and ethics involved
in such experiments.
HELSINKI DECLARATION
The patient must not get any monitory
benefit against the experiment . Experimen- In 1964 , the 18th World Medical Assem-
tation should be against a diagnosed disease. bly met in Helsinki, Finland , to outline
He must not suffer from many diseases, so basic ethical principles of research involv-
as to obscure the result of experiment or to ing human subjects and human experi-
pose difficulty in proper metabolisation or mentation. The code was revised in 1975
excretion of the experimented drug. The at the 129th World Medical Assembly in
manufacturing firm must have licence to Tokyo Japan . The code includes 12 guid-
manufacture the drug. The doctor also should ing nonnative principles :
have authority to experiment the drug. (a) Biomedical research involving hu-
Informed consent in favour of carrying man subjects must conform to gen-
out the experiment has to be there. It has erally accepted scientific principles
been disussed above in detail. However, in and should be based on adequately
human experimentation the guidelines given/ perfonned laboratory and animal ex-
adopted at different times are considered perimentation and on a thorough
"Good Clinical Practice Regulation", which knowledge of the scientific litera-
are as follows : ture;
1. Nuremberg Code of 1947-to safeguard (b) The design and perfonnance of each
the integrity of the research subject with experimental procedure involving
introduction of voluntary consent. human subjects should be clearly
2. 18th and 129th convention ofWorld Medi- formulated in an experimental pro-
cal Assembly held in 1964 and 1975 in tocol which should be transmitted
Helsinki and Japan respectively concern- to a specially appointed independent
ing biomedical research involving human committee for consideration, com-
subjects (Declaration of Helsinki) and its ment, and guidance;
review study in Japan. (c) Biomedical research involving hu-
3. Committee of proprietary Medical Prod- man subjects should be conducted
ucts of the European Community-"good only by scientifically qualified per-
clinical practice for trials of medicinal sons and under the supervision of a
products in the European Community". clinically competent medical person;
4. Council for International organisations of the responsibility for the well-being
Medical Sciences-international guide- of the human subject must always
lmes for ethical review of epidemiologi- rest with a medically qualified per-
cal studies. son and should never rest on the

. ..
~
chapter 3: LEGAL AND ETHICAL ASPECTS OF PRACTICE F MEDICINE I 75
subject of research, even though the equately informed.9f the aims, meth-
subject has given his or her consent; ods, anticipated benefits and potential f{'
(d) Biomedical research involving hu- hazards of the study and the discom-
man subjects cannot legitimately be fort it may entail; he or she should be
carried out unless the importance informed that he or she is at 1iberty
to abstain from participation .at any
of the objective is in proportion to
time, the doctor should then obtain
the inherent risk to the subject;
the subject's freely given informe" '
(e) Every biomedical research project consent, preferably in writing;
involving human subjects should be
(j) While obtaining informed consent
preceded by careful assessment of
for the research project the doctor
predictable risks in comparison with
should be particularly cautious if the
foreseeable benefits to the subject
and to others; concern for the inter- subject is in a dependent relation-
ests of the subject must always pre- ship to him or her or may consent
vail over the inte~sts of science and under duress; in that case the in-
society; formed consent should be obtained
by a doctor who is not engaged in
(f) The right of the research subject to
the investigation and who is com-
safeguard his or her integrity must
pletely independent of this official
always be respected; every precau-
relationship;
tion should be taken to respect the
privacy of the subject and to mini- Ck) In case of legal incompetence; in-
mize the impact of the study on the formed consent should be obtained
subject's physical and mental integ- from the legal guardian in accordance
rity and· on the personality of the with national legislation; where
subject; physical or mental incapacity makes
(g) Doctors should abstain from engag- it impossible to obtain informed con-
ing in research projects involving sent, or when the subject is a minor,
human subjects unless they are sat- pennission from the responsible rela-
isfied that the hazards involved are tive replaces that of the subject in
believed to be predictable; doctors accordance with national legisla-
should cease any investigation (re- tion.
search) if the hazards are found to (l) The research protocol should always
outweigh the potential benefits; contain a statement of the ethical
(h) In publication of the results of his consideration involved and should
·c:~
or her research, the doctor is obliged indicate that the principles enunci-
to preserve the accuracy of the re- ated in the present declaration are
sults; reports of experimentation not complied with. [Source: Declaration
in accordance with the principles laid of Helsinki, revised edition, World
down in this Declaration should not Medical Association, Inc.]
be accepted for publication~ 6. Human Genome Project-A project ap-
(i) In any research on human beings, proved and collaborated by different coun-
each potential subject must be ad- tries and private establishments, to (i)

identify all (approximately 1,00,000) Types of consent-Consent may be :

genes in human DNA to know the se- 1. Implied consent-When the conduct of a
quence ofhuman DNA and store the in- person is clearly indicative that he is
formations in database. Additional aims agreeable to some act or he desires the
of the project was to develop further and act to be done, then it is implied that he
more efficient techniques for these ex- has given consent for the act, even
periments and study. Side by side genetic though he has not expressed his consent
make up of animals were also studied. It in words or in writing. When a patient
was started in 1990 which was scheduled comes to a doctor's chamberfo treatment
to be completed in 2005. But the sched- and narrates his complaints it is implied
uled study was completed in 2003. Now, that he has given consent to the doctor
further test of project which have been for his physical examination.
undertaken consists of practical applica-
2. Expressed consent-In many circum-
tion of knowledge acquired, with respon-
stances consent is not implied. In these
sibility, to know the characters of the
circumstances, the person concerned is
genes containing predisposing ·property
asked, if he gives his consent for the act
for certain diseases. But this does not
in question. If he expresses his consent
mean that this property of the genes will
for the act, then the consent is termed
precipitate the disease , which also de-
pends on extraneous precipitating factors. expressed consent. Expressed consent
may be (i) verbal (when expressed ver-
Side by side the inherited properties of
bally in words) or it may be (ii) written
genes may help to cure some diseases or
prevent some diseases . Their properties (when expressed in writing). Though ver-
.or influence encompasses both physical bal consent is sufficient for performing
and mental functioning, and the capacity some acts, in future in case of a litiga-
ofunderstandingdecision making. How- tion (court case) written consent may be
ever this progressive study on genes has required to prove in the court that con-
to be undertaken by maintaining confi- sent was taken for doing the act. See ex-
dentiality, human dignity and for the com- ception below.
mon good without raising any problem It may be remembered that if the doctor
of ethics, privacy and ethnicity issues. cannot prove that he took the consent of the
7. CLONING- (see page 634) victim of a criminal case, before examining
him or her, then it may amount to commis-
sion of assault by the doctor on the victim.
...• ''I"J7;.:,,
Treatment of a patient without his or her
".:~- • .: • - '~ ·,.. - ~ ~ • - • ~ ' • ~ ... ~ 1
consent may subsequently make the doctor
to face a charge of negligence or assault.
Definition-Consent is free and voluntary
agreement, approval ·or permission for com- Consent should be giVen directly and per·
pliance of some act. Consent is valid only if it sonally to the person who needs it. It should
is given after knowing the nature and conse- be given freely and voluntarily after under·
quence of the consent and those of the act standing I.e ., after being informed about the
for which consent is given. nature, quality and consequences of the act

for which it is given. In case of expressed con- ily, giving or refusing consent for any medi-
sent, it should be clearly expressed without cal procedure involving him/her, the decision
any twisting of the words and without any for which is made by him/her with sufficient
ambiguity. Consent is mvalid if It has been knowledge of the benefits, burdens or risks
gi en under tf ..tr of InJUry, with mibconcep- involved if any. This needs (1) adequate dis-
. o ) a fact or if the consent has been given closure of this informations to him/her,
by an ·n ane or mtoxicated person who is (2) his or her freedom of choice, (3) his or her
unable to understand the nature and conse- comprehension (understanding) of informa-
quence of the matter for which he gives his tion received and (4) his or her capacity to
consent (Sec. 90 !PC) make or take decision, so that the consent
becomes voluntary, after proper understand-
When consent has been given after knowing of circumstances and consequences, made
ing all the pros and cons of the act for which deliberately, carefully considering the ben-
consent has been given i.e., the nature and efits, burdens and risks of the act for which
quality of the act, the risk involved in it, he or she is consenting. Essentially the dis-
whether he has any other choice for the act closed information consist of (a ) findings/di-
in question, it is termed 1r. formed consent. agnosis, (b) treatment/report, (c) risk or ben-
Intormed consent after "full disclosure" efit oftreatmentor report and (d) so far treat-
of the nature and consequence of the act (e.g. ment is concerned if there is any alternative
about the treatment of a patient) is best for treatment.
all purposes. The disclosure may be made to
Circumstances where consent ofthe
the patient or the guardian of the patient.
But ifthere is chance that the full disclosure patient should be taken in course of
may make the patient unnecessarily fearful medical practice
and apprehensive and may cause harm to the 1. Consent is required in all cases of medi-
patient in that way, then a doctor enjoys cal examination and treatment. But or-
some degree of therapeuttc privilege to keep dinarily , when the patient comes to the
a limit of his disclosure to the patient. But it chamber of the doctor for a remedy. it is
remains a fact that consent obtained after full implied that he has given consent for
disclosure of the risk involved in a method of examination and treatment.
treatment gives maximum safety to the doc- 2. When the method of investigation and
tor, from a possible charge of negligence. If treatment extends beyond usual proce-
the patient refuse to be trea ted in the way dure and involve risk then written con-
recommended by the doctor, after being in- sent for these should be obtained, so that
formed about all aspects (including the risk the doctor will not be charged for crimi-
involved) of the treatment, then such in- nal negligence if the risky procedures
formed refusal should be recorded in writing cause some injury or harm to the pa-
which also may be helpful for the doctor if he tient.
is later charged for negligence for not doing
3. Written consent should be taken before
the needful for the cure of the patient.
examining a person for the purpose to
The principle of informed consent is based prepare a medical or medico-legal report.
on right and responsibility of every compe- Consent in these cases should be taken
tent person, to exercise freely and voluntar- after infonning the person that he/she

78 I PRINCIPLES OF FORENS.IC MEDICINE
reserves the right to refuse examination 11. When any operation or treatment of a
and that the report may go in his/her fa- husband or a wife involves the risk ofloss
vour or against him. of fertility or potency then it is advisable
4. While examining the victim of a crimi- that consent should be taken from both
nal case (victimofrape, assault, etc.) con- the spouses if withholding of the treat-
sent must be taken . Victim of a. .criminal ment will not involve the risk of life or
~ase cannot be examined with~rit\ is or otherwise well-being of the patient.
her consent. 12. A patient cannot be detained in a hospi-
.
5. Ordinarily, consent should also be sought tal against his will and without his con-
· for examination of an accused person . sent.
However, on the strength of a request of 13. Consent of the guardian should be taken
. a police officer not below the rank of sub- for an act to be done in good faith for the
. inspector or an order from an authorised benefit of a child under 12 years of age or
person (e.g., a magistrate) reasonable an insane person . (Sec. 89 IPC).
deg:r:ee of force can be applied to exam: 14. A person above the age of 18 years can
ine an accused person, if he/she refuses give a valid consent to suffer any hann
to give consent or submit for necessary which may result from an act not in-
examination. tended and not known to be likely to cause
6. Different countries, according to their death or grievous hurt. (Sec. 87 IPC).
need, have. made certain medical serv- 15. A persrm can give a valid consent to suf-
ices compulsory, e.g., immunisation fer any hann which may result from an
against certain diseases . To render these
act not intended to cause death but done
servi~es, no consent from any person is
in good faith for his benefit (Sec. 88 IPC).
necessary.
16. Where a person is unable to give con-
7. Except in circumstances of privileged
sent , the same is not required for an act
communication, the secret information
done in good (mth for ~e benefit of the
· about ~e patient should not be disclosed
person even if the act causes some harm
without consent.
to him.
8. In course of medical practice, wherever
17. Consent is necessary for the examination
necessary, consent should be taken as a
and treatment of and for preparing re-
precaution against a possible charge of
port about a person, intoxicated with al-
professional negligence, though in many
cohol or such an agent. If the person is
circumstances, particularly in the cases
not in a state of sound mind or conscious-
of criminal negligence, consent cannot be
ness to give a valid consent then the same
used as a defence.
may be taken from his relative who may
9. _Not only in criminal negligence cases, con- act temporarily as his guardian, so far
sent given for any criminal act is invalid. his examination and treatment is con-
10. For the purpose of treatment of either cerned: In such a state, if he is not ac-
the husband or the wife, consent of the companied by anybody to act as his guan:l-
person to be treated is ~~cessary and no ian, then, for his benefit , the examina-
consent from the other spouei~ 'is neces- tion and treatment part can be carried
sary , except as in no. l1 below. - on without any consent A medicolegal

report on him may be prepared without Maantenance of Medical Records

his consent, but it should be submitted
only with his consent when he regains
Maintenance of medical records of patients
consciousness. But, if he is involved in
in the hospital or by a private practitioner is
an offence, then the same may be fur-
a very important job of the profession. The
nished even without his consent, if
medical records of the patients should be
needed by the court or the police.
maintained serially with dates. The records
18. For the greater interest of the commu- should contain the followings:
nity, a person may be subjected to force-
1. Particulars of the patient, e.g., name, age,
ful treatment without his consent, when
sex, address, name, of the guardian.
there is dange~ tha , .from him the dis-
ease may infect many others. 2. Dates and hours of visit or consultation.
19. Consent for examination and treatment 0. Dates and houTS of admission and dis-
is necessary from the inmate of a hostel charge -in cases of hospitals ar.d nurs-
or a lodge for his treatment if he is above ing homes.
12 years of age. If such an inmate dnes 4. The complaints of the patient.
not give consent then he can be asked to 5. Past history of the patient and his rela-
leave the hostel or the lodge but cannot tives, having relevancy with the present
be compelled to'Undergo treatment. Ifthe illness.
inmate is below the age of 12 years, then
6. Personal habit of the patient ; his occu-
the superintendent of the hostel or the
pation.
lodge gives the consent in his place.
7. Findings on physical examination and
20. For transplantation purpose, an adult can
result of laboratory investigations.
give consent for removal of a spareable
organ or tissue from his body during his 8. Diagnosiswithi.C.D.-10.
life time. Consent from nobody else is 9. Treatment given.
necessary for removal of such an organ 10. Prognosis.
or tissue during his life time.
11. In case of death- the precise cause, date
21. For removal of organ or tissue from a and time of death.
dead body, consent of the legal heir of
12. If any other doctor is consulted then de-
the deceased is necessary even though,
tail of the same including the opinion of
during life time, the deceased donated the
the consultant.
same or consented for the removal of the
same organ or the tissue from his body 13. In a medicolegal case, the police has to
after his death. be informed.
22. Consent of the legal heir of the deceased 14. In case of hospital indoor patients- if
is not necessary for medico-legal post- discharged from the hospital, then the
mortem examination of the body of the cause of discharge, whether cured or
deceased. relieved of complaints or referred to
any other centre or discharged on re-
23. Consent from the legal heir of the de-
quest from the patient, should be re-
ceased is necessary for pathological post-
corded.
mortem examination to be conducted on
the body of the deceased. See also page 33.

80 I PR•NCIPLES OF FORENSIC MEDIC INE
Different laws and statutes having sation is related with the degree of dis-
relevancy with medical profession and ability, extent of injury or the nature of
practice of medicine the disease. To be compensated, the
ha:r 1 or tl e suffering should have !kP1,
L CrPC (Criminal Procedure Code)-This
causPd in course of delivery of duty . If
code describes the procedures and provi-
the conduct of the employee is responsi-
sions to deal with different crimes.
ble for the accident or the hazard, then
2. IPC (Indian Penal Code l-It defines and he may not be allowed any compensation.
prescribes punishment for different of- For example, if an employee sustains in·
fences jury while workmg with heavy machine
3 CPC (Civil Procedure Code)-This de- under the influence of alcohol. then he
scribes the procedure of civil court cases. may not get cr. mpensation for the acci-
4. COPRA or CPA (Consumer's Protection dent or the injury. Compensation is pa1d
Actl-This Act IS aimed to help the suf- on the basis 01, 1. Whether the disability
ferer patient. (See pa~ 83). is permanent or temporary and
5. Indian Evidence Act-This deals with dif- 2. Whether the degree of disabiiity. is total
ferent categories of evidence and the pro- or partial If the disability is partial, then
cedure for the collectiOn, preservation its percentage is assessed in terms of
and use of different evidences in a court extent ofloss of function of different parts
oflaw. or systems of the body. In case of death
6. Drugs and Cosmetics Act 1940 (page no. of a worker as a result of occupational
722 of Toxicology chapter). hazard, his family dependant, who is his
legal heir, is paid compensation.
7. Pharmacist Act of 1948 (enacted to regu-
late professional affairs of pharmacist). The role of a doctor is very important in
connection with assessment of degree of
8 Narcotic Drugs and Psychotropic Sub-
disability or hann suffered by a worker
stances Act of 1985 (promulgated to con-
from his place and type of occupation.
trol use of psychotropic drugs and sub-
stances) 1-.1 Employees' State Insuranei: Act of1948-
9. Mental Health Act 1987 (page no 610 of This Act is aimed at providing certain ben-
the chapter in Forensic Psychiatry). efits to some categories of workers at dif-
ferent private and corporate sectors.
10. Environmental Protection Act (enacted
Under this Act, workers of certain estab-
to make pollution-free environment).
lishments are compulsorily insured and
11. Prenatal Sex Determination Act, 1994 protected with difft:·rent healtb care pro-
(page no 660l. grammes . This Act provides for sickness,
12. Bio-Medical Waste (Management and maternity and disability benefit for the
Handling) Rules, 1998 employee and dependants of the em·
13. Workmen's Compensation Act of 1923- ployee, insured under this scheme . This
This Act provides for payment of compen- Act provides for appointment of doctors
sation by the employer to the employees who are eligible to treat and certifY about
for suffering any injury, disabilit;y or dis- the health condition of the workers and
ease resulting from accident or as occu- their dependants who are under cover of
pational hazard . The amount of compen- this scheme. The Act also provides for

the e t-:obh · hment ofhospitals, dispensa- this Act provides authority to doctors con-
n and maternity centres. Whenever cerned to notify births or deaths when
applicable in tenns of this Act, employ- they attend these events, and, in case of
ees and their dependants also get mon- death, certification ofthe same, ifhe has
etary assistance in connection with their attended the deceased during his termi-
sickness and treatment. nal illness.
15 F ac >riesAct 63of1948-ThisAct 19. Consumer's Protection Act-( COPRA or
provides for employment of qualified CPA) of 1986, ammended by Act 50 of
medical practitioners to supervise/inspect 1993-In the recent period, the Consum-
different factories to ascertain if a factory er's Protection Act of 1986 (COPRA or
is liable to create any health hazard and CPA) has created great stirr amongst the
to see if any young child labour is em- Medical professionals on the ground that
ployed in any hazardous job. it would be extensively damaging to the
This Act provides that, a child under the profession and the public service. Though
age of 14 years cannot be employed in a there are many counter-arguments
hazardous job in a factory. According to against this feeling of the doctors in pro-
this Act, a child, above the age of14 years fession, it can be said that the act must
but below 18 years, can be employed in a be enforced with full precaution.
hazardous job in a factory only if he is
The purpose of the Ad
found medically fit for the job. To issue
such a certificate, the medical officer must The purpose of the Act is to protect the in-
have know ledge about the nature of the terest of the consumers of different commodi-
job and personal know ledge about the ties and also service, for which they pay but
environment in the factory. Such a fit- do not get standard quality of material or
ness certificate is issued for a period of 1 service. The Act, in its jurisdiction includes
year at a time and may be renewed an- services of various facets oflife namely, qual-
nually or may be withdrawn, depending ity of the commodities of use, banking/ financ-
on the effect of the job on the health of ing services, electric supply, transport, food,
the young employee . This Act may be entertainment and amusement articles, etc.
ammended on the ground of child abuse
Any sufferer consumer or consumers or
and on the insistence ofNational Human
registered voluntary consumers' association
Right Commission.
or State/Central G<>vt. may lodge complaint
16. The Plantation Labour Act, 1951 -The against the erring trader/supplier or firm or
provisions of this Act in connection with person for service for substandard material
appointment of young workers and medi- or availed on payment made or to be made,
cal supervision of plantations are similar which caused some hann to the consumer.
to Indian Factories Act 63 of 1948. The complaint is to be lodged before a duly
17. The Mines Maternity Benefit Act, 1941 - constituted Redressal Forum for easy disposal
This Act provides for the maternity leave of the grievances, instead offollowing the or-
and other maternity benefits for the fe- dinary course oflaw which takes much time
male workers of the mines. and is much expensive to a poor consumer to
18. Bi. Deaths and Marriage Certification get justice. In case the defect in supply or
Ac -So far a medical man is concerned, service is established in a consumer dispute
' F M -61 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
disposal forum, then the same is to be made sumer Dispute Redressal Commission
good by rectifYing the defects or replacement which is a State level Forum to be chaired
of goods or refund of price and in some cases by a person who is or has been a High
by paying compensation for the damage Court Judge and two other members as
caused. The medical practice comes under the selected in case of District Redressal Fo-
purview of the Act on the ground of medical rum.
service rendered on receipt of fees or on the (c) Where the compensation clai,med is more
ground of "unfair trade practice". It does not than Rs. 1 crore, the complaint has to be
include service rendered free of charges or lodged before the National Body, i.e., Na-
under a contract of personal service. For non- tional Consumer Redressal Commission.
compliance of order of the forum a person This body is constituted with a person
may be imprisoned from 1 month to 3 years who is a sitting or a retired a Judge of
with or without fine. the Supreme Court , selected by the Un-
For frivolous or vexatious complaints, the ion Govt. to act as the President of the
complaining party is liable tci pay up to Forum, with four other members includ-
Rs.10,000 or more as compensation. to the ing a Lady Member.
defendant. All these 3 categories of fora or commis-
sion a'ct with the authority of civil courts.
Procedure for lodging complaint and Their orders are executed just as the orders
disposal of cases of civil courts or through a civil court having
jurisdiction over the residential area or place
The complaint can be lodged at any centre as of practice of the doctor.
mentioned below . There are three strata for
lodging complaints: After the introduction of COPRA or CPA
1986, a good number of complaints have been
(a) At District level , District Consumer Dis-
lodged against doctors at different levels,
pute Redressal Forum - to be chaired by claiming huge compensation against damage
a person who is or has been or qualified sufferred by patients in the hands of statedly
to be a Dist. Judge and two other mem- negligent doctors.
bers of ability , integrity and standing with
It is a contention in Medical profession
knowledge, experience and capacity to
in general that the Act in itself during for-
deal with the problems relating to eco-
mulation, did not mean to include the serv-
nomics, law, commerce, industry, etc., of
ice of a doctor rendered to his patient, as doc-
which one member should be a woman.
tor-patient relationship is something more
At District level, a claim for compensa-
than consumer-trader relationship. However,
tion towards damages was fixed to a maxi-
one ofthe Ld. Judges of Supreme Court ruled
mum of Rs. 1lakh at the starting which
in favour of inclusion of service of Medical
had been enhanced once toRs. 5 lakh and profession within the jurisdiction of the Act.
presently, the maximum compensation The Medical Practitioners in general appar-
allowed at the district level is Rs. 20 lakh . ently found reasons to be apprehensive for
(b) For cases, where compensation can be fear of its misuse and the obvious and una-
claimed for more than Rs. 20 lakh but voidable turmoil it may create in the whole
not more than Rs. 1 crore, the complaint profession. The reasons of apprehension are
has to be lodged before the State Con- that-

(a) this act will totally disturb the Doctor- severe negligent cases and claim of damages
patient relationship. which can be compensated by money. There
(b) it will impose an undesirable tendency is again another set of establishment to deal
in doctors, particularly in general practi- extensively the misconduct and unethical
tioners and in new graduates to be more practice of a registered medical practitioner.
evasive of their responsibilities towards Medical Council of India and different State
their patients and refer more number of Medical Councils are entrusted with the duty
cases to consultant specialists and to ad- to deal such cases properly. The arguments
vise extensive laboratory investigations of the pro-Act corners are that the time nec-
which will make their position compara- essary to come to a decision in a Court of
tively safe without the improvement of Law concerning payment of compensation to
clinical mind and experience thereby mak- suffered patients is too long and is expensive
ing the treatment for general population too. The common consumer of medical serv-
to be costlier, even up to the extent of ice should be given some reliefby way of pro-
being beyond the reach of many. viding them an alternative redressal forum
(c) Another apprehension is that the doctor for their grievances. The other argument of
will develop a tendency to assure him- this section is that the Medical Councils
self free from the danger of paying com- (State and Central) being bodies of the doc-
pensation by surrendering to the differ- tors themselves, may have some natural par-
ent professional indemnity society/insur- doning tendency for the faulty doctors. Apart
ance firms which are bound to crop up to from this, many of the State Medical Coun-
make a good business, taking advantage cils are virtually non-functor sloth in their
ofthis situation. action. Thus, generally speaking, justice re-
mains far from the reach of the patients who
(d) As a consequence to what will happen as
suffer for the negligent acts of the doctors.
described abov~~- that, the treating phy-
The argument of the medical professionals
sician will charge from the general pa-
in this respect is that, different Medical Coun-
tients more than what they presently
cils can be reactivated and can be made more
charge.
effective and acceptable by inclusion, if nec-
How the Doctors in general should deal
essary, of some legal personals as their mem-
the problem as the profession is kept bers and by allowing them to impose payment
within the purview of CPA (1986) of compensation by the erring doctors. They
argue further over this point that, the act of
-the argument ofMedical Professional Com- negligence and misconduct of a doctor can be
munity is that: better appreciated and assessed by members
The present law of the land is not defi- of medical profession alone. Inclusion of mem-
cient in dealing with the erring doctors. It is bers from other corners of the society in the
not their contention that an erring doctor Medical Council will ensure that nothing
should not be accountable for his negligent wrong will be done and no case can be just
act. Presently for a negligent act which may skipped off without application of mind and
come under the purview of CrPC and IPC without attention.
should continue to be dealt in the same way. As we have seen from the above discos-
The Civil courts are there to take up less sian, it may be appreciated that, doctors Hke.

all other members of the society should be Purpose of the Acli--Better protection of
accountable for their works, particularly be- human rights and for matters connected
cause they deal with life and death issues of therewith or incidental thereto, (in all as-
other members of the society. All the while, pects of life and functioning of the society
arguments placed by the doctors also can- and state).
not be just overlooked or glossed over. There TheN ational Human Rights Commission
is no indication that the Consumer Redressal
(NHRC) constitutes of-
Fora will have Medical men as their mem-
bers, particularly when a case of therapeu- (a) A chair person who has been a ChiefJus-
tic controversy will be taken up. If the Govt. tice of the Supreme Court.
and the Society think that the present legal (b) One member, who is or has been a Judge
procedure is not sufficient to deal with the of the Supreme Court.
negligent doctors, they should make provi- (c) One member who is or has been a Chief
sion of infalliable judgement from medical Justice of a High Court.
point of view, in whatever forum the negli-
(d) Two members to be appointed from
gent act of a doctor is tried, with p.rovision
amongst persons having knowledge of, or
of inclusion of members of medical profes-
sion in any such case and also to provide practical experience in matters relating
compensation to be paid by the complaining to human rights
party to the doctor if he is not found negli- (e) The chair person ofN ational Commission
gent. Thirdly, these cases should not be for Minorities, National Commission for
made public through media and press so as Scheduled castes and Scheduled tribes
to hamper the professional life of the doc- and National Commission for women are
tor, as the case may ultimately be proved to deemed to be members of NHRC in rel-
be a mistake of fact without any indication evant cases.
of any wrong having been committed by The Central Government may make
him. rules covering different aspects of function-
20. The Protection of Human Rights Act, ing of the NHRC. The NHRC may enquire
1993 (No. 10of1994- 8th January 1994) any case on the basis of a complaint or suo-
The medical profession being closely remota, if there is reason to suspect that hu-
lated with human welfare and rights, its func- man right has been violated in a case. For
tioning at times comes under the considera- the purpose of enquiry it can summon any
tion of the Human Rights Act. It is more im- person to give evidence and cause production
portant for those doctors who perform medi- of any document before it. It makes its rec-
colegal work. Hence a young doctor when ommendation for action to the concerned
graduates should have some idea about power Government after completion of enquiry It
and nature of functioning of the Commissions encourages functioning of different non-gov-
formed under this Act. ernmental organisation for protection of hu-
man rights.
The Protection of Human Rights Act,
1993 is deemed to have come into force on The State Government concerned may
28. 9.1993. Th8 Act provides for constitution make rules concerning procedure of functions
of a National Human Right Commission and of State Human Rights Commission and al-
State Human Right Commissions lied aspects of the Commission's functioning.

chapter 3: LEGAL AND ETH IC AL ASPE CTS O F PRA CTI C E OF MEDICI NE I 85
The functions of State Human Rights Com- being to work for establishment of human
missions are similar to N a tiona} Human rights everywhere. It is a democratic self-
Rights Commission. governing movement where decisions are
The National Commission shall not in- taken by an International Council formed with
quire into any matter which is pending be- representatives from all nations. It is funded
fore a State Commission or any other Com- by members of all national sections no fund
mission duly constituted under any law for is raised from any government for its works
of investigating and campaigning against
the time being in force.
human rights violations.
The National Commission or the State
21. Transplantation of Human Organs Act,
Conunission shall not inquire into any mat-
1994
ter after the expiry of one year from the date
on which the act constituting violation of A bill titled Transplantation of Human
human rights is alleged to have been com- Organs Bill, 1993 (Bill No. XIX of 1992) was
mitted. enacted by the Parliament as Transplanta-
tion of Human Organs Act, 1994 (Act 42 of
(For autopsy protoc0l as directed by N a-
1994) which has been adopted by many Leg-
tiona} Human Right Commission see chap-
islative Assemblies. It came into force in West
ter 43).
Bengal on 11.8.1995.
Amnesty International is an organ/move-
The purpose of the Act is to legalize and
ment of people for campaigning internation-
regulate transplantation of human organs
ally recognized Human Rights. Its idea is
including removal of organs both from living
based on the thinking that every person in
subjects as well as dying persons ("living ca-
the world enjoys human rights as embodied
davers") in whom brain-stem death has oc-
in the "International Declaration ofHuman
curred; and storage and transplantation of the
Rights" and other international human right same is to be done.
standards.
The donorofthe organ may be a relative
Amnesty International undertakes re- or a non-relative who can donate an organ to
search and action to prevent and end severe a needy person out of affection . Under the
abuses of rights to physical and mental in- Act it is provided that a person when alive
tegrity, freedom and conscience and expres- can donate his organ to be removed after his
sions, freedom from discrimination and to death for tansplantation, but after his death
promote all human rights. consent from the legal guardian (near rela-
The organisation is independent of any twe) will be needed. Such removal of the or-
government, political, economic and religious gan is allowed after brain- stem death of the
influences. It does not have any interest in donor has occurred (though respiration and
any Government or political system to sup- circulation of the subject are maintained
port or oppose and the same is true for the artifically). Guidelines are laid down for di-
victims whose right it seeks . Its only objec- agnosis ofbrain-stem death. The donor should
tive is impartial protection of human rights. be in a state ofbrain-stem death for donating
It has a network of members and supporters his organ. Acceptability of the foreign organ
and subscribers in over 150 countries and by the recepient should be tested in the rec-
territories having different social, political and ommended line . The laboratory where differ-
religious background, the only determination ent tests will be done and the hospital where

transplantation will be performed should have • Ethics m Medical Practice by M G. Garg in Medical
proper facilities and should be certified by the ethics- a review and an update, published by Indian
"Appropriate authority" appointed by the Cen- Medical Association- 1991
tral or State Government. The concerned Medical Coun~of India- Bulletin- July, 1992 .
•
doctors should have proper qualification and
experience. • Medical Ethics- Maurice Davidson -1957 .
(A last minute stay order blocked execu- • Medical Law and ethics in India - Homi Shapurji
Mehta- 1963.
tion of a condemned man in Alabama so that
he could donate kidney to his ailing brother. • Medical Negligence by Nathan Lord (1955).
This has raised ethical question amongst Butterworth.
some doctors. Dr. Harold Helderman, medi- • Medical Profession & Law- R D. Lele- 1992 .
cal director of the Vandebuilt Transplant cen-
tre in Nassville, Tennesse has questioned
• Official year-book of International Hospital Federation
-1984.
why somebody should be made· completely
healthy before being killed? The docton; have • Rights & Responsibilities of Doctors published by Brit-
also questioned ifNelson, the condemned con- ish Medical As~ciat10n - 1988.
vict, "is a voluntary donor".) • Society/community expectations- A Nandy- JIMA
-Vol. 89, No. 5 -1991.
Grafting (or transplantation) of animal
tissue in human being. It is still in a risky • The Ethics of Animal and Human Experimentation -
pre-experimental stage, though there are Peter P De Deyn - 1994.
reports that experiments are occasionally • The Protection of Human Rights Act, 1993- by West
undertaken in a clandestine way. It is highly Bengal Human Rights Commission- 1994.
risky. Chance of rejection can be taken as a
rule, even from genetically closer animals. • Canadian Medical Association (1996). Code of Ethics
of the Canadian Medical Association.
• World Medical Assoctation International Code of Medi-
. • . • I cal Ethics, as amended by the 35th World Medical
. '• ~ ~ .' .._ • 'I
Assembly, Venice, Italy, October 1983.
• Code of Indian Medical Association as adapted by • World Medical Association Declaration on the Rights
the working committee of the Indian Medical Asso- of the Patient, as amended by the 47th WMA Gen -
ciation at Srinagar- 1959. eral Assembly, Bali, Indonesia, September 1995.
• Code of Medical Ethics - Medical Council of India, • World Medical Association Declaration of Helsinki, as
approved by the Central Government u/s 33 (m) of amended by the 52nd WMA General Assembly, Ed-
the Indian Med1cal Council Act 1956 (Oct 1970). inburgh, Scotland, October 2000.
• Code of Medical Ethics and guideline on the code of • World Medtcal Association Statement on Human Or-
ethics as adapted by the West Bengal Medical Coun- gan &Tissue DonatiOn and Transplantation, adopted
cil. by the 52nd WMA General Assembly in Edinburgh,
• Consumers' Protection Act Published by R.P Kataria Scotland, October 2000.
- 1994. • World Medical Association Declaration with Guide-
• Ethics and research on Human subjects (International lines for Continuous Quality improvement in Health
Guideline) Edited by- Z. Bankowsky and R.J. Levine Care, as adopted by the 49th World Medical Assem-
-1993. bly, Hamburg, Germany, November 1997 •

chapter J: LEGAL AND ETHICAL ASPECTS OF PRACTICE OF MEDICINE I 87
(c) Administration of anaesthetic agent.

(d) Consultation.
Long questions 10. Fiduciary duties of a doctor.
1. What do you understand by Infamous conduct? Give 11. Ethical malpractice
some examples. 12. Medical maloccurrence.
2. What are the duties of a registered medical practi-
13 Therapeutic misadventure, iatrogenic diseases
tioner?
14. Corporate negligence.
3. What do you understand by professional secrecy. Give
some examples where the doctor should not divulge
15. Calculated risk.
the Informations about his patient 16. Doctrine of common knowledge.
4. What is privileged communication ? Give some ex- 17. Novus Actus lntervenins.
amples 18. Duties of a patient.
5. What is malpractice/negligence, in professional term? 19. Vicanous responsibility orRespondent superior
What are the types 7 What are the defsnces of a
20. Product liability
doctor, charged for negligence?
21. MedicallndemnitySociety.
6. What is consent 7 What are the types 7 In which
circumstances expressed consent 1s necessary in 22. Malingering.
medical practice? 23. Contributory negligence
Short notes and oral questions 24. Euthanasia/mercy killing -types. methods.
1. Structure and functions of Medical Council of India. 25. Human experimentation.
2. State Medical Councils. 26. Workmens' Compensation Act.
3. Disciplinary action committee 27. Employees' State Insurance Act.
4. Criminal negligence. 28. Indian Factory Act.
5. Res Ipsa Loquitur. 29. Implied/Expressed/Informed surrogate consents.

6. Hippocrijtic oath. 30. Differentiate between -
7. Rights and privileges of a registered med1cal practi- (a) Civ1l and Criminal negligence.
tioner. (b) Professional negligence and misconduct.
8. Professional death sentence. (c) M.CI. and State Medical Council.
9 ~ Duties of a doctor regarding 31. Consumers' Protection Act.
(a) Operation cases. 32. What is voluntary I non-voluntary I involuntary I ac-
(b) Poisoning cases, tive/ passive/ physician assisted EUTHANASIA?

NOTES
••

Identification of an offender or an unknown with scientifically approved procedure should
victim in a criminal case as also of a person give exactitude of an individual, unless wil-
in a civil case is necessary in different liti- ful and/or ethnicity ignorance vitiates the
gations (law suits or court case). Identifica- process of identification.
tion of a person, es. en tally 1 the JOb or po By and large the process of identification
lief peopl ' · But they alone can progress very of a subject in this chapter will be based on
little, for infalliable determination of iden- individual physical features and material evi-
tity to specify a person . Establishment of dence.
identity with conclusive evidence for the
prosecution in the court being the job of the Types-Identification may be (a) complete
police, he, without any expertized knowl- or total when scientific analysis of different
features or data ultimately pinpoints a sub-
edge, has to take assistance of experts of
ject as Mr XX, or it may be (b) incomplete or
different concerned branches for collecting
nartial when some features of the person
opinion/report for presenting material evi-
matches with some known features of the
dence in the court, for this purpose success-
person searched for. By these alone it may
fully. The medicolegal expert is just one of
not be possible to pinpoint anybody as to be
such experts . But at times, the evidence col-
the person searched for. But these data used
lected by a medical person for this purpose
alongwith other scientifically approved data
has much weight and value. All these are
available from other sources, may ultimately
apart from evidence of eyewitness, which
help to establish complete or total identifica-
may or may not be within the reach of the tion.
police or prosecution.
I'he different data for identification of per-
De{lmtiun-Though the tenn identifica- sor· are.
tion does not need to be defined, we may say
1. Race, ethnicity, religion and national-
that "identification means e tabli. l>m t of
ity,
mdividualit.} of~ pf'rsm1". No two persons in
this world is identical either physically or 2 Sex,
mentally. Thus proper database study can 3. Age,
establish the individuality of a person. This 4. Stature, general development and body
means, features of a person when studied built,
89
5. Complexion, CONSIDERATION OF INDIVIDUAL

6. Features of hair, fDENTIFtCATION FEATURES
7. Features of eyes, (also iris, retina, see
page 180) Race (and ethnicity )-Race as a subspecies of
Homo sapiens (humans) is no more approved
8. Congenital and acquired peculiarities like
by scientist, sociologically. Still we will dis-
malformations, birth marks, moles, scar
cuss it, as some morphological features are
marks, tattoo marks, occupational marks,
awarded to people of each "race" differentiat-
deformities, disease and wounds, etc., ing them from others. Conception of race re-
9. Features present in the teeth, fers to divide the origin of people into groups
10. Photography (very important but may depending on certain features having regard
be deceptive in some cases), to the idea of branching from a common an-
cestry and based on some conunon traits, like
11. Anthropometric measurements including
colour of skin, colour and texture of hair, iris,
height and weight,
facial and some other features and also self-
12. Fingerprint (single confirmatory crite- identification of a group of population as of
rion), sole print, nail print, lip print and his or her 'race'. Categorisation of his race
palate print, bears a sense of influence of genetic trait,
13. Study of DNA profile, geographical and socio-cultural factors . "In-
tra-racial" differences in cultures , customs
14. Teeth and bite mark,
habits and social behavioural traits does not
15. Some other biometric identification fea- get consideration in racial categorisation or
tures like-(a) hand geometry, (b) palm classification. Presently phenotype and geno-
vein authentication, (c) retinal scan, (d) type are being studied and considered in the
iriJ> scan, (e) signature, (f) voice analysis, context of race or racial subgroups or more
·(g) face recognition, correctly to assess the said categorisation of
16. Dress, ornaments and other belongings Homo sapien species (Homo = one, single,
including pocket or purse articles like sapiens =which replace all others. Presently
diary, passport and letter, used to mean wise one, intelligent species).
According to Darwin, human species in
17. Cosmetics,
course of progressive adoption has branched
18. Superimposition technique (in case of into different subspecies. Racial groupings and
dead subjects), reconstruction of facial subgroupings are result of social and envi-
structure and appe.,arance, ronmental adoption.
19. Handwriting and signature, voice, gait, A marginally different conception is avail-
habits, tricks, manners, educational sta- able from a definition which says that a race
tus, memory and intelligence (only in liv- is a population that shares a common bio-
ing), logical ancestry (one from whom a person or
20. Facial sketching on the description of a group of population has descended) essen-
eyewitness, tially similar, mutually compatible generic
traits which distinguish it from all other
21. Dog's scent ideptification, populations and are not diminished or lost
22. Secured card technology/gene card DNA by within-group reproduction. Hence, accord-
identification. ing to this definition, a branch of humanity

chaptet4: IDENTIFICATION OF INDIVIDUAL I 91
can be regarded as a race only when its dif- 3. Negroes-(The word means black)-They
ferent elements are sufficiently homogenous are the black people of African origin,
or genetically compatible-that they can Non-Jewish, Afro-semitic and semitic
freely intermix without negating or dimin- north.
ishing their unique genetic resemblance and
The term Race used to be applied to physi-
racial traits. Example of intermingled or in-
bred subgroups: cally distinctive categories of population on
the basis of colour of skin, shape of head and
(a) Cocasoid-Sweden, Italy, Armenia,
hair and some other physical features. The
Egypt, Iran primarily
racial divisions by former scientists into the
(b) Mongoloid-Korea, Malayasia, and the three main groups caucasians/cacasoids,
Amerendias of Peru. Mongolians/mongloloids and Negroes/
(c) Negroids-In Africa, other countries like negroids were rather hypothetical. Some ad-
America (mainlands) and nearby islands vocated 6 to 30 racial groups. Bluemen Back
(mostly from Africa and America) in 1775 classified human races in 5 ( fivel
Negroids are mainly i·dentified as groups on the basis of skin colour, ( 1) Cauca-
subsahara congoid or capoid (South Africa), sian (white), (2) Mongolian (yellow),
and are rather scattered. The capoid are pri- (3) Ethiopean (black), (4) American (red) and
marily identified as Khoi (Hottentoid) and San (5) Malayan (brown). But now it is scientifi-
(Bushman). Capoid are sufficiently distinct cally proved that there is no genetic racial
from congoid. division Race should rather be considered in
The above three groups (a), (b), (c) are the background of cultural, social, geographi-
the result of migration, intermingling free- cal, economical but not biological basis. There
breeding and influence of other cultural are genetic differences between populations
norms and psychology of the originally but without any historical or biological line-
thought 3 primary racial catagories of manage and the genetic variations are more indi-
kind were thought primary subspecies of the vidualistic in nature. Hence, presently, most
species homosapiens. scientists have rejected the concept of race
The "subspecies" emerging out of human as a dividing line, rathertheypreferthe term
species were thought to be the broad primary "ethnic group" or"ethnicity". Group isolation
racial groups. These were: of homo sapiens has never been prolonged
enough. One of the basis of racial grouping,
1. Caucasian (Indigenous ofEurope, North
pigmentation of skin, is clearly intense in hot
Africa, Western Asia and India). They
were native inhabitants of caucasus of the humid tropical region and not a feature of
caucasian language family. cold region. Since all humans can inbreed to
produce fertile offspring they belong to same
2. Mongolians-People who speak mogolian
species and hence creation of racial group is
language, they are thought to total 6
unscientific.
million out of which 3.5 million are in
China (inner Mongolia), Y2 million in Rus- Ethnicity-This is a term that overlaps
sia. In South Korea 20,000-30,000; in Ja- with concepts of race. nation, class and reli-
pan only a small groups of Mongolians gion to inherit a sense of cultural identity in
migrated with Kublai Khan between 1274 people Ethnic groups refer to people who
to 1281 share a common sense of identity often based

on traditionally shared culture , language , speaker of the language descended from a

religion and customs . It may or may not in- plathora of different races that ultimately
clude common territory, skin colour or com- adapted one or more languages. The imprin~
mon descent. The USA, for example, is a of each of these groups may be seen in at
multi-ethnic society. Many members there least some snack segments of the population.
would describe themselves as members of an In the long run these superficial difference
ethnic group, e.g., Jewish, Black, Irish as well in appearances have blurred to a great ex-
as Americans. In the USA they have an yard- tent. The founders of culture of the Indians
stick of grouping people on the basis of eth- come from these various people who contrib-
nicity for identification, (rather ethnicity cum uted to Indian civilisation as it is today. India
race, excluding genetic consideration). houses a population of 110 crore (1.1 billion)
approximately (2006), almost 1/5th ofworld
Ethnicity in America
population. As we have seen above they are
1. Hispanic-Cuban, Mexican, Puerto-
remarkably diverse . Estimation says that,
Rican.
diversities are more than two thousand.
2. Latino-South or Central American and Therefore invasion and migration from mid-
Spanish. dle east, and Central Asia and West and mi-
For racial perception America has fol- gration from Tibet, Northern China, Burma,
lowed a totally different root : etc. Believers in Hinduism is about 80%. Mus-
1. American Indian-North-Central-South lims more than 13 per cent Zoroastrians
America maintaining tribal affiliation or 0.01%, Christian 2.3%, Sikhs 1.94l1i:, Bud-
community. dhists 0. 76%, Jains 0.41 %, Jews and Bahais,
castes, subcastes and tribals.
2. Asian
Due to vast population and extreme de-
3. Black or African-American
gree of intermingling, clear-cut ethnical
4. Hawaian-Hawaii, Guam, Samon and grouping, which depends on multifactors, is
other specific islands. not possible to categorise identification fea-
5. White-Europe, Middle East, North M- tures in India as in many other countries. At
rica. this stage we need not ignore altogether , the
Ethnicity in India-National census of racial divisions and feature as that will lead
India does not recognise racial or ethnic us to no advantageous position for identifica-
groups , though recognises scheduled casts tion purpose .
and tribes. In India people are descended from
all categories who invaded/migrated and set-
tled here including Dravidians , Ind-Aryans , MORP110L~I AL FEATURES OF"tHE
Austro-Asiatics , Persians , Hepthalites , THRE~ PRUMIY RACES AND Tf-WIR.
Greeks , Tibeto-Burmans , Scynthians , Turks , ALLIEDS
Arabs , Parthuns , Parthians , Siddis , Mughals ,
Europeans , etc. Dravidians, Indo-Asians and Caucasians or Caucasoids : European Cauca-
Austro-Asiatics are related with linguistic sians have thin, fair skin, blue or grey iris;
terms and directly and in totality can be taken thin, straight or wavy, fair or light brown or
as ethnic. It simply means that the speaker reddish scalp hair; raised forehead; narrow
belongs to a particular linguistic family. The nasal aperture; -r:nostly roundish, meso-

chapter 4: IDENTIFICATION OF INDIVIDUAL I 93
cephalic (intermediate variety) skull with In average Europeans, the value is 74.5
cephalic index being between 75 to 80 (see and in average Negroes, it is 78.5.
below).
Length of Tibia
Mongolians or Mongoloids: They have yel- Crural In dex= x 100
Length of Femur
lowish or pale skin; black iris; black and
straight or wavy hair; inclined forehead; In Europeans, the average value is 83.3
higher, roundish orbit; large, flattened face; and in Negroes it is 86.2.
small upper and lower extremities and a _ LengthofHumerus x
100
square, short, brachy-cephalic or intermedi- Hun~ro-Ferrm-allndex- LengthofFemur
ate (meso-cephalic) head with cephalic index
In Europeans, the average value is 69 and
(See below) being between> 80 to 85 or> 75
in Negroes 72.4.
to 80, respectively.
Inter-Membra} Index=
Negroes or Negroids: They have black,
tough skin; black iris; black, curly or wooly LengthofHumerus+ Length of Radius x
100
scalp hair; small and compressed forehead; Length of Femur+ Length of Tibia
lower and wider orbit; broad and wider nasal The average of the statistical study is al-
aperture; prominent malar bones; oblique most same in both Europeans and Negroes
(outward) teeth; proportionately longer fore- which is about more than 70 and less than
arm than ann; proportionately longer leg than 70.5 respectively.
thigh; backwardly projected heel-bones; nar-
row, dolico-cephalic (oblong) skull with ce- M01phological Features oflru:lia1l3--An av-
erage Indian has dark-brown, brown or mod-
phalic index varying between 70 to 75.
erately fair skin complexion; black iris; black
Cephalic Index =
curly or straight hair and meso-cephalic skull.
Maximum Breadth of the Skull Physical growth of North Indian and North-
-------------------------------- x lOO
Maximum Anterio - posterior Length of the Skull west Indian people are alike Caucasians, that
of East Indian people have certain mongoloid
Basing on the cephalic indices of the skull
features and that of North-east Indian people
or head we have three categories of popula- are more close to Mongoloids.
tion: Dolico-cephalic or oblong headed per-
sons, Meso-cephalic or intermediate headed
persons and Brachy-cephalic or short, square-
headed persons. Pure Caucasians, Negroes
and some aborigins have dolichocephalic head;
most of the European caucasoids and Chinese In our country we have two dominant reli-
mongoloids have meso-cephalic head and pure gious distributions: HINDU and MUSLIM.
mongolians have brachy-cephalic head.
Hindu males are not circumcised. Some
Apart from cephalic index, some other in- categories of them have hair tuft. Some have
dices or bodily measurements also may be temporary religious marks, e.g., sandal wood
taken into account to determine the race of paste or vermilion marks on their forehead
a person These are- and other parts of the body. Some wear
. d Length of Radius wooden beaded necklace and some may have
Brae h 1a11n ex= x 100
Length of Humerus sacred thread on the trunk.

94 I PRINCIPLES OF FO RENSIC MEDICINE
Muslim males have their foreskin circum- phroditism, etc.) are of academic and clinical
cised; there are callosities over lateral malleo- interests mainly. With some increase in the
lus of their left leg and on their forehead due demand of bodily change to a specific gender/
to regular practice of'Namaz'. (See Fig. 4.119 sex of tansgender/transexuals and also for
on page 155). otherwise social need of such change on the
Hindu females have nasal ring prick on basis of social and personal feeling or require-
the left ala of nose, silver toe ring and ver- ments, it has also become medicolegally im-
milion mark on the forehead and hair depart- portant to detern1ine the exact sex/gender po-
ing line on the scalp, if married. sition of a person, when such questions arise.
An understanding of the matter, to some ex-
Muslim females have nasal ring prick on tent, is hence necessary. Such understand-
the nasal septum and multiple ear ring holes ing may be helpful in deciding some of the
on the margin of the helix. Muslim females
related social problems.
never use vermilion on th(;) scalp.
Sex of a person can be determined from :
(a) Physical/morphological features,
(b) Bones,
(c) Microscopic study of sex chromatins
From the dress, pocket articles (e.g_, pass- in Cf' 1 Js,
port) and tattoo marks, nationality of a per- (d) Drt.s ... (not always reliable),
son can be guessed. (e) Gonadal biopsy and
(f) Hormonal study (in intersex cases).
InHIGHLY DECOMPOSED dead bodies

where soft tissue morphology is lost or dis-
torted, prostate and uterus may still be iden-
In a dead body, this can be known from the tifiable and may help to know the sex of the
pocket articles like letter, diary, etc. and al~o subject. Scalp hair, dress and ornaments may
from the tattoo mark on the body, if any writ- also help in these cases. Lastly, the bones
ing is inscribed. In a living subject, in addi- can be cleaned and examined to find out the
tion to these, the language can also be known sex features in them.
by way of conversation.
In MUTILATED dead bodies, when only
some fragments of the body are available, sex
can be known from the presence and absence
of the facial or body hair, distribution of pu-
bic hair, breasts, sex organs, shape of shoul-
Question ofdetermination of sex arises in go- der and hip (one will be broader in males and
nadal dysgenesis cases in livings and in ex- females respectively), waist, shape ofbuttock,
tremely decomposed or mutilated dead bod- shape of fore arm, shape of thigh, toughness
ies or m case of bony remains of a body. Go- and delicacy of skin, predominance of mus-
nadal dysgenesis cases namely intersex/ culature (male) and subcutaneous fatty tis-
genderqueer (Turner's syndrome, Klinefel- sue (female). In mutilated also, bone/s may
ter's syndrome, True and Pseudo Herma- be helpful.

~
Table 4.1 Detennination of Sex from Physical/Morphological Features
(Prinary and Secondary Sex Features)
I
Features Mae Female
1. General built Muscular, slrong and stout Less muscular, delicate and slender
2. Scalp hair Short and coarse Long and fine
3. Eye-brow hair Coarse and thick Fine and thin
4. Head and face Larger Smaller
5. Body height More Less
6. Bodywe1ght More Less
7. Facial hair Present Absent
8. PomumAdami Prominent Not prominent
9. Voice Hoarse after puberty Soft
10. Larynx Lo~ Shorter
11. Shoulder Broader than hip Hip broader
12. Breasts Not developed, nipples and areolae small All well-developed after puberty
13. Pubic hair Thicker, coarser, extends upward with Thinner, finer, does not extend upward,
apex at umbilicus lriangular in distribution with
baseline at mons veneris
14. Hair on other parts of body Grow over ches~ linb and other parts No significant g-owth of har on other parts
15. Relation between dinensions Dinensions of thoracic seg-nent is more Dimensions of abdominal seg-nent is more
of thorax and abdomen
16. Waist Not well defined Well defined
17. Gluteal region Flat Full and roundish
18. Forearm Anterio-posteriorly flat Roundish
19. Thg1 Cylindrical Conical
20. Wrist and ankle Rough due to prominent bones, tendons Smooth, roundsh and delicate
and vessels
21 Gonads Scrohrn with testicles and penis Labias, vagina from outside and uterus,
externally and prostate, seminal fallopian tube and ovaries
vesicle and spennatic cord internally internally
22. Wearing apparels, ornaments Suggestive Suggestive

and cosmetics
I

MALE FEMALE
Short Scalp hair - - - - - - - - --11!'" k------ Long Scalp hair
Presence of beards
& moustaches -----------"~~ ;:j.______ Absence of beards
& moustaches
Prominent Pomum Adami --------:::;~
Narrow shoulder
Broad Shoulder - - - ' No chest or body hair
Presence of hair - - - - - -f-----f::::-"'--7
On chest & body r------Enlarged breasts
Muscular - - - - - Smooth roundish
Prominence body surface
Waist not Well defined waist
well defined Broad hip
Upward trend Horizontal line of
of public hair ~ Public hair mear mons
Hip not broad l~ Delicate wrist
Wrist not delicate -...___ Female external
Male gonads with genitalia-Vulva
Panis and scrotum
With testicles
Fig. 4.1 : External Morphological Features in Male and Female
DETERMINATION OF SEX FROM BONES SEX DIFFERENTIATING FEATURES IN

STERNUM, SCAPULA, TIBIA, VERTEBRAE,
When bones are sent for medicolegal exami- RIBS AND TEETH
nation, some of them become very helpful
for detennination of sex of the subject. If the In addition to the bones described already, the
whole skeleton is available then sex can be sternum, scapula, tibia, vertebrae, ribs and
detennined accurately in 100~ cases . When teeth also can tell about the sex of a person.
skull and pelvis are available accurate result STERNUM: The body of a male sternum
may be obtained in 98% of cases . With pelvis is longer and wider than that of a female. In
alone the rate of accuracy is 95~ , with skull case of males, the length of the body is more
alone 90%, and with long bones 80 to 85%. Of than twice the length of the manubrium and
all the bones of the body, pelvis (hip bones in anatomical position the upper margin of
and sacrum), skull , mandible , sternum with the manubrium is at the level of the lower
manubrium and femur help maximum to margin of the second thoracic vertebra. In
know the sex of the subject. females , the length of the body is less than
chapter 4: IDENTIFICATION OF INDIVIDU A L / 97
Fig. 4.2: Male and Female Skull (Frontal view)
Fig . 4.3: Male Skull (Front view)
Table 4.2: Sex differentiating Features in Skull i

Features Male Female
1. Size Larger, intra-cranial capacity 10% more Smaller, intra-cranial capacity 10% less
than females than males
2. Glabella Less prominent More prominent
3. Supra-orbital ridge More prominent Less prominent
4. Mastoid process More prominent Less prominent
5. Occipital protruberance More prominent Less prominent
6. Zygomatic arch More pronounced Less pronounced
7. Forehead Steep (rather flat) Roundish
8. Frontal eminence More pronounced Less pronounced
9. Orbit Lower, relatively smaller, roundish margin, Higher, relatively larger. sharp margin,
square shaped roundish in shape
10. Nasion Angulation distinct Angulation less prominent
11 . Malar prominence More and laterally curved Less and laterally compressed
12. Nasal aperture Higher and narrower Lower and broader
13. Parietal eminence Less More
14. Occipital condyles Large Small
15. Condylar facet Long and narrow Short and broad
16. Foramina Larger Smaller
17. Palate Larger, 'U' shaped Smaller, parabolic
18. Digastric groove Deep Shallow
19. Frontal sinuses More developed Less developed
20. Teeth Larger Smaller
21. Bony surface As a whole rough with prominent sites for As a whole smooth with less apparent
muscular attachments. sites for muscular attachments.
r~ ~~ - 71 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

Fig. 4 .4: Male Skull (Side view) Fig. 4.5: Female Skull (Side view)
Table4.3:
-1- --- -1
Fettures Male Feml'ie
1. Size Larger Smaller I

2. Anatomical angle Everted Inverted
3. Chin Square shaped Roundish
4. Shape of thebone 'V'shaped 'U' shaped
5. Mental tubercle Large ar,d prominent Insignificant I
6. Myelohyoid line Prominent and deep 1 Less prominent and shallow
7. Height at symphysis mentii More Less :
8. Ascending ramus Broader Narrower
9. Condylar facets Larger Smaller I
10. We~ht and surface Heavier, surface roughwith prominent Lighter with smooth surface !
sites for muscular attachments.
11. Teeth Larger I Smaller !
Fig . 4.6: Shape of Male and Female mandibles

(3rd from left is female , others male)
1 Table 4.4: Sex d1fferenilating FeatJres 1n H1o bone 1

Features M~ Fem~
1. General features Heavy, rough with prominent sites for Light with smooth surface
muscular attachments
2. Ilium High, vertical in anatomical position, Low, laterally divergen~ anterior surface
anterior surface deep shallow
3. Obh.:rator foramen Large and oval Small and triangular.
4. Greater sciatic notch Narrow and deep Broad and shallow
5. Pre-auricular sulcus Infrequent, when present it is narrow Frequently present, broad and deep
and shallow
2 2
6. Acetabulum Shape- more than 3 rd of a hollow Shape - less than 3 rd of a hollow
sphere. directed laterally sphere, directed antero-laterally
7. Ischio-pubic ramii S ghtly everted More everted
8. Snape ofpub1s Triangular Square
9. Pubic symphysis Higher Lowe1
10. Ischial tuberosity Inverted Everted
11 . Ischio-pubic index = 73to94 91to 115

Length of pubis x
100
Length of ischium
I
12 Auricular surface Larger Smaller
Figs. 4.7 & 4.8: Sex ditterentiating features in Hip bones: Fig. 4.9: Sex differentiating features in Hip bones·
Lt. Sice - Female Lt. Side- Triangular pubis in male,
Rt. S10e - Male (See differenes in Acetabular cavities, Rt. Side - Ouadragular in female
Obtu rator fo mmens. Ischi al tuberosities , Lt. Side - Everted ischial tuberosity
Ischiopubic ramii, Shape of pubis and general Rt. Side - Triangular acetabulum and broad obturator
appearance) foramen in female
I Table 4.5: Sex differentiating Features in Sacrum

Features Mlie Fernfie
1. General features Larger, heavier and rough Smaller, lighter and smooth
2. Breadth of the body of 1st More than breadth of one side ala Less than breadth of one side ala
sacral vertebra
3. Sacral promontory More projected ventrally Less prominent and less projected ventrally
4. Inner curvature Uniformly curved anteriorly Abruptly curved at the last two segments
5. Number of sacral vertebra May be 5 or 6 Always 5
6. Corpora-basal index = Morethan42 Less than 42
( Breadthofbodyof 1stsacralvertebra }
100
Transverse diameter of base of sacrum
7. Sacral index = I Lessthan114 More than 114

( Transversediameter of base of satrum }
100
Anterior length of sacrum
1
8. Sacro-iliac articulation Extends up to 3rd segment Extends up to 2 2 to 3rd segment
9. Deepest point of the inner Higher Lower

curvature at anatomical position
10. Sciatic notch index 4-5 5-6
( Widthof sciatic notch } 100
Depthof sciatic notch
Fig. 4.10: Two views of Male hip bone Fig . 4.11 : Two views of Female hip bone
chapter 4: IDE NTIFICATION OF INDIVIDUAL I 101
Fig . 4 .12: Sex differentiating features in Sacrum Fig . 4.13: Male Sacrum upper view (broad body of 1st
sacral vertebra) on left, fem ale on right
Table 4.6: Sex differentiating Features in ARTICULATED PELVIS in addition

to those present in Hip bone and Sacrum
.~
Features Mae Femlie
1 Pelvic brim Heart shaped Circular
2. True pelvis More spacious Less spacious
3. Subpubic angle Acute Right angle or obtuse
4. Distance between two anterior Less More

superior iliac spines
5. Distance between highest points Less More

of iliac crests of two sides
Table4.7: Sex differentiating Features 1n Femur
Features Mae Femlie
1. Head Articular surface is more than 2/3rd of Articular surface is less than 2/3rd of
a sphere a sphere
2. Neck and shaft Make an acute angle (upper) Make a right or obtuse angle (upper)
3. Inward inclination of the shaft Less More

at the lower end
4. Vertical diameter of the head About4-5cm About4.15cm
5. Trochanteric oblique length About45cm About39cm
6 Popliteal line About14cm About10cm
7. 81condylar width About7.5cm About? em
8. General features Heavier, rough with prominent sites for Light with smooth surface
muscular attachments
Fig. 4.14: Male Pelvis (v1ewed from above) Fig . 4.15 : Female Pelv1s (·Jiewed from above)
...
Fig. 4.16: Mal& PE>Ivis (viewed from front) Fig. 4.17: Female Pelvis (viewed from from)
Fig. 4.18: Morphological appearance of Male (above)

and Fem<Jie (below) Femurs_ _ __ _J Fig . 4.19: Appearance Female sternum
chapter 4: !DENTIFICNION OF INDIVIDUAL I 103
tw · ce the length of the manubrium and the m1cl2 a•t> se): chromosomes. In a normal male
upper margin of .he manubrnun is anatomi- the pattem of se.· chromosomes is XY and in
cally at the level of the lower margin of the a normal female the pattern is XX. The XX
third thoracic vertebra. Lengtl. ib more than pattern of sex chromosomes more frequently
14 em in male and less in female. present themselves under microscope as vis-
TIBIA: The length of the tibia in male is ible sex chromatin when cells from specific
more than 31 em and in female it is lesR than body sites are suitably stained and studied.
31 em. In neutrophils , we find them as DAVIDSON
SCAPULA. Dwmeterofthe glenoid cav- BODIES. having appearance of spherical com-
ity o the male scapula is more than 3.5 em pact masses extended from one lobe of the
and that of the female is less than 3 5 em. nucleus by a slender neck like sbudure, giv-
ing a drumstick appearance to the whole
VERTEBRAE . Atlas is wider m males
thing. Leishman or H. E. stain can be used.
than in females. Length of the vertebral col-
unm in males is more than 65 em. In females The compact sphere is about 1. 5 micron in
it is less. Breadth of atlas is more than 8 em diameter In females, they are found in more
in male and less in feamle than 3% of all neutrophils. In squamous cells
of mucus membrane of mouth or vaginal
RIBS : R1bs in moles nrP thicker. Their
mecus membrane, sex chromatins are de-
curvatures in males ~.re less and •.h~y arc less
oblique than in females monstrable :n the fonn of BARR BODIES
which i'!re deep basic stained, compact, plano-
TEETH : Male teetn are larger and convex masses situated inside the nucleus
thicker than female teeth.
near the nuclear wall . When scrap from the
'MEDULLARY IN"DICES of lung bones mucus membrane of the mouth or vaginal
al 'O vary With sex. But this study could not wall is subjected to H.E. or basic Fuelgen
be popular in practice. stain. Ban· bodies can be seen in more than
15t>;. of the:-;e squmnous cells in females. In
DETERMINATION OF SEX OF A PERSON males 'drumsticks' o1· 'Barr bodies' are either
BY MICROSCOPIC STUDY OF SEX not demonstrable m their typical shapes or
CHROMATINS are visible only in much too less nun1her of
cells No sex r.hromatin in gonadal agenesis.
Of the 46 ehromosomes present m each of
our body cells, 44 (22 pairs> are autosome.:; BIOPSY: In mtersex cases (see below),
having conLradictory sexual morphological
features. biopsy from the primary gonads,
namely the testicles or the ovaries, can say
for definite as to whether the person is
sexually an active male or female or nei-
ther.
In a CONCEALED SEX CASE the per-
a b son dresses himself or herself with the cos-
Fig. 4.20: Appearance of Sex chromatins in Neutrophil tumes of the opposite sex to conceal the iden-
and buccal epithelium
(a) Davidson body (drumstick appearance) in
tity. Simple undressing of the person in
Neutrophil doubtful cases will be sufficient to know the
(b) B<:~rr bodv ir buccal ep!thelium
sex.
104 I PRINCIPLES O F FORENSIC MEDICINE
INTERSEX/ GENDERQUEER/ GO- ignated gender or persons with deviation or

NADAL AGENESIS DYSGENESIS-In the contradiction of biological (morphological)
intra-uterine life the foetus has no sex differ- gender. Gender queer or Androgynae people
entiation till 7th wk ofiU age. Sex differen- do not usually agree that they have a confus-
tion starts between 7-9 wk IU and recognis- ing or contradictory or deviated biological or
able sex develops between 9-12 wk IU. morphological gender. They identifY them-
Our general conception perceives binary selves as 3rd or 4th or 5th gender. On the
gender (2 sexes) male and female. But it is a other hand, 17 or more intergenders or
fact that about 2.5 million (about 25lakhs) of genderqueer or intersexes have been identi-
living newborns every year come out of moth- fied.
er's womb with confusing sex. They are At birth these intersex infants may ex-
termed as 'Intersex' or 'Genderqueer'. They ternally have a micropenis (very small pe-
have a good number of generally accepted nis) with undescended, testis to look more
synonyms like , Androgynae, Intergender, like a female infant, or otherwise may have
Bigender, Multigender, Third·gender, Neu- a very big clitoris looking like a penis though
ter, Neutrois, Agender, Gender fluid (other none of them are binary gender. They may
than binary gender), Sexual or Gender inter- have testis in one side and ovary in the other
mediate. Apart from the synonyms, in differ- side, or ovo-testis (combined ovary and tes-
ent countries and in different regions of each tis, in parts in either or both sides). The uterus
country, locally they have been attributed may be incomplete being in the side in which
separate tenns, as in India we call them, an ovary or ovotestis is present with a
"Eunach" or "Hizra" and also in different fallopian tube also being present. A male phe-
parts of one country they are given different notype (who appears male externally) may
tem1S. The tem1 'Transgender is used with a have a female karyotype and a female phe-
different sense . Genderqueer or intersex per- notype (apparently female) may have a male
sons who adapted or tried to adapt either male karyotype, due to polarisation defect ofX and
or female gender/sex by surgical and or hor- Y chromosomes in spenns/ovary during mi-
monal therapy are generally termed as totic cell division.
Transgender. The Govt. of India has accepted The intersex persons have normal physi-
the third gender to be recorded in passport cal, and emotional lives, not strained by the
when the case may be so. society and may even not be identified in their
While intersex or genderqueer or any of actual position. They should not be subjected
their synonyn1S indicated biological or physi- to surgery until they are of their consenting
cal conditions or related to sex organs, i.e., age. Though it may be true that therapeutic
some deviations and contradictions of sex intervention is best, as early as possible. But
organs in one individual, there is another when "Gay" and "lesbians" are accepted and
group of terms namely 'pansexual', tolerated legally or with legal reasoning (may
'omnisexual' 'polysexual' or 'multisexual' not be in India), there is no reason why a
which in addition or apart from biological subject having normal, physical and emo-
deviation or contradiction, are indicative of tional trait should be 'mishandled' before
psychological, behavioural and environmen- their understanding capacity develops. Con-
tal sexual inclination of a person of the stated dition of congenital adrenal hyperplasia is
categories, towards whom the person feels different as this is a life threatening condi-
attracted (or are open for or to attraction) to tion. A man of forensic medicine if possesses
any binary gender, i.e ., either sex or no des- some knowledge; thinking, and understand-
,.,
Fig. 4.22: A case of Hermaphrodite 15 days after birth

(By Courtsey: Prof. Tapas Kumar Bose)
Fig. 4.21 : Surgical change of

sex from female to
male with excision of
breast and creation
of artificial phallus
with approval of girl
friend
Fig. 4.23 : The beauty pageant for transgenders, and kothis in Salt Lake .
Courtsey by ''The Telegraph" Kolkata
ing capacity may exercise the same when le- ticular induction ability in comparison to 46%
gal question emerges in some cases. We may of them with female phenotype.
keep it in mind that some surgeons prefer to However, ovotestis is the common go-
take therapeuti~ sex reconversion/interfer- nadal complex in true hermaphrodites , next
ence before the age of 18 months EU . But in possibility is ovary and last in frequency is
this may have serious implications in future .
testis. This is the sequence despite varied ap-
There is even history of commission of sui-
pearance of external gonads at birth. Pres-
cide in future -at a very late age in that
ence, absence, location, morphological and
sense, say at the age of 38 years. The mental
functional status in all the varieties may be
trauma as a result of such step being taken
variable to a great extent. In case of:XX male
in non-cognigible age may not be tolerable.
syndrome 46XX.karyotype does not necessar-
In my view their psychological vis-a-vis sexual
ily promote a female phenotype. Translocated
status have not yet been studied at length.
'Y' chromosomal sequence may be the respon-
Many of them identifY theii?-Selves as either
(a) male with female mind , (b) non-male sible factor. In any case, such externally (Phe-
(kathocy )though apparently male and (c)peo- notype ) males may have either or any of the
ple of totally different entity . signs like bifid scrotal fold, cryptorchidism
hypospadiasis , smaller penis and undescended
HERMAPiffiODITISM: This tennis quite testis .
akin to intersex and genderqueer or andro-
gyne . From forensic point of view apart from True hermaphroditism must not be mixed
identification we should as well be conversed up with mixed gonadal dysgenesis .In gonadal
with their effects on their morphological, psy- dysgenesis germinal epithelium is absent in
chological and genetic state. A13 to date, in our gonads malting them true infertile. In contrast
understanding hermaphrodites may be germinal epithelium being present they have
(a) True hermaphrodites the potentiality to be fertile. This is compara-
tively more common in female phenotype va-
(b) Pseudohermaphrodites .
riety than male phenotype variety because
This is rather a simple primary classifi- male phenotype seldom can produce adequate
cation. sperm both quantitatively and qualitatively in
Pseudo hermaphrodites may be their hypoplastic testes.
(a) Male pseudohermaphrodites In male true hermaphrodites malignant
(b) Female pseudohermaphrodites. conditions like teratoma, seminoma,
A really complex matter classified in a gonadoblastoma remain possibilities .
simpler way Treatment depends on proper diagnosis
True hermaphrodites : Generally they which is of course a difficult job. ABsignment
have one testis and one ovary in each side or and growth of phallus should be followed by
· 'one ovary or testis on one side and one ovo- hormonal and psychological therapy which is
testis on the other side, Ovotestis (tissue of not a simple job.
ovary and testis in parts), with ovary in one Male pseudohermaphroditism -It is also
side and ovotestis on the other. Their karyo- termed as testicular feminisation-a condi-
type is 46XX . With a testis in place of ovary tion with congenital genital malformation
their karyotype is 46XY . With 46XX chromo- ambiguous genitalia. Their karyotype is
some complement have male phenotype in 46XY .Maternalexposuretotoxicagentsntay
54% of cases. They may have a greater tes- be a cause. There may be endogenous andro-
ing capacity may exercise the same when le- ticular induction ability in comparison to 46%
gal question emerges in some cases. We may of them with female phenotype.
keep it in mind that some surgeons prefer to However , ovotestis is the conunon go-
take therapeutic sex reconversion/interfer- nadal complex in true hermaphrodites , next
ence before the age of 18 months EU . But
in possibility is ovary and last in frequency is
this may have serious implications in future .
testis. This is the sequence despite varied ap-
There is even history of commission of sui-
pearance of external gonads at birth. Pres-
cide in future -at a very late age in that
ence, absence , location, morphological and
sense, say at the age of 38 years. The mental
functional status in all the varieties may be
trauma as a result of such step being taken
variable to a great extent. In case of :XX male
in non-cognigible age may not be tolerable.
syndrome 46XX ka1yotype does not necessar-
In my view their psychological vis-a-vis sexual
ily promote a female phenotype. Translocated
status have not yet been studied at length.
Many of them identifY themselves as either Y chromosomal sequence may be the respon-
(a) male with female mirid , (b) non-male sible factor. In any case, such externally (Phe-
(kathocy )though apparently male and (c)peo- notype ) males may have either or any of the
ple of totally different entity . signs like bifid scrotal fold , cryptorchidism
hypospadiasis , smaller penis and undescended
HERMAPI:ffi.ODITISM: This term is quite testis .
akin to intersex and genderqueer or andro-
gyne . From forensic point of view apart from True hermaphroditism must not be mixed
identification we should as well be conversed up with mixed gonadal dysgenesis . In gonadal
with their effects on their morphological, psy- dysgenesis germinal epithelium is absent in
chological and genetic state. N; to date, in our gonads making them true infertile. In contrast
understanding hern1aphrodites may be germinal epithelium being present they have
(a) True hermaphrodites the potentiality to be fertile. This is compara-
tively more common in female phenotype va-
(b) Pseudohermaphrodites .
riety than male phenotype variety because
This is rather a simple primary classifi- male phenotype seldom can produce adequate
cation. sperm both quantitatively and qualitatively in
Pseudo hermaphrodites may be their hypoplastic testes.
(a) Male pseudohermaphrodites In male true hennaphrodites malignant
(b) Female pseudohermaphrodites. conditions like teratoma, seminoma,
gonadoblastoma remain possibilities .
A really complex matter classified in a
simpler way Treatment depends on proper diagnosis
True hermaphrodites : Generally they which is of course a difficult job. Assignment
have one testis and one ovary in each side or and growth of phallus should be followed by
· 'one ovary or testis on one side and one ovo- hormonal and psychological therapy which is
testis on the other side, Ovotestis (tissue of not a simple job.
ovary and testis in parts), with ovary in one Male pseudohennaphroditism -It is also
side and ovotestis on the other. Their karyo- termed as testicular feminisation-a condi-
type is 46XX . With a testis in place of ovary tion with congenital genital malformation
their karyotype is 46XY . With 46XX chromo- ambiguous genitalia. Their karyotype is
some complement have male phenotype in 46XY. Maternal exposure to toxic agents may
54% of cases. They may have a greater tes- be a cause . There may be endogenous andro-

chapter 4: IDENTIFICI'.TIO"J OF INDIVIDUAL I 107
gen production in the mother. Along with Hon11one l and oestradio-testesteroue ratio.
ambiguous genitalia thEre uhly be other con- Inhibin ~ is decreased.
genital anomalies like perineal orifice, go- In microphallus cases hormonal therapy
nads may not be present, pelvic ultrasound can increase the size of penis and avoid fu-
may show some anomalous state, Mullerian ture psychological problems
structure may be present, 17 hydroxy pro-
gesterone may be increased or nonnal an- Turner's Syndrome It occm-s about 1 in
drogen receptor capacity should be assessed. 3,000 live births. There is primary amenor-
Gonadal biopsy may be necessary. rhoea and infertility, cystic hygroma. lymphad-
enoma, lack of spontaneous pubertal develop-
Female Pseudohermaphroditism ment, short stature, infantile female genita-
Visible features-E.cterna! genitalia are lia and breast. In about. 50c:t casea there is
masculinized but internal genitalia 1'!re that webbed neck, ptosis and lower ey2lid creases
of female. 1infra orbital), broad chest With widely plaeed
This condition m.ay occur Llue to excess nipples, delayed growth of axillary and pubie
maternal androgen, viristng lutesma, con- hair, ~ubitus vulgus, short 4th-metaearpal,
genital adrenal hyperplasia, ingeation of an- high arched pabte, CJ'Owdeii teeth, low poste-
drogen or synthetic oestrogens during preg- rior hairli.J.1g, congenitall3m~phcdeala., hyper
nancy. deficiency of placental germ-line convex nails, aortic coarctation, bicuspid aor-
aromatase. Other causes are deficiem:i8s of tic valve, hype1tcnsion. strabismu:'l. recurrent
different related enzymes like, 3~ hydroxy- otitis madia and partial deafness, renaJ mal-
steroid d.ehydrogenase-l'ype-2, 21 hydroxy- formation, auto-inunune, thyTOiditis, scoliosis,
lase, 111:1 hydroxylase. .cong·enital hip dysplasit:: By ordinary puber-
tal age FSH is increased one missing X chro-
Klinefelter's syndrome: It is the most
mosome, karyotype 45X Pe1iodic concerned
common major abnormality of sexual differ-
investigation and regular conectional tht1rapy
entiation.
with regulm· check up is necesSHlJ'.
It occurs in 500-1000 male newborns, who
CONCEALED SEX: Already riiscu ssed
in matured age are infertile. with so01e de-
(page 103).
gree of me!1tal reLardation. The subjects are
tall , usually thinly built but may be obese and
ma~· suffer from varicoi'iity. Penis is small,
testes are small and finn with azosperm.ia or ESTIMATION OF AGE
oligospe1mia. 'rhere is gynaecomastia with (For estimation of age of foetuses
s:::arce facial hair. Sluggish motor function, see page 138-143)
speech and comprehensive capacity are af-
fected den1isted attention. social maladjust- The process of deterioration of different sys-
ment, diabetas mellitus, osteoporosis, chance tems and morphology of the body occurs with
of bone sarcoma, thyroid dysfunction and ageing of a aubject. The resultant changes
most strikingly late eunuchoid features help us to detennine the age of a person. The
Karyotype is 4 7XXY or 48XXXY or 49 XXYY, medicolegal importance of different r..ges have
which are of non-separation and non-polari- been detailed in page 145-147. Apart from
sation in one or both parents, condition is those mentioned in these pages ageing has
clearly an exan1ple of gonadal (testicular) dys- cognitive, economic, cultural and social ef-
gene.,;is. 'rhere is increased FSH (Follicular fects on a person. AGE IS NIEASURED IN
Stimulation Hormone; and LH (Luteim~ing Fl.JLL YEARS.

108 I PRINCIPLES. OF FORENSIC MEDICINE
'Senescence ' is the tenn used for the state Estimation of age from physical features of
of process of ageing. Senescence may be a person
'organismal ' which means ageing of organ- 1. Height and weight of the person- Start-
isms and may be 'cellular' where capacity or ing from the intra-uterine life up to a
cell division gets limited. All these may have certain age of extra-uterine life, the
direct or medicolegal importance. When the height or body length and to a lesser ex-
tenn 'Gerontology ' is used, ageing seems to . tent the weight of a person have certain
be linked with disease . Though we will not relationship with his or her age. For es-
agree with it in its face-value we have to agree timation of age, the height or length of
that ageing and morphological appearance or the body can be taken into account only
status of a human subject have direct rela- up to 21 - 22 years oflife . The weight, of
tionship with genetic nutritional, caloric in- course, is much less dependable except
take, geographical distribution and psycho- for the intra-uterine period of life . (Ref.
logical or mental condition. Memory, emo- HeighU weight chart in the Appendix).
tion, experience, intelligence, etc. m~y have 2. Growth ofhair over selective parts of the
influence of ageing. body-
Modern standard division of life-span is (a) In females pubic hair grows by about
described as follows : 13-14 years ; axillary hair by about
1. Fertilization - Zygote -7th day to 3 14-15 years. Nonnally, no growth
months of hair occurs at any other part of
the body. Greying of scalp hair starts
2. Foetus -3 months to 9 months
by about 40 years of age and grey-
3. Infancy-Birth to 1 or 2 years (param- ing of pubic hair by about 55 years.
eter of different countries), 1 yr in India Baldness is less conm1on in females.
4. Childhood 1 or 2-13 years. (b) In males ' pubic hair grows by 13 -
5. Adolescence 13-18 or 19 years. 15 years; axillary hair by 14 - 16
6. Early adulthood 19 or 20 to 40 years. years; beards and moustaches by 15
- 17 years and hairs on other parts
7. Middle adulthood 40-60 years.
of the body by 17- 20 years. Greying
8. Late adulthood or old age 60+ years. of scalp hair, beards and moustaches
In some countries age is counted on com- start by about 40 years of age. Bald-
pletion of a year. In some countries the age ness starts usually after 45 years of
is counted including the currently running age, though it has extreme degree of
age. In this book the 1st method has been variations . Greying of pubic hair
adopted (not withstanding anything). starts after 55 years of age usually.
Age of a person in the post-natal life can 3. Development of breasts in girls occurs
progressively between 12 years to 20
be estimated from :
years of age.
1. Physical or morphological features
4. Hoarseness of voice occurs in boys be-
2. Some laboratory tests (in infants) tween 15-17 years of age .
3. Teeth 5. Stature of a person starts decreasing af-
4. Ossification activities and growth of ter 25 years of age, at the rate of 1 mm
bones. per year .

chapter 4: IDENTIFICATION OF INDIVIDUAL I r09
6. Archus senilis (circular opacity at the lim- teeth are not replaced by any other. When
bus of the cornea) appears at about 40 they fall off, there is no further replacement.
years of age. They are 32 in total, usually. In some people
7. Menopause in women comes between 41 their total number may be limited to 28 - 31,
- 45 years u sually. due to non-eruption of some or all 3rd mo-
lars.
8. Cataract does not occur without precipi-
tating factors before 55 years of age.
9. Partial deafness may occur above 65
ESTIMATION OF AGE FROM TEETH
years of age.
10. Creases and wrinklings appear in the A Germination ofteeth-It occurs during in-
skin above 55 years of age. tra-uterine life. For deciduou s (tempo-
(For changes in the skin , colour and rary or milk ) teeth, gennination starts
changes in tlie umbilicus and umbilical in the maxilla and mandible by 4th/5th
cord after birth see page 676 & 679). month I. U. For pen nanent teeth, ger-
Some laboratory tests may help in get- min ation starts before birth. This can be
ting some idea about the age of an infant. tested by X-ray examination. But during
X-ray examination the positioning of the
1. Absence of nucleated RBC in the periph-
maxilla and 1nandible has to be done very
eral blood occurs by 24 hours after birth.
cautiously, otherwise the findings may be
2. Fall of reticulocyte count (to 2%) in the wrongly interpreted.
peripheral circulation occurs by 10 days
B. Eruption of teeth-As has alr eady been
after birth.
discu ssed , teeth erupt in two series.
3. Replacement of foetal haemoglobin by Their ages of eruption are as follows :
adult haemoglobin is complete usually by
6 months to 2 years of age, thou gh per-
Table 4.8:Ages of eruption of teeth
centage is much less by 3rd month and
in many cases may be altogether absent Teeth Ages of eruption
by 6th month after birth. Temporary Penn anent
LoVJer central incisors 5th/6th month 7th/8th year
ESTIMATION OF AGE FROM TEETH, AND Upper central incisors 6th/7th month
OTHER MEDICOLEGAL IMPORTANCES Upper lateral incisors 7th/8th month 8th/9th year
OF TEETH LoVJer lateral incisors 8th/9th month
Canines 1'!. year 11th/12th year
Every individual has two sets of teeth in his First premolars XX 9th/1Oth year
life time, one of which is fo r early ages of life Second premolars XX 1Oth/11th year
and these teeth are known as temporary or
First molars 1 year 6th/7th year
deciduous or milk teeth . Wh en all a r e
Second molars 20- 30th month 12th-14th years
erupted they are 20 in number. Temporary
(average- 2 yrs)
teeth are replaced by pennanent teeth . Some
Third molars XX 17th-25th years
pennanent teeth erupt as such without re-
or more
placing any temporary tooth. Per manent

110 I PRINCIPLES OF FORENSIC l'v1ED 1CINE
Table4.9: Differences betw~n lemrhary and Petmanent Tt>eth !

Fect.ures Temporary Permanent
1. Size and weight Smaller in all dimensions and lightei Larger in dimensions and heavier in
in weight weight
2. Colour China •Nhite r~rv wnite
3. Incisors Vertical ~ig~tly projected forward
4. Neck 1 More consbicted Less conslnc,ted
5. Ridge I Present in between neck & body No ridge present
6. Roots of mof~Js More divergent but small<.!!' Less divergent but larger
I -----------
7. Rep!acernent j Replaced by permanentteelh Nol. r~laced by any
8. Totalnumb-.er------+l-21~_...-:...:... _ _ _ _ _ _ _-f-3-2-(so_!_m_eti-.m-es~2:_8_-~3-1)_ _ _ __
te=eth===~-1-+--~-o-pr_en_l_o_lar_s_,8-m--ol-ars
===9=.==D=iffer==en=ce==in=ty=pe=s=o=f= _______+-8-premolars and 12 molars
Table4.10: Chronological appearance of Table4.11 : Chronolog1cai appearance of

temporafiJ set of teeth perrnai1entset of teeth
Lo\ver central incisors 6thM
First molar 6th y'f
Upper central incisors 7thM All between
Central inc1sors (both upper and lower) 7th yr
Upper lateral incisors 8th M 1/2 yr to
Lateral incisors (both upper and lower) Bthyr
Lower lateral incisors 9th M 3/4th yr
Firs! pren1olars 9thyr
Hence illcisors start erupting 112 yr Second pr61Tlolars 10th yr
Incisors complete erupting 3/4 yr Camne 11th yr
First molars 1 yr Second permanent molar 12th-141hyears
Canines 1Yz yr Thrrd pennanent molar 17t'1- 25th years
Second molars 2 years or later
To remember easily, students shouk If the students remember the chronol-

memorise the ch~·onology of eruption of the ogy, then the next point required to remenl-
temporary teeth and note the 112 yearly f<'''· ber in connection with eruption of perma-
mula. Incisors stCirt erupting at 1/2 yr of age-, nent teeth is that, starting from 1st molar
1st molars en1pt after 112 year of this, i.e., to 2nd molar, each set including those of
by about 1 yr of age, canine after about l/2 yr central incisors, lateral incisors, premolars
ofthis age, i.e., by about l%years of age and and canines in the pennanent group en1pt
second temporary wolars also erupt after almost at an interval of 1 year. It should be
about 1/2 yr of this age, i.e., by about 2 years further remembered that in a few persons
of age. Lower central, upper central, upper all or some of the third molars may not
lateral and lower lateral incisors erupt almost erupt at all, throughout the life. The third
at 1 month intervals respectively, starting at molars are also known as WISDOM
6th month. TEETH.

Period of :MIXED DENTITION - Start- Alternatively:

ing from the day of eruption of one penna- No. ofteeth Age
nent 1st molar till before the day of eruption 1 - 2 temp. teeth = 6th- 7th months
oflast pennanent canine, there will be both 3-4 = 7th - 8th months
temporary and permanent teeth in the jaws. 5-6 = 8th- 9th months
This period, when both pennanent and tem- 7-8 = 9th - lOth months
porary teeth are present in the jaws, is 9-11 " = lyr
known as the period of mixed dentition. 12 > 1 yr < l V2years
Maximum total number of temporary 13 -15 " = 11/2years
teeth is 20. With eruption of permanent teeth 16 > 11/2 years < 2 years
there is increase in the total number of 17 - 19 " = 2 years
twenty, in phases, only when permanent :, = 2 - 5 years
molars erupt This is so ~ecause all penna- 2C " and 1-4 perm. teeth =6th -7th years
nent molars erupt at new sites behind the 16 - 19 " " 5 -8 ;:: 7th - 8th
, ,
most rear temporary teeth, the second tem- 12 - 15 " 9-12 ;:: 8th- 9th
, , 13- 16 , ,
porary molars. All other permanent teeth, 8-11 =9th- lOth "
e.g., all incisors, canines and premolars, 4-7
, ,
17-20
, =lOth -11th
,
, , ,
erupt by replacing the temporary teeth. 0-3 " 21-24 =11th -12th
, , 25-27, =12th- 14th,
Hence, 0
, ,
0 28 = 12th - 25th ,
Total no. of teeth between 2 - 5 years is 20 (all
0
, , , =17th- 25th,
29- 31 "
temporary) , ,
0 32 = any age more
" at 6th yr is 21 to 24 than 17 years
due to eruption oflst
permanent molars.
" " 7th to 12th years re-
mains 24, though INTEINATIONAL SYSTEM OF
there is eruption of NUMBERING OF INDJVfDUAl TOOtH
more permanent tee-
th other than molars. To maintain a unifonn pattern for study of
12th to 14th years is dentition, each tooth has been awarded a
between 25 to 28, due number with two digits. The left side digit of
to eruption of 2nd each number indicates whether it is a per-
permanent molars.
manent or temporary tooth and the quadrant
14th to 17th years is of the gum to which it belongs . The rt. side
28 as there is no erup-
digit of the number indicates the tooth proper.
tion of any other tooth
during tlris period. Thus, all pennanent teeth of upper right
quadrant have ' 1' as the left side digit ofthe
17th to 25th years is
between 29 to 32, due
numbers; all pennanent teeth of upper left
to eruption of 3rd quadranthave ' Z as the left side digit; all per-
permanent molars. manent teeth of lower left quadrant have the
, , digit ' 3' in that place; all permanent teeth of
above 25 years should be
32 due to eruption of lower rt. quadrant have the digit ' 4' there;
all permanent teeth. all temporary teeth of upper rt. quadrant have

the number '5 ' there; those ofupper left quad- know ledge of the author that a baby was born
rant have the number '6'; those in the lower to a mother with one erupted lower central
lt. quadrant have the digit "7 ' there and all incisor, without any obvious disease or pa-
temporary teeth in the lower rt. quadrant thology in the baby. ·
have the digit '8 ' at that place. FALLING OF TEETH-All temporary
The digits on the rt. side of the number teeth fall off with eruption of permanent teeth
vary according to the type of tooth irrespec- in the respective places. Falling of permanent
tive of the quadrant. For a permanent tooth teeth starts ordinarily after 50 years of age.
this digit may be 1, 2 , 3 , 4 , 5 , 6 , 7 or 8 , de- But due to caries and bad maintenance of
pending on whether it is CI, (central incisor), teeth and gum, teeth may fall off earlier.
LI (lateral incisor), C (canine), PM1 (first Conversely, when oral hygiene is well main-
premolar), PM.z, M 1 (first molar) Mz, or M3 , tained, teeth may not fall even after 60 years
respectively. For a temporary tooth the rt. of age.
side digit for each quadrant may be 1 , 2 , 3 , 4 C. Estimation of Age from Teeth in Elderly
or 5 depending on whether it is CI, LI, C, M 1 Subjects : In elderly subjects, age can be
or Mz, respectively. Thus the whole set can ascertained by application of Gustafson's
be represented as in Table 4.12. formula (based on the ageing and decay-
It must be remembered that diseases ing changes of teeth). Most of the crite-
and nutritional deficiency states may delay ria or changes (except attrition and peri-
eruption of teeth. Similarly, there may be odontosis) used in this fonnula are use-
ful only while examining a dead subject
premature eruption of teeth. The present
or skeleton because, for examination of
author had the occasion to examine erup-
those changes, teeth have to be extracted
tion of teeth pattern in about 2,000 girls and
from their sockets.
boys. During that study it was observed that
there is a wide degree of variation in the After 18 - 20 years of age the following
eruption of teeth. In some children, it was changes progressively occur in teeth :
observed that some or even all permanent 1. A'ITRITION-This change occurs on
second molars were erupted though one or the opposing mastication surfaces of the teeth
two premolars and permanent canines did of upper and lower gums due to continuous
not erupt yet replacing the temporary mo- friction. Four degrees are attributed to this
lars and temporary canines. It is also to the change:
Table 4.12: International system of numbering teeth
Right Left
Permanent l18 J 17 116 15 14 13 12 11 21 22 23 24 25 26J21J2ai Permanent
Temporary 55 54 53 52 51 61 62 63 64 65 Temporary
Temporary 85 84 ro !2 81 71 72 73 74 75 Temporary
Permanent l48147j46 45 44 43 42 41 31 32 33 34 J) 3)J3ll3)1 Permanent
Right Left

chapfer 4: IDENTIFICATION OF INDIVIDUAL I 113
Ao or '0' degree - No attrition. 8 0 or '0' degree - When there has been no

deposition of secondary
AI or 1st degree - When attrition is limited
dentine tissue in the pulp
within the thickness of
cavity.
the enamel.
8 1 or 1st degree - When secondary dentine
~or 2nd degree - When attrition is limited
tissue starts to deposit at
within the dentine tissue. the upper part (in case of
AJ or 3rd degree - When attrition has ex- lower jaw and reverse in
posed the soft pulp of the case of upper jaw) of the
tooth. cavity.
8 2 or 2nd degree - When about half of the
2. PERIODONTOSIS-When mainte-
pulp cavity from 'above' is
nance of teeth and gum is bad, there may be occupied by secondary
loosening of teeth and 'continuous eruption' dentine tissue .
with exposure of length of the root where
8 3 or 3rd degree - When almost whole of the
there may be often deposition of hardened cavity is filled up by the
(stony hard) debris which Gccurs gradually dentine tissue.
over a long period.
4. ROOT RESORPTION is another de-
According to the length of exposure ofthe caying change. It is classified into 4 grada-
root, periodontosis has also been awarded four tions :
degrees. The rating of periodontosis is done R0 or '0' degree - No resorption at any
as follows: place of the root.
P 0 or'O'degree -No periodontosis or no R 1 or 1st degree - Resorption is noticed only
exposure of root. in some spots.
PI or 1st degree - Exposure of less than ~ or 2nd degree - Resorption is conspicuous
1/3rd of the part of the over a larger area.
root next to crown. R3 or 3rd degree - Resorption of more ext en-
P 2 or 2nd degree - Extension of periodonto- sive area, involving both
sis or exposure is more cementum and dentine
than 113rd but less than tissue.
2/3rd of the root from near 5. CEMENTUM APPOSITION is another
the crown. ageing change counted for estimation of age.
P 3 or3rddegree -Periodontosis extends This occurs on the surface of the root. There
beyond2/3rdofthe length are 4 grades:
of the root from near the C0 or '0' degree - Only a normal layer of
crown. cementum is noticed.
3. SECONDARY DENTINE-With ad- C 1 or 1st degree -When cementum apposi-
vance in age, there is deposition of second- tion is slightly greater
ary dentine tissue in the pulp cavity. The thftn normal.
process progresses till replacement of almost c2 or 2nd degree - When a thick layer of ce-
whole of the pulp. It starts from above in case mentum apposition has
of mandibular teeth and from below in case occurred
of maxillary. This change has also been given c3 or 3rd degree - When a heavy layer of ce-
4 ratings: mentum is present.
n::: ~,., o1

6. TRANSPARENCY OF ROOT-This
B
occurs in the root, from below upwards in
lower jaw and from above do·w nwards in up-
per jaw teeth due to rarefication of the den-
tine tissu e. 4 grades are used to record the
degree of transparency:
R0 or '0' degree - No transparency noticed 0 Ill
Points
anywhere.
R1 or 1st degree - When transparency is Fig . 4.24: Show how age is determined from points
just noticeable, mostly calculated out from decaying changes of
teeth using Gustafson 's formula
over the apical region.
R2 or 2nd degree - When up to 1/3rd from the
For the purpose of estimation of age, a
apical region becomes
transparent. standard regression line has to be made out
. by the examiner basing on the relationship
· R3 or 3rd degree - When tranpparency ex-
of ages of some known persons and the point
tends up to 2/3rd length
values of their teeth obtained from the
of the root, from the apex.
POINT FORMULA for the decaying teeth
Of all the above criteria, transparency of (Fig. 4.21).
root alone is the single most important one
(see below). Ratin g of cementum apposition Dots are used basing on the relations be-
is most difficult to assess. tween point values and corresponding known
ages. Basing on the dots, a regression line
THE POINT FORMULA: \Vhile using the A- B is drawn. In unknown cases, age of a
decaying changes for estimation of age, the person 'n' can be estimated from the point
aggregate of points alloted on the basis of value 'm', when the perpendicular line from
degrees of different changes are taken into the point 'm' on the axis is extended upwards
account. which intersects the regression line A-Bat
'z' from where another perpendicular line is
Formula-
drawn on the age-line (ordinate) to get the
A,+ Pn + Sn + R,, + Cn + Tn =points~ age in years. estimated age (x), which has a possible error
Example- of± 3.63 years (y) .
A0 + P 0 + S0 + Ru + C0 + T0 = 0 points~ estimated age The probability of increase in the range
= x ± y years, of deviation from the real age is marked when
AI+ p2 + s1 + Rl + c2 + T I = 8 points~esiimated age number of cases examined is increased. Thus,
= x1 ± y years, when 3 cases are examined, in 2 cases the
A2 + P 2 + S 1 + R1 + C 2 + T 1 = 9 points~ Estimated age estimated age will be in close approxinmtion
= x 2 ± y years.
to the real age but in 1 case the error may
where~. P 0 , ......... ;AI> P 2 , ......... ; ~. Pu extend up to ± 3.63 years. This means, in 1
........ . are the degrees of different decaying out of 3 cases or .in 33% cases the deviation
changes of three teeth. x, xl' Xz are the ages, from the real age may extend up to
e.s timated depending on the total points of ± 3.63 years. When 22 cases are examined,
the decaying changes of the three teeth. y is in 1 case the deviation may extend up to
th e error which is about± 3.63 years. ' ± 7.3 years which means in 1 out of22 cases

or in 4.5% cases deviation of the estimated the person can be read out from the re-
age from the real age may extend up to± 7.3 gression line or a chart.
years. Similarly, in 1 out of 100 examined E. Boyde's Formula : Boyde (1963).found out
cases or in 1% of cases, the deviation from a method of studying the cross striations
the real age may extend up to 9.1 years and which develop in the enamel of teeth till
in 3 out of 1,000 cases or 0.3% cases the de- the enamel goes on depositing on the
viation may extend up to 10.9 years. Two im- teeth. It is thus useful to estimate the
portant points have to be remembered in con- age of a dead infant when death occurs
nect ion with the use of these changes for es- before the end of complete formatio'n of
timation of age: (1) For estimation of age, the enamel on the teeth. However, as the
tooth has either to be extracted or it should cross striation lines represent daily in-
have fallen off naturally. So it is suitably used cremental lines of the enamel, by this
in death cases, but its value in living sub- method age ofthe infant can be estimated
jects is only very limited. (2) If oral hygiene in terms of days. But the process of count-
was not maintained at all, then this method ing the number of cross striations is very
overestimates the age ofthe subject. tedious.
D. Estimation ofage from root transparency F. Stack's Metlwd : Stack evolved a method
or translucency alone : Miles (1963) re- to know the age of infants and children
marked that, of the changes used by from the weight and height of the erupt-
Gustafson in his point formula, root ing teeth of a child. This method can be
transparency or translucency alone is the used on both deciduous and permanent
most dependable criterion to know the teeth during their erupting phase.
age of a person. The two opposite sides
of an extracted or naturally fallen off tooth
IDENTIFICATION BY MATCHING OF
is ground unifonnly to thin it up to less
TEETH ,
than 1 mm thickness. Then its translu-
cency is assessed and the age is estimated
By different comparative studies, it can be
with the help of a regressionlinl3 prepared
said whether two teeth available from two
by studying the translucency of teeth of
different sources belonged to the same indi-
known ages.
vidual or not. This can be done in the follow -
The translucency of a tooth can be as- ingways-
sessed by placing a ground tooth on a
1. From the surl:a~e stains, due to betel
paper with numerous uniformly placed
chewing or tobacco chewing or smoking:
dots on it. The outline of the ground tooth
is drawn on the dotted paper. Without 2. By comparing the decaying changes in
the teeth (Gustafson, 1947).
disturbing the tooth the number of dots
visible through it are counted . Then the 3. By comparative study of the "Ebner lines"
ground tooth is removed and the number in the longitudinal ground sections of the
of dots present within the outline of the two teeth (Gustafson, 1947).
tooth is COU11ted. From the percentage of 4. By studying the distribution of the striae
dots visible through the ground tooth and of"Retzius" in the two teeth.
actual number of dots present inside the 5. By studying the DNA profile from the
outline of the tooth, the estimated age of tooth pulp.

RECORDING OF DENTAL DATA OF A RACE FROM TEETH

PERSON FOR MEDICO-lEGAL
PURPOSES In civilized societies , among molars, first per-
manent is the largest and the third is the
Apart from the eruption pattern of teeth, smallest. In primitive races it is just the re-
while recording the dental data of a person verse. The first is the smallest and the third
for medico-legal purposes, many other fea- is the largest. In mongolians and mongoloids
tures of the dentition should be recorded. the first premolars of the lower jaw may in
These include: some cases have three cusps. The lower mo-
1. No. of teeth present lars (both permanent and temporary) have
2. No. ·of healthy teeth three roots in them.
3. Teeth, missing though erupted
4. Teeth, for which only roots are present,
rest are missing SEX FROM TEETH
5. Tooth, recently extracted
Male teeth are larger and heavier than fe -
6. Tooth, needing extraction
male teeth. Examination for presence of Barr
7. Condition of the crown
bodies in the cells of the pulp tissue may help
8. Presence of cavity detennination of sex from the teeth.
9. Filling of cavity
10. Tortion of a tooth
11. Inclination of a tooth DETERMINATION OF 'J\80" BLOOD
12. Movement of tooth with direction GROUP FACTOR OF A PERSON FROM
THE TEETH
13. Supernumerary tooth
14. Additional tooth
By using absorption-elution technique or
15. Temporary tooth present by the side of mixed agglutination technique , the blood
the permanent one, without being re- group of a person can be detennined from
placed the soft pulp tissue of the teeth.
16. Decaying changes like attrition, periodon-
tosis, etc.
17. Artificial denture. EXAMINATION OF THE BITE MARKS
The National Health Service Act of 1954
of Great Britain approved certain signs for Bite marks may be from a human being or
many of these changes which can be used for an animal. Criminals often leave bite marks
. medico-legal purposes also. on the body of the victim of his assault or on
Detail particulars of artificial denture some foodstuff when they eat a part of the
have to be noted, e.g., 1. whether it is a full foodstuff and leave the partly eaten remains
set of the upper or lower or both jaws, a sin- at the place of commission of the crime. The
gle tooth or a few teeth; 2. make of the arti- foodstuff may be a fruit or a tough cake of
ficial teeth and other particulars inscribed in butter or cheese. To resist attack, the victim
them, if any; 3. type ofbase; 4. material used also may leave bite marks on the body ofthe
with colour and 5. mould. assailant.

chapter 4: IDENTIFICATION O F INDIVIDUAL I 117
Comparison of the bite marks on the body able to take the impression of the bite marks
of the victim and impression of teeth of an from a dead body by tracing as is done in case
accused: For this purpose a life-size trans- of living subjects, instead of preserving the
parent impression· of the teeth of the victim bitten part of the skin by incision because,
is made. A plaster cast of the wax impression drying and preservation may shrink and al-
of the teeth of the accused is first prepared. ter the features of the teeth bite mark.
This is then varnished and the tip areas Teeth bite marks which are not visible
stained with printer's ink which will not eas- by naked eye examination may become vis-
ily dry up. Then a wet soft paper is pressed ible when examined under ultra-violet light
over the stained area of the cast. The print- in a dark room, because in a wound, the
er's ink impression of the tip of teeth, thus melanin pigment of the skin shifts to the pe-
obtained on the paper, is transferred on a riphery or margin of the wound which makes
transparent celluloid sheet by pressing the the margins of the teeth bite marks promi-
paper over the cel~uloid sheet. A life-size nent when U. V. light is focussed on the site
transparency of the tips of the teeth is thus of the bite.
made out. This transparent impression of the
teeth is then directly superimposed on the However, matching of bite mark on the
teeth bite mark or superimposed on a trans- body of a victim and with a cast of teeth of a
parent impression of the bite mark prepared suspected person, superimposed on each
by tracing the impression of the bite mark other must not be the sole evidence or prime
over a transparent sheet. evidence for conviction. Many judgements
even in advanced developed countries con-
Transparent impression of the bite marks victing the suspect on the ground of such
over foodstuff can be made out by taking plas- matching had to be reversed on appeal.
ter cast of the eaten part of the foodstuff and
then transfering the impression on transpar- In some other cases if DNA from the pulp
ent celluloid sheet in the process as was of teeth can be made available, then an al-
adapted for preparing transparent impression most conclusive opinion can be given either
of the teeth. The two transparent sheets can in the positive or in the negative side by com-
then be compared comfortably. Here the two paring the profile with those if (available) ac-
plaster casts can also be compared by naked cidentally from other source like suspected
eye, on the characteristic points like gap be- blood drop or similar material (say semen)
tween teeth, angulation and inclination of from the site or body of the victim.
teeth, depth of each teeth and other impres-
sions and features of teeth imprinted on the
cast.
SUMMARY OF DIFFERENT MEDICO~
lEGAL IMPORTANCES OF TEETH
For naked eye study and for preparation
of the transparent tracing of the teeth, bite I. Regarding Identification of the subject-
mark on the skin should be examined as
1. Race can be detennined from the
quickly as possible and in the same position
teeth.
of the involved body part as was the position
at the time of being bitten, so as to avoid dis- 2. Sex of the person can be ascertained.
tortion of the bite impression which is very 3. Age of the person can be estimated
likely to occur if the position of the body part by various methods already dis-
is changed when tracing is done. It is advis- cussed.

118 I PRINCiPLES OF FORENSIC MEDICINE
Fig. 4.25 : Artificial denture and filling of cavities with specific substance and materials-metallic or otherwise are
very good identification marks in mass disaster cases
Fig. 4.26: Dental peculiarities with gapping , tortion
Fig. 4.25 to 4.29:

By Courtsey Prof. Tapas l<umar Bose
Fig . 4.29 : Dental peculiarities with gapping ,

Fig . 4.28: Dental peculiarities with staining tortion

4. Identification is possible from the IV. An offender can be detected from the bite
occupational marks present in the mark, he might have left on some mate-
teeth of some persons (see occupa- rial like, some food substance or on the
tional marks). body of the victim. The bite mark can be
o. Blood group of the person can be compared with the impression taken from
known from the pulp tissue. the teeth of the accused. The saliva left
6. Individual features like gap between at the site of bite may also further help
two teeth, total number of teeth, detection of the offender by telling his
missing of teeth, missing of part of blood group, if he is a secretor (see Chap-
a tooth, condition of the crown, pres- ter 5).
ence of cavity, filling of cavity, V. Teeth bite marks on the breasts or near
tortion of teeth, inclination of a the private parts of a woman are support-
tooth, additional and supenmmer- ive of sex offence having been commit-
ary tooth, decaying changes in the ted on her. Also see page 693.
teeth, fracture or crack in a tooth, VI. Artificial denture may be the cause of ac-
artificial denture and ornamentation cidental death due to choking.
and metallic decoration of teeth.
7. DNA profile of a person can be stud-
ied for comparative study for match- DETERMlNATiON OF AGE OF A PERSON
ing and identification. FROM OSSIFICATION ACTIVITY AND
8. Habit of a person, like betel chew- OlliER CHANGES OF BONES
ing or tobacco habit.
9. Depressions and elevations on the Some of the bones are cartilaginous and some
teeth are said to be individualistic. are membranous in origin. Ossification or cal-
10. Teeth resist decomposition. So in cification gives final shape and texture to
extremely decomposed dead bodies them. But tmly, changes in all bones con-
and where body is mostly burnt, tinue even after complete ossification and,
teeth may be well preserved and rather, until death. These ossification and
help identification. other changes in the bones are taken into
11. In mass disaster like aviation acci- consideration to estimate the age of a person
dent. when the body parts of the vic- because these occur maintaining a reason-
tims are fragmented and destroyed, able sequence and chronology.
teeth and artificial denture may help It is wellknown that, starting from the
identification. Artificial denture may intra-uterine life up to 2(}-21 years of age,
bear the particulars of the manufac- there is gradual increase in the linear dimen-
turer inscribed, with whom the iden- sion of the long bones of the body. On this
tity of the victim may be available. basis, taking femur as the suitable long bone
TI. Grievous hurt - Crack or fracture of a to study, a relationship between the length
tooth or its dislocation amounts to griev- of its shaft (i.e ., excluding the epiphyseal
ous hurt. ends) and the age of the subject has been
Til. In case of death due to poisoning with worked out. Thus, from the length of the shaft
heavy metal like arsenic, the same can of the femur, the age of the person can be
be detected from the teeth after a long calculated up to a certain period of life, so
time of death. ' long the bone continues to grow in length.

120 / PRINCIPLES OF FORENS IC MEDICINE
Fig. 4.30-4.35: Showing decaying changes due to ageing in teeth
Fig . 4.31 : Second degree attrition with secondary

dentine tissue and translucency
Fig . 4 .32: Second degree attrition , root resorption , Fig . 4 .33: First degree attrition and root
cementum apposition partial translucency translucency
Fig. 4.34: Second degree cem entum aposition Fig . 4.35: Second degree attrition , no much secondary
dentition in pulp

chapter 4: IDEI'Jl r r ': N ~ JAL /21
Fig. 4.36: Second degree cementum aposrtion 1 Fig. 4.37: S&•X·r•r.l degreE- :::ttrrtron no much se cndary r
io_n in pulp
' - - -- -d_e_r_rt_it_ _ _ ~
...,. .. - ~~ r. .,.
- \
.• .. ····
~ ..
Fig. 4.38: Secondary dentine deposition Fig . 4 .39: Root resorptr-.:r s ,, d se• and degree
;Jttritron
J
I
.. }
Fig. 4.40: Root resorption Fig. 4.41 : Root res err
Parvej
Fig . 4.42: Dentine de positron in
pelp
Fig. 4.43: Root resorption
Dr. Md. Ahsan Uddin (Nayan)

Fig. 4 .44: As u
J
CoMC-24
But if the femur is not available for examina- Bones being structures which form skel-
tion and if some other long bone is available, eton are made ofhard durable minerals. As
e.g., tibia, fibula, humerus, radius or ulna, such they resist decomposition for a long
then, by use of different proportionate multi- time . Forensic study ofbones gives informa-
plication factors available for these , the tion like sex, age , injury sustained by a per-
length of the unavailable femur can first be son and some pathological information in-
calculated. Then , from the calculated length cluding those arising from chronic poisoning,
of the femur, the age of the subject can be particularly with heavy metals . Serological
found out with the help of a regression line tests of bones does not help much from fo-
prepared by plotting on a graph paper with, rensic point of view. But in occasions some
(a ) axis for age in months and ordinate for serological tests ofbone becomes necessary.
length in case ofiU:tra-uterine life and (b ) axis But it provides excellent evidence in DNA
for age in years and ordinate for height of typing which have tremendous medicolegal
the subject during post-natal life. This proc- importance .
ess may be used for estimation of intra-uter-
ine age and extra-uterine age up to.18 years
oflife. ESTIMATION OF AGE FROM OSSIFICA-
However, for estimation of age of a per- noN ACTIVITIES OF DIFFERENT BONES-
son from bones, in the practical field, activi- STUDY Of OSSfFI TION CENTRES
ties of different ossification centres in the
pre-natal and post-natal period oflife, up to With increase in the number of social litiga-
the age of 20 - 22 years are given more tion cases both in criminal as well as in civil
weightage . In elderly subjects, skull vault side, a forensic specialist is presently heavily
suture closure , union activity of the sternal burdened with cases of estimation of age of
complex, changes in the shape of mandible, people sent to him, which he has to do de-
changes at the pubic symphysis and around pending mainly on study of activities of dif-
glenoid cavity of scapula and general ferent ossification centres. The members of
the legal institution and the contesting par-
changes in the bones due to ageing are taken
ties, all want that the doctor.declares a spe-
into account.
cific age for the person he has examined,
There are hundreds of ossification cen- which the doctor is helplessly unable to do.
tres in the bones of the body. The appear- He gives a range of the estimated age. In the
ance, and fusion of some centres in the bones court, the Ld. defence counsellor, taking
with others of the same bones form the basis guidelines from different text books , may try
of estimation of age from the activities of dif- to strongly argue with the doctor over the
ferent ossification centres. When bones are age range, and if the doctor is inexperienced,
available for examination, naked eye exami- the attempt of using science for the delivery
nation of the centres is sufficient. But in liv- of justice may be seriously threatened. An
ing subjects and in dead bodies in some cases, honest forensic specialist may feel frustrated
radiological examination of the different os- when he finds that, on his honest submis-
sification centres are performed. But it should sion in the court of law, an accused may be
be kept in mind that, there may be some dif- declared juvenile, though he realizes that the
ferences in the findings of naked eye and ra- accused mayor may not be ajuvenile or, even
diological examinations. though he believes that the person is not a

chapter 4: IDENTIFICATION O F INDIVIDUAL I 123
juvenile, he has been or is going to be de- distribution and sex The process of ossifica-
clared so because the defence has sought for tion may also be influenced by food habi~
the benefit from the reasonable wide range nutritional status, infectious diseases, hor-
of the estimated age of a person. In this re- monal and metabolic disorders and physical
gard the author most strongly expresses activity. Generally speaking, ossification ac-
th at , everybody should feel that, the evi- ' tivities occur earlier in Indian population than
dence regarding estimation of age by ossifi- in Western population. The activities are
cation test should not be given more value generally earlier in females than in males.
than corroborative evidence. It would be A chart showing the ages of appearance
best, if the medical evidence of age is used and fusion of different ossification centres,
to see, whether the age shown by the most has been prepared by the author on the basis
dependable of the other evidences of age of of over one thousand and five hundred cases
the person, falls within the range of age studied by him over a period of thirteen years
given by the docto.r or not. and on the basis of already available Galstaun
Countable differences are noticed in the and other formulae. The subjects of the study
appearance and fusion activities of ossifica- were mostly Bengalee males and females and
tion centres depending on race, geographic some males of Bihar.
Table 4.13:Ages of appearance and fusion of ossification centres of different bones
Bones Centres A~ of appearance Age of fusion
J Mates Females Males Females
1 .. 2 3 4 5 6
'
Frontal Primary 2m I.U. (partly) 2m I.U. (partly) 2-8 years in both sexes
Tempera! 4m I.U. 4 m (I.U.) with styloid: 4th yr in both sexes
Parietal 7 wk I.U. 7 wk I.U. (also see union of sutures)
Occipital 4 m I.U. (partly) 4 m I.U. (partly) 5th yr with condyles ]
Sphenoid Greater wing 8 wk I.U. ] 8 wk I.U. Body +greater wing- in both
Lesser wing 9 wk !.U. 9 wk I.U. 6th m (E.U.) sexes
Body 11th wk I.U. 11th wk I.U. (with the body}
Palatine 8th wk I.U. 8th wk I.U.
Eltlmoid (Orbital plate region) 5 m I.U. 4m I.U. ] in both
Maxilla 6 wk I.U. 6 wk I.U. Both unite sexes
Premaxilla 7 wk i.U. 7 wk I.U . . by 8th wk I.U.
Mandible 2m I.U. 2m I.U. 6 month E.U.
Scapula Body 8 wk (I.U.) 8 wk (l.U.) ·
1
Acromion process 14 · 15 years 12 : 14 years ' ' 14-19years 13 -16 years
1
Glenoid cavity ': Around puberty in both sexes •:.:· ·· 17th • 20th yrs in both sexes
·r r
Clavicle Shaft ' 4 - 5 years ~ -.·s wk (I.U.)
J I ) IJ • $
. t •:l'
Acromion process
- r.l \Ti~~~ ... • •:;. ·1 ', ~ • • • } :. ~t
Medial end 15-17 years 14-16 years 22 yearS 2o'years
• _.j • .. , I '

2 3 4 5 6
Stermm Manubrium 5 m (I.U.) 5m (I.U.) above 50 years (with
Body - 1st segnent 5 m (I.U.) 5m Q.U.)l the body)
2ndsegnent 7 m (I.U.) 7m (I.U.) 14-25 years from in both
3rdsegnent 7 m (I.U.) 7 m (I.U.) below upward sexes
4thsegnent 10m (I.U.) 10m (I.U.)
Xiphoid process 3 years 3 years above 40 years (with
Humerus Shaft around 8 wk I.U. around 8 wk I.U. the body)
Upper end-
Head 1 yr 1 yr 16-17 years 15-16 years
(fusion with shaft)
Gr. Tubercle 4 years 4 years 4 - 5 years fusion with inboth
Head of humers sexes
Lr.Tubercle 5years 5 years 5 - 7 years fusion with
Lower end- Gr. tubercle l
* Capitulum 1styr 1st yr
Med. Epicondyle 6-7 years 5-6 years
Trochlea 10-11 years 9-10 years 14-15 years 13 - 15 years
* Lat. Epicondyle 11 -13 years 10-12 years • (by conjoined epiphyses)
Radius Shaft around 8 wk I.U. around 8 wk I.U.
Upper end or Head 5-7 years 5-6 years 15-16 years 13-14 years
Lower end 1 yr 1 yr 16-17 years 17-18 years
Ulna Upper end or Olecranon 11 -12 years 9 -11 years 15 - 16 years 13-15 years
Lower end 5-7 years 5-6 years 18 years 17 years
Carpals Capitate 1styr 1styr
Hamate 1st yr 1st yr
Triquetra! 3rd yr 3rd yr
Lunate 4 years 4 years
TrapeziliTl 4-5 years 4 - 5 years
Trapezoid 4-5 years 4 -5 years
Scaphoid 6yrs 6 years
Pisifonn 9 - 12 years 9-12 years
Metacarpals Body of all metacarpals B -10 wk I.U.
(almost same 1st 2nd yr 2nd yr 15-17 years 15-17 years
for both 2nd 2ndyr 2nd yr
sexes) 3rd 2ndyr 2nd yr
4th 2ndyr 2ndyr
5lh 2nd yr 2ndyr
Phalanges Tht.ntl
Base of proximal 2-3 years 2- 3years 17-18 years 15-17 years
Base of distal 2-3 years 2-3 years 16-18 years 15 - 17 years
Body of each Bth, 9th wk I.U. Appr.
in both sexes

l
2 3 4 5 6
Other fingers
2 • 3 years 2 • 3 years 17-18 years 15-17 years
B'"' of prox"""l
Base of middle 2 · 3 years
Base of distal 2 · 3years 2 • 3 years 17-18 years 15-17 years
Body of each 9th/10th wk appr. in both sexes
Hyoid From before birth to 1 • 2 years
after birth in both sexes
Vertebae Body 3rd m I.U. both sexes
Other centres 4th m I.U. both sexes
Ribs 2m (I.U.) 2m (I.U.)
,.
'~"""'""']
Sacrum
2nd segment 3m (I.U.) 3m (IU.) ] 14 years to 25 years from below
3rd segnent upwards
J
4th segnent
5thsegnent
5 • 6 m (I.U.) 5 · 6 m (I.U.)
Hipbone Tri-1c1diate Cartilage 10-13 years 12-13 years 14 - 15 years 14 years

Crest of Ilium 16 years 14 years 19 · 20 years 17-19 years
Ischial Tuberosity 15-17 years 14-15 years 20 years 20 years
Pubis 8 • 9 years 8 • 9 years
Femur Shalt 8 wk I.U. 8 wk I.U. 16-17 years 14-15 years
Upper end
Head 1 yr 1 yr 16-17 years 14- 15 years
Gr. trochanter 4 years 4 years 17 years 14 years
LI. trochanter 14 years 14 years 15-17 years 14 -15years
Lower end before birth (9th, 1Oth month) 16 - 17 years 15 - 16 years
Ti:Jia Upper end around birth or just after birth 16-17 years 15-16 years
Lower end 1 yr 1 yr 16 years 14.11o 14.4yeas
Fibula Upper end 2 · 5 years 2 · 5 years 14-16 years 14-16 years
Lower end 1 yr 1 yr 14-16 years 13-15years
Patella 2 • 3 years 2 · 3 years
Calcaneum 5 • 6 m I.U. in both sexes
Talus 6 · 8 m I.U. in both sexes
Navicular 2nd yr in both sexes
Cuboid at birth
Cunefonn Laterl1 · 3m E.U. in both sexes
lntamediate 1 yr 1 yr
Medial 1'/. yr 1'/. yr
Metatarsals
2nd
1&
3rd
J Shaft
Base
9 - 10 wk
2ndyr
9-10 wk
2ndyr J 18 • 20 years
4th Head 3 • 4 years 3 • 4 years in both sexes
5lh
Pr. Phalanges
Body
Base
] 1 · 2 years in both sexes Around 18 years in both sexes
Head
Distal
phalanges Body 4th yr in both sexes

Ant Fontanelle 1}S, yrs- 2 yrs, b.s.
Met.sul. 2-a yrs. b.s - - - - - _ _ , _ r - - - - - - - FSO yrs +(bs)

r - - - - A.Head 1yrs AT-4yrs
2 MIVb.s. - - - - - - - - . . . . . . _
L -5yrs
3MlU.b.S. - - - - - - - - . . . . . . _
m.A. 14-16yrs ------~~
F 20 yo5J A 15 -16 yn. F-20 yn A Cap 1 yr, M.ed
A4-5WIU bs -------~ Ep 6-7yn;m
A 8 W!U bS - - - - - - - - - , . S..6 yrs flr tn 11yrs m
9 -tOyrsl.
Lat. E p-~1 -1~
yrs m
10·12}-rsf.
F-MI-14-15 yrsm.
13 15yrsf
·12 yrsm9-11 yrsf
F-15-16 )'I'Sm
-:::========-
-.....
13yrs-15yrsf
A.8 VIIU
AS MlU.b.s.
_ . . . - - - - - - - A 5-7yrs m, 5-{i yrs (
.b.s
F 18yrwm, 17yrsf
- - - - - - - - - - Al""'s
Fig. 4.45: Whole skeleton [A= appearance , M =mouth, F =fusion, m =male , f =female ,
bs =both sexes , IU =intra uterine , EU = Extra uterine , W =week]
----A.16 yrs m, App-

14 yrs f, 5M.I. U.
b.s.
-+.- - - 5 M.I.U.
A.3 MIU bs b.s.
14-25 yrs .from 7 M.I.U.
Below upward -E'-----'!--<.. b.s.
Tri-rad . Cart
in both sexes --+- - 7 M.I.U .
A.10-13 yrs m. '' -- A.5 MIU bs b.s.
10 M.I.U.
b.s.
",',t 1 I
3 yrs
& yrs (F). ,·.~ ~ b.s.
Fig. 4.47: Body, manubrium and xiphoid
Fig . 4 .46: Hip bone J process of sternum

'o: 'I .
App - 5 - 6 yrs (f)

App 9- 11 yrs (f)
5 - 7 yrs (m)
11- 12 yrs (m)
App-
Union Union
16 - 17 [1 yr
yrs
~:::.---
13- 14 yrs (f)
Union
13- 15 yrs (f)
-m 4 yrs 14- 15 yrs (m)
15- 16 yrs 15- 16 yrs (m)
-f 5 yrs
8WIU (a)
8WIU(a)
Union
13-15 yrs (f)
Union
14-15 yrs (m)
Cap.- 1 yr. 16- 17 yrs (f) 17 yrs (f)
17 - 18 yrs (m) 18 yrs (m)
Med epi. - 5 - 6 yrs (f)
6- 7 yrs (m)
Tro. 9 - 10 yrs (f)
10- 11 yrs (m) 1 yr (a) bs App - 5 - 6 yrs (f)
6-7 yrs (m)
Lat. epi 10- 12 yrs (f)
11 -13 yrs (m)
Fig . 4.48: Humerus Fig . 4.49 : Radius Fig . 4.50: Ulna
1 yr. (a)- bs. App-At Birth (b.s)

Union - 14-15 yrs. (f) Union - 15-16yrs. (f)
15-17 yrs. (m) 16-17 yrs. (M) (a)
2- 5 yrs. (b.s.)
4 yrs (a) bs
14-16 yrs. (f)

11 - 16 yrs. (m)
Union
14 yrs (a)- bs. 14 yrs. (f)
Union -14-15 yrs. (f) 17 yrs . (m)
15-17 yrs. (m)
8WIU 8WIU
Union
13-15 yrs. (f)
14-16 yrs. (m)
1 yr. (a) b.s.

App-9th/10th m IU Union
14yrs(f)
16 yrs. (m)
) "'"t;·
,' Fig . 4.51 : Femur Fig. 4.52: Tibia Fig. 4.53 : Fibula

126 / 0
Union
20 yrs. (f)
App-4-5 WIU-bs
22 yrs. \m)
e
.,...
App-
14-16yrs. (f)
15- 17 yrs. (m )
App 12 -14yrs.(f)
14- 15 yrs . {m )
Un1on -13- 16 yrs. (f)
14- 14 yrs. {m)
'
App -puberty (bs)
Un•on - 17- 20 yrs. (bs }
App- 8 WIU lbs)
Fig . 4.54: Cl.-Jvlcle ;:md Sc.1pul.J
Fig. 4.55 : A girl of 11 years 6 months

<1ge . X-ray view of ossifica-
tion activities of elbow jt.
Lower end humerus -
cen tres for capitulum,
media l epicondyle and
torch lea - appeared but
not fused. Lat. epicondyle
- not appeared yet. Upper
end (head) of radius and
upper end of ulna
(olecranon)- both appea-
red but none fused.
Fig . 4.56: A g1rl of 7 yrs <1ge. Al l cen tres :1round elbow jt. appeared
except for lat. ep1condyle of ,,umerus and odecranon .
L.__ _ _
But no11e has fused
_

Fig . 4.57 : A girl of age 12.5 yrs. All centres :1 round Fig. 4.58: X-ray of wnst: centre for lower end of
elbow it. except bt. ep,condyle o 1 r;Jdius ~ppea•e d but not fused . centre for
appeared bu: '10 1 fuse:>d lower en d of uln<:J - not :~ppeare d . All
carpols except pisiform ~ppeared - age
- 5 to 6 years . (a boy)
Fig. 4.59: X-ray of wris• Lower end of r.,:1 .us <Jnd Fig . 4.60 : X-roy of pelvis- centres for upper end of
ulna appe~ r .o d bu• not user A:' c :np~ls femur-all appeared ~nd fused. Centres for
appeared . b 1se oi 1 st -ne• ·t· .11 1liac crests- appeared. Not fuse d . Centre
appeared but not fused. Age - 15 to 16 for ischial tuberosities-not appeared. Age-
years (a boy) 15 to 16 years. (female)
Fig . 4.61 : Showing oss ifica tion

state of whole pelvis
and upper parts of
femures

130 I PRJNCIPLE:S OF FORENSIC MEDICINE
I Fig. 4.63:0 ss fH 1i. n ~ciivity at the wrist

joint 6 carpal bones have appeared,
lower end of radius and ulna appeared
but not fused. Age, - 5 y1s
Fig. 4.66: 5 carpals have appeared , lower end of radtus Fig. 4.67: Midi at epiccndyle c:nd upper end of radius
appeare d, 'lOt fused. Lower end of ulna not iippeare d, not fused. Othe · secondary
ared. -4-5 __ I .___ _ _ centr:._s not ""D~· eClre~g=--=--:bout 7 yrs
- 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

chapter 4: IDENTIFiCATION OF INDIVID!JAL I 131
"'; .1 S8 All centres ut elbow joint have appeared Fig . 4.69: Epiphyseal centres
except lateral epicondyle. Age- 11-12 yrs of metacarpals and phallan-
1a girl) ges. Some have joined some
not
=--~ . 4.70 : All centres at wrist joint have appeared. Fig. 4.71 : 6 metacarpals, lower end
Lov1er ends of radius and ulna in the proca5s of of radius appeared. Lower en d of
1oining ulan just appeared
.::;E :::HANGES IN MANDIBLE about 90° or almost a right angle. The men-
tal foramen is midway between the lower mar-
DCRI;..;-G I~FANCY anc! EARLY CHILD- gin and the alveolar margin; the ramus stands
HOOD. the mandible is thin and described straight; the condyloid process is at a leve.l
as shallow. TI1e ramus is obliquely placed and higher than the coronoid process.
thE medicolegal angle (inner angle formed b:v In OLD AGES the body of the mandible
the body and the ramus) is an obt1Jse angle. is again narrow; the ramus again stands ob-
The mE>ntal forame11 is near the lower mar- liquely; the mental foramen is. near the al-
E'-':'.. of the body. The condyloid process is at a veolar margin; the medicolegal angle is again
::w.=.r leYel than the coronoid process. obtuse; the coronoid process is again at a
In ADP LTS, the mandible is thick and somewhat higher level than the condyloid
long-. the medicolegal angle (inner angle) i;; process.

132 / PRINCI PLES OF FORENSIC MEDICI NE
(a)
2 3 4 5 6
(b)
Fig. 4.72 : (a and b) Showing changes in mandible due to ageing
(a) From right to left- Childhood to old age (Photograph)
(b) From left to right- Childhood to old age (Diagram)
lind component - changes occurring at the

AGE CHA '":.ES AT THE S (MPHYSEAL
ventral demiface- ven-
SlRFACE OF THE PUBIS
tral half of the symphy-
seal surface.
The changes at the symphyseal surface of pu-
Illrd component - changes which occur in
bis due to ageing occur as three distinctly
common, around the
separate series of phenomena, which are de- whole symphyseal sur-
scribed as three different components. The face, after the series of
age changes at the symphyseal surface were changes occurring in the
first studied by T. W. Todd (1920-21) who Ist and lind components
recorded 10 stages of changes. McKern and are over (Table - 4.14).
Stewart (1957), also studied the changes and Table 4.14 is not a comparative chart.
de scribed them as three components of Changes of lst component occur compara-
changes. They subdivided the changes in each tively early and those ofllnd component com-
component into 6 stages (starting from no paratively late. Changes of the Illrd compo-
change or '0' stage to 5th stage of changes, in nent occur more or less after completion of
each component). the activities of theIst and lind components.
The three stated components are as below: According to the stage of the change in
Ist component - changes occurring at the each component, 0 to 5 score is awarded for
dorsal demiface- dorsal each component. The total score secured by
part (half) of the sym- a bone will tell the age of the subject at the
physeal surface . time of his death. For example, as available

Table 4.14: Changes under different components of symphyseal surface due to ageing
Stage Changes occurring in different components
/sl component lind component lllrd component
0 No margin on dorsal border No bevelling on ventral border No rim formation on any margin of the
surface
1 Marginformation starts in the middle Bevelling at the upper end of the Round, smooth, rim formation at the upper
third of the dorsal border ventral border end of the dorsal margin
2 Margin formed all along dorsal border Bevelling has downward extension Dorsal rim complete; ventral rim starts
formation at any site
3 Formation of a plateau with resorption Ventral rampart begins to form by Rim formed all around the surface. The
of ridges and filling of grooves or bony extensions from either or both surface is irregular and finely grained
billows upper and lower ends
4 Plateau formed all around qorsal Rampart extends with some gaps in Rim starts breaking and is now sharply
surtace upper 213rd of ventral border defined. Lipping present inthe ventral
margin; surface is smooth
5 No trace of billowing, surface Rampart formation complete Breakdown of rim continues; irregular
granulated but ftat ossification along ventral margin;
. rarefaction of symphyseal surface
from the statistical data, ifthe total score is intermediate thirds. It then extends to the
0, then the estimated age is below 17 years. inferior, dorsal and superior margins. By 35
If the total score is 4 or 5, then the range of to .40 years irregular lipping occurs around
age should be 18 to 23 years . If the total score the clavicular facet . Between 35 to 45 years,
is 6, 7 or 8, then the range of age should be facet like change occurs at the inferior sur-
23 to 29 years. face ofthe acromion process . By 50 years and
Determination of age from the changes over, the triangular demarcation at the base
at the symphyseal su rface is considered more of the scapular ridge becomes more promi-
dependable than from the skull bones' suture nent. Formation of cristae scapulae occurs
closure . also at this age.
Before the above changes are appreci-
ated, ageing of scapula can be tried from
CHANGES IN SCAPt1L~ the process of its maturity which starts oc-
curring by middle of3rd decade oflife. Sur-
Changes in scapula due to ageing are less uni- face vascularity on the bone becomes vis-
form and less constant. However, the follow- ible by 25 years of age. However, as age
ing changes may occur in bones of elderly advances they disappear . But deep
subjects : vascularity which appears by 25 to 30 years
By JO to 35 years of age lipping may start of age prevails longer. By 45 years, local-
on th e ventral margin of the glenoid cavity ised bony atrophy can be noticed by tran-
near the notch at the junction of upper and sillumination test.

134 I PRINCIPLES OF FORENSIC ivlEDICIN c
By courtesy of Prof. S.K Sen ~
Fig. 4 .73 Fig. 4 .74 Fig . 4 .75

Components I, II, Ill Components I, II, Ill Components !. II , IIi
Changes 0, 0, 0 Changes 4, 4, 3 Changes 3 , 1, i
Fig. 4 .76 Fig . 4 .77 Fig . 4 .78

Components I. II, Ill Components I, II, Ill Components I, II, Ill
Changes 4, 4, 2 Changes 4, 3. 2 ChangE's 5, 5, 2
Fig. 4 .79 Fig . 4 .80 Fig . 4.81

Components I, II. Ill Components I, II, II! Components I, II, Ill
Changes 5. 5, 3 Changes 5, 4, 3 Changes 5, 5, 5

chapter 4: 1DENTIFICATION OF INDIViDUAL I 135
Fig. 4 .82 Fig. 4 .83

Components I. II. Ill Components I, II, Ill
Ch<mge:;. 4, 1, 0 Changes 5, 5, 5
Hl-19 yrs 25-26 yrs 35-39 yrs 4.5-50 yrs 50+ yrs
v~
~~ . \ Fig. 4.84
Components I, II, Ill
.
.
Changes 4, 2, 0
•I Showing different levels

of changes at different
j ages
2 3 4 5
-----
(a)
(c) (d)
Fig . 4 .85 : Showing different levels of C'hanges ir. different components in different ages
'(e)
(a ) (b) (c) (d) (e )
II, Ill I, Ill I, II. Ill I, II, Ill I, II, Ill
1 Q 1 0 3, 3, 4. 4. 3 3, 2 , 1

Fig. 4.86: Intact Metopic suture. Age - 20 years

Fig . 4 .87: Non-union of co ronal,
sagittal and lambdoid suture
Fig. 4.88: Endocranial surface showing almost

comp letion of union of coronal. sagittal and Fig. 4.89: Show1ng partial union of coronal and sagittal
lambdoid sutures Male - 54 years sutures (Ectocranial) Age - 30 years - Male
OLD AGE At'ID VERTEBRAE rior fontanelle du~es by the second year. The
two postero-lateral fontanelles close within
a short period after birth and the antero-lat-
By 35 to 40 years lipping of the margins of
eral fontanelles rlose within the first 6
the vertebral bodies starts Generalised
months after birt.h .
lipping of the margin suggests very old age.
METOPIC SUTURE - The metopic su-
ture between the two frontal bones closes
AGE FROM OSSIFICATION ACTIVITIES betweeu 2 to S years , but sometimes may
OF THE SKULL BONES remau: int::tct en' n in adults.
SKULL VAULT SUTURES - Skull vault
FONTANELLE - Posterior fontanelle closes sutures start their fusion activity by 24th-
between birth to ll/2 month after birth . Ante- 25th y<·!a!·s of age. Suture closure usually

chapter 4: IDENTI FICATION OF INDIVIDUAL I 137
Fig . 4.9 1: Ossification centre for lower end of femur

Fig . 4.90: Showing non-union of coronal, sagittal, and (Age- 9M. I.U.)-by courtesy Dr. B. Kahali
lambdoid sutures, (Endocranial) Age - 23
years- Male
Fig. 4.93: Abnormal growth of skull bone in length and

thickness. Museum , F.S.M. , C.M.C.
Fig . 4 .94: Endocranial vault sutures

starts at the ectocranial surface. But, though For ossification activities in the clavicle
the start in the endocrani.al surface occurs and sternal complex please refer the chart
late , the progress at this level is speedy ,more (Table. 4.13).
uniform and more complete than at the
ectocranial level. In many skulls the fusion
of the sutures at the ectocranial surface is DEVELOPMENTAL FEATURES AT
not complete . DIFFERENT AGES
FUSION.OF THE SAGI'ITAL SUTURE
- On an average, closure of sagittal suture Intra-uterine life -Though cell division and
starts by about24-25 years , at the ectocranial growth starts soon after fertilisation of the
surface, at its third part. Complete fusion of ovum by the sperm, for about a week it can't
the endocranial surface of the suture occurs be said that the woman is pregnant, until
between 45-50 years . By this age , the the fertilized ovum is impregnated in the
ectocranial surface reaches its peak closure body of the uterus. After impregnation of
activity, though complete closure may not course, the duration of pregnancy is counted
occur here at all. from the day of fertilisation . The fertilised
In the CORONAL SUTURE the closure ovum, which after impregnation is termed
activity starts by24-25 years of age over its embryo , in course of its growth, with the
third part (pars pterica). Between45-50 years development of placenta , is called a foetus ,
complete fusion occurs in many skulls at the after the end oftwo months of intra-uterine
endocranial surface. By these ages, peak but age .
not complete closure is achieved at the Morphology ofl month old embryo :
ectocranial surface. ·'
Length - 1 em
In the LAMBDOID SUTURE , the fusion
Weight- 2.5 gm
activity starts late and the progress is also
slow. In this suture, closure starts between Black spots for eyes develop
25th to 27th years in the ectocranial surface Mouth cleft appears.
near the asterion. In some cases complete Morphology of2 months old embryo :
fusion of the suture at the endocranial sur- Length-4 em
face may occur by 50 to 55 years . At the
Weight- 10 gm
ectocranial surface the peak or maximum
closure occurs at above 55 years . Limb buds appear
Site of anus represented by a black
In contrast with other ossification cen-
spot
tres, fusion of sutures occur comparatively
Placenta may be present in its fom1a-
early in males. It also occurs comparatively
tive stage.
early in negro community than in white com-
munity. Morphology of3 months old foetus :
The P ARIETO-TEMPORAL SUTURE Length- 9 em
closes by about 70 years or above. Weight - 30 - 35 gm
The BASI -OCCIPUT fuses with BASI- Neck- fonned
SPHENOID by about 18 to 20 years in fe- Nails , present in membranous form
males and by about 20 to 22 years in males. Pupillary membrane present.

chapter4: IDENTIFICATION OF INDIVIDUAL I 139
· By courtesy of Dr. B. Kaha/i
l J Fig. 4.95 : Scalp hair, vernix, caseosa (on shoulder and

neck) , Lanugo hair (7 M.I.U.)
Fig . 4.96: Lanugo hair (7 M.I.U.)
Fig . 4.97: Obliteration of pupillary membrane Fig. 4.98: Nails projecting beycnd the tip of fingers
(7 M.I.U) (10 M.I.U)
Fig . 4.99: Ossification centres of body of sternum , Fig. 4.100: Ossification centre for calcaneum and talus.
position of diaphragm (1 0 M.I.U .) , (Age- 7 M.I.U.)

.. • .
140 / PRINCIPLES OF FORENSIC MEDICINE
By courtesy of Dr. B. Kaha/i
·•
Fig. 4 .101 : Foetal developmental anomalies involing both Presence of sex organ in a still born foetus
feet - cas e of still birth testicles in the scrotum. Scrota l sack not
developed yet
Foetuses of different ages and

A case of abortion - after 8 months development
pregnancy
Fig . 4.1 05: Abnormal limb growth (in a dead born 4 106: Discharge of meconium in a foetus which
foetus) died in the process of delivery

chapter 4: IDENTIFICATIO N O F INDIVID UAL I 141
By courtesy of Dr. B. Kahali
A picture to show position of different

intrathoracic and intraabdominal organs in a
near term foetus (lung , heart, liver, intestine - Testicle in the inguinal canal in a foetus -
are shown in their usual position) 7 MIU
Rigor mortis in a dead born foetus 36

weeks of pregnancy Fig . 4 110: Appearance of eyelash in the foetus
Fig. 4.112. Dissection to show appearance of

Fig Measuring the circumferance of head of a epiphyseal centre at the upper end of tibia
foetus (early phase of 1Oth MIU)

142 I PRIN CIPLES OF FORENSIC ·MI:DICINE
Morphology of 4 months old foetus : Morphology of 7 months old foetus :

Length - 16 em . Length - 35 em
Weight- 120 - 130 gm Weight- around 1 kg
Sex- differ entiable. · Scalp hair - more than 1 em long
Lanugo hair (downy body hair) - may Eye lids - separated
be present on any part of the body Pupillary membrane -absent
surface. Eye brows- present
Meconium (mixture of bile, mucous Skin - thicker, fibrous
and shaded off mucus membrane) - Nails - near the tip of fingers
present in the upper pait of small Meconium - in the descending and
intestine. pelvic colon
Convolutions in brain -begins. Testicles - near the external ring in
Morphology of 5 months old foetus : the left side and near the internal ring
in the right side.
Length - 25 em
Bile -present in the gall bladder
Weight - 400 grn
Centre for talus - present in all cases
Scalp hair appears
Centres for 2nd and 3rd segment of
Nails - up to the proximity of tips of
the s ·;, 'num- present
fingers .
Meconium- up to ascending colon. Morphclogy of 8 months old foetus:
Ossification centres for manubrium Length - 40 em
and 1st segment of the body of ster- Weight - About 1. 5 kg
num appear; centre for calcaneum
Scalp hair- 1. 5 em
may appear.
Testicles - left side in the scrotum,
Morphology of 6 months old foetus :
right side near the external ring.
Length - 30 em
Weight - 700 gm Morphology of 9 months old foetus :
Skin - reddish, wrinkled Length - 45 em
Vernix caseosa (soft, pasty, whitish, Weight- 2-2.5 kg
caseous, thin layered coating on the Scalp hair- 2 em
skin) - present Nails - at the level of tips of fingers
Eye-lashes - present Lanugo hair- around shoulders only
Subcutaneous fat - present in drop- Testicles - both in the scrotum
lets Circumference of head- 30 em
Meconium- in the transverse colon Position of the umbilicus - Compara-
Both testicles in male foetus - near tively nearer to xiphoid process than
respective kidneys .-. -. l ~"' .-: pubic symphysis.
Centre for calcaneum- pres(1;nt-in all Mid point of the body- 1-2 em above
cases . '. umbilicus.
Centre for talus - ·m ay be present. , '· Nails .!.. beyond the tips of fingers

chapfer4: IDENTIFICATION OF INDIVIDUAL I 143
~Ieconium - in the rectum DETERMINATION OF AGE IN

Centre for the lower end of femur - EXTRA-UTERINE LIFE
present.
:\Iorphology of 10 months old or full term As we have seen earlier, the physical or mor-
roe tuB: phological features including secondary sex
Length- 50 em (may be slightly less characteristics, eruption of teeth, decaying
in females and slightly more in males) changes in teeth and ossification activities and
Weight- 3 kg to 3.5 kg other changes in the bones, all may help es-
Scalp hair - 4 em timation of age of a person at some stage or
Mid point of the body- just above the other of his life.
mnbilicus After birth, the following changes occur
Centres of ossification appear in !~. body of a person at different ages:
-··-
cuboid, upper end of tibia and 4th Within 15 days after birth-Skin l:-ecomes
:segment of the body of sternum pale. Changes occur in the umbilical cord and
Placenta- 22 em diameter, about 700 umbilicus (see live birth, in abortion and in-
grn in weight fanticide chapter). The thin layer of cuticle
mbilical cord - 45 - 50 em long. starts falling off from over the chest and ab-
N.B. The students must r emember the domen by 4th and 5th days after birth and
morphological and ossification from other parts of the body by 6th and 7th
changes which occur at the end of days after birth. Nucleated R.B.C.s disappear
the 3rd month, 5th month, 7th from circulation within 24 hours after birth.
month, 8th month and tenth month, During the first 3 months-The infant
as these intra-uterine ages of the grows in length by about 1 mm per day, and
foetus have medicolegal impor- it gains in weight by about 15 grn per day;
tances. posterior fontanelle closes; the infant re-
Relationship between length of a foetus sponds to different stimulii. Foetal haemo-
and its age globin reduces in percentage, centres for capi-
tate and hamate present. Foramen ovale
Hasse's formula states that for the first 5 closes in the third month.
months of intra-uterine life, the length of a
Between 3 months to 6 months-Body
foetus in em is equal to the square of the
length and body weight increase in the same
age of the foetus in lunar month. After 5
rates as in the 1st 3 months; further reduc-
months and till full term the length of the
tion of the foetal haemoglobin occurs; two
foetus in em is equal to the age in lunar
halves of the mandibles unite at the symphy-
month x 5.
sis mentii; temporary lower central incisor
for the first 5 months, age of the foe- teeth may erupt.
tus in lunar months=
" .•·)" ... ' . Between 6 months to 1 yeaJ.!-Tempof ary
~length of the foetus in em incisors and temporary 1st molar teeth erupt.
. . , ,t..,,. . Ossification centres for capitate, hamate,
For the last 5 months, age of the foetus in lower end of radius, head and capitulum of
lunar months= lengtho{the foetus in em+ 5 humerus, and head of femur appear.

Between 1-2 years-Temporary canine Between 14-16 years-Centre for lesser

and temporary 2nd molars erupt. Ossification trochanter of femur in males and centres for
centres for head of fibula , base of iliac crest and ischial tuberosity in both sexes
metacarpals, base of proximal phalanges of appear. Fusion oflower end of humerus, up-
fingers and base of middle phalanges of toes per end of radius, upper end of ulna and up-
appear. Anterior fontanelle closes. per end of femur in both sexes and upper end
Between 2-5 years-Ossification centres of humerus in some cases of females occur.
for triquetra}, lunate, trapezium, trapezoid, In girls and in most of the boys axillary hair
greater and lesser tuberosities of humerus, appears. In boys, pubic hair appears and their
greater trochanter of femur appear. Metopic voice becomes hoarse.
suture.closes in most children.
Between ~ 7 years-1st pen11anent mo-
lars and permanent central incisor teeth
erupt. Ossification-centres for lower end of
ulna, upper end of radius and medial epi- Fig. 4.113: Breast of an
condyle of humerus appear (in females ). In adolescent girl.
(Age 16- 17)
males, lower end of ulna and upper end of
radius appear. Centre for scaphoid appears
in both sexes. Metopic suture closes in rest. Between 17-18 years- 3rd permanent
Between 8-10 years-Permanent lateral molar may erupt in some cases . In females,
incisors, 1st premolars and 2nd premolars fusion occurs at the lower end of radius, ulna,
erupt. Ossification centres for trochlea, ole- femur, and upper end of humerus, tibia and
cranon ofulna appear in females and medial fibula. In some females, fusion occurs at the
epicondyle, trochlea and sometimes ole- iliac crests and ischial tuberosities . In males,
cranon of ulna appear in males. fusion occurs at the lower end of radius, up-
per end ofhumen1s and upper end of femur.
Between 11-12 years-Pennanent ca-
Beards and moustaches appear in males.
nine and sometimes some of the permanent
2nd molars erupt. Centre of ossification for Between 19- 20 years-3rd permanent
pisifonn and lateral epicondyle of hmnerus molars erupt. In males fusion of centres oc-
appear in females and centre for pisiform and curs at the lower ends of ulna, upper ends of
sometimes centre for lateral epicondyle of humerus, tibia and fibula. In both sexes, fu-
humerus appear in males. Breasts in girls sion occurs at the iliac crest, ischial tuberos-
start enlarging. Girls m.ay attain menarchy. ity and between basi -occiput and basi-
sphenoid.
Between 12-14 years-2nd pennanent
molars erupt. Ossification centres for lesser .tsetween 2~22 years-Centres at medial
trochanter, iliac crest and ischial tuberosity end of clavicle fuse. 3rd molars erupt. Decay-
may appear in females and centre for lateral ing changes in the teeth start. Changes in
epicondyle appears in males . Fusion of cen- the symphyseal surface of pubis start.
tres at the lower end of hum.erus and upper Between 23-25 years-3rd molars erupt.
end of radius and ulna may sometimes occur Decaying changes in the teeth progress. Up-
in females. Pubic hair appears in girls. They pen110st segments ofthe sternum and sacrum
attain menarchy and their breasts enlarge. may get united. Changes at the symphyseal

chapter 4: IDENTIFICATION OF INDIV IDUAL I 145
surface of pubis and around glenoid cavity of the sternum. Greying of pubic hair may be
scapula noticed. Fusion activities at the sag- noticed.
ittal and coronal sutures start at the ecto- 60 years -Fusion activity at the
cranial surface followed by endocranial sur- ectocranial smface of the lambdoid suture
face. reaches peak. Decaying changes in the teeth
Ben-...een 25-30 years-Fusion activity and changes at the symphyseal surface of
;;:an~ in the lambdoid suture , first at the pubis progress further. Skin creases appear.
ectocranial surface and then at the endocra- Cataract appears in some .
nial surface. Decaying changes in the teeth Above 60 years - Skin creases increase;
and changes at the symphy.:seal surface of cataract occurs in many; decaying changes
pubis and around the glenoid cavity of scapula progress further; parieto-temporal suture
continue . fuses . Osteo-arthritic changes occur at the
Between 30-40 years- Changes occur- bony joints.
ring between 25- 30 years progress further. It should be remembered that , body
40 ye ars-Decaying changes in teeth, height of a person increases up to 21-22 years
fusion activities in the skull vault sutures, of age . Then, after 25 years it decreases by
changes in the symphyseal surface and about 1 nun every year. But body weight may
around glenoid cavity progress . Archus seni- go on increasing up to 40-45 years and even
lis (white lining over the limbal zone of the after that.
cornea) appears; scalp hair starts greying. It must be remembered that estimation
Between 40-45 years-Menopause comes of age must not be pin-pointed and made ab-
in women. Xiphoid process unites with the solute , irrespective of whether it protects the
body of sternum. Other changes as in 40 years interest of the case or not. A reasonable range
of age progress further. must be there in the estimated age and the
lability of the estimated age must not be for-
50 years-Endocranial smfaces of sagit-
gotten. In the Court, let the doctor stick to
tal and coronal sutures close in many. Fu-
the range without pinpointing the age and
sion activities at their ectocranial surfaces
without going outside the range, except for
and at both smfaces oflambdoid sutures and
the probable exceptional cases. It will be re-
changes at the symphyseal surface of pubis
ally for the cause of justice, if this nonn is
and around glenoid cavity of scapula and de- followed by the doctor in the Court and if oth-
caying changes of teeth progress further. ers concerned realize it.
55 years-Lambdoid suture in some and
coronal suture and sagittal suture in many
fuse completely at their endocranial surface. MEDICOLEGAL IMPORTANCES OF
Sagittal and coronal sutures reach their peak DIFFERENT AGES
fusion activity at their ectocranial surface .
Fusion oflambdoid suture at ectocranial sur- 7 days after fertilisation of the ovum by the
face further progresses. Decaying changes in sperm-By about this period the fertilized
teeth and changes on the symphyseal sur- ovum. gets impregnated 1n the uterus and it
face and around the glenoid cavity further is tenned embryo . The woman is pregnant
progress. Manubrium fuses with the body of from this period.
-= •.4 - i"l

2lunarmonths of intra-uterine lifs-The the court, depending on whether the child

embryo from this period is known as foetus . does or does not understand the nature and
Killing of a foetus amounts to foeticide. consequence of the act.
3 lunar months or 12 weeks-For termi- 10 years of ags-If a child below this age
nation, till this duration of pregnancy, deci- is removed from his or her lawful guardian
sion about the applicability of the indications for the purpose of robbing movable property
provided by the M.T.P . Act, can be taken by from his or her body or possession, then it
one doctor alone. Above this age of the foe- will amotmt to the offenc& cf kidnapping
tus, opinion of two doctors are necessary to 12 years-Nothing is an offence which is
decide if the indications of the M.T.P. Act are done in good faith for the benefit of a child
applicable or not. under this age, when such act is done by his
5 lunar months or 20 weeks of preg- or her guardians or on the consent of the
nancy- For termination of pregnancy, this . gJ.Iardian, even if the act ultimately causes
is the maximum period of gestation for use ham1 to the child.
' of all the indications of M.T.P . ~ct. Above this Also, a child below this age cannot give a
age, pregnancy can be terminated only on the valid consent to suffer any ham1 which may
· ground of mother's physical ill health. result from an act done in good faith for his
28 weeks-A foetus born after this pe- benefit.
riod, if does not show any sign of life and if 14 years-According to the Factory Act,
does not breathe, is termed a still born foe- a person below this age is a child and cannot
tus. be employed in factory jobs.
7 calendar months or 210 days-Legally Between 14 and 15 years of age, a person
a foetus at this age becomes viable. If a foe- can be engaged in non-hazardous factory jobs
tus born alive after this age is killed, then it for a limited period during the day hours.
will amount to infanticide.
15 years-Sexual intercourse, even with
10 lunar months-A foetus at this age is one's own wife, below this age. amounts to
a full term foetus. rape.
1 year of extra-uterine lifs-Till comple- A person above 15 years of age can be
tion of 1 year, a baby is an infant. Killing of employed in a factory like an adult, ifhe has
such a baby within 1 year after birth amounts a fitness certificate for employment in that
to infanticide. job.
5 years of ags-Above this age a child be- 16years-
comes responsible for his act leading to wreck-
(a) Taking away or enticement of a male
age of a train, (according to the Railway Act).
person under this age, without the
7 years-Below this age a child is not consent of the lawful guardian
criminally responsible for his act, as the child amounts to the offence of kidnap-
below this age does not understand the na- ping. ' 'l • • • .
ture and consequence of the act (according (b) Intercourse with a girl below this
to the Indian Penal Code). age irrespective of whether with or
· Between 7~12 years of age, a child may without her consent, amounts to
or may not be held responsible for his act by rape (statutory rape).

(c) Below this age an offender is a juve- G) A person above this age, if mentally
nile offender, and for his alleged of- sound, can make a valid will.
fence he is tried in a juvenile court (k) A person above this age can exer-
and if convicted, is sent to a borstal cise the right to cast vote in differ-
or reformatory school, where he ent elections at national, state and
stays up to 21 years of age, if the other levels.
conviction covers this age.
21years--
18years-
(a) If a girl below this age is "imported"
(a) At this age a person attains major-
to India from outside the country or
ity, except when he is under the
from the state of Jammu and Kash-
guardianship of a court.
mir for the purpose of forcing her
(h) It is the minimum permissible age or seducing her to illicit intercourse,
for marriage, for women.
then the act amounts to kidnapping
(c) Taking out or enticement of a girl and is punishable by imprisonment
below this age, from the custody of for 10 years and fine.
her guardian amounts to commis-
(b) It is the minimum age for marriage,
sion of the offence of kidnapping.
for males.
(d) Kidnapping a boy or girl below this
(c) A person who was under the guardi-
age for the purpose of begging is
anship of a court attains majority at
punishable with imprisonment for a
this age.
period of up to 10 years with or with-
out fine. (d) Up to this age, an offender can stay
(e) Maiming a minor for the purpose of in a borstal school
begging is liable to be punished with 25years-
up to life imprisonment and fine. (a) Minimum age for contesting for the
(f) Inducing a minor girl under the age membership of parliament or other
of 18 years to go from one place to legislative bodies.
another, and to force or seduce her (b) It is the maximum age for entering
to illicit intercourse is punishable by into some government services.
imprisonment for up to 10 years
and/or fine. 35 years-Minimum age for appointment
as President, Vice-president oflndia and Gov- ·
(g) A person above 18 years of age can
en1or of a state.
be employed in any authorised job
in a factory. 41-45 years-During this period oflife a
(h) A person above this age can give a woman usually loses the child bearing capac-
valid consent to suffer any harm ity.
which may result from an act which 55-65 years-The ages of retirement
is not intended or known to cause from services under the Government, Gov-
death or grievous hurt. ernment undertaking, statutory bodies, au-
(i) It is the usual minimum age for en- tonomous bodies or institutes or from higher
tering into a government service. judiciary services.

148 I PRIN CI PLES O F FO RENSIC MEDICINE
long bones are available, then stature of the

person can be calculated.
By STATURE we mean body height or body Estimation of stature from (dismembered)
length of a person. It is an important crite- body parts-
rion for identification of a person. Starting from 1. When both side anns are outstretched
the intra-uterine life, stature increases up to in a straight line, then distance between
20-21 years of age of a person. After 25 years the tips of the two middle fingers of the
of age, though not of much significance, it hands is approximately equal to the stat-
slightly reduces with further increase of age. ure of the person.
Stature is more- 2. Stature is equal to twice the length from
vertex to symphysis pubis or equal to
l . It is maximum between 20-25 years of
twice the length from symphysis pubis
age of a person.
to one side heel, with the hip and knee
2. It is more during morning hours of the extended and the ankle dorsiflexed.
day.
3. Stature is equal to length of one forearn1
3. It is more in the recumbent position. {1- in em (from tip of middle finger to the
3cm) acromion process of the clavicle) x 2 + 34
4. It is more in dead bodies during the stage em (30 em for the length of two clavicles
of primary relaxation (up to 1.5 em in and 4 em for the breadth of the manu-
males and 2 em in females ). brium).
Stature is less- 4. Stature is 3.3 times the length from. the
1. After the age of 25 years, it decreases@ sternal notch to the symphysis pubis.
about 1 mm per year. 5. Stature is 3. 7 times the distance between
2. During the evening hours, the stature of the tip of olecranon and tip of middle fin-
a person may be about 1.5 em less than ger of the same side.
what it is in the morning hours. This is Stature from bones-
due to decreased elasticity and increased 1. Stature is 2.5-4 em more than the length
tonicity of the vertebral muscles in the of the whole skeleton. (The total thick-
evening hours. ness of the soft tissues in between the
3. In standing posture, the stature is slightly bones at different joints from heel to ver-
less than what it is in the recumbent po- tex is about 2.5-4 em).
sition. 2. When the whole skeleton is not available
4. In a dead body, the length reduces dur- but one or so1ne long bones are only avail-
ing the stage of rigor mortis. able, then any one of the following for-
A forensic specialist is often required to mulae can be used to get the stature of
estimate the stature of a person from dis- the person, depending on the racial or
membered body parts and bones. Length of geographic origin and sex of the person
different body parts bears more or less some and condition of the bone (see table 4.15).
constant relationship with the body length. (a) Karl Pearson's formula (1899)-This
Hence, if body fragments containing some fonnula was in world-wide use for a
such body segments are available or if some long period. It gives different calcu-

chapter 4: IDENTIFICATI O N OF INDIVIDUAL I 149
latingfactors for bones for males and Trotter and Glasser's Formulae (1952,
females of European subjects, de- 1958)- See page 149-151
pending on whether the bones are
wet with intact cartilages or are dried They succeeded in finding out more depend-
and devoid of cartilage. The calcu- able formulae for detennination of stature,
lated stature is usually less than the for males and females of white and Negro
actual by 2.5-4 em which should be origins. For the purpose, they considered the
added to the calculated figure. For lengths of the long bones separately and in
each long bone, there is a separate combinations. The subjects of their study
multiplying factor. A constant fac- were between 28-30 years of ages. They have
tor (different for each bone) is to be also provided a range of error for each of such
added to the product of the length calculated stature. Due consideration should
of the bone multiplied by the multi- be given while using their fornmlae for eld-
plying factor. Thus, formul ae for erly subjects in whom with increase in age
long bones of males and females of there is decr ease in st ature, though very
European origin are as follows : nominal Their fonnulae for the four differ-
ent categories of subjects, taking into con -
Table 4.15: Karl Pearson's formula sideration, one bone alone at a time or two
bon es combiningly when available, according
Length Multiplying additive
to preference for accuracy are as follows :
factor factor
(i) For WET bones - MALES- 1. For WHITE MALE subjects-

Femur =(lengthinem-.7em) x 1.880+81 .231 em Stature is equal to -
Tbia ={Length in em -.5 em) x 2.376 + 78.807 em (a) Lengths of (femlll' +fibula) in em x 1.31 +
Humerus =(length in em -.5 em) x 2.894 + 70.714 em 63.05 em; (error ± 3.63 em).
Radius ={lengthinem-.3em) x 3.271 +86.465cm {b) (femlll' + tibia) in em x 1.26 +
67.09em; (error± 3.74 em).
{ii) For WET bones - FEMALES-
(c) (fibula) in em x 2.60 + 75.50 em
Femur =Length in em x 1.945 + 73.163 em (error± 3.86 em).
Thia x 2.352 + 75.369 em (d) (femlll') in em x 2.42 + 81.93 em
Humerus = x 2.754 + 72.046 em .
(error± 3.94 em)
Radius = x 3.343 + 82.189 em
(e) (tibia) in em x 2.42 + 81.93 em
{iii) For DRY bones - MALES- (error ± 4 em)
Femur = Length in em x 1.880 + 81 .306 em (f) (humerus+ radius) in em x 1.82
Thia x 2.376 + 78.664 em + 67.97 em (error± 4 .31 em)
Humerus = x 2.894 + 70.641 em (g) (humerus + ulna) in em x 1.78 +
Radius x 2.271 + 89.925 em 66.98 em (error± 4.37 em)
(h) (humerus)inem x 2.89+ 78.10 cm
(rv) For DRY bones - FEMALES-
(error ± 4.57 em)
Femur = Length in em x 1.945 + 72.884 em (i) (radiu s) in em x 3.79 + 79.42 em
Da x 2.352+74.774em (er ror ± 4.66 em)
merus x 2.754 + 71 .475 em (j ) (ulna) in em x 3. 76 + 75.55 em
~us x 3.343 + 81 .224 em (error ± 4.72 em)

lating factors for bones for males and Trotter and Glasser's Formulae (1952,
females of European subjects, de- 1958)-See page 149-151
pending on whether the bones are
wet with intact cartilages or are dried They succeeded in finding out more depend-
and devoid of cartilage . The calcu- able forn1ulae for detennination of stature,
lated stature is usually less than the for males and females of white and Negro
actual by 2.5-4 em which should be origins. For the purpose, they considered the
added to the calculated figure . For lengths of the long bones separately and in
each long bone, there is a separate combinations . The subjects of their study
multiplying factor. A constant fac- were between 28-30 years of ages. They have
tor (different for each bone) is to be also provided a range of en-or for each of such
added to the product of the length calculated stature. Due consideration should
of the bone multiplied by the multi- be given while using their fornmlae fo r eld-
plying factor. Thus, fonnulae for erly subjects in whom with in crease in age
long bones of males and females of the re is decrease in stature , though very
European origin are as follows : nominal Their formulae for the four differ-
ent categories of subjects, taking into con-
Table 4.15: Karl Pearson's formula sideration, one bone alone at a time or two
bones combiningly when available, according
Length Multiplying additive
to preference for accuracy are as follows :
factor factor
(i) For WET bones- MALES- L For WHITE MALE subjects-
Femur =(Length in em -.7 em) x 1.880 +81.231 em Stature is equal to -
Thia =(Length in em -.5 em) x 2.376 + 78.807 em (a) Lengths of (femur +fibula) in em x 1.31 +
Humerus =(Length in em -.5 em) x 2.894 + 70 .714 em 63.05 em; (error± 3.63 em).
Radius =(Lengthinem-.3em) x 3.271 +86.465em (b) (femur + tibia) in em x 1.26 +
67.09em; (error± 3.74 em).
(ii) For WET bones- FEMALES -
(c) (fibula) in em x 2.60 + 75.50 em
Femur = Length in em x 1.945 + 73.163 em (error± 3.86 em).
ilia x 2.352 + 75.369 em (d) (femur) in em x 2.42 + 81.93 em
Humerus x 2.754 + 72.046 em ,
(error ± 3.94 em)
Radius = x 3.343+ 82.1 89em
(e) (tibia) in em x 2.42 + 81.93 em
(iii) For DRY bones - MALES - (error ± 4 em)
Femur = Length in em x 1.880 + 81.306 em (humerus+ radius) in em x 1.82
ilia = x 2.376 + 78.664 em + 67.97 em (error± 4 .31 em)
Humerus x 2.894 + 70.641 em (g) " (humerus + ulna) in em x 1.78 +
Radius x 2.271 + 89.925 em 66.98 =(error ± 4.37 em)
(h) (humerus) inem x 2.89+ 78.10em
(IV} For DRY bones - FEMALES -
(error± 4.57 em)
Femur =Length in em x 1.945 + 72.884 em (i) (radius) in em x 3.79 + 79.42 em
-00 x 2.352 + 74.774 em (error± 4. 66 em)
'-umerus x 2.754 + 71.475 em (j) " (ulna) in em x 3. 76 + 75.55 em
R2aus = x 3.343 + 81.224 em (error ± 4. 72 em)

2. For WIDTE FEMALE subjects- (g) " thumerus + ulna)in em x 1.65 +

70.67 em; (error± 4.23 em).
Stature is equal to -
(h) hwnerus in em x 2.88 + 75.48
(a) Length of humerus in em x 0.68 +length of em; (error± 4.23 em).
femur x 1. 7 + length of tibia x
(i) radius in em ~ 3.32 + 85.43 em;
1.15 in em+ 50.12 em; (error±
3.51 em) (error± 4.57 em).
(j )
, ulna in em x 3.30 + 82.77 em;
(bl (femur + tibia) in em x 1.39 +
53.20 em; (error± 3.55 ern). (error± 4.74 cml.
(c) femur in em x 1.48 +length of 4. For NEGRO FE11ALE subjects-
tibia in em x 1.28 + 53.07 el:n;
Stature is equal to -
(error ± 3.55 em).
(a) Length of humerus in em x 0.44 +length of
(d) fibula in ern x 2.93 + 59.61 em;
radius in em x 0.20 +length of
(error·± 3.57 em).
femur in em x 1.46 + length of
(e) " tibia in em" 2.90± 61.53 em tibia in em x 0.86 + 56.33 em
(error± 3.66 em). (error± 3.22 em).
(f) humerus in em x 1.35 + length of (b) femur in em x 1.53 +length of
tibia in em x 1. 95 em + 52.77 em; tibia in em x 0.96 + 58.54 em
(error ± 3.67 em). (error± 3.23 cml.
(g) femur in em x 2.4 7 + 54.10 em (c) (femur + tibial in em x 1.26 +
(error± 3.72 em). 59.72. em; (error± 3.28 em).
(hl radius in em x 4. 74 + 54.93 em (d) femur in em x 2.28 + 59.76 em;
(error ± 4.24 em). (error± 3.41 em).
(i) ulna in em x 4.27 + 57.76 em; (e) humerus in em'< 1.08 +length of
(error± 4.30 em). tibia in em x 1.79 + 62.80 ern;
(j) (error± 3.58 em).
" humerus in em x 3.36 + 57.97 em;
(e"tTor ± 4.45 em). ([) " tibia in em x 2.45 + 72 .65 em;
(error± 3.70 em).
3. For NEGRO MALE subjects- (g) fibula in em x 2.49 + 70.90 em;
Stature is equal to - (error± 3.80 em).
(a) Length of (femur + fibula) in em x 1.20 + (h) humerus in em x 3.08 + 64.67
67.77 em; (error± 3.63 em). em; (error± 4.25 em).
(b) " (femur + tibia) in em x 1.15 + (i) ulna in em x 3.31 + 75.38 em;
71.75 ern; (error± 3.68 em).
(error± 4.83 emJ.
(c) femur in em x 2.10 + 72.22 em;
(j } " radius in em x 2.75 + 94.51 em;
(error± 3.91 ern).
(error± 5.05 ern).
(d) tibia in em x 2.19 + 85.36 em;
(error± 3.96 em). In 1958, M . Trotter and G. C. Glesser
(e) " fibula in em x 2.34 + 80.07 em; worked further on this field and found out
(error± 4.02 em). formulae for estimation of stature from bones
(f) (humerus+ radius) in em x 1.66 for Mongoloid subjects. This work was on and
+ 73.08 em; (error± 4.18 ern). for male subjects only.

Formulae for estimation of stature from on subjects of racial origin different from In-
bones. for MALE MONGOLOID subjects- dians. These are suitable for the people on
whom and for whom these were worked out.
Stature is equal to-
As such these cannot be satisfactorily used
at Lengthof (femur+ fibula) in em x 1.22 +
for Indian subjects. Further, people of differ-
70.24 em; (error± 3.18 em).
ent con1ers of India bear different morpho-
(femur + tibia) in em x 1.22 + logical features depending on their geographi-
70.37 em; (error± 3.24 em).
cal distribution and primary racial attach-
el fibula in em x 2.40 em; ment. For this reason a single formula can-
(error :t 3.24 em). not suit all parts of the country . The differ-
dl tibia in em x 2.39 ± 81.45 em; ent formulae available for different parts of
{error± 3.27 em). India are given below .
femur in em x 2. 15 + 72.57 em; These fonnulae are simpler to work out
(error ± 3.80 em). in the sense that a bone is to be multiplied
(humerus+ ulna) in em x 1.68 + by a factor to get the stature of the person.
71.18·em; (error± 4.14 em). To mention som.e such formulae which are
(humerus+ radius) in em x 1.67
in use in our country: 1. Pan's formulae (1924)
+ 74..83 em; (error± 4.16 em). for males and females of Bihar, Bengal and
Orissa; Nat's formulae (1931) for male sub-
humerus in em x 2.68 + 83.19
jects of Uttar Pradesh and Siddiqui and
em; (error ± 4.25 em).
Shah's formulae ( 1944) for the males ofPun-
radius in em x 3 .54 + 82.00 em; jab and neighbouring areas (vide Table 4.16).
(error.± 4.60 em).
In taking the measurements of the bones,
Ulna m em x 3.48 + 77.45 em;
their maximum lengths as described below
!error± 4.66 em). are considered. Use of Hepbum type osteo-
A.ll the formulae so far mentioned were · metric board gives most accurate measure-
fc r:-nulated on the basis of statistical works ments. In this type of board one vertical plane
Table 4.16: i. :~ltplic2.liJD factor:>fer difterer.tboiles for calculc;tion of stature of persons of different parts of India,
based nn the worl<s of Pan (1924), Nat (1931) and Sidd,qui and Shah {1 944)
Benes Multiplication factors to get the stature
For Bengal, Bihar and Orissa, ForU.P For Punjab
-Pan(1924) Nat(1931) Siddiqui & Shah (1944)
Male Female Male Male
=emlJ' 3.82 3.80 3.70 3.60
Too 449 4.46 4.48 4.20

rDI.ila 4.46 4.43 4.48 4.40
Humerus 5.31 ,. 5.31 •. 5.30 5.00
·~:--
O-acius '6.78 . 6.70 6.90 6.30
'I
ul'la 6.00 6.00 6_30 6.00

'I" \

is fixed and the other (opposite) vertical plane MEDICOLEGAL ASPECTS OF SCARS
is movable. To get the maximum length of
the bone it is placed lengthwise in between
A scar is the product ofhealing of an wound
these two vertical planes. The maximum
by fibrosis and cicatrisation •. "Car is made
length of the bone is the distance between
of fibrous tissue, is covered~-' .:pithelial cells
these two planes caused by the length of the
and is devoid of hair follicles, pigment and
bone. For femur, the overall maximum length
sweat glands. Vascularity in a scar is also less.
from the head to the medial condyle is meas-
ured. For tibia, the maximum length from All permanent scars, in the truest sense
the lateral condyle to the tip of the medial of their histological morphology, are penna-
malleolus is measured. The intercondylar nent, which may change in their sizes dur-
eminences must be avoided. For fibula, the ing the growing ages, but their shapes re-
length between the tip of the head and the main unchanged throughout the life, if there
tip of the lateral malleolus is measured. For is no keloid fonnation or any other interfer-
radius, the greatest length from the medial ence.
margin of the head to the tip of the styloid "Superficial scars" are the result ofheal-
process and for ulna, the length from the top ing of abrasions which are temporary in na-
of the head to the tip of the styloid process ture without any change in the histological
are measured. Wet or humid bones are structure of the tissue . Permanent scars re-
slightly longer than the dry ones. While meas- flect involvement of tissue, deeper than the
uring humid bones, some authors have rec- epithelial covering, either in the fonn of in-
ommended deduction of 7mm in case of fe- jury or in the fonn of infeCtion.
mur, 5 mm in case oftibia, 5 mm in case of
humerus and 3 mm in case of radius to bring Medicolegal aspects of Scars
the lengths of the bones at par with the
lengths at their dried state. It is known that 1. Scars, being pennanent in nature, which
the left femur, the right humerus and the do not change in shape and relative posi-
right radius are sometimes slightly longer tion with anatomical landm.arks of the
than the bones on the opposite sides. But body, are good identification marks. To
these differences are subjected to extreme record a scar as identification mark, it is
degree of individual variations. Hence, for all to be noted in tem1S of its size, shape,
practical purposes the differences need not site in relation to two anatomical land-
be taken into consideration while calculat- marks, whether raised or depressed in
ing the stature from these bones. To main- relation to the surrounding area and
tain a uniform standard, some authors have whether freely movable or fixed with the
recommended use of right side bones only. deeper tissue. A keloid resulting from a
But maintenance of such unifonn standard scar cannot be used as an identification
cannot assure increased accuracy ofthe esti- mark because it may change both in
mated stature. Further the right side bones shape and size. Vaccination marks and
may not always be available . To reach near- pock marks though scars, cannot be used
est to the exact stature, one should examine as identification marks because of their
as many of these long bones as available, and common appearance in many persons.
the average of all should be recorded as the 2. Age or duration of formation of the scar
estimated stature of the person. is important because that can link the

chapter 4: IDENTIFICATION OF INDIVIDUA L I 153
pen:on with a criminal assault or circum- 4. The weapon of offence can be detemlined
5tance. From the appearance of the scar, from the shape of the scar. In case of a
a rough idea about its age or the time scar resulting from a stab wound, the
lapsed after infliction of the injury which 'w eapon of offence can be detennined as
has caused it, can be fonned. noted in the above paragraph. In case of
\\nen not infected, a sharp and not very linear scar resulting from an incised
deep injury heals completely with fonna- wound, a weapon with a sharp edge must
tion of a scar, by 5th or 6th day. Deep have been used . Irregular scar of a Iacer-
and gaping injuries, injuries being in- ated wound produced by hard blunt or
fected or having low blood supply or with rough weapon may or may not be deeply
low ,;tality of the person, all delay the attached. Scar resulting from a punctured
process of healing and scar fom1ation. wound caused by a bullet is circular or
After fo1mation, for some days a "recent oval with irregular margin and is slightly
scar" is soft, tender and reddish or bluish depressed and deeply attached.
in colour ("angry looking scar") . During 5. Infection of the injury may cause wide,
this period, blood supply in the scar is irregular and raised scar.
more. These features continue till the end 6. Scar causing pennanent disfiguration of
of the second week. After the second the head and face amounts to grievous
week it looks pale but is still soft and may hmt.
still be slightly tender. Between 2 to 6
7. Scar causing contracture at or around a
months, the scar is brownish, not tender
joint restricting the movement or func-
but still moderately soft. After this pe-
tion of the joint amounts to grievous hurt.
riod, the scar is tough and its surface is
8. Scar over cornea amounts to grievous
corrugated or creased due to contraction
hurt by way of causing pennanent, total
of the scar tissue.
or partial loss of vision.
3. Type of injury: From the shape of the scar
9. Scar at cubital fossa or dorsum of hand
it can be said whether it is the result of
may indicate drug addiction: Such scars
an incised, lacerated or stab wound. In
are caused due to intravenous injections
case of an incised wound, the shape of
of the drug, at the same site, over a long
the scar is elliptical, oval or linear. Scars
period.
of incised wounds may not have deep at-
10. Striae gr avidarum indicate past or
tachment. In case of a lacerated wound,
present preguancy.
the shape of the scar is irregular. In case
of a stab wound, depending on the shape 11. Scar due to injury inflicted on the vic-
of the weapon or blade , the scar may be tim, may be claimed by the accused party
elliptical (double-edged sharp cutting as to be due to infective ulcer.
weapon), oval (double-edged sharp cutting 12. Scar resulting from infection and ulcer
weapnn), circular (a pointed conical may be claimed by a person as to be due
weapon), irregular (a cylindrical or quad- to injury.
rangular weapon) or triangular (single 13. A scar may be removed by plastic sur-
edged sharp cutting weapon). Scar of a gery, or its shape and size may be
stab wound will have deep attachment. changed by surgical operation or by caus-

ing further injury there, to escape iden- TATTOO.MAAKS

tification or to avoid implication with a ------~--------.1
criminal offence .
Tattoo marks are fairly good identification
14. A scar may be caused to remove a tattoo
marks, both for living and dead subjects.
mark ordestroy the fingerprint pattern,
These may give wide range of inforn1ations
to avoid identification . about the person possessing them.
15. Scars in some circumstances as discussed
Mode of production -Tattoo marks are
above may amount to grievous hurt. But
produced by imprintingpigments of different
keloids of any size and any placement
colours in the dennis . by multiple puncture
though might have resulted from scars
method. This may be done mechanically or
will not amount to grievous hurt , because
keloids are formed due to personal fac- by electrical device (battery operatedJ .
tors and not due to the injury directly. Pigments used -Carbon dust, Indian ink,
16. An apparentlyinvisible scar may be made indigo, chinese black, prussian blue , cinna-
visible by use ofultraviolet rays , applica- bar, cobalt, vennilion.
tion ofheat or by rubbing. Small and faint Duration of stay of tattoo marks- Tattoo
scars can be examined properly by a mag- marks are fairly pennanent, and stay life-long
nifying glass . if the pigments are placed in the dennis and
17. Scar marks being fonned of fibrous tis- on the covered parts ofthe body. They may
sue with less vascularity, resist decom- fade away, 1) if the pigment is placed in the
position and as such can help identifica- sub-epithelial level; 2) if these are imprinted
tion of a grossly decomposed dead body. on the exposed parts of the body (due to ex-
4 .114: Tattoo mark indicates Fig. 4.115: Tattoo mark showing sexually
mental status perversive mental status

chapter 4: IDENTIFICATION OF INDIVIDUAL I 1SS
Rg . 4.119: Callosities at left knee and ankle

due to regular practice of "Namaz"
Fig. 4.11 B: Keloid (by courtesy Dr. Nayan K. Mohanty.

S.C.B. Medical College, Cuttacl<) Fig . 4.120: Keloid

posure to sunlight); 3) if imprinted on those in the lymph gland for the concemed part of
parts of the body which are subjected to con- the body by histological examination (practi-
stant friction. In these cases the marks may cable only in dead bodies of course).
fade away by 8 to 10 years. Examination of tattoo marks-Tattoo
For various reasons a person may like to marks are to be examined in respect of their
remove ta,ttoo marks , including intention to number, situation, dimension, colour, design,
evade identification. · etc. A diagramnmtic or photographic evidence
may be kept.
Removal of tattoo marks-Tattoo marks
may be removed in more than one way. More MEDICO-LEGAL IMPORTANCES- Tat-
successful removal depends on size , age of too marks tell us about the identity, mental
tattoo mark (old. ones an~ comparatively dif- make up, social status, desire and mental in-
ficult to remove), level of injection of pig- clination of the person.
ments in the skin (if injected at the same level 1. In connection with identification it may
removal is easier). give an idea about : a) Race/ethnicity,
Methods -(1) Excision of the skin in- b) Nationality, c) Occupation, dl Religion,
volved . For a larger tattoo mark , the exci- el Travel, f) Language, gJ Nam.e of the
sion may be done in phases and the margins person, h) Name of the relative, friend
are stitched up. Later skin grafting may be or lover.
done. (2) The skin involved may be frozen by 2. The design of a flower, obscene figure ,
application of freezing agent. Then the fro- an idol, etc. tell about the mental make
zen area is abraded and cracked and the tis- up , desire, inclination. religion. nation-
sue involved is reduced to dust and removed . ality, occupation and place of travel of the
(3l Simple vigorous abrasion after application person.
of saline over the area. Help of local anaes- 3. A faded tattoo mark may be made visible
thetic agent is necessary here. (4) Some Q- by use of ultra-violet light, rubbing the
switched lasers may be used after use of lo- area and using a hand lens.
cal anaesthetic agent. Pulses of light from
4. In case of dead bodies if the tattoo mark
the laser is to break the pigment material.
appears to have been obliterated or has
The isolated pigments are removed by
become invisible then the pigments used
macrophages. (5) by using corrosive agent .
can be detected in the nearest lymph
(6) by electrolysis , (7) by inflicting bum in-
glands concerned.
jury over the area.
5. In decomposed dead bodies, the invisible
Whatever the method is used, some evi-
marks become prominent on removal of
dence of the same (removal) remains on the
the epidermis.
area .
6. Artificial obliteration of tattoo marks is
Evidence of tattoo mark when it has faded strongly suggestive of attempt to conceal
away or has been removed - 1. The invisible
the identity with criminal background.
tattoo mark when faded away may be made
visible by exposure to ultra-violet light, by 7. Sometimes, the same design may be im-
rubbing the doubtful area and using a hand printed on the identical body parts of dif-
lens. 2. Even if the mark is absolutely invis- ferent individuals.
ible or has been removed artificially, the pig- 8. Tattooing, in a few cases may cause infec-
ments used to produce them may be detected tion , sepsis , ulcers and keloid formation.

chapleT 4: IDENTIFICATION OF INDIVIDUAL I 157
9. Tattooing may be caused due to impreg- 5. Most characteristics mental and moral
nation ofunburnt or semi-burnt gunpow- qualities.
der of a fired cartridge, surrounding the Bertillon's method of scientific indexing
main injury caused by the bullet or pel- and filing of the physical descriptions of a
lets and tell about the distance of firing person is for the purpose ofhis future identi-
from the victim. These are called invol- fication which is considered as means of"spo-
untary tattoo marks. ken portrait".
Bertillon's observation on iden tification
ANTHROPOMETRY AND IDENTIFICATION from ear-His method was not for unique-
(Bertillon's System of Identification) ness of the ears which he m.eant to suggest
as "it is in fact almost impossible to meet with
two ears which are identical in all their parts".
In 1883. Alphonse Bertillon 1 , a French police
He reconunended recording of all features of
officer and expert introduced the system of
ears but did not tell anything about partial
recording of a detailed spoken portrait ("por-
and pressure distortion of ear impression, in
trait parle") including pre6se body measure-
connection with establishment of identity. In
ments canthropometry) of a subject, as data
tbe ear his method suggests to collect data of
for identification of the subject.
(a) 3 portions of the body of the ear (helix),
As the bodily measurements are not ex- including its degree of openness, (b) contour
pected to vary after 21 years of age (except of the ear and its degree of adherence with
very little variation in stature), this system the cheek and the dimensions of the lobule,
of recording the physical identification fea- (c) the degree of inclination of the ear in dif.
tures of a person is applicable in adult sub- ferent positions along with the degree of re-
jects (above 21 years of age). The djfferent versing forward of the antitragus, (d) degree
data recorded in the Bertillon's system of of windings of both ascending and median
identification are - antihelix.
1. Descriptive d a ta of hair, eyes, complex- EAR-PRINT IDENTIFICATION HAS NO
ion and shape of nose, ears and chin and STATUS AS YET.
colour of cleft) iris. Dis adva ntage of Bertillon's system of
2. Bodily marks like moles, scars and tat- identification is that, possible inaccuracy in
too marks. measurements may lead to wrong identifica-
3. Bodily measurements like height, antero- tion or difficulty in proper identification.
posterior diameters of head and trunk, Full recording of Bertillon's anthropo-
span of outstretched arms; length of left metric data requires about 15 pages.
foot. left foreann, left middle and little Bertillon's claim was that if all the data
fingers and length and breadth of right as per his reconunendation were given due
ear. attention and recorded, then chance of simi-
4 Photographs of front and right profile larity of one individual with another was 1 in
"iews of the head cand face). 286, 435, 456.
But Bertillon's system of identification is
-r:.~:r x =*-: r;.-: .: i s-~o "'s ·s9naebc lnS1rucl•onwhteh •ncllded theory
presently discarded all over the world as it
r : :-r-.c~ :- ;r--.:~·: ~~·..,:ahler"•fiCattOn translated b'f R W McCmghry '"
-~:T.Y:" ~ ~-:s:·-=-: .SA.., 18F"' in addition to being a cumbersome process

could not provide dependable individualistic 2. The patteniS remain unchanged in an

data for identification. Bertillon never en- individuals throughout his/her life, and,
gaged himself in the research work over this. 3. Study of the ridge patterns in the finger-
He did not t:ome up to the status of a reliable prints, available at the scene of crime,
.and successful scientist. may help identification of the offender
when these are compared with finger-
prints of known criminals or suspects.
STUDY OF FINGERPRINTS AS A METHOD After Dr. Faulds, Sir William James
OF IDENTIFICATION Herschel , a British officer posted in the
Hooghly district of Bengal iu Iudia, claimed
Study of fingerprints as a method of identifi- in the same magazine "Nature" that he used
cation is also known as DACTYLOGRAPHY fingerprints (actually palm prints) for identi-
or DACTYLOSCOPY, and at present also as fication of pensioneers and prisoners.
HENRY-GALTON SYSTEM OF IDENTIFI- But the first mentionable study on fin-
CATION . gerprint was done by Sir Francis Galton in
Dactylography is the process of taking the 1892. In his book "Fingerprint" he observed
impression of papillary or friction ridges of that, a) ridge patterns of any two fingers dif-
the finger tips, for the purpose of identifica- fer and the patterns are never identical in
tion of a person. IDENTIFICATION BY TillS two persons \; the ridge patterns in an indi-
METHOD IS ABSOLUTE , without any vidual never change. In the book, he dis-
chance of error. cussed the methods of classification and re-
cording of fingerprints.
History of finger printing
Sir Edward Henry, who later became com-
Papillary ridges like carvings ofprehistoric missioner of Scotland Yard, studied in his
age have been discovered on a cliff of Nova official capacity, the applied aspects of Galton's
Scotia. Use of fingerprints were practised in observations and reconm1endations. Mean-
official documents of China. dating as back while in Argentina, Juan Vucetick applied the
as 3000 B.C It was alsc in nse in ancient In- study of fingerprints for identification of crimi-
dian docmnents. The dimension of the pur- nals. Vucetick developed his own system of
poses of these uses are of course not clear. classification of tidge patterns.
M. Mulpighi 11680 ). a professor of Edward Henry partly modified Galton's
Anatomy , was the first to make scientific system of fingerprint study, which was offi-
study of ridge pattems of fingers . J. E . cially introduced in the process of investiga-
Purkinje, another professor of anatomy, for tion in England and Wales in 1901, and that
the first time, classified different fingerprints system of fingerprint study is still in effect in
into 9 types, depending on the diversified ridge most of the countries of the world, which is
patterns. Dr. Henry Faulds (1880), from To- popularly known as Henry-Galton system or
kyo , first published au article in "Nature" simply Galton's system of identification.
tnentioning that,
Types of fingerprints
1. The distribution of ridge patterns are
extremely divergent in different individu- Primarily there are 4 types of ridge patterns .
als. '.'" · ,, According to the percentage of their distri-

chapter 4: IDENTIFICATION OF INDIVIDUA L / 159
II a
Core
Delta
Core
Core
•
Delta Core
Delt Delta
c c e e
Fig. 4.121 : Primary finger pnnt type, based on ridge-pattern-

(a) arch , (b) loop, (c) whorl , (d) pocke! loop, (e) tented arch , (f) composite (twin loop)
bution in the whole population of the world, or a single ridge runs spirally in multiple
these are- rounds.
Loop about65% Arch-In arches, the ridges start from one
Whorl side and after proceeding for some distance
about25%
take backward course to end in the opposite
Arch about 7% side. In PLAIN ARCH, the ridges make a
Composite about2- 3% wave-like curve without sharp or spike-like
rise at the curving point. In TENTED ARCH,
Of the four types, composite type is not there is sharp or spike-like rise forming an
considered by many as a separate type. It is acute angle at the curving point.
rather taken by some as a combination ofloop
Composit~In composite variety, there
and whorl, or two loops or 2 whorls of sepa-
is a combination of more than one pattern,
rate origin in one fingertip .
either a combination of whorl and loop pat-
To these distinctly identified ridge patterns, or two different loop patterns (twin or
terns. some add one more type, termed as double loop), or two whorl patterns or an arch
accidental variety, where no specific ridge and a loop.
pattem is available. In a CENTRAL POCKET LOOP, sur-
Loop-In loops, the ridges start from one rounding a central circular or oval ridge,
side. run in parallel lines and then curve there are other ridges which take loop like
backward to terminate in the same side of course.
its origin . If the ridges start and temrinate In loops or whorls, the main part of ridge
from and in m.e dial side of the finger, then pattern (the inner part) is surrounded by two
the loop is called ULNAR LOOP. Ifthese start series of divergent ridges known as TYPE
and end at the lateral side then it is termed UNES The point of outermost ridge (in the
as RADIAL LOOP. loop or whorl pattern), which is nearest to
Whorl-In whorls, there are multiple cir- the divergent type lines, is the DELTA and
cular or oval ridges, one arom1d the other, the apparent central point of the ridge pat-

tern is the CORE . Actually the core is the

16+ 8 + 4 + 2 + 1 + 1 32
distalmost point of the innennost ridge from
16+ 8 + 4 + 2 + 1 + 1 32
the delta in case of a loop. In case of a whorl,
the central point of circular or oval whorl or At the next stage the total score at the
the inner starting point of a spiral whorl is numerator is multiplied by the total score at
the core. In whorls and pocket loops, there the denominator. In final calculation this
are two deltas, one on each side. When the gives a maximum of 32 x 32 = 1,024 score.
two deltas are connected by a line, it does
Ifno whorl is present in any of the fin-
not touch the itmer circular or oval ridge or
gers, then the score distribution will be:
ridges, in case of a pocket loop . But in case of
whorls, the line touches or cuts at least one
0+0+0+0+0+1 1
circular or oval ridge. Arches have no deltas . 0+0+0+0+0+1 1
Maintenance offmgerprint records-The
F .B.I. (Federal Bureau of Investigation) of or, 1 x 1 = 1 will be the ultimate score.
U .S.A. maintains records· of more than This way, due to presence or absence of
twenty millions (two croresl offingerprints. whorl in fingers any number from 1 to 1,024
Yet, when necessary for comparative study, can be the total score. On the basis of this
any desired fingerprint can be searched out scoring, a total of 1,024 boxes or files are made
in a nrinute or two. This is possible due to which are tenned "pigeon holes". According
systematic maintenance of separate files for to the total score of a person his fingerprint
different types of prints. There are eight suc- is preserved in the box or file bearing the
cessive classifications of fingerprints. In the same number. Khan Bahadur Azizul Haque
primary classification, different scores areal- invented this primary classification for sys-
located for presence of whorl pattern in dif-
tematic recording and Rai Bahadur
ferent fingers of each hand. For presence of
He1i1chandra Bose invented the secondary
a whorl in right thumb or right index finger
classification (not mentioned in this book).
16 score is awarded. If whorls are present in
Both of them were from Bengal.
the right middle or ring finger then 8 score
is awarded for each place. For whorl, in right In 60% of the world population, there is
little finger or left thumb 4 score is allowed no whorl in any finger. For all of them the
for each place. For whorls at left index or score on primary classification is 1. But there
nriddle finger 2 score and for whorls at left are other subsequent classifications which
ring or left little finger 1 score is awarded. distribute the fingerprints efficiently, so that,
No scores are awarded for fingers where no when necessary for comparative study of one
whorls are present. The scores are then ar- with another, the desired fingerprint can be
ranged as below: very easily and quickly searched out.
R.I. + R.R. + L.T.,+ L.M. + L.L. + 1
Method of fingerprinting
R.T + R.M + R.L.I+ L.I. + L.R. + 1
Fingerprints are taken with the help of print-
R.I.= right index, R.T. =right thumb, etc . er's ink, on non-glazed papers, after cleaning
In both numerator and denominator po- and drying the fingertips.
sitions, 1 score is added for convenience of
It may be taken in two ways:
calculation. Thus, if whorl is present in each
finger then counting will be as follows: (n) Plain method; (b) Rolled method

b ; :ain method , the inked finger is In addition to the latent or invisible fin-
tr.::~t in cont~ct with the paper and pressed gerprints, visible fingerprints may be present
~n::y - rolled mE:>thod one side ofthe inked at the scene of crime. VISIBLE FINGER-
fingl:- mp is gently pressed on the paper and PRINTS may be left at the scene of crime ,
then ~ithout lifting, it is rolled on the paper when finger touches something after being
~ that maximum. area of the ridge pattern stained with blood or some such materials
leav.:=:; irs impression. and also as due to sabaceous secretion on fin-
gertips and suitable surface of contact.
It is recommended that for each indi-
vid·Ja.l . both plain and rolled impressions of PLASTIC FINGERPRINTS are fingertip
the :':ngertip should be taken. The rolled print impressions left on soft materials like soap
gives the impression of a larger area and the
or wax or similar material pressure on which
by a finger produces inverted replica of the
plain impression, which is mo.r e clear, helps
ridge patterns, i.e., the raised ridges produce
to ~b eck ridge pattern at a particular place,
depressive lines .
if the rolled impression is blurred at that
place. Development of latent fingerpr·ints-The
invisible or faintly or partly visible finger-
PATEKT F C\GER PRINTS-These are
prints can be developed by using various de-
impresions of unknown origin but are as such
veloping agents. The choice of the develop-
prominent and clearly visible, due to dirt, ing agent depends on the type of the surface
sweat, paint or any such material present in needed to be searched for fingerprint. When
the fingert ips which produce them. the surface is hard and non-absorbent for the
sebaceous secretion, like glass , porcelain,
painted or sunmica-covered wooden furniture
LATENT OR CHANCE FINGERPRINTS or metallic article, some developing powder
(Invisible fingerprints)
is used. For soft absorbent surfaces like pa·
per, cardboard or cloths, chemicals like io-
The fingertips are usually layered with seba- dine vapour, silver nitrate and ninhydrin
ceous secretion like other parts of the body. (triketohydrindene hydrate ) are suitable (vide
Due to this oily sebaceous secretion, when- Table 4.17).
ever a person touches some material, he
Lifting of fin~erprin.t s-Latent finger-
leaYes the impression of his fingertips over
prints on paper or small articles can be pre-
the material. These impressions or finger-
served a~er development. But when they are ·
prints are not ordinarily visible . But by deal-
on a large inunovable hard surface, the print
ing with certain chemicals, these can be de-
can be lifted for preseiVation after being de-
veloped and made visible. Such fmgerprints veloped. An adhesive cellophane paper may
which are as such not visible but can be so be used in these cases. After photography of
deYeloped and made visible are called LA- the fingerprint developed with powder, the
TE)J'T FINGERPRINTS or INVISIBLE FIN- adhesive surface of the cellophane tape is
GERPRINTS. pressed on the print and then taken out gen-
Latent fingerprints of the offender is tly and pasted against a cardboard sheet. The
searched for on articles at the scene of crime. powdered fingerprint pattern is lifted by the
If any such fingerprint is obtained by chance adhesive smface of the tape and is thus pre-
then that is called CHANCE FINGERPRINT. served pennanently. This method is app!ic,!!-.
r .1': .., . . _ _
. ~· ... ": :-~ -:
rF M - 111
i
I Table4.17: Dilfefentmethods of develOJlllent of latent fingerpnnts
Developing Agents Method of use Developed feature Remarl<s
Grey powder (Aluminium dust) Spreaded over by a camel hair Powder stick to the sebaceous For good con~ast, used on dark
brush secretion in the line of ridges coloured surface. Developed
print can be lifted for preseNa·
non.
Black powder -<b- -dJ- Used on light or ~A'hite coloured
(mainly charcoal) surface. Can be lifted for
preseNation.
Iodine vapour · SurfaCB with latent print held Ridges take yelloWish brown Should be photogaphed imme-
over vapour colour diately after being developed,
as the developed print disappe-
ars in absence of iodine vapour.
Ninhydrin 0.6% soln. in Paper sprayed ~~th/or dipped · Ridges appear in maroon or Amino-acids present in seba-
acetone or ethyle alcohol in soln-. for 1 to 48 hours purple colour ceous secretion react with
depending on age of the ninhydrin. Most suitable for
print; old print may need old prints.
heatof80"C to 100"C
Silver nitrate 3% soln. in Brush-painted on the surface of Black or reddish brown colour With chloride of sweat forms
water the paper of the ridges silver chloride which changes
to metallic silver. It destroys
chemical p·operty of the print.
Hence used only ~en other
~above chemical methods faiL
Radioactive substance or X-fay Radiography Ridge pat!em develops Used for prints over skin
(Grenz ray technique) on the film surface or clothes A difficult
technique
ble when some powder is used for develop- data on the basis of characteristics like, ridge
ment. endings , ridge bifurcation and average dirc~c
Fingerprint study by use of computer- tion of ridges. The FINDER system takes 8
fingers into account excluding little fingers
The use of computer system for automatic
ofboth hands.
reading, classification and codification of fin-
gerprint is in much progress. The light re- Comparative study of two fingerprints--
flected from a fingerprint can be measured Apart from the type of ridge pattem, certain
and converted to digital data which is classi- other features of the fingerprints are also
fied in the computer which stores it in its taken into consideration. All of course are
memory for future comparative study with related with the ridges. For comparison, only
others. FINDER II (FINgerprint reaDER) is small portions of identical parts of the two
a computerised autor ttic fingerprint read- fingerprints are studied. 1 sq. em area is suf~
ing system used by F.B.I. ofU. S.A. which can ficient. The two prints are compared on the
record each fingerprint data in % second. The following points, as regards their placement
FINDER computerised system records the in relation to the delta or core.

chapler 4~ IDENTIFICATION OF INDIVIDUAL I 16.1
Points ofcomparison between two finger- the ridges get their norn1al shapes and
prints- 1. Ridge pattern, 2 . Ridge endings, sizes.
3. ::\lissing ridge, 4. Gap iu two ridges, 7. Rough idea about the age of a fingerprint
5. R1dge breaking, 6. Ridge bifurcation, can be made by studying the migration
7. Ridge re-union, 8. A dot in the ridge-gap, of the chloride ions from the fingerprint.
9 A ~tud in the ridge. 10. An island fonna- (Chloride is present in the sebaceous se-
rion . 11. A ~ake formation, 12. A dot in a lake, cretion which gradually vanishes from
13. t:nion oftwo ridges, 14. Starting of anew the fingerprint.) ·
ridge i."l between two ridges, 15. Pre.;;ence of
8. To apprehend internationally operating
a scar. 16. Distance between delta and core,
criminals, details of fingerprints can be
17. Number of ridges between delta and core,
sent from one country to another, by tel-
18. Direction of any particular ridge (tracing
econmmnication system.
from either the delta or the core ) etc. See
Fig. 4.124. The absolute authenticity of fingerprint
as infallible identification mark has been chal-
Adva ntages of fingerprints as lenged in a few occassions: DNA has been
identification marks advocated by them as more dependable. But
it must be remembered that DNA profile of
1. The ridge pattern once developed in an
same parenthood may give similar DNA pro-
individual in the intra-uterine life, re-
file in siblings. Whereas finger print patterns
mains unchanged for the rest of the life.
of uniovular twins also vary, and are not iden-
2. No two fingerprints can be identical This tical These fingertip friction ridges are not
is true even for uniovular twins. So, only penuanent, they are unique for an indi-
matching oft.wo fingerprints makes fixa- viduaL because they are f01med due to ge-
t ion of identity infalliable. netic factors with influence of some other
3. Millions of fingerprints can be stored in factors like movemen~ of foetus, maternal
such a systematic way that, whenever diet and temperature. Its fonnation is ran-
necessary, the desired print can easily be dom during foetal life.
searched out for study.
However, it is a logistic argument that
4. Criminals often leave their fingerprints latent fingerprint though developed with
at the site of crime, unknowingly or un- maximum care may be deceptive or mean-
consciously, which though not apparently ingless due to being of a small area, lack of
visible, can subsequently be developed prominency and often being fragmented or
and made visible for successful study.
distorted.
5. Fingerprints can be taken from even
highly decomposed dead bodies. either
from the peeled off epidennis of the fin- POROSCOPY
get-s or from the dennis when the epi-
dernris is lost. Study of pores on the palmar aspect of finger
6. Fingerprints can be taken even from was first explored and used by Dr. Edmond
mummifted dead bodies by dipping t.he Locard, the famous French criminologist, in
dissected out finger tips in weak alkaline the year 1912. Pores are placed all over our
solution, when the finger tips along with body to excretf' fluid and waists. Whereas

other body parts have about 400 pores per soles of shoes and the SECONDARY mark-
sq. inch. Palm, palmar aspect of fingertips, ings are due to changes which occur in shoe-
soles and solar aspect of toes may have up to soles due to use, and these markings are in-
about 4,000 pores per sq. inch. In these places dividualistic. It should be remembered that
there are about 1,000 pores on au averge per the primary marks last comparatively longer
sq. inch. Their shape , size, their inter dis- but the secondary nmrks are subjected to con-
tance from each other on a ridge vary. Hence stant change.
close study of these particulars, if rightly im- The following additional points are. to be
pressed on suitable papers with suitable ink, noted irrespective of whether they are due
and studied by expert in poroscopy then, it is to bare soles or soles of the shoes -
claimed that individual identification is pos-
1. Whether there is more than one set of
sible when matched with good quality of fin-
the print at the site of inspection.
gerprint. However, some points should be re-
membered. These are - the quality ofink and 2. The side of additional pressure or incli-
paper must be good and suitable . There nation.
should not be any dust or dehtis on the pa- 3. The tortion ofthe prints.
per. The pressure applied for taking the print 4. The direction and extent of the different
should be just adequate. Humidity, excess footprints at the scene.
sweating due to hit, fear or excitement, dis- 5. The gap between the same type of prints
ease or drug and food habit may foil the ef- due to stepping.
fort . Fingertips should be clean, non-greasy
6. Alw abnonnality, like absence of impres-
and not wet. Size and shape of the pores vary
sion of a particular toe in all of a particu-
to cause extra sweating in some circum-
lar type of print.
stances.
7. Di1:nensious of eacl1 footprint.
Like fingerprints, footprints may also be left .-

by the offender at the scene of crime. Foot-
prints, whether of bare foot or with shoes,
can be individualistic. Only a small portion
of the sole of the foot or shoe should be suffi-
' ..
cient for comparison purpose.
In case ofbarefoot impression, the ridges
or creases of particular areas of the soles
when available are comparable and studied. . '
..
In case of shoes, different primary and
secondary markings on the soles of shoes are
compared. Th~se marks in one sense are like -
the prinmry and secondary marks present on Fig. 4 .122: Photograph of a fingerprint showing
the surface of a used bullet. The PRIMARY details of a radial loop, with different
features of individual ridges
markings tell about the make of the shoes or

6 3
7 ~~~\ ~.. ,,
5 • '•' ~'IJ 6
8
9
5
~~~· * '
~~ ,>'
·:!:: •
, . . :- '!";";. 4
-:r
(a) (b)
Fig . 4.123: Showing comparative study of two fingerprints (two whorls) [taken from 2 sources]
(compare pointwise)
/
I
a b c d e
g h k
Fig . 4.124; Individual patterns of ridges-(a) Ridge breaking, (b) Ridge bifurcation, (c) Ridge
union. (d) Ridge reunion, (e) A stud in break, (f) A lake, (g) Ridge curving, (h) A
dot in an island , (i) An island without dot, Ul Ridge ending, (k) Missing ridge
Fig. 4 .126: Latent fingerprint developed by iodine,

F.-g. 4.125: Fingerprint and photographed •
•·.
166 / PRINCIPLES OF FORENS•C MEDiCINE
P ert
Impression
_,...,...'
,;.:::::---;::No
• Contactv
/ -
lnelination
··,.,,
1 ):·.. - ·'
I ..... '1-:
I
L_
Fig . 4.127: Soie print of foot
soft surface
011 a
Fig. 4.129: Plaster cas t of shoe print on muddy soil

taken fro m the spot of Fig 4.70(a). Comp::u e Fig. 4 .130: Flasier cact of foot print on
the 2 pictures pointwisE! mud (!:>are foot)

factor (style of walk), type of sole (soft, hard,

spongy, deeply groove designs) and the na-
ture of soil (muddy, sandy, grassy or hard and
presence ofblood and some such things).
It should also be remembered that to
avoid confusion or distortion of footprints of
the offenders, everybody at the scene of crime
should walk on a fixed demarcated track.
Recording and preservation of footprints :
1. Footprints can be directly photographed
from the scene of crime when it is promi-
nent on some smooth surface .
2. Cast preparation with plaster of Paris is
suitable when the prints have depth, as
in case of prints on muddy or soft yield-
ing surface.
Fig . 4.131 : Shoe sole photograph. Note the
primary and secondary marks 3. On grassy field, the irregular shape of the
footprints can be given regular shapes by
It should be remembered that production placing a glass plate on the place, which
of footprint impression depends on personal can then be photographed .
Type- II
~I
Type-Ill Type:- IV
Type-V
Fig . 4.132: Lipprint--direcl Fig . 4.133: Different types of lip-prints: Type I- clear cut grooves
impression of lips running vertically over the lips , Type I' - partial length
.>tained with lipstick grooves of type I variety. Type II - branched groo:ves,
Type Ill ~ intersected grooves. Type IV - reticular
grooves, Type V - other non-classified

168 / PRINCIPLES OF FO RE NSIC MEDICINE
4. Lifting of footptints with the help of ad- Type ill - Intersected grooves
hesive celophane paper-This is helpful Type IV - Reticular grooves
when the prints are on hard surface, hav- Type V - Other patterns (irregular non-
ing no depth and the colour of the prints classified patterns).
are same with the colour of the surface,
It is thought that, lip prints show dissimi-
so that plaster casting or direct photog-
larity amongst individuals. It is also thought
raphy will not be helpful for·recording of
that hereditary factors may have some influ-
the prints.
ence on the lip groove patterns. However,
Uses of footprints: influence of seasons and age over the lip
1. For identification of the offenders (from groove patterns remains a problem in its
the prints available at the scene of crime). popular use as life-long constant identifica-
2. · To record as identification marks of the tion feature.
newborn children in a maternity hospi- Though there may have some arguments
taL This is done to avoid chance or change in favour of using lip-print for identification
or mixing up of children in maternity this 'evidence' alone should not be taken as
hospitals, as all new born infants may look conclusive. There has been instances in some
more or less alike and as in case of in- countries when verdict dispensed on the ba-
fants fingerprint impressions are not very sis oflip-print alone had to be reversed later.
prominent and hence not easy for com- It is not in practice in India.
parative study.
Lip-prints on wine bottles, glasses or on love Ridges on the surface of nails, their number,
letters have in some occasions helped distribution, dimensions of each ridge, their
indentification of the concerned persons. depressions and elevations, all combined, are
LeMoyne S~yder ( 1950), pointed out that claimed by some to fom1 individual identifi-
wrinkles and cracks oflips have certain indication features.
vidualistic characteristics like fingerprints .
Santosh classified wrinkles and grooves
of lips into simple and compound types and
then sub-divided them in 8 types for the pur- The anterior part of the palate has laterally
pose of personal identification. Kazuo Suzuki extended curved ridges and grooves which are
and Yasuo Tsuchihashi (1970) tenned the lip- considered very much individualistic in their
prints containing grooves as "figura linearum patterns.
labiorum .robrorum" and classified them into
the following types: (See Figs. 4.132, 4.133,
page 167).
Type I - Clear-cut grooves rwming verti-
cally over the lips
Type I' - Partial length grooves of Type I
variety
Fig. 4.134: Nail Ridges
Type II - Branched grooves

chapter 4: IDENTIFICATION OF INDIVIDUAL I F69
4. DNA typing for matching and identifica-

DENT!FICATION FROM HAIR
edico-legal aspects of hair and other tions.
fabrics) 5. Whether bleached or any dye has been
used.
Hair is appendage of mammalian skin. It 6. If hair bulb is present, then the blood
grv~s from a root inside two sheaths from group of the person concerned.
within hair follicle under the surface of skin. 7. If any idea about the occupation of the
Root i:o co,·ered by an inner sheath and an person concerned can be made from the
:uter sheath. The shaft of the hair above the hair.
sian i:o made of strong proteinous structure - 8. If any trace material (trace evidence) can
keratin. Growth of hair follicle occurs in re- be detected from the hair, which can help
peated chronological phases, namely, anagen, identification of the person concerned .
caragen and telogen. Anagen phase is active 9. Is the hair identical with the hair of the
phase and hair grows maximum during this victim. or the accused ?
phase. Catagen phase is transition phase when
B. Concerning other medicolegal aspects:
the follicle shrinks, hair growth begins to slow
down and the met~bolic activity reduces . 1. To which part of the body did the hair
Telogen phase is the resting phase with stop- belong? <It is important in circumstances
page of metabolic activity and growth ofhair. like rape or other sex offences, as in case
After this phase recycling of phases with of sodomy detection of pubic hair from
anagen starts again. A new hair grows push- around the region of anus.)
ing out the old one. In addition to some evi- 2. Whether taken out forcibly or fallen oft
dence of ABO group substances in the hair naturally (to indicate presence or absence
shaft, satisfactory serological test can be per- of struggle) ?
fonned for ABO grouping and enzyme typing 3. To establish relationship between the of-
with the root. At present nuclear and mito-. fence, offender and the victim (e.g., de-
chondrial DNA study to know the origin of tection of a foreign female pubic hair on
hair is done even in absence of root, though the glans penis of the accused in an al-
there is some controversy about nuclear DNA leged case of rape), and sometime the
typing which is thought to give positive result offending weapon (as in case of assault
if the shaft is contaminated with sweat, etc. with the weapon).
But mitochondrial DNA typing is reliable, 4. Cause of death (Heavy metal poisoning).
though presently a lengthy process. The
5. Type of injury.
method should rather be adapted after screen-
ing by conventional microscopes. 6. Type ofwe:::.tJon used.
7. When nature of death is homicidal, pres-
Different medicolegal questions which
ence ofhair in the grip of the hand of the
may arise in connection with hair are related
deceased which is in a state of cadaveric
to identification of a person and other medi-
spasm, tell about the homicidal nature
colegal aspects. To enumerate them,
of the death and help detection of the
A Concerning identification of a person assailant, if the hair did not belong to the
1. Is the material hair or some other fibre ? deceased himself
2. If hair, is it human or animal hair? 8. Detection of certain poisoning cases.
3. If of human being, then its, (a) race, (b) 9. Singeing of hair has importance in death
sex and (c) age. due to bum or _fire-ann ~ju~~~·

10. Time since death can be estimated from ibility, density, solubility and chemical com-
the length offacial hair in male subjects, position. To differentiate them from one an-
with habit of shaving. other, tests for these properties are per-
11. Presence of trace evidence like presence formed .
of blood of a person other than of the vic-
tim, and semen are helpful in criminal
MORPHOLOGY OF HAIR
investigations.
C. Hair has a special medicolegal importance In its length, at its origin hair has a bulb or
concerning identification and other medi- . root attached with the skin and a shaft which
colegal aspects in that ,hair resist putre- tapers to tl~nnin~~e at the free end as tip.
faction or decomposition for a pretty long
period which makes it an extremely help- The BULB is sheathed inside the hair
ful tool in medicolegal practices. follicle in the skin . It is roundish whGn
healthy and is shrivelled, shmnk and dis-
D. Foreign hair present in the hand of a de-
torted, when nnhealthy. Hair grows in length
ceased victim in a state of cadaveric
spasm will not only indicate. it as homi- and also afresh so long the hair bulb is
cide, such available hair may also help healthy. Rate of growth of beru·ds is about
identification of the suspect. 0.4 mm. per day. The rate of growth of scalp
hair is slightly less and rate of growth of other
Details on medicolegal aspects of hair: body hair is still slower.
Al. Is the material hair or some other fibre? The SHAFT fonn the length and exter-
Hair may very occasionally be confused with nal part of the hair. In its thickness it has
some other fibres which may be of animal three layers, cuticle, cortex and medulla,
origin like silk fibres, vegetable origin like from periphery to centre.
cotton or jute fibres, semisynthetic fibres like
The CUTICLE is the outer covering of
those manufactured from cellulose or purely
the shaft of the ·hair fonned by thin non-
synthetic fibres like nylon, polyvinyl or poly-
ester fibres . N at.ural fibres can be known by pigmented scales which are attached with the
naked eye and microscopic examination. For cortex at their lower margins . The lower part
synthetic fibres, to know their exact nature, of the upper scales are covered by the free
certain other tests are necessruy. Human and upper part of the )ower scales. Bemg non-
animal hair have distinct morphological fea- pigmented and thin, the scales are transpar-
tures which are discussed after description ent. For examination nnder microscope, the
of other fibres . hair should be mounted in a media having a
refractive index different from that of the hair,
Description of fibres so that the transparent scales will be visual-
COTTON FIBRES are flattened and twisted. ized . Before mounting, the hair has to be
Microscopically they have long tubular cells. cleaued with some fat solvent so that oil stain
from the hair will be removed. An altema-
JUTE fibres are smooth fibres with ir-
tive method to study the scale pattem of the
regular cell cavities.
cuticle is to prepare gelatin or cellulose ac-
SILK fibres are fine, long filaments hav- etate cast or mould of the surface of the hair.
ing no cells in them. The cleansed hair is pressed on a gelatin or
SYNTHETIC FIBRES are non-cellular fi- cellulose layer, when it is soft and the hair is
bres of varying thickness, elasticity, contract- taken out when the material hardens . Im-

chapter 4: IDENTIFICATION OF INDIVIDUAL I llr
.; .
pression of the whole circumference can also be limited near the central o;· th~ peripheral
be taken by rolling gelatine coat.ed glass slide zone. depending on the species. In human
o...-er a hair. According to the scale pattern beings, the pigment is usually distributed
the types of cuticles are classified. near the periphery. The pigment may be
In Hausman's classification, the scales present uniformly all along the length of the
are primarily of two types In CORONAL type, cortex or may be present in segments. In
each scale surrolmds the shaft circumference some animals, more than one colouring pig-
completely. In IMBRICATE type. one scale ment may be present in different segments
dOf's not completely surround the circumfer- in a hair. Hair may be artificially bleached
ellce of the shaft. The coronal type may be by use of chemicals. Prolonged exposure to
simple or senated at its margin. 'rhe imbri- sunlight may partly bleach the hair in some
cate type, according to the shape of the ex- but that is not a constant feature for every-
posed pa11 may be, ovate, elongate or flat- body having prolonged exposure. Malnutri-
tened . SCALE INDEX is Lhe ratio of the ver- tion or kwashiorkor disease may discolour
tical length of the exposed part of tlte scale the hair to smoky red . However. such
to the diameter of tlie hair shaft. The scale changes in the colour of th~ hair or pigmen-
index is minimmn in the flattened type and tation due to exposure , disease or due to ap-
maximum in the ovate type . plication of bleaching agent are temporary
In Moritz's classification, the shape and and when the cause is remedied or removed
free margin of the scale have been taken into the original colour of the hair returns . In ·
consideration. Accordin~ly, he described 7 buried dead bodies, the hair becomes brown-
types of scale pattern. Type I is the elongated ish-red after 3-4 months period. ALL THESE
variety of the imbricate type . Type II ofMo- HAVE IMPORTANCE IN CONNECTION
ritz is the serrated or dentate variety of the WITH IDENTIFICATION OF A PERSON.
coronal type. Type ill, IV and V are not much The cortex contain~ abundant of keratin.
elongated. 1'here is gradual decrease in ver- This gives the repulsive smell when hair -is
tical length in them. Type VI is a flattened bumed.
variety with smooth free margin and type VII The cortex can be studied in length un-
is the flattened variety wiLh se1Tated mar- der microscope, m0unting it in an
gin. Type VII is the human type. isorefractive media. But deep pigmentation
The: CORTEX is the intermerl.iatc layer may not allow detail study of the cortical
of the hair und emeath the cuticle and forms structure and distribution of different mate-
the bulk ofthickneS!; of the hair. It gives the rial!i in the cortex. For sectioning of a hair, it
hair its strength and elasticity. When pulled may be softened with sodium hydroxide so-
from both ends, hair resists tear du~ to elas- lution It may not be preferred by many, as it
ticity and strength of the cortex. It extends swells the hair. By applying suitable proce-
in length and becomes nanow. But it returns dure, hair ma~ be sectioned by a hand razor.
to its original length and thickness when the Hair may also be sec.tioned by automatic mi- ·
pull is released. 'rhe cortex consists oflongi- crotome after embedding it in paraffin wax.
tudinally placed non-nucleated elongated The hair has to be cleaned of fat nr oil by
cells. Diffuse and/or granular pigmentation petrolewn ether, then dried and soaked in
occur in the cortex of the hair which may be xylene before embedding in paraffin wax. ·
distributed all around in the cortex or may Freezing microtome sectioning is another .

172 I PRINCIPLES OF FORENSIC MEDfCINE
method recommended by some for quick The TIP oft he hair-The undisturbed tip
preparation. of the hair is roundish under the microscope
Cross sectioning helps to study the thick- and is covered by cortex and cuticle and is
ness of the cuticle , cortex and medulla in devoid of medulla for some length. In recently
cut hair, the tip is sharp and flat under the
detaiL
microscope with medulla being seen till the
Hair can be deformed artificially . Hair is end along with other two layers. When old,
as such resistant to ordinary mechanical de- the cut-end becomes smooth. roundish and
fanning forces . But on application of moist devoid of medulla. The tip-end of the hair gets
heat, or certain chemicals, hair can be sof- splitted or frayed , if it is subjected to con-
tened to change the shape from straight to tinuous friction , as in case of axillary or pu-
curly or~ly to straight . Frequent artificial bic hair or hair which are too frequently
treatment of the hair, may damage the cuti- brushed with pressure.
cle and the cortex. Bleaching of the hair, as a
If the hair is singed , the affected part is
process of using dye , can be done by treating
hair with alkalinized hydrogen perqxide . swollen and appears bulbular, due to gain in
the medullary space , occupied by the trapped
The MEDULLA is the central core of the air there and the gas produced by the burned
shaft of the hair. The diameters of the me- keratin , which becomes soft due to heat, al-
dulla vary, and accordingly medulla may be lowing the hair and the gas to give a balloon-
broad, intennediate or narrow. The medul- ing appearance at the affected part. When the
lary space is actually hollow space which is shaft is crushed at a place, the part appears
filled with air. In some varieties, the medulla flat with splitting of the elements locally, vis-
is nan·ow and the space at places may be so ible under the microscope.
much narrow so as to be obliterated. Thus ,
A2 . Is the hair a HUMAN hair or an ANI-
medulla may be continuous , interrupted (ob-
MAL hair ?
literated intennittently for short distances)
orfragmented (obliterated intennittently for The difference between hun1ill1 and animal
greater lengths). The longitudinal extension hair can be drawn on the following points :
of the medulla where the air spaces are the~ , 1. Usually the hun1ill1 hair is comparatively
may be arranged in interlacing criss-cross delicate, but animal hair is coarse except
fashion or it may be a ladder medulla, where ventral hair of some species.
the rectangular blocks of air spaces are ar- 2. Human hair is black , grey , reddish or red-
ranged one _over the other in a ladder like dish-brown in colour but animal hair may
pattern. be of any colour. Even a single animal
In longitudinal mounting under micro- hair may have different colours at differ-
scope, the medullary details may not be seen ent parts.
if the cortex contains thick dark pigment. The 3. The cortex makes the maximum thick-
hair is then bleached and treated with carbol ness of the shaft of human hair, which is
fuchsin stain which occupies the vacuum cre- much more than in animal hair. The cor-
ated by the shifting or removal of the air from tex is always more than 4 times thicker
the medullary spaces, if the hair is stained in than the m.e dulla in human hair. The
vacuum. In untreated and unstained hair, the proportionate thickness is not so high for
air gives dark appearance of the medulla. the cortex in case of animal hair.

4. :\ledulla in human hair is very narrow, (b) SEX from hair: In MALES, the hair
may be continuous, interrupted, frag- is comparatively thick or coarse .
mented or even absent in some hair. In Scalp hair is comparatively shorter.
animal hair medulla is always present, Facial hair and hair on other parts
is broader, continuous, and may some- of the body namely chest and limbs,
times have ladder or lattice arrangement. are abundant and distribution of
In animals, the thickness of the medulla pubic hair has upward extension
is not less than half of the thickness of with the apex near the umbilicus.
the cortex. Microscopically , Barr bodies are
5. Pigment in human hair is usually distrib- very rare in the cells of the hair
uted more abundantly towards the pe- bulb.
ripheral zone of the cortex, in contrast In FEMALES, the hair is compara-
with animal. tively thin or delicate . Scalp hair is
6. The scales in the cuticular layer of the comparatively longer. Distribution
human hair is flattened, with irregular ofhair is usually limited in the scalp,
serrated margin and is of fhe imbricate axilla and pubic regions. Distribu-
type. According to the classification of tion of pubic hair is limited in a
Moritz it belongs to type VII. The cuticular transverse straight line, a short dis-
scales of the animal hair may be of any tance above the mons veneris. Mi-
variety of the coronal or imbricate type. croscopically, Barr bodies are com-
According to the classification of Moritz, paratively more conm1on in the cells
any of type I to VII may be present in of the hair bulb.
animal hair. Sex or gender identification of lm-
7. Precipitin tests are specific for different tnan hair using fluorescence in situ
species and can differentiate human hair . hybridization. The efficacy of this
from other animal hairs. method has been tried by using chro-
A3. RACE, SEX and AGE of the person from mosome X and Y centromeric
the hair- probes . Preliminary study using
fluorescence in situ hybridization
(a) RACE: In European and American
has been claimed to be encoura-
Caucasoids, the hair is delicate in
geable and said to have correctly
texture , straight or curly in shape
fixed the sex of hair as late as 26
and pale, reddish or reddish brown
days after shedding. The test can be
in colour.
performed easily, rapidly an d accu -
In Mongoloids, the scalp hair is me- rately.
dium in texture, straight in shape
(c) AGE from hair. The scalp hair ap-
and black in colour.
pears in a foetus in 5th month and
In Negroids, the hair is thick or the downy lanugo hair on the body
coarse in texture, extremely curly of the foetus appear in the 4th .
or woolly in shape and black in col- month. At birth, scalp hair is about
our. 4 - 5 em in length and the lanugo
In Indians, the hair is medium in hair is distributed only on and
texture. straight or curly in shape around the shoulders. Pubic hair ap-
or form and black in colour. pears by 13th/14th year in girls and

14th/15th year in boys. Axillary hair was vulnerable to be contaminated in course

appears by 14th/15th year in girls of his occupation with the trace elements to
and 15th/16th year in boys ; Facial be detected in his hair. In occupations, where
hair appears in boys betwf(en 16th- the person is exposed to substance like ar-
18th year, first moustaches, followed senic , the same may be detected in his hair.
by beards. With extreme varic>.tion, In aniline industries , the hair of the workers
scalp hair <>tarts greying by 40 years , may have a bluish tinge and in copper indus-
pubic hair greys above 50 years and try it may have greenish tinge . In miners and
body hair above 60 years, usually. some other industrial workers, there may be
Baldness may appear in males by early baldness. In some industries, hair of
about 50 years . Females usually do the workers may become brittle and lustre-
not go bald less .
A4 . Whether BLEACHED or any DYE has A8. If any TRACE ELEMENT present-
been used -
Trace elements as discussed in A7 above . will
When bleached, hair appears pale or colour- help identification of the person. Trace evi-
less and when dyed it takes the colour of the dences like blood or smnen may help to iden-
dye. Grey hair is usually dyed with black dye . tify the assailant or the rapist by grouping
In some community, hair is bleached and then test of the blood or semen present.
dyed with 'mehendy' to give a reddish brown A9. Is the hairidentical with the hair of the
colour to the hair. When dyed, the time passed victim or the accused ?
after dyeing can roughly be calculated out
.. · from the length of the hair near the root If the sample hair is studied against the hair
which has grown after dyeing ofthe hair and of the accused or victim on all the points dis-
does not shov;· the presence of the dye. Chemi- cussed in above paragraphs, then it can be
cal analysis of the dye used can also help to said whether the sample hair belonged to the
identify an unknown person or dead body. accused or the victim.
Bl. To which BODY PART the hair belonged?
A5. BLOOD GROUP of the person from
hair- This can be determined from the length,
shape, texture and some other features of the
If hair bulb is present, then the blood group
hair.
of the person can be determined by "absorp-
tion-elution technique '' or mixed agglutina- Scalp hair is long, straight or wavy or
tion technique (see Ch. 5). curly and medium in texture in Indians. In
A~ . Genome test of Hair (DNA Profiling) - - males, the tip may be flat if the subject had
recent hair cut. In cross section, the cut sur-
Ans~ers of many questions are relateQ. with face is circular or oval or plano-convex, de-
issues linked with identification and disease pending on whether the hairis straight, wavy
of the subject. or curly.
A7 . Hair and OCCUPATION - Beards and moustaches are short in
Ck.cupation of a person can be guessed from length (length may be up to 3" for moustaches
the hair if trace elements can be detected and 10" for beards), wavy or curly, thick or
from his hair by using modem scientific in- course and tip may be flat, if recently shaved.
vestigation processes including neutron acti- In cross section, the cut surface is plano-con-
vation analysis, if the hair of the person is or vex or triangular.

chapter 4: IDENTIFICA TION OF INDIVIDUAL I 176
Eyebrows and eyelashes are short, B3. Relationship between the OFFENCE,
curved. thick and taper to the tip. In cross OFFENDER, VICTIM and sometimes the
section, the cut surface is plano-convex or OFFENDING WEAPON -
triangular . If a female pubic hair is detected on the glans
Axillary hair is short, straight or curly, of the accused of a case of rape or if a male
thick or coarse and the tip may be splitted or pubic hair is available near the private parts
frayed. Cu t sections have nothing in specific. of the victim of a case of rape, then relation-
Pubic hair is short, curly, thick with ship between the offence, offender and vic-
splitted or frayed tip in a few . Cut section tim can be established by studying the sam-
has oval or triangular surface. ple hair recovered from the male or female
genitalia and the pubic hair of the victim or
Nasal hair is very thick, short, curved
~· · · ~cused. Similar is the position in sod-
with tria ngular cut surface.
omy cases (pubic hair of the active agent and
Hair on other parts of the body is short, anal hair of the passive agent) and bestiality
curved, thick with triangular cut surface. cases (pubic hair of the accused found near
The body part to which the hair belonged, the anus or vagina ofthe animal and the ani-
is important, to know, whether it was n. case mal h air near the private parts of the accused).
of assault on the head or a case of sex as- If it is a case of mechanical assault, then hair
sault, viz ., rape or sodomy. may be present in the weapon recovered from
B2. Whether taken out forcibly or fallen off the possession of the accused , which may be
compared with the hair of the victim to es-
naturally -
tablish relationship between the offence, ac-
A hair taken out forcibly, will have a full cused, victim and the weapon of offence .
roundish hair bulb covered with a tom sheath
B4. CAUSE of death -
A hair fallen off naturally, will have no bulb
and sheath at its root end If the hair has In death due to head injury, the hair of the
been taken out forcibly, that indicates fight affected part of the head may be crushed or
or struggle. may show sharp cutting, depending on
cuticle or scale
~
&
cortex
medulla
fo)c
~@ b
d
a
a b c d
Fig. 4.136: Human hair -longitudinal and cross section
Fig. 4.135: External morphology of human hair- of human hair- (a) Layers of hair thickness,
(a) Root of a naturally fallen hair, (b) Healthy (b) Cross section of a straight hair, (c) Cross
hair bulb , (c) Tip of hair (normal), (d) Tip of section of a curly hair, (d) Cross section of
hair (after recent hair-cut) eye brow

whether hard, blunt or shailJ cutting weapon beards and moustaches, or beards alone, it
was used. In death due to arsenic poisoning, can be said, for what period the deceased sur-
the poison may be detected in the hair. vived after his last shave. This indirectly gives
B5. Type ofiN,JlJ'RY - the time of death. (Rate of growth of beards
is approximately 0.4mnl per day.)
In case oflacerated injury over head, the hair
bulb is crushed . In case of incised or stab Bll. Detection of some TRACE EVIDENCES
wound, the hair is shailJly cut. in hair-
B6 . Type of WEAPON used- See colunm A6 and A7 above.

In case of head injury, if the hair bulbs are C. Hair in OLD CASES OF DEATH -
crushed, then it can be said that hard, blunt H air resist putrefaction and thus can help to
weapon has been used. If there is sharp cut identify the deceased and at times can help
on the hair, then a sharp cutting weapon to know the cause of death (see Col. B4.),
must have been used. even years after death when hair and/or
B7 . NATURE of death - bones may be the only available remains of
the dead body.
In homicidal cases the hair of the assailant
may be held in tight grip of the hand of the
victim in a state of cadaveric spasm , as are-
IDENTIFICATION FROM OCCUPATIONAL
sult of struggle before death.
MARKS
B8 . Detection of POISON -
In chronic arsenic poisoning, when the pa- In some cases, occupational marks are left
tient is still surviving, hair serves as good on the body of a person. Some of these are
m.aterial for detection ofthe poison and diag- temporary and are removed with time or can
nosis of the case. be. washed away. But in some cases occupa-
B9. SINGEING of hair - tional marks may be retained pem1anently
In burning cases the hair get singed. Singe- or more correctly for a considerably long pe-
ing of hair, of course, does not specifically riod, i.e., for months or even years.
indicate antemortem or post-mortem nature
Examples of temporary occupational
of the burning. It is a point to differentiate
marks
between ulcers due to burn. scald or chemi-
cal agent. In fire-arm injury cases, singeing Engineers and mechanics may have grease
of the hair around the wound indicates about marks on their body or dress, from the ma-
the short distance of the firing. Ifhair around chines and tools they handle . Workers in
the wound are singed, then muzzle end of flour mill may have flour dust and those in
the weapon was within a distance fron.1 which jute or cotton factories may have jute or cot-
the fire from the muzzle end could travel up ton fibres on their body, for some time after
to the body of the victim at the time of the the day's work is over.
firing.
Examples of permanent occupational
BlO. EstimationofTIMEOFDEATH -
makrs
In case of death of a male subject, if the date
and hour ofhis last shave is known (e.g., from Tailors may have multiple prick marks on
. the fixed barber), then from the length of the their fingers which persists for some days .

-:: oblers may develop a groove on the inci- 2. Palm vein authenticity-Infrared beams
~= r teeth due to repeated holding of thread are used to scan the palm veins and the
v.::h the teeth. Flute players may have unu- veins appear as black lines. The system
~.lal attrition of their incisor teeth due to has a good many positive sides. The palm
:-:::1stant holding of one end of the musical veins pattem is constant and not change-
__ strument in between the teeth ofbothjaws. able. As these are deeper structures they
:allosities may develp on the back of the left are less vulnerable to external effects and
elbow and the medial aspect of the right wrist not vulnerable to counterfeiting. The sys-
and lateral aspect of the right middle finger tem does not expose the person ohmhy-
in a person who uses his right hand for writ- gienic habit.
ing, resting on the table his left elbow, for 3. Iris scan-Analyses the structures of the
over a long period, say many months or years. coloured ring which surrounds the pupils
There may be bluish lining in the gum in of the eyes . There are more than 200
workers in lead factories , green lining in points to compare/study and record .
workers in copper factories ; bluish tinge in Though its importance for iden tification
the scalp hair in workers of aniline factories purpose is known since 1936 but it was
or green tinge in workers of copper factories. not until the early 1990s that algorithms
In miners, there is premature baldness. In for iris recognition were used (and also
tram drivers, there may be varicosity of the patented) . Current iris recognition sys-
leg veins. In tram drivers varicosity may ap- tem is held by Indian technologies (as po-
pear in the lower legs, due to constant stand- tential). The process of image acquisition
ing and vibration of tram.
for matching one to many was initially
Biometric identification-It indicates developed by John G. Daugman, PhD. It
physical characteristics of identification of a is used in practice in United Arab Emir-
person. Of the features Anthropometry, fin- ates. Iris being rather a protected organ,
gerprinting, hair, racial, sexual feature s, etc. image of the irides has very high authen-
have already been discussed in this chapter. tication value. Its texture is said to be
We will discuss here some more biometric unique even in genetically identical twins.
features . 4. Retinal scan-By retinal scan blood ves-
In USA, FBI has collected biometric data sels located at the back of the eye can be
of about 50 million of people-American na- analysed. The pattem of these vessels
tionals, service holders, visitors, criminals I remains same throughout the life . This
accused persons and preserved them in data- was first suggested in 1930s. For scan-
base system, in a way that within minutes a ning, low intensity is used to take an
desired biometric data can be made available image of the pattern fonned by the blood
for comparative study with another. These vessels.
can also be made available to INTERPOL, if
necessary.
1. Hand geometry-Different physical fea- SUPERIMPOSITION TECHNIQUE OF
tures of the hand are measured. But hand IDENTIFICATION
geometry do;s not have high degree per-
manency to detennine individuality. Still When a bunch of bones are sent for exami-
it has some definite importance or value. nation and opinion, concerning identification
· 1= M- 121

178 I PI<INC !PLES Of I-0RENSIC MEDICINE
and other medicolegal aspects. superimposi- in the bunch, and life-time frontal view pho-
tion technique can be used to establish the tograph of the missing person is also avail-
identity of the deceased. Ifthe bones are :::usable, then photograph of the skull is taken
pected to be those of a. missing person and if from an angle matching with the view of the
the skull or skull and m.<tndible
. are present available life-time photogrnph of the missing
Fig . 4.137-4.138: Superimposition technique of identification
r' -~
Photogr.:~ph
Fig . 4.137: Life time Photograph
l: g. 4.'138: Lite time
---
superimposed
on rhotograph of skull bone
Fig. 4 .139-4.140: Superimposition of photograph of Face and Facial view of skLIII and mandible
Fig . 4.140: Life time photograph superimposed

Fig. 4.139: Life time pnotogmph on facinl skel9ton shadow

_;}€'rson. Transparent of the skull photograph The thickness of <>Oft tissue over bones
and the transparent<negative) of the life-time on the face of a person is different at differ-
pnotograph are focussed on the same sensi- ent spots. Accordingly, the skull bone is coated
ri,-e printing paper. The focussing· is so ad- with some materials to give it thickness for
jt15ted that the different anatomical landmarks the covering soft tissue. This is so done , giv-
,:frhe fa('e from bot.h the transparents (nega- ing due consideration to the variation of thick-
::·:t:;: . will have maximum alignment, after ness of the soft tissue at different points of
?=o;ing due consideration to the thickness of face. Then, on the description given by per -
:he soft tissue in the transparent of the life- smls who knew the 1nissing person, fncial
:::...e photograph. Then, from the positive print cunre1; and creases are mapped. Shape of the
L.'lus obtained which now possesses shadows chin, eyebrow curve, look in the eyes, shape
: ~-me outer surface of the face (from the trans- oflips and other finer details of face are also
parent ,Jflife-time photograph\ and the skull incorporated, basing on the description given
bone . from the transparent of the skull bone), by the person who knew him. The extensive
it becomes easy to study whether the bony labour required in such reconstn1ction of fa-
prominences, elevations;depn~ssions and dif- cial contour may or may not lead to success
ierent cleavages of the two shadows match to bring the actual facial appearance of the
properly or not, so as to say whether the skull person roncemed .
C.Juld belong to the m.issing person or not.
Facial matching is possible by image of SKETCH IN G THE FACE OF A MISSING
:-ace in database. Many existing automatic sys- PERSON, PARTICULARLY OF AN
-.. ~ m.s are available to match one or more ques- ABSCON DING CRIMINAL
:~c.!led image of face . It is most useful for se-
curity surveillance. The meth od involves On getting detail description from persons
;: :-e<iefi.ned anthropometric data and analysis who have seen the absconded person, an art-
- ; ;acialland marks. 3D digital photograph are ist, who has expertised himself in this line,
:aken by 3D digital stereophotographic geom- may draw the facial portrait of the person.
etry scanner. 8 photographs of face is taken The description on which the artist depends,
from different angles simultaneously. From consists of scalp hair, shape of the face , ap-
:h~.se photographs ultimately 61 different fa- pearance of forehead , ears , eyebrows, eyes ,
cial landmarks are available for matching pur- nose , cheek , chin , lips , angles of mouth in-
po.se. It speaks about probability and not cer- cluding their curves and creases, etc. Based
~runty of matching. on these descriptions, the artist draws sev-
eral portraits one of which may reflect the
appearance ofthe criminal
RECONSTRUCTION OF FACIAL
CONTOUR
SKETCHING THE FACE IN COMPUTER
·,\1Jen the skull and mandible are available ON THE AVAILABLE DESCRIPTION OF
3...··d are suspected to be those of a missing AN ABSCON DING PERSON
-~~;:c,n whose life-time photograph is not
:.";· :dable. then the facial shape and appear- Several curves for each of facial creases,
: :. :-E- can be given to the skull and mandible prominences, shape of forehead, eyes, ears,
-- tr_e following way : nose, cheek, chin, lips and also of scalp hair.

180 I PRINCI 0 LES OF FORENS C 11/.f::l!C:NE
Fig. 4 .141 : Handwriting (Identification Aid).

By courtesy Prof. T. Bose
Fig. 4.142 . Ornamentation and its use helps

identification of unidentified dead
bodies. By courtesy Prof. T. Bose
.,.
Fig . 4.143 : Abnormal (congenital) very Fig . 4.1 44: Shoes apart from sole prints sometime
effective landmark for identification . helps identificution of a missing person.
By courtesy Prof T. Bose By courtesy Prof. T. Bose

chapfel4: IDENTIFICATION OF !NDIVIDUAL I 181
Fig. 4.1 45: Handwriting-

A tool of
identification .
By courtesy
Prof. T. Bose
=g. .14 7 Coronary vascularity is said to be 4. 148: Coronary vascularity is thought to be

individualistic if not atfected by disease 1nd1V1dualistic if not affected by disease

182 I PRINCIPLES OF FORENSIC MEDiCINE
moustaches, beards, teeth projections may TRICK MANNER AND HABIT-From

be stored in a computer. According to the these features, a person can be identified
narrated descriptions of the different features, when met after a long gap of period .
hundreds of varieties of face can be drawn on HANDWRITING including SIGNA-
the screen of the computer in course of a few TURE-A person can be identified from his
minutes. By addition and alteration of curves haridwritiug and signature. comparing these
more or less exact appearance of the face can with known specimens ofhis handwriting and
be drawn which, if approved by the persons signature. Style of writings, angulations,
who saw the criminal, can be printed out for carves oflet.ter and words, continuity oflet-
using the same to search out the criminal. ters in a word, etc. are considered for match-
PHOTOGRAPH-Frontal and side views ing. But it should be r~membered that two
of the head and face are helpful. But, occa- signature~ of a person cannot be identical in
sionally, photographs may be misleading as all respects. In such a case one ofthem must
in case of twins or. even in case ohm related be a forged one (Figs. 4.141 and 4.145J.
persons, the photographs lllay appear identi- MEMORY and INTELLIGENCE-
cal. Memory and intelligence of a person can be
CLOTHES, ORNAMENTS AND OTHER tested to identifY him.
BELONGINGS-Clothes, ornaments and DOG'S SCENT IDENTIFICATION-Us-
other belongings, including the pocket arti- ing trained dogs to identify criminals, mate-
cles, namely identity card, letter. diary, pass- rials belonging to criminals or material from
port, etc. help extensively to identifY both liv- a crime scene is being practised since long.
ing as well as dead subjects. Letter, identity Undue value must not be given on this
card, diary or passport in possession, give total method of identification of criminal or crime
identity oftbe person including the name and scene materials. It is established on experi-
other particulars of the person. In case of mental research work. H haR been noticed
unknown dead bodies. clothes, omaments that dogl' cannot discriminate the scent
and other belongings of the deceased lHay be (odour) of different parts of body of a person.
recognised by the relati.,es m1d friends ofthe Further. any kind of strong odorus substance
deceased (Figs. on pages180-181j. n1ay cuver the nonnal odour of criminal re-
VOICE-From the voice, a person can be lated substances. Before giving high impor-
1dentified by another perS(lU to whom he is tance over it, it is necessary to follow some
known, even if the person has not been seen guidelines-
by him in a particular occasion. 1. Presence of scent of perpetrator at the
scene of crime.
Voice identification through modern tech-
nology- Unique voice characteristics of a 2. The material should be from the scene.
person if printed then later the voice prints 3. Dog's previous knowledge of the scent of
can be matched with test prints and the per- the article.
son can be identified without. mistake. '!'here 4. Number of trials given with dog and ma-
are various processes of doing the job. It has terial.
many civil as well as criminal uses . 5. Number of trials given with the dog dur-
GAIT-From gait a person can be identi- ing its training so that the dog should
fied (guessed) from the back. have scent identification capacity.

chapter 4: IDENTIFICATION OF INDIVIDUAL I 18J
6. Similar tests should be perfonned with way all the new DNA chains in the offspring
other trained dogs . inherit the specific hereditary properties of
7. Random test in presence and absence of both the parents through th<:l strand. each of
the testing material. them contlibute. This conception has revo-
8. Standard of trainer of the dogs and his lutionised the forensic investigation by ap-
presence during the actual test ascer- plication of this knowledge of molecular biol-
tained, to help and guide the dog and ogy. Matchingofnucleotide sequences of each
interprete "its behaviour. strand of one cell with those of another, both
being from different sources, tells for cer-
tainty that both the cells are from the same
human being.
USE OF DNA (DEOXYRIBONUCLEIC
ACID) THE GENETIC SUBSTANCE FOR Sir Alec Jaffreys, University ofLeicester
IDENTIFICATION AND OTHER FORENSIC obse1ved in 1985 thr,t in 2 iudividuals (hu-
PRACTICES man) most of the DNA ;;equences are com-
mon. But there at·e highly variable repeat-
Fredrich Michel ( 1869), discovered DNA, and ing sequences, termed minisatellites.
its molecula-r structure was first detennined Number of these m.inisatellites at a given
by J·. D. Watson, F . Crick and M. Wiikins in locus are unlikely to be <>ame in two unre-
1953. The DNA molecules are present in chro- lated persons (i.e., except in identical twins);
mo~omE::s 1.c1bout 99(,:(. l and in mitochondria chance of being identical is one in a billion
<100 crore).
(1%). They are very long but of negligible
breadth and thickness. The DNA in a hmnan For the purpose of matching test sam-
cell is composed of about 500 crore (5 billion) ples of any tissue, blood , semen, saliva or
subunits (undeotide:;;J each of which is com- human remains can be used. However, de-
posed of deoxyribose (earbohyd.rute residue) pending on legal norms or provisions of a
phosphate with a heterocydic base of adenine, country or area. in addition to the power en-
th,ymine, guanim·, or cytosine. The DNA chai11 joyed by police authority conc:;ent of the per-
i.3 mostly (exc.ept in virus) in pair of2 strands son whose hlood, etc. are to be tested or has
of polynucleotide. Of the four bases. adenme to be taken, an order from a court having
of oue strand pairs with thymine of the other jurisdiction, may be necessary for such test.
and guanine of one with cytosine of the other, However. DNA database of many categories
as if one base of one chain is complimentary of people (e.g., criminals/accused) is main-
to one of the other chain . Hence, the sequence tained in some com1tries like USA ~md UK
of nucleotide subunit in one st.rand speaks Iin USA as in 2007, 4. 5 million of such records
about the sequence of nucleotide subru1it of were maintained). They tenn it as National
the other strand of the chain. During the for- DNA Database iNDNAD). The rnatching ma-
::nation of spenuatozoa and ova by the proc- tetials may he collected from any available
es::: of cell division, the two strands of a chain sonrce including a biological relative.
s:>parate and the DNA molecular chains of Methods of DNA Fingerprinting-RFLP
rhe fertilsed ova, or for that purpose the off- analysis <Restriction fragment length poly-
~p:-ing contains a strand from each parent in morphi:5m)-DNA is extracted from the test
~ach chain in the cells of the offsp1ing. This sample and separated from the material and

184 / PRJNCJPLES OF FORENSIC MEDICINE
cut into double stranded DNA pieces of dif- Medicolegal application

ferent sizes using restriction enzyn1es, pro- 1. To identify an assailant by studying the
tein without damaging the bases. 'I'he nega- nucleotide sequences of cells of blood and
tively charged pieces are sorted by gel elec- hair bulb, etc. available at the scene of
trophoresis when smaller particles go to posi- crime with those of the cells of the ac-
tively charged bottom earlier. Heat or anal- cused.
kaline solution is used to denature DNA and 2. Similarly, identification of a rapist or ex-
separate it into single stranded ones. Nitro- oneration of such an accused by studying
cellulose paper is fn'St pressed and then baked the spenn cells available on the body or
to attach the DNA particles. '!'hen a radioac- cloth of the victim and cell of an accused,
tive probe is made with DNA polymerase. For is possible by studying their nucleotide
this the DNA is placed in a tube. Horizontal sequence.
breaks of the DNA is made along the strand. 3. In the same way studying the nucleotide
Then nucleotides are added. Cytosine (C) is sequences of DNA of woman (Mother),
used. Polymerase is added . It separates ex- man (!<'ather) and baby, disputed pater-
isting nucleotides to be replaced by new nity cases can be settled.
nucleotides. When the lower strands have a 4. Disputed maternity cases can be settled
G (Guanine) base, then C or Cystosine be- in the same way.
comes radioactive. 'I'o split the 2 strands of
5. Mixed babies in hospitals can also be iden-
DNA heating is necessa1y. Some of the sin-
tified in this way.
gle stranded probes which are radioactive can
6. Missing persons can in this way be iden-
be used to cause hybridization reaction when
tified, ifhis parents or children are avail-
two sequences bind together due to the hy-
able.
drogen body between the bases pair-two
bonds in between A (Adenine) and T (Thym- 7. Using one step advanced technique (P.C.R
technique) a person can be identified in
ine) and three in between C and G. Dena-
definite tenn from his old dead body re-
tured DNA radioactive probe and liquid sa-
mains, if his or her parents or children
line are placed in a plastic bag and shaken to
and wife or husband are available, as by
fonn bond between the radioactive probe and
the studyoffingerprints. Hence, in foren-
denatured DNA which is not essential for hy-
sic practice, identification by this method
bridization. 'I'he VNTRs (variable number is tenned as DNA fingerprinting.
tandem repeats) are made . Every human
8. Affirmation or negation of relationship be-
being has those repeating sequences. By ra-
tween a suspect and incriminating evi-
dioactive version of such VNTR, speciftc
dence available at the scene of crime.
VNTR is probed in a hybridization reaction .
9. Helps in case of quality hybridization of
That way DNA fingerprint is framed. Every
animal and food stalk.
person has VNTRs which he inherits from
one or both ofhis parents. Nobody can have 10. In relation to tissue or organ transp lan-
a VN'rR which neither of his parents have. tation.
In one sense VNTR is unique which becomes 11. Detection of hannful bacteria or genn,
more so if more VNTH probes are made and in body soil, air, water.
used for study. 12. To authenticate some biological products.

chapter 4; IDENTIFICATION OF IN DIVIDUAL I 186
PCR or Polymerase chain readion method zygote as homozygote. Amplified FLP can be
of DNA study highly automated and may cause easy crea-
tion of poly genetic trees based on individual
When very small quantity of DNA chain is samples of DNA Its cost is low, easy to set
available from a cell, then by PCR technique up and operate.
the quantity of DNA can be increased by nul-
STR-Basing on PCR it is now the most
lions of times. This can be done by subject-
popular method. Highly polymorphic regions
ing the available DNA to variation of tem-
with short repeated sequence of DNA is used,
perature and supplying nucleotides and
the regions which can detemlinate individu-
polymerase. At about 95°C the two strands
ality. The STR loci are targeted with sequence
of the chain separate. Then at 55°C, with the
specific primars and are amplified by PCR.
help of polymerase, the added nucleotides
Resulted DNA fragments are then separated
take position at opposite ends of free mar-
and detected by (a ) capillary elect rophoresis
gins of each strand, which at 72°C rapidly
or gel electrophoresis . Each polymorphism
extends to each other, all throughout the
in a locus as such is shared by about 5-20% of
lengths of free strands, forming a replica of
population. But by searching multiple loci
the original chain. The pro.cess is so rapid
unique combination of polymorphism is avail-
and repeated so quickly that in an hour mil-
able which gives it the individualistic status.
lions of replica chains are produced which are
Many STR regions can be tested at the same
identical. Thus use of PCR technique, when
time.
only minute amount ofDNA is available helps
to increase the volume of the same enor- In capillary electrophoresis, electroki-
mously, making its study possible , meaning- netic movement through application of an
ful and useful for comparative purposes. electric field injecting the DNA fragments
through a capillary glass tube is used to fill it
The reliability ofPCR technique, however
up with polymer. The DNA fragments are
depends on the type of polymerase used. Heat
detected by fluorescent dyes which were at-
stable polymerase gives better result than
tached with the primers. Multiple fragments
heat labile ones. The latter may create wrong
are amplified and studied at a time . The
sequence of newly formed DNA strands.
method is eA."J>ensive but the capacity of the
Amp. FLP (Amplified fragment length machine is also high .
polymorphism)-This technique is faster than
G€1 electrophoresis also act on the same
RFLP. PCRcan be used here to amplify DNA
principle. Instead ofcapillary a large polyacry-
samples. It follows the same VNTR polymor-
lanucle is used here to separate the DNA frag-
phism technique to differentiate various
ments. Electric field has to be made.
alleles, which is separated on a polyacryla-
mide gel using au allelic ladder instead of It should be remembered that there may
molecular weight ladder as in VNTR. Bonds be repeats at many loci.
which appear can be visualized by silver stain- Y Chromosomes-Recently primers tar-
ing the gel used for the test. One popular lo- geting polymorphic regions of y-chromosomes
cus for fingerprinting is DlSSO. As with all (Y-STR) are in use to allow multiple male
PCR based tests, degraded or very small profiles. Y-chromosomes being paternity in-
amount of DNA, there may be allelic drop- hel'ited Y-STR study helps to identify pater-
out causing wrong interpretation of hetero- nally related features in concemed males.

Mitochondrial DNA has many copies of tively to see whether a sibling exists between
them in each cell. Hence in very much de- them or not. In case of reasonable degree
graded test samples mitochondrial DNA (mt matching the probability of sibling status is
DNA) is studied. For this it is needed to am- very high, may be as high as ggc,(-, provided
plify HV1 and HV2 regions of mtDNA, then that genes they inherit are not common in
sequence each region and make comparative general population. Further, in case of such
study of single nucleotide differences in rela- matching, DNA test of other relatives of par-
tion to a reference. mtDNA is maternally ents or parent should also be done. Hence ,
inherited and hence can directly give idea apart from establishment of identity in crinri-
about maternal relatives in the sense who nal cases, the test has value in civil cases
has genetical link with mother. A difference also, e.g. ; disputed paternity, missing chil-
of2-3 nucleotides may be considered to be an dren-; etc.
exclusion for the purpose of matching.
Whatever the method of testing, high Identification by DNA Gene Card (Smart
degree e:k.-pertisation and possibility of tech- Card/Secure Card)
nical error must be remembered at the time
of testing. Even very very rare accidental For identification many cow1tries now follow
matching must not be forgotten. Further, to the Gene cru·d-DNA Identification technology.
implicate somebody it should be remembered In the card in addition to original identifica-
that source of DNA may be planted. Moreo- tion features some enhanced services are
ver, even if the DNA of an accused matches given, e.g., DNA profile-loci and marker for
with sample collected from the site of crime ready reference tthis may have forensic im-
it might have been left by the accused some portance), additional health data with related
time else and not by the still-unknown ac- DNA profile , digital photo and digitally
tual offender, when the .crime was commit- scanned fingerprint , with single and clean
ted by him. Lastly, DNA fingerprinting is enrolment."
never as discriminatory as real fingerprint- Secure card has been devised which of-
ing. fers First Clue Gene Card application system
that provides complete identification and au -
DNA test for siblings thentication solution for emergency services,
medical facilities , enforcement oflaws. crimi-
The test is performed to detennine whether
nal justice, paternity and genetic testing etc.
two or more children share the same parent-
hood (biological parent or parents). Ful1 sib-
lings are from same biological mother and
biological father. Half siblings, each share References
DNA profile of only one of the parents, ei-
ther mother or father. • Arey, Leslie Brainar - Developmental Anatomy, Ed.
With same parents or parent, they have 1959.
more often matching genes/DNA in them, in • Breathnack, A. S. - Anatomy of human skeleton,
comparison to biologically unrelated persons. 1958.
Hence, in case of matching genes, though • Cobb, W M. 1952. Skeleton in Cowdry's problems of
not in totality, it is required to verify exhaus- ageing- Edited by lensing, A L., Baltimore.

• Dwight, T. (1890). Closure of suture as a sign of age • Tad, T. W. (1921). Age changes m the pubic bone. II
- Bust on Medical and Surgical Journal, 122 : 389 - -IV, VI, A.J.P.A. 4: 1 : 407.
392. • Todd, T. W.. Lyon, D. W (Jr.). Cranial suture closure,
• Essentials of Forensic Medicine 11985) -4th Ed. by its progress and age relationship, l, A.J.P.A., 7: 325.
Polson. C.J. Gee, D.J. and Knight, B. • Trotter, M. and Glesser. G.C. (1952) Esrirnat1on of
• Gla1ster's Medical Jurisprudence and Toxicology stature from long bones of American White and Ne-
(1 973) - 13th Ed by Rentoul, E. and Smith, Hamil- groes. 10 : 463.
ton. • Suzuki. K. and Tsuchihash1, Y (1 970). J. Forensic
Gustafson, G. (1950). Age determination on Teeth. Medicine 17 : 2; 52 (on lip prints) .
•
J. American Dental Asso. 41 : 45. • Chase. Cheryl, (1998). "Affront1ng Reason" in Look-
Hoover, J. E. (as Director. F.B.I.). 1n the Encyclopedia ing Queer: Body Image and lclentity 3s lesbian. Bi-
•
sexual. Gay and Transgender Communities, edited
Americana (1976). Jn the article on Fingerprinting ;
by Ouvid Atkins. pages 205-219. 2002, 15 (1 0): 1013-
Vol.11.p215-219.
1019.
• Krogman. W. M. (1962) -The Human skeleton in
legal Medicme. • Gender Queer. Voices From Beyond tne Sexual Binary,
Joan Nestle. Clare Howell. Riki \Nilchins (2002) Alyson
• Cameron. J. and Sim> B. G. (1974)- Fore ;sic Den- Boo~s. New York.
tistry.
• The Transgender Studies Reader Susan Stryker,
• Modern Trends in Forensic Medicine - Vol. I, {1 953) . Stephen White (2006) Routledge. New Yo1k
td. by Simpson. C.K.
• "Ambigous Sex" or Ambivalent Medicme? by Alice
• Modern Trends in Forensic Medicine - Vol. II Domurat Dreger, published in The Hastings Center
(1967). Ed. by Simpson. C. K. Report MayjJun 1998, Volume 28.1ssue 3 Pages 24-
• Modern T:ends in Forensic Medicine - Vol Ill (1973). · 35.
Ed. by Mant. A K. • Sex and Gend& are Dirterent· Sexual Identity and
• Modi's Medical Jurisprudence {1977). Eel. by N. J. Gender Identity are Different, by rv1ilto11 Diamond. PhD,
Modi. published in Clinical Child Psycholr.gy & Psychiatry -
Special Issue In Press for July 2J02.
• Mantagu. M. F. and Ashley (1938). Ageing of the
Skull. A.J.P.A. 23 : 255- 27'J. • Sax, Leonard (2002) . "How comnwn is intersex? A
response to Anne Fausto-Sterling". Journal of Sex
• Satferstem. R. (1976). Crim1nallstics: An introduction
Research 39 (3) : 1"74-178.
to Forensic Science.
• De Marchi M. Carbonara AQ, Carow F. eta/ (1976) .
• Singer, R. (1953). Estimation of c.ge from cranial su-
"True h&maphrvditism with XX/ XY sex chromosome
ture closure, J. Forensic Med. 1 (1) : 52-59.
mosaicism: report of a case". Clin. Genet 10 {5).
e Recent Advances in Foren:;ic pathology, (1969). Ed . 265-72.
by Camps. F.
• Blackless M. Charuvast1a A, Derryck A. Fausto-Strr-
• Stewart, T.C. {1957). Distortion of the pubic symphy- ling A. Lauzanne K. Lee E (2000). "How sexually di-
seal surface in females and its effect on age determi- morphic are we? Review and synthesis". Am J Hum
nation, A.J.P. A.. 15 : 9 Bio/12[2): 151 -166.
0 Taylor's Prinr.iples and pract1ce of Medical Jurispru- • Anne Fausto-Sterling, "How Many Sexes Are Thore?
dence (1984). 13th Edn. Ed. by Mant, A. K. from The New Yo1 k Times, Op-Ed page, March 12,

1993, reprinted in Sterling Horwood, ed., Business as Possible Questions

Ethical and Business as Usual (Belmont, CA:
Wadsworth Publishing Co., 1996), pages 168-170. Theoretical
• M. M. Grumbach, and F. A. Conte. 1998. "Disorders of 1. What is identification? What are the different data
sex differentiation." in Williams Textbook of for identification of a person ?
Endocrinology, eds. J.D. Wilson. OW Foster, H.M.
2. How do you determine the sex in a highly decom-
Kronenberg, and P.R. Larsen, (Philadelphia: W B
posed, or mutilated and dismembered dead body?
Saunders: 1303-1425) .
3. How do you establish sex of a person from bones ?
• Olsen. Robert D., Sr. (1972) "The Chemical Composi-
4. How identification is established in an extremely de-
tion of Palmar Sweat" Fingerprint and Identification
composed or mutilated dead body or from bones?
Magazine Vol 53 (10).
5. What medicolegal informations can we get from
• Henry, Edward R., Sir (1 900) Classificauon and Uses
bones? (see also the chapter on medicolegal au-
of Fingerprints London: George Rutledge &Sons. Ltd.
topsy.)
• Faulds, Henry, MD (1880) Nature.
6. What are the types of fingerprints? How fingerprints
• Galton, Francis. MD, Sir (1892) Fingerprints London: are used for identification ?
MacMillan and Co.
7. What are its advantages?
• Jeffreys, A.J., Wilson, V., Thein, S.W. Hyper variable
8. How do you know the race of a person?
mini sattelite regions in human DNA-Nature 314:
9. How do you estimate the stature of a person?
67-73. (1985).
10. How DNA study and PCR helps identification?
• By W. Batharat Woodman and Charles M Tidy in
Forensic Medicine and Toxicology, vol1 -2007. Short Notes
In addition to the many short notes being possible
• W. Doglous Hemming in Forensic Medicine and Toxi-
from the above questions there may be some more
cology- 2008.
as follows :
• W.G. Aitchison Robertson in Aids to Forensic Medi-
Cephalic index. Gonadal dysgenesis. Klinefelter's syn-
cine and Toxicology- 2008.
drome, Turner 's syndrome, Superimposition technique
• Wilson Krogman and Yasar !scan, Human Skeleton in of identification, Lip-print, Foot-print. Poroscopy. Medi-
Forensic Medicine - 1986. colegal application of study of O.N.A.
• By Mary H. Manhein. Tail of Bones: More cases from What are the medicolegal importances of ages--
the Forensic Anthropologist- 2005. 10, 12, 14, 16. 18 and 21 ?
• Bhattacharya Shaony (2004). Killer convicted thanks What are the medicolegal importances of mandible.
to relatives DNA- New Scientiest. hair. tattoo marks, scars, occupational marks?
• Kati Brinton and Kim AN Lieberman- Basics of DNA Sex differentiation from skull, hip bone. sacrum. pel-
Rngerprinting. vis, mandible. femur.
• Burke, Terry, DNA Fingerprinting approaches and Ap- Oral Questions
plications. First International Symposium on DNA Fin- Any question from above mentioned long and short
gerprinting, Burn, Switzerland, Oct. 1990. questions.

Sometimes, something contaminated with tenaciously, then it can be said that all crimi-
other materials come to tremendous help in nal case investigations can be successful.
medicolegal and other forensic investigations .
For example, when a weapon is found stained
with blood of the victim of assault, then it BLOOD AS TRACE EVIDENCE
becomes very much reasonable to suspect (ld ontifi ce1tion from Blood and Other
that, that particular weapon might have been Med icolegal Aspects of Blood)
used to injure the victim. Blood of the victim
on the weapon here acts as trace evidence to Blood itself is a very important entity in
link the weapon with the assault on the ba- medicolegal practices, which alone or along
sis of which further investigation proceeds. with other trace evidences plays key role to
unfold different criminal problems
LOCARD ' S PRINCIPLE OF IONIC
F.XCHANGE Examination ofblood and blood stain has
importances in both civil and criminal fields
Edmond Locard (1877-1966), a lawyer and ofi1westigations conceming identification of
doctor, proposed that every criminal carries an individual on one side and many other
and leaves some clements with and from him medicolegal issues on the other. No other
at the scene of crime by which he can be
body fluid or tissue has such divergent medi-
linked with the crime. These are tmce ele-
colegal im.portances as blood has.
ments in cases of criminal investigation. His
postulation was proved to be a reality when Medicolegal importances of examination
three accused persons linked with dealing of blood
with cow1terfeit coins were examined. On his
advice, the garments of the accused persons Civil importances-Examination of blood of
were examined and particles of the metals individuals becomes important and imperti-
used in the counterfeit coins could be detected nent in certain civil disputes like 1. pater-
in the gannents of the accused persons. On nity or matemity issues, 2. divorce and nul-
the basis of this finding the accused persons lity of marriage cases, 3. compensation cases
were arrested and they all confessed the com- related to workmen's welfare considerations
mission of the offence. If the principle of the or 4. civil negligence issues arising in hospi-
Locard's theory is followed meticulously and tal or medical practices, etc
1~0 I PRINCIPLES OF FO RENS IC MEDICINE
In disputed patemity or matemity cases, larly, matching a blood stain present on the
blood is essentially a helping tool for identifi- clothings or the wearing apparels of the ac-
cation of the father or mother of the baby. cused of a homicidal case with the blood of
Questions of intersex and presence of some the victim or such matching in a case of sex
forbidden diseases may be settled by exami- offence, i.e., identification of the blood stain
nation of blood in connection with divorce and as that of victim of such a criminal offence,
nullity of marriage cases . In industrial and in such cases, has great evidentinl value. In
commercial workers, who are exposed to dif- a case of homicide, ifblood stain, present on
ferent toxic agents, examination of blood may a lethal weapon, matches with the blood stain
become essential to ascertain the degree of present on the wearing apparel of a suspect
hann suffered by the workers due to a toxic in one hand and the blood of the victim on
agent. In different chemotherapeutic prac- the other, then a definite relationship be-
tices and blood transfusion cases. question of tween the offence ofhouricide, the victim, the
ins6tutional negligence against a hospital or offender and the offending agent. is estab-
a nursing home or against a doctor may ne- lished. Various poisons 1nay be detected by
cessitate blood test. The last point may in examination ofblood of the deceased persons,
some case~ have some relationship with some which may be attributed as to be tr,e cause of
c1iminal ca::;e!:-. their death . Numerous chemical and bio-
Criminal importances - Examination of chemical analysis ofblood have been recom-
blood in connection with criminal cases be- mended for E. "imation of time of death for
comes necessary for 1. identification of the which the .·eader may refer to the chapter of
victim or offender of a crime like, homicide, "death and postmortem changes" in this book.
sex offences or where death occurs due to In sex offence cases, as in other cases like
rash or negligent acts on the part of persons homicide , blood stain present in different
who are expected to act. with responsibility. materials (vagjnal fluid extract. undergar-
Apart from identification of individuals, ex- ments of the victim or the accused), acts as
amination of blood may settle other issues in important corroborative evidence . Cloth
crimin a! cases like. to know thE:' 2. cause of stained with animal blood presented as tn be
death r e.g., detection of poison or some other the result of bleeding from an injury , hae-
pathology. responsible for the daath J; 3.time moptysis , haematemesis or bleeding from
of death (different chemical and biochemical other sources . may create confusion and re-
tests of blood may be helpful); 4.criminal abor- quires species specification tests.
tion cases · 5. investigation of sex offence To sum up, different medicolegal ques-
cases; 6. to establish relationship between ~~1e tions which are related with blood can be
offence , offender , the offended (victim of the enumerated as follows :
offence) and the offending agent ; and. lastly,
1. Whether the stain is due to blood or some
7. w'llingering cases.
other materiRl ?
When some blood stain is available at the
2. If it is due to blood, then whether it is of
scene of crime it requires to be tasted to know
human origin or it belongs t.o some other
whether it belongs to the victim or to another
animal?
person, the possible offender . Matching the
blood stain with the blood of a suspect may 3. What is the source of the bleeding:
help to establish identity oft he offender. Simi- (a) Is it from arterial or venous source?

cnaprer 5: IDENTIFICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 191
(b) Does it belong to the victim or the pending on whether it is from arterial sour~e
accused? or from venous source, respectively. A blood
(c) Is it from an injury or due to hae- stain is reddish and soft in case of recent bleed-
moptysis, haematemesis, meDstrua- ing. It is dark red or even blackish, if old.
tion or miscarriage? Bleeding from arteries has a sprouting effect
(jet like ejection and spilting) and is bright
4. In connection with 3 aboYe, and other
red when fresh. Bleeding from a vein occurs
circumstances:
passively, in drops. The drops may have
(aJ What is the sex of the person? stellate appearance. Even when fresh , it is
1bJ W11at is his blood group, his DNA rather dark. See Figs. 5.l(a) to 5. 2(b).
profile? Ante-mortem bleeding causes coagula-
(c) If any other identification factors like tion, when the blood partly solidifies with
rare group factors , abnonnal constitu- seflaration of serum. The clot can be taken
ents and abnonnal haemoglobin a!B out enmasse from the spot and the .5tained
present in the blood . Foetal haemo- area after removal of the clot retains the
globin is sometimes searched for. in impression of the fibrinous network resulted
relation to law-court cases. due to the process of clot fonnatiou. Post-
mortem solidification occurs without proper
5. In cmmection with the cause of death , it
coagulation change and the clot cannot be
should be seen whether the blood con-
taken out enmasse. On removal from the
tains any poison in lethal concentration
spot it does not leave the impression of
or there is any other abnonnality which
fibrinous network. In post-mortem phenom-
can be considered as the cause of death, enon, three layers are detected in the mass,
as in case of mismatched blood transfu- one predominated by platelets, second by the
sion or certain haemopoetic disorders. RBC and the third by the WBC.
6. In case of death, time passed after death: HAEMOPTYSIS blood is bright red (be-
7. Time passed after bleeding, i.e., time of ing oxygenated in the lungs), and is frothy
assault or injury (known from. the age of (due to some churning effect with the inspired
the stain, whether recent or old). and expired air). Its reaction is alkaline.
8. \Yhether the bleeding was ante-mortem HAEMATEMESIS blood being primarily
or post-mortem . from the stomach source, is essentially al-
To an:::wer the above questions, various tered blood, at least partly and is dark in ap-
tes rs are reconunended. These are physical pearance, not frothy and acidic in reaction.
tests. chemical tests, physico-chemical tests, MENSTRUAL blood does not undergo
mcluding micro-chemical tests and i1m1mno- clotting, is acidic in reaction (due to lactic acid
:::erological test8. of vagina), and if subjected to microscopic
examination will show presence of vaginal
PHYSICAL TESTS for blood epithelial cells and monilia, etc. Endometrial
shreds may also be present.
1. Naked eye examination In case of ABORTION, bleeding per va-
Jr. naked eye examination, non-coagulated gina may have some amount of clot in it. Here
blood is reasonably thick, viscid, and may be also microscopic findings may be typical,
b;ght red or slightly dark red in colour de- showing presence of parts or tissue of pro-

In disputed patemity or maternity cases, larly, matching a blood stain present on the
biood is essentially a helping tool for identifi- clothings or the wearing apparels of the ac-
cation of the father or mother of the baby. cused of a homicidal case with the blood of
Questions ofintersex and presence of some the victim or such matching in a case of sex
forbidden diseases may be settled by exami- offence, i.e., identification of the blood stain
nation ofblood in connection with divorce and as that of victim of such a criminal offence,
nullity of marriage cases . In industrial and in such cases, has great evidential value. In
commercial workers, who are exposed to dif- a case of homicide, if blood stain, present on
ferent. toxic agents, examination of blood may a lethal weapon, matches with the blood. stain
become essential to ascertain the degree of present on the wearing apparel of a suspect
hann suffered by the workers due to a toxic in one hand and the blood of the victim on
agent. In different chemotherapeutic prac- the other, then a definite relationship be-
tices and blood transfusion cases. question of tween the offence ofhomicide, the victim, the
institutional negligence against. a hospital or offender and the offeuding E:gent is estab-
a nursing home or against a doctor may ne- lished. Va1ious poisons may be detected by
cessitate blood test. TI1e last point may in examination ofblood of the deceased persons,
some ca;::,et: have some relationship with some which may be atbibuted as to be tl'..e cause of
criminal ca~et- . their death . Numerous chemical and bio-
Criminal importances-Examination of chemical analysis ofblood have been J-ecom-
blood in connection with c1iminal cases be- mended for t. ~imation of time of death for
comes necessary for 1. identification of the which the .·eader may refer to the chapter of
victim or offender of a crime like, homicide, "death and postmortem changes" in this book.
sex offences or where death occurs due to In sex offence cases, as in other cases like
rash or negligent acts on the part of person:; homicide , blood stain present in different
who are expected to act. with responsibility. materials (vaginal fluid extract. undergar-
Apart from identification of individuals, ex- ments of the victim or the accused), acts as
amination ofblood may Eettle other issues in important corroborative evidence . Cloth
criminal cases like, to know the 2. cause of stained with animal blood presented as to be
death 1e g., detection of poison . or some other Lhe result of bleeding from an injury , hae-
pathology, responsible for the daath); 3.time moptysis , haematemesis or bleeding from
of death (.different chemical and biochemical other sources . may create confusion and re-
tests ofblood may be help full; 4.criminal abor- quires species specification tests.
tion cases; 5. investigation of sex offence To sum up, different medicolegal ques-
cases: 6. to establish relationship between !."!1e tions which are related with blood can be
offence , offender , the offended 1victim of the enumerated as follows :
offence) and tlu" offending agent : and, lastly,
1. Whether the stain is due to blood or some
7. IJl'llingering cases.
other mate1ial ?
When some blood stain is available at the
2. If it is clue to blood, then whether it is of
scene of crime it requires t.o be tested to know
human origin or it belongs to some other
whether it belongs to the victim or to another
animal?
person, the possible offender . Matching the
blood stain with lhe blood of a suspect may 3. What is the source of the bleeding:
help to establish identity of the offender. Sim1- (a) Is it from arterial or venous source?

cnopter 5: IDENTIFICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 191
(b) Does it belong to the victim or the pending on whether it is from arterial sour~e
accused? or from venous source, respectively. A blood
(c) Is it from an injury or due to hae- stain is reddish and soft in case of recent bleed-
moptysis, haematemesis, me11strua- ing. It is dark red or even blackish, if old.
tion or miscarriage? Bleeding from arteries has a sprouting effect
Get like ejection and spilting) and is bright
4. In connection with 3 above, and other
red when fresh. Bleeding from a vein occurs
circumstances:
passively, in drops. The drops may have
Ia) What is the sex of the person? stellate appeamncc. Even when fresh, it is
1bl What is his blood group, his DNA rather dark. See Figs. S.l(a) to 5.2(b).
profile? Ante-mortem bleeding causes coagula-
(c) If any otheridentification factors like tion, when the blood partly solidifies with
rare group factors, abnonnal constit:u- senaration of serum. The clot can be taken
ents and abnonnn1 haemoglobin are out enmasse from the spot and the .>tained
present in the blood. Foetal haf'mo- area after removal of the clot retains the
globin is sometimes searched for. in impression of the fibrinous network resulted
relation to law-court cases. due to the process of clot forrnation . Post-
mortem solidification occurs without proper
5. In connection with the cause of death, it
coagulation change and the clot cannot be
should be seen whether the blood con-
taken out emnasse. On removal from the
tains any poison in lethal concentration
spot it does not leave the impression of
or there is any other abnonnality which
fibrinous network. In post-mortem phenom-
can be considered as the cause of death, enon, three layers are detected in the mass,
as in case of mismatched blood transfu- one predominated by platelets, second by the
sion or certain haemopoetic disorders. RBC and the third by the WBC.
6. In case of death, time passed after death. HAEMOPTYSIS blood is bright red (be-
7. Time passed after bleeding, i.e., time of ing oxygenated in the lungs), and is frothy
assault or injury (known from the age of (due to some churning effect with the inspired
the stain, whether recent or old). and expired air). Its reaction is alkaline.
8. \\l1ether the bleeding was ante-mortem HAEMATEMESIS blood being primarily
or post-mortem. from the stomach source, is essentially al-
To an:::wer the above questions, various tered blood, at least partly and is dark in ap-
teE<ts are recommended. These are physical pearance, not frothy and acidic in reaction.
tests, chemical tests, physico-chemical tests, MENSTRUAL blood does not undergo
including micro-chemical tests and iimnuno- clotting, is acidic in reaction (due to lactic acid
serological tests. of vagina), and if subjected to microscopic
examination will show presence of vaginal
PHYSICAL TESTS for blood epithelial cells and monilia, etc. Endometrial
shreds may also be present.
1. Naked eye examination In case of ABORTION, bleeding per va-
In naked eye examination, non-coagulated gina tnay have some amount of clot in it. He·re
blood is reasonably thick, viscid, and may be also microscopic findings may be typical,
bright red or slightly dark red in colour de- showing presence of parts or tissue of pro-

duct of conception !decidual tissue or foetal solution before microscopic examination. If

parts or chorionic villi l. on some cloth, then the stained areas have
Stains due to human blood from insect to be located and numbered and a part of a
sources like MOSQUITO or BED BUG, may stained area is cut out, leaving a mark
in microscopic examination show presence of arolmd the margin of the cut area. The piece
of cloth thus taken out should be left over-
insect appendages or body parts.
night dipped in nonnal saline solution, to get
the stain extract. If ready examination is
2. Microscopic Examination necessary, then after dipping the stained cloth
in the nonnal saline solution, it should be
When frank blood is obtained, it may be sub-
gently agitated with the help of the tip of a
jected to various microscopic examinations.
needle. The stain extract thus obtained can
But in case of dried stain, the stain extract
should be cautiously prepared in a way, not be subjected to physical, chemical, serologi-
to disturb the features and properties of the cal and other tests.
blood as far as possible. If it is in the fonn of Microscopic examination of blood or
dried stain on floor or smhe such other sur- blood -stain extract: "Demonstration of RBC
face, it can be scraped out with the help of a by microscopic examination is a positive test
blade and then dissolved in nonnal saline for blood ".
••
•
.,
' .-
'
5 .1(a) 5 .1 (b) 5.2{a) 5 .2(b)
Fig. 5.1(a): Jetting or spurting of blood from artery. Fig . 5.1(b): Diagrammatic representation
Fig. 5.2(a) : Drops of venous blood (passive bleeding), FIQ . 5.2(b): Diagrammatic representation

chapter 5: IDENTIFICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 193
WET TEST: A drop of the stain extract is Thus, different coloured rays occupy differ-
placed on a glass slide and then covered with ent zones according to their wavelengths .
a cover slip and observed under high power When light rays are passed through trans-
observation of a microscope . Intact red blood parent materials, for example thin film of
cells con finn the stain to be that due to blood. blood and then through the prism, then the
From the shape and other features of the red rays of some specific wavelengths get ab-
blood cells, its species source can sometimes sorbed in the substance, whereas rays ofother
be said. Hwnan RBCs are circular, biconcave , wavelengths pass through, unabsorbed. The
non-nucleated and are of an average diam- area of the spreaded spectrum with rays ab-
eter of 7 f.i . All mammalian red blood cells sorbed by blood, appears as dark band . Thus
are circular., biconcave and non-nucleated haemoglobin, the colouring matter of blood,
except that of camels which are oval, bicon- can be detected in its different chemical
vex and non-nucleated . In fish , avians and forms , from the appearance of dark bands in
amphibians the RBCs are oval, bi-convex and different zones of the spectra, when light is
nucleated . first passed through the blood film and then
STAIN TEST: Careful staining of a film splitted by a prismic arrangement in a spec-
of the stain extract by Leishman stain will troscope.
not only reveal the detail picture and features For OXYHAEMOGLOBIN , two dark
ofRBCs, WBCs and platelets, but drumstick bands are available between D and E lines in
appearance of Davidson bodies in the poly- the yellow zone of the spectrum. When am-
morph cells may also be detected and their monium sulphide is added in the blood sam-
count may help to know the sex origin of the ple, the oxy-haemoglobin is reduced and a
blood. It also may help to detect the abnor- spectrum of reduced haemoglobin is available.
malities of the blood cells and thereby to di-
agnose some poisoning or other pathology For REDUCED HAEMOGLOBIN , a
responsible for the cause of death. Thus, in broad. dark band is available between D and
chronic lead poisoning, basophilic stippling E lines of the yellow zone of the spectrum.
may be present in the red cells. In aplastic For CARBOXY-HAEMOGLOBIN , two
anaemia due to some poisoning, premature dark bands, like those of oxyhaemoglobin are
ce Us should be present in the field of vision. available in an area further right of the bands
Decomposition or very old blood stain or available in case of oxyhaemoglobin, nearer
blood contaminated with chemicals may des- to the violet zone of the spectrum. But the
troy the morphology of blood cell structure, difference with oxyhaemoglobin is that car-
and the microscopic test with such samples boxyhaemoglobin cannot be reduced by addi-
may be negative. tion of ammonium sulphide and hence un- ·
like oxyhaernoglobin the position and appear-
3. Spedroscopic Examination ance of the bands do not change with addi-
By spectroscopic examination, blood can be tion of ammonium sulphide.
detected in its different physical and chemi- For methaemoglobin , 4 dark bands are
cal states, without any chance of mistake. available, 1 band in between C and D lines in
In a spectroscope, the sunlight rays are the orange zone, 2 in between D and E lines
spreaded over acconling to the wave lengths of the yellow zone and the 4th in between E
oflight rays, when passed through a prism. and F lines in the green zone.
IF. M. - 131
For acid haem.atin, a dark band is avail- 4. Chemical tests for detection of blood
able near the C line and in case of ALKA- in a stain (Presumptive tests)
LINE HAEMATIN, one band appears near
A good number of chemical tests are recom-
the D line. Reducing the alkaline haematin
m.ended to know whether a stain could be
with ammonium sulphide, picture ofhaemo-
due to blood or not. These chemical tests are
chromogen is available.
not confinn.atory for blood. The principle of
For HAEMOCHROMOGEN, two bands all these chemical tests are same with some
are available. 1 in between D and E lines in degree of variability on tl.d !' l'eliability and
the yellow zone and the other in betwP.en E sensitivity which makes one preferable to the
and F lines near the green and violet zones . other, depending on quality, duration and
With cyanhaemochrornogen, the bands are quantity of the stain. These tests are based
similar except that these are wider now. on the presence of the enzyme peroxidase in
Test for haematoporphyrin is necessary the red blood cells. Hence the reagents for
in case of old and decomposed blood when by these tests are so chosen that the action of
adding strong sulphuric acjd or strong alkali, peroxidase is demonstrated with change in
acid or alkaline haematoporphyrin will be the colour of the reagents, to indicate that
fonned. The acid variety will have a dark the stain could be due to blood. To demon-
band between D and E and the alkaline vari- strate presence of peroxidase, H 2 0 2 is used
ety, 4 bands, 1 between C and D, two between which when acted upon by peroxidase liber-
D and E and the 4th between E and F lines. ates oxygen that acts on the reagent which
The 4th is the darkest and broadest. changes in colour The different tests recom-
mended are:
A Benzedine test:
Reagents -
(a) Benzidine solution- Benzidine pow-
der in glacial acetic acid ( 10% Ben-
8 C D E F
zidine in glacial acetic acidJ.
<b> Hydrogen peroxide - 30 volume for
strong stain extract: 100 volume for
weak stain extract.
II
The test- ·
(a) Tube test - To the stain extract in a
II!
test tube, a few drops of lOck solu-
tion of benzidine in glacial acetic acid
and a few drops ofH~ 0 2 are added
Fig. 5.3: Different blood spectra : successively. Blue colour change
····' I. Sunlight spectrum-No absorption band anywhere infers positive result.
II. Oxyhaemoglobin spectrum - 2 dark absorptions (b) Filter paper test - The stained area
bands in the zona between D & E
Ill. Carboxyhoemoglobi'l spectrum (as in case of CO- is moistened with nornla.l saline and
• poisoning)- 2 dark absorption bands in the zone a blotter is pressed over the area.
between D & E but the band nearer to E IS broader.
This is fol1owed by addition of one

chapter 5: IDENTIFICATION FROM TRACE. SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES/ 195
drop of b~nzidine solution and one C. Leucomalachite green test:

drop of hydrogen peroxide succes-
l
Reagents -
sively over that part of the blotting
A Stock solution -
paper. Presence of blood gives blu-
ish colouration. Leucomalachite green - 1 g
E Pr.en olphthalein test (Kastle Meyer test): + • (11
Glacial Acetic acid- 100 ml
Reagents -
ta) Stalk solution - Reduced alkaline +
phenolphthaline solution. 2 g of phe- Distilled water - 150 ml (2)
nolphthalein powder is added to 20% 1 + 2 makes slightly green Cleuco-
potassium hydroxide solution in dis- malachite green) soln.
tilled water, to make 100 ml of al- B. Hydrogen peroxide ( 100 vol.)
kaline phenolphthaline. This is then The slightly green leucomalachite
reduced by boiling in presence of zinc green solution tums bright green
granules. To keep the quantity and when oxidised
concentration of different constitu-
Test -
ents unaltered, the reduction is
done by reflux boiling in a round To the stain extract a few drops of
bottom glass flask. The stalk solu- leucomalachite green solution is
tion can be p~served for about a added. This is followed by addition
month inside a brown or amber col- of a few drops of H 2 0 2 solution ( 100
oured bottle, in a dark place with vol. ). A bright green colouration sug-
some additional zinc granules left gests presence of peroxidase or
inside the bottle . blood.
D. Orthotolidine tBlue or Green) test (Kahn
(b) Hydrogen peroxide ( 10 or 20 vol-
and O'kelly test) :
ume).
Reagents -
Test -
A Stock solution - 4% solution of
On diluted stain extract in a test
orthotolidiue in ethyl alcohol (can
tube, first a few drops of reduced al-
be s ored at 48°C for a month.)
kaline phenolphthaline and then a
few drops of hydrogen peroxide ( 10 A 1. Working solution- Stock solution-
or 20 val.) are added. The test is 1 part, Glacial acetic acid - 1 part,
Distilled water - 1 part. ·
positive, if pink colour develops .
B. Hydrogen peroxide - (10 val.)
Phenolphthalein is white crystalline
powder. 2ck. phenophthalein in 20lk- The test -
alkaline solution is pink in colour. Equal volumes of working solution
But when reduced, it becomes col- (A1) and H 20 2 ( B) is mixed. Then a
ourless. On being acted upon by oxy- few drops of this mixture are added
gen liberated from H 2 0 2 by the ac- to the stain extract in a test tube. If
tion of peroxidase, the solution is blue or green colour appears, it will
oxidised and tums pink again. indicate that the stain extract could

be blood. This test can also be per- substance which contains peroxidase or
formed with blotting paper. which can liberate nascent oxygen from
the hydrogen peroxide . Hence false posi-
E. Luminal test:
tive result for blood may be obtained with
Apparatus: An all-glass atomizer. sputum, pus, or other body fluids , green
Reagents: Alkaline solution of 3-amino- vegetables on one side, aud oxidising
phthalhydrazide and H:z0 2 in agents like iron rust (ferric oxide) on the
the following measures - other.
3-aminophthalhydrazide - 1 g 4. Benzidine test is very sensitive (positive
Sodium carbonate - 5 g with 1 in 1,000,000 dilution). But benzi-
dine powder is a known carcinogen.
Hydrogen peroxide (10 vol.)-
5. Phenolphthalein and leucomalachite
50ml
green tests are more specific for blood
Distilled water - 1litre.
than benzidine test but they are compara-
The test: The above working soltition is tively less sensitive.
sprayed on the cloth or stained 6. Though these tests, when positive, only
material with the help of an
suggest presence of blood, yet the tests
all-glass atomizer inside a
have great importance from other con-
dark room. The stained areas
siderations, e.g., their high sensitivity.
will luminesce if blood is
If a screening test is negative then there
present in those areas.
is no necessity to go for any confirma-
tory test, which are no doubt specific but
are much less sensitive. Hence direct con-
MERITS AND DEMERITS OF DIFFERENT
firmatory test being less sensitive may
CHEMICAL TESTS FOR BLOOD
give a negative result which will be far
from conclusive, ifthe stain is an old one
1. The above chemical tests are only screen- or there is a chance that the blood might
ing tests for blood and are not confinna- have decomposed.
tory.
7. When the stained area is small, then a
2. The basis of all these tests is the pres- confirmatory test should be attempted di-
:. '
ence ofperoxidase in the RBC Glacial ace- rectly.
tic acid breaks RBC and makes permci-
8. In the above consideration, benzidine test
dase available to act on hydrogen perox- • ~t '
has an edge over other tests; in that, the
ide, when nascent oxygen is liberated
which oxidises benzidine or whatever is sample of stain extract subjected to ben-
used in different screening tests, to cause zidine test, if gives a positive result, then
change in colour of the respective solu- the tested extract can again be used for
tion. In case of luminal test there is spectroscopic examination for confirma-
luminosity of the stained area in the tion.
dark. Vide table on effectivity and danger of
• I ' ~
.1 ~~• , t
3. The tests are positive with any organic each screening test for blood in page 197.

chapter 5: IDENTIFICATION FROM TRACE SUBSTANCES & THEIR OTH ER EVIDENTIAL VALUES I 197
1· Screening tests for blood - effectivity and dangers

Table 5.. i
Test Indication of Sensitivity Remarks

posmve result
1. Benzidine Blue colouration ++++- Highly sensitive, can be subjected to

(1} confirmatory test even after doing this test
Reagent is known carcinogenic
2. Tetramethyl -<b- +++ Very good sensitivity, can be subjected to
(2} confirmatory test after this test is performed
Probably carcinogen
3. Luminal test Fluorescence +++++ Very high sensitivity
(5-amino-2, 3-di-hydro-
1, 4 pthalazinedione (3}
4. Orthotolidne tes~ Dark green +++ Good sensitivity
(4} colouration Probably carcinogen
5. Leucomalachite green test green ++ Comparatively moderate sensitivity
(5} Relatively safe
6. Phenolphthalein Pink +++ Good sensitivity ,
(Kastle Meyer test} (6) May not be safe i
7. Haemastic Deep green +++ Good sensitivity, safe
(orthotoludinewith water
permeable membrane
all around} (7)
N.B.: No. 2 being related to no. 1 and no. 7 being related to no. 4, those have not been described separately in
presumptive chemical test, in page 194, page 196
5. Co"firrnatory Mkrochemicol 1-Qsts The reagent takes about 2 days for matura-
(Crystal tC!sts) for blood (~b for tion for use. Takayama reagent can be stored
haomogtobin of blood} in amber coloured bottle in a dark place for 1
A Haemochromogen crystal test - month .
Reagents- TAKAYAMA REAGENT The test: A little of the stain extract is

(Stock so'l ution )·- ' dried over a glass slide . It is
., covered with a cover slip .
L Pyridin - 3 g '·
: -.· ,
-'
Takayama reagent is added
2. 10% So.diwn,hydroxide-
3 nil ' ···:'. ·' .-. from the side of the cover slip.
A little wanning accelerates
3. Saturated solution of glu- the process of the chemical re-
cose- 3 ml
,. action involved. Mter 20 to 30
4. Distilled water -7 ml minutes , clusters of pink
This stock solutio~ r$lA~.c-:· S:'00i~. reagent.
l' .t # • 'J : : I •
feathery crystals of haemo-

198 I PRINCIPLES OF FORENSIC M EDICINE
Fig. 5.4 : Pinkish feathery clusters of Haemochromo- Fig . 5.5: Dark brown Rhomboid shaped Haemin
gen crystals I crystals
chromogen will be visible un- result may be obtained in haemin crystal test
der the microscope. In some if quantity of salt is more . False negative re-
cases, it may take hours for sult may be obtained in both tests, if the stain
appearance of the crystals. In extract is contaminated with some chemical,
case of a very old stain it may or if the stain is very old or decomposed, or if
take 24 hours (Fig. 5.4). the takayama reagent is very old.
B. Haemin crystal test (Teichmann's test) -
6. Sero-immunological tests for blood
Reagents: Chemically pure N aCl , Glacial
acetic acid . The medicolegal purposes of serological or
The test : A little of the stain extract is immunological tests of blood are :
dried over a glass slide. A few 1. Species identification .
crystals of chemically pure 2. Specific identification of a person.
N aCl is taken over the stained
3. Alleged mismatched or unsuitable blood
area of the slide and covered transfusion cases .
with a coverslip . Glacial ace-
4. Disputed patemity and matemity cases.
tic acid is added from the side
of the coverslip . It may be In criminal practices, once the stain is
warmed slightly for prompt proved to be due to that of blood, the next
reaction. Within 5-10 min- question arises is, whether it is human blood
utes, dark brown rhomboid- or blood of any other lower animal.
shaped crystals should be vis- The serum of the blood stain contains
ible if the stain is due to blood. proteins . If antihuman serum is treated with
Of the two microchemical (crystal) tests, the blood stain from human source , then
haernochromogen crystal test is more de- there will be antigen-antibody reaction which
pendable, but it is comparatively more time- can be demonstrated by various serological
consuming and less sensitive. False negative tests, each suitable to a specific circumstance.

chapter 5. IDENfiFICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 199
It is to be remembered that, many animal in round bottomed glass tubes of 5 em length

serum proteins may be agglutinated by or and 5.:> Irun inner diameter. Equal volume of
may be reacted upon by antihuman sera . The anti-human serum is added in the tube by
serum protein prefened for these tests is muning down along the wall of each tube. A
globulin, ~nd anti-human globulin is prepared precipitation ring is fonned at the interface
by injeeting human semm in rabbit. The an- of the two fluids , with 1 in 1,000 dilution of
tisera to be used should first be made free the stain extract, if the srain was ofhuman
from reactivity with the animal blood proteins blood . Control tests are necessary with nor-
by treating the antisera with the commonly mal saline, human se1um and sera of other
available animal proteins (sera). Certain ani- animals.
mals like monkey and ape have proteins in
their sera which, if treated with antihuman 2. Anti-human globulin consumption test
sera, may completely neutralize the antisera , (Absorption- inhibition test)
rendering it inactive to human semm To
solve such a problem. stain extracts of differ- Anti-human globulin agglutinates red cells
ent titres. without being first reacted upon which are strongly sensitized by incomplete
by ape semm can be used to assess the anti-D .
atnmgth of reactivity of the stain extract, with Anti-human globulin is mixed with the
ape serum as one of the control tests , to ex- stain extract of different dilutions and left for
clude the possibility of the stain being from 2 to 48 hours depending on the age of the
ape source, in which case the reaction is of stain. The mixed fluid with different dilutions
course quite weak than with the stain ex- of stain extract is placed in the wells of a white
tract if it is ofhuman origin. Also. anti-hu- tile with one drop of each dilution of the stain
man sera can be prepared by injecting apes in a separate well. Then one drop of D +ve
wit.h the human serum in which case the red cells sensitized by incomplete anti-D is
senun will not react with stain extract of placed in each well. Presence of human globu-
ape origin. lin in the stain ext:;:act is indicated by absence
The different serological tests for species of agglutination of the sensitizPd •·ed cells by
identification of the blood are -- the mixture of stain extract and anti-human
1. Ring test. globulin due to earlier neutralization of the
antihuman globulin by the human globulin
2. Antiglobulin consumption test.
of the stRin extract. Control tests are neces-
3. Mixed antiglobulin test. sary with 1. anti-human globulin+ saline so-
4. Diffusion precipitation in gel. lution; 2. anti-human globulin + red cells
5 Passive haemagglutination test. (sensitized}; 3. sensitized red cells and stain
extract and 4. anti-human globulin and ex-
6. C'n::l electrophoresis test.
tract from unstained area of the material. IF
7. ABA Card test. THE TEST IS POSITIVE (i.e., ABSENCE OF
AGGLUTINATION) WITH STAIN EXTRACT
1. Ring test
OF 1 IN 4 DILUTION IN THE ANTI-HU-
It is a precipitation test perfom1ed with anti- NIAN GLOBULIN SERUM, THEN IT CAN
human serum and stain extract. 0.2 ml of BE SAID 'l'HA T THE STAIN EXTRACT
stain extract of different dilutions are taken CONTAINED HUMAN GLOBULIN.
'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38 ~&- -
3. Mixed antiglobulin test 4 . Gel precipitation test
Anti-human globulin rabbit serum is prepared Both anti-human globulin and serum protein
and is treated with A, B and 0 Group cells present in the blood extract pass through
and sera of other species of common animals agar gel media. Precipitation reaction occurs
to avoid error in record of study, due to pos- at the meeting point in the agar media, when
sible reaction with anti-human globulin sera in
they are placed at some distance the agar
and these agents. The red cells chosen are plate.
used after washing for at least ten times in Procedure- 15 g of agar and 8.5 g of so-
normal saline solution. The anti-human dium chloride are dissolved in 50 ml of 10%
globulin thus treated and obtained is suitable phenol. Distilled water is added to make 1
for use in the test. 0 Rh+ve red cells are used litre of the solution. It is boiled to dissolve
as the indicator cells for the +ve reaction in the agar. This agar solution is then poured
the test. Sensitized red cells are prepared by on a microscopic glass slide to make a thick
mixing 1 ml of 2% suspension of 0 group layer out of it. When the gel bas hardened,
Rh+ve red cells with 1 ml of 1 in .10 dilution then multiple holes (one central and others
of incomplete anti-D sera and the mixture is peripheral to the central one) are cut out on
incubated for 1 hr at 37°C. These cells are the gel coat over the slide.
washed and made to 1% suspension with rab-
The Test-Anti-human globulin is placed
bit protein (serum) which then becomes in the central whole and different dilutions
agglutinable by anti-human globulin serum. of stain extract and undiluted stain extract
The Test-The fabrics ofthe stained area are placed in the peripheral holes. The di-
is cut into small pieces and the fibres are sepa- luted stain extract should be in the strength
rated after fixation of the stain by alcohol and of 1 in 10, 1 in 100, 1 in 200, and 1 in 500. The
then washing them for some time. In a glass AHG (anti-human globulin) diffuses through
tube the separated fibres are mixed with the gel. If there is human protein in the stain
0.1 ml of 1 in 10 dilution of anti-human globu- extract, then that also diffuses. Precipitation
lin sera and then washed with normal saline occurs at the meeting point of the AHG and
for two or three times. To this is then added the protein in the stain extract. Care should
0.1 ml of sensitized indicator cells. This is be taken to prevent leakage of the liquids
then gently rotated for twenty to thirty min- from the holes through the under-sUrface of
utes. The antihuman globulin serum which the gel coat over the slide. Control tests
remains fixed on the surface of the fibres, should be performed by extract from un-
even after washing (if the stain on the fibres stained area of the cloth by serum of other
would have been due to human blood), ag- animals and normal saline. Gel precipitation
glutinates the sensitized RBCs which became test is specially useful when the stain extract
agglutinable by anti-human globulin serum, is not clear and when precipitation may not
after processing it as described above. If the be appreciated by ring test.
fibres are taken out and examined under
5. Passive haemi:Jgglutination test
microscope, then clumps of red cells will be
seen on the surface of the fibres . Sometimes RBCs, when treated with tannic acid, becomes
clumped red cells are seen separated out from capable to bind proteins on their surface. If
the fibre. the stain extract col'ltains protein (lue to the

presence of human blood. then tanned hu- stain extract that underwent precipitation
man RBCs can bind the protein in the stain reaction with the anti-sera of a particular ani-
and hence the RBCs thereafter will be agglu- mal or human origin.
tinated when further treated with anti-hu-
Points to be remembered in relation to
man globulin
serological tests for stain extracts
The Test-1 rnl oftanned red cells in sa-
line of pH 7.2 is used where Group 0 and All reasonable control tests are to be per-
Rh-ve red cells were treated with 1 in 20,000 formed along with all tests. Ageing of the
to 1 in 40,000 dilution of tannic acid in saline stain, heat and washing with soap or deter-
solution. The tanned red cells are mixed with gents may give a false negative result How-
a mixture of 0. 5 ml of stain extract and ever, if the stain is otherwise protected from
0.5 rnl of buffered saline at pH 5. The result- decomposition or contamination from dust or
ant nrixture is incubated for half an hour at chemicals, then ageing alone does not dam-
37°C. It is then washed with buffered saline age much the reacting capacity of the stain
at pH 7.2. The cells are then suspended in serologically.
equal volume of the buffered saline. One drop Once it is established that the stain is
of the cell suspension is mixed with one drop due to blood and that it belongs to human
of anti-human globulin serum Clumping in- being, the next series of serological tests in-
dicates presence of human protein in the stain volved are for detection of group factors in
extract. The test should be performed with the blood, that may help to relate the stain
different dilutions of the stain extract and extract with a particular individual.
different dilutions of the anti-human globu-
lin sera. For stabilisation of the tanned red 7. ABA Card test
cells, some prefer addition of 0.4% normal ' Hen:m' test strips are used. Stain extract is
rabbit serum to tanned red cells. If the rab- applied to the bottom of the test strip. In case
bit serum agglutinates the red cells, then it 'of presence of human Hb in the extract it
is to be discarded. Different control tests are will combine with a monoclonal anti-human
to be performed simultaneously. Hb, which is labelled with a dye in the strip.
If human Hb is present in the extract, anti-
6. Gel electrophoresis test 1 , gen-antibody combination will occur which
In this test, extracts of different stains are will migrate through an absorbent membrane
placed in separate holes in one side of the gel to the test area of the strip. The test area of
strip and anti-human globulin a.."ld anti-sera the strip has a.. immobile polyclonal anti-
for other conunon animals are placed in sepa- human Hb, which will capture Ag-Ab (anti-
rate holes on the other side df the gel strip. gen antibody) complex to form an Ab-Ag-Ab
The set is then subjected to electrophoresis sandwich zone, and a pink dye in the strip is
in such a way that albumin and non-gamma visible as a band in the test region if the con-
globulins from the stain extract side travels centration of human Hb is above 0.05 mg/ml
to the anti-sera side, to meet the gamma of the stain extract. An internal control which
globulins there. Aline ofprecipitate fonns at is used, and which consists ofhuman Hb an-
the meeting point of proteins travelling from tibody-dye conjugate, cannot bind the anti-
the stain extract side with the specific anti- . body in the test area but is captured by an
sera. which denotes the species origin of the antibody in the control area.

A positive test will present two pink In addition, DNA test of blood of a per-
bands , one in the control area , one in the son if tallies with the stated blood stain then,
test area . A negative test will show only one that may be taken as confinnatory. This as-
pink band in the control area. In case of any pect has been further discussed in relation
error in the test there will be no visible pink to disputed paternity cases in this chapter.
bank either in the control area or in the test.
In such case the test has to be re-performed . BLOOD GROUP AND TYPE FACTORS
ABO GROUP SYSTEM -Of the different blood

SPECIFIC IDENTIFICATION OF AN
groups, the ABO group system is the primary
INDIVIDUAL FROM BLOOD
and most important because it is most com-
For specific identification of an individual, a mon, conspicuous and easily detectable.
good number of blood group and type tests By ABO blood group system the whole
are available. popula tion of the world can be grouped into 4
If the groups and types of the test blood
groups. Thus a person may be of-
or blood stain do not tally with the blood (a) Group A , when the antigenic (agglu-
groups or types of a person, then the person, tinogenic) factor in the surface of the
for all practical purposes, is excluded as to be RBCs is A and the antibody (corre-
the source of the blood or the blood stain. On sponding agglutinin) in the serum
the other hand, if the groups and types of the is anti-B.
tested blood tally with those of a person, then (b) Group B - antigen or agglutinogen
it can be suggested that he might be the on the surface of the red cells is B
source ofthe blood or the blood stain. In this and the antibody or agglutinin in the
instance, it is only a suggestive opinion ~d serum is anti-A
not a conclusive or confirmed one, because (c) Group AB - an tigen or agglutino-
many persons share same blood groups and gen consists of both A and B factors
types. However , the chance of the person and no corresponding antibody or ag-
being the source of blood or the blood stain glutinin is available in the serum.
_increases if a good number of blood groups (d) Group 0 - None of the two anti-
and types are tested with results in both side gens or a gglutinogens is present on
tallying. The more numbers of the tests tally, the cell wall but the serum contains
the more is the chance of the particular per- both anti-A and anti-B antibodies or
son being the source of the blood. If blood agglutinins.
stain from a scene of crime, tally in grouping The genotype combinations of ABO group
and typing tests with those of an accused , system has been considered in disputed pa-
then an additional force involves in the ex- ternity and maternity part of this chapter .
planation that the accused person is probably
the source of the blood stain, as because the Subgroups of Group A -
groups and types of the blood stain have tal- Group A has subgroupsA1 andAz . Anti-A
lied with the groups and types of the person sera of group B blood agglutinates all group
who was already suspected having some rea- A blood cells. Anti-A 1 agglutinates about 80%
sons to believe t hat he was present at the of all group A blood . Thus, use of these two
place of occurrence (P .O.) and was the source sera in the testing series can differentiate and
of the blood. identify both A1 and Az subgroups. The blood

chapter 5: IDENiiFICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 203
in which cells clump with anti-A but do not The red cells to be tested are washed
clump with anti-All are of A;. subgroup. Cells with normal saline and ::>uspended
which clump with both anti-A and anti-A 1 are in normal saline. One drop (0. 02 -
of A1 subgroup. 0.03 ml) of cell suspension is added
In addition to these two subgroups of to equal volumes of each of anti-A,
group A, some rare subgroups of group A anti-B and 0 group semm in sepa-
namely, A?,, A_. , ~ and A, 11 are also perceived rate tubes. These are left in room
in course of different group tests. But for temperature for 1 to 2 hours. When
these rare subgroups no specific anti-sera are the reaction is strongly positive,
available . then naked eye clumping due to ag-
glutination is well appreciated .
Apart from some group B sera, a good When naked eye clumping is not
source of the anti-A 1 factor is the latex of the clearly visible, one drop of the mix-
plant Dolichos biflorus . ture is taken out from each tube on
BLOOD GROlJPS AND 'l'YPES OTHER separate glass slides with the help
'l'HAN ABO SYSTE~I ARE DISCUSSED IN of separate pasteur pipettes, and ex-
PAGES209-214. amined under microscope for detec-
tion of microscopic clumps of small
number of cells.
TESTS FOR ABO GROUP FACTORS
(b) In TILE :METHOD, one drop of the
cell suspension and one drop of each
Whether a blood or a blood stain belongs to anti-sera are mixed separately in dif-
group A, B, AB or 0, can be known directly ferent wells of the tile, shaken by
by testing for antigen or agglutinogen, hand and examined for clumping by
present on the surface of the blood cells if naked eye and under microscope.
the cell stmcture is intact, or indirectly by Here much time cannot be allowed
testing for the antibody or agglutinin present for the reaction to occur as the sam-
in the serum or the antigen present in the ples get dry quickly (Table. 5.1).
stain when the cell structw·e is lost.
2. When blood group is to be determined
The test - from unknown serum, then known cell
For group specific antigen or agglutino- suspensions of A, B, and 0 groups are
gen - taken and the test is carried on as above
1. When the red cells are intact then direct (Table 5.2).
agglutination test with the help ofknown Whenever necessary, the subgroup A1 or
anti-sera can be undertaken either by pre- A!. can be deterrn:ined for both tmknown
cipitin tube method or by tile method. cells or serum by using anti-A1 sera or
Tube method is preferred to the other latex ofDolichos biflorus plant and cells
method. 1 , 1 •
of A1 or Az respectively.
(a) In TUBE :METHOD precipitin tubes GEL CARD TECHNOLOGY-For typing,
of size 5 em long and 5. 5 mm inner red cells are spun into a colunm containing
diameter with r<>und bottom are anti-senirn to the red cell antigens·. For
used. 1
l ' ;.P. / screening, the patient's serum and reagent

·····
Table 5.2: Interpretation of ABO grouping test for unknown cells

Sample cells or Serum Findings Inference
test cells (unknown) (Known) (Group of the tested blood)
~
cllil1)ing Group A
anti-A ·
no clumping Group B orO
Unknown cllJ!llling GroupB
anti-S
RBC no clumping Group A orO
anti-sera of clumping Group A, Bor AB
group 0 blood no clumping GroupO
Table 5.3: Interpretation of ABO grouping test for unknown serum

Sample sen1m or ·Groupce/fs Findings Inference
test serum (Knoym) (Group of the tested blood)
clumping Sera of Bor group 0 blood
A
> no clumping sera of A or group AB blood
Unknown clurrping sera of A or group 0 blood
B
serum no clumping sera of B or group AB blood
0 no clumping sera of 0, A, B or group AB blood
red cells are placed above the column. After Materials required for the test-
centrifugation, the red cells get exposed to 1. 0. 8% v/v suspension of patient's cells.
the antiglobulin reagent and agglutinated
2. Micropipette
cells are trapped . Non-agglutinated cells are
not impeded and fonn a button at the base of 3. DiaMed system centrifuge
the colunm . 4. Disposable pipette tips.
The difference in specific gravity between Procedure-The cassette is labelled with
the red cells and serum causes the red cells patient's name or first 3letters. Cells are then
to pass into the colunm and the senun is ex- added and the cassette is centrifuged using
cluded being less dense. The polymers in the the DiaMed centrifuge.' Front and back of
diluent, in addition to excluding the senun, individual colunm is observed for agglutina-
also enhance agglutination. This procedure tion. Then the result is recorded in the com-
is less subjective in interpretation and si~ puter system and in\ he 'request form'.
ple to practise . Interpretati~m.~!\ positive reaction is
GROUPING WITH DIAMED GEL recorded when red cells are retained in or
CARDS-The card contains specific typing above the gel column after centrifugation. A
reagent, more clonus antibodies to the vari- negative reaction is recorded when a distinct
ous red cell antigens. ~ :•, , . . ,• button of cells sediment•to the bottom of the

chapter 5: IDENTIFICATION FROM TRAC E SUBSTANCES &. THEIR OTHER EVIDENTIAL VALUES I 205
column after centrifugation. Haemolysis is

recorded as a positive reaction. Reading and
interpretation of result are done only on ini-
tial spin within 30 minutes of centrifugation.
If the cells agglutinate with Anti-A only,
it is group A; with Anti-B only, then group B;
with both Anti-A and Anti-B, then Group AB;
and if there is no agglutination with Anti-A
and Anti-B, then the blood group of the test
is 0 .
3. Absorption inhibition technique of deter-
mination of blood group may be used
when the cells' structure is damaged and
they cannot be subjected to agglutination
test. Even if the cells' structure is lost,
the antigenic group factor or the agglu-
tinogen is present in a blood stain.
Fig . 5.6: Clumping (Agglutination) of RBCs
The test: To the stain extract, known (M icroscopic view). .
antisera, anti-A, anti-B and anti-H (sera of Courtesy: Dr. Prabhas Chakraborty
Table 5.4: Interpretation of results of absorption inhibition test

Stain Known anti-sera of Indicating Reach on Interpretation
extract different dilutions cells ·
anti-A Acell dufllling B or 0 group stain

anti-A , A cell no clumping A or AB group stain
anti-A ,, Bcell . .
Unknown anti-A ' Ocell II II
anti-B . Acell . .
aoti~.B n. , Ocell " "
Lf~;..;..
group anti-B Bcell clumping A or 0 group stain
"
anti-B rJ , ,, Bcell no clumping 8 or AB group stain
~
anti-1-:l A cell dun-ping B or AB group stain
factor ' anti-Hl .T -, • ' ~· Acell no clumping A group stain
-~
_a.nti-!t .,
··- Bcell \""r .L) clurrping ., <, , A or AB group stain
J '- .J } I .,:. -~
' -
anti.t.h 1~:; :'• Bcell ' no clumping :
1
8 gr<X.p stain
anti-H Ocell " "

206 I PRINCIPLES Ot FORENSIC MEDICINE
F~g . 5.7: No clumping (No agglutination) , Fig . 5.8 : Mixed-agglutination test clumping of
{Mtcroscopic view). RBCs along the treated stained fibres.
Courtesy- Dr. Prabhas Chakr<Jborty L_.._ __ c-, • 'esy: Dr. Prabhas Chakraborty
blood group 0> are added in different dilu- themselves may be incapable to agglutinate
tions <dilution is increased by double dilution the cell antigen.
method). The mixtures are left for two hours 4. Mixed agglutination test: The stained
at a temperature of 48cC. area of the cloth is cut into pieces of
In the second phase, 2lJf suspension of 2-3 mm length and the fibres are sepa-
known cells of group A, B, and 0 are added rated from each other either as such or
separately in different tubes with mixtures after being softened by treating with a
of stain extract and antisera of different dilu- little nom1al saline solution. To each fi-
tions. bre, in separate siliconized glass tubes,
anti-A, anti-B, and anti-H sera are added
Result : With the use of anti-A sera, A-
in neat strength and in 1 in 10 dilution
group cell factor or A-agglutinogen will be separately. The tubes are incubated at
reacted upon and anti-A sera will be neutral- 37oC for 2-3 hours. The fibres are then
ized. Thus. if the blood stain contains A or washed with saline for 3-4 times. h1 each
AB group factor then, there will be no clump- tube are then added known indicator red
ing of the used known A cells. This is inhibi- cell suspenf:lions. The tubes are then
tion test. Similar interpretations are made placed iu rotator for 30 minutes. The fi-
with use ofanti-B sera and B cells and anti-H bres are then taken out, placed on a
sera and AB group cells. (Table 5.3) But to siliconized glass slide and examined un-
give reasonable emphasis on the inhibition der microscope. Clumps of red cells will
test (when there is no ·Clumping),' dihition of be seen adhered along the fibre with a
anti-sera showing inhibition , should not be few clU:mps being scattered away from the
very high because the diluted weak anti-sera fibre , if£he test is positive. Positive test
t-, ...,...,
I \' ~c.: \.., '- ~ •1

chapter 5: IDENTI FICATION FROM TRACE SUBSTANCES & THEIR OTHER EVIDENTIAL VALUES I 207
means that the blood group of the indica- known indicator RBCs get adhered to and
tor cells which have clumped along the clumped around the bigger squamous cells
length of the fibre is the group of the tested for knowing the group factor.
blood stain on the cloth. For example, if After about 60 years ofLandstein's work
the cloth was stained with A-group blood, on ABO blood group system, Latles in 1915
then A-group factor present in the
realized that blood cell structures get easily
stained fibre will absorb anti-A sera which
disintegrated spoiling partly the antigen. But
will sbck to the fibre even after washing
the corresponding antibodies in the semen
and will subsequently attract and clump
are very stable. He used this knowledge for
A-group cells.
detennination of blood group in such cases.
5. Absorption elution technique. As in case Rut he also noticed that the indirect method
of mixed agglutination test, the cut pieces de"13loped gave very week reaction in these
of fibres are first treated with anti-sera. cases and was mostly of not much importance,
washed and then the fibres are trans- because of negative results of these tests
ferred in the wells of a tile and known were to be taken into account to detennine
cell suspensions are then added. ThP tile the group.
is then placed inside a moist chaml>er at
55°C for 5-6 minutes. Then the slide is illtimately he developed a technique from
taken out of the chamber and rotated which conclusion could be drawn with positive
swiftly and the fibre is pushed to one side reaction. This is in gist the background status
of the tile. The tile is then left in a rota- of mixed agglutination test and absorption elu-
tor for 15-20 minutes at room tempera- tion test as described above in nos. 4 and 5.
ture. The content of the wells of the tile
are then examined by naked eye and if BLOOD GROUP AND DISPUTED
necessary under a microscope. Clumps PATERNITY AND MATERNITY CASES
will be noticed if the test is positive. As
in case of mixed agglutination test, in When the mother of a child names a person
case of a positive result, the group of the as to be the father of the child and when the
known indicator cells is the group of the man denies this, it remains to be proved
blood-stain on the cloth. whether the putative father is the actual fa-
Absorption elution test and mixed agglu- the!" of the child. Apart from morphological
tination test are the direct tests to know the features, examination of blood group factors
group of the blood stain, as they give the group comes for consideration to settle the dispute.
of the stain when the tests are positive. The The basis of blood group tests in such
disadvantage of these tests is that with weak cases is that, 1. a blood group antigen will be
or diluted anti-sera the result of the test may present in a child, only if at least one of the
be wrongly concluded. parents has it; and that, 2. if the blood group
Mixed agglutination technique has an- antigen in one parent is homozygous then it
other advantage. This test is helpful to know must appear in the child
rhe group factor of a person from body tissue Thus, from 1 above we get that if the
:ike squamous cells of mouth and vagina or blood cells of a child contain A-antigen then
:ells ofth,_. hair bulb. In these cases, the pro- at least one of its parents have A-antigen in
:.o-dure being S:ll.,.. e as with stained fibres, the his or her blood cells

208 I Pt<INCIPl.E:S vf FORENSIC MEDICINE
Table 5.5: ABO phenotype and genotype relationship between parents and children
Mating Mating Possible Possible Impossible Impossible
phenotypes genotypes genotypes phenotypes genotypes phenotypes
in children mchildren in children in children in children
A+A AA+AA AA A AB, 88and80 AB,B

AA+AO AA,AO A
AO+AO AA,AO, OO A, O
8+8 88+88 88 8 AB, AA, AO AB,A
BB+BO 88,80 8
80+80 88, 80,00 8,0
A+B AA+BB , AB AB AA,B8 NIL
AO+BB A8,80 AB, B
AA+BO AB, AO AB, A
AO+BO AB,AO, 80, 00 AB,A, 8,0
A+AB AA+AB MA8 AAB 00,88 0
AO+A8 AA, A8, AO, 80 A, 8,AB
8+A8 88+A8 88,A8 8,AB OO,AA 0
BO+AB BB, A8, AO, 80 A,B,AB
A+O AA+OO AO A AB, BB AB,B
AO+OO AO,OO A.o . BO,AA
8+0 88+00 80 B AB, 88 AB,A
80+00 80,00 8,0 AA,AO
AB+A8 A8+A8 AA, BB,AB A, B, AB "A0,80,00 0
AB+O AB+OO AO+BO A,8 AA, 88, AB, 00 O,AB
0+0 00+00 00 0 AO, 80, AB, AA, BB A,B,AB
From 2 we get that if the father or mother nor in the putative father , the anti-
mother have homozygous A-antigen (AAJ , gen must have come from another person .
then it must be present in the blood cells of Having no dispute about the identity of the
the child . mother, it can be said that if the antigen is
absent in the mother, then it must have come
The only chance of exception ofthe above
from the father and as such the putative fa-
two theories is the chance of mutation which
ther is not the actual father of the child be-
may occur in 1 in 50,000 new-borns.
cause the actual father must possess that
On the basis of the above two theories, antigen which has been inherited by the
if a group antigen is present in the blood of child from one parent and which is absent
the child which is neither present in the in the mother.

Considering ABO group system, the A, B MN Group System

and 0 antigens are inherited by 3 allelomor-
When it is not possible to exclude the puta-
phic genes and every person has two of these
tive father from being the actual father, by
three types of genes, one from each parent.
Hence with ABO group system. we get 6 types ABO grouping test, MN group system is tried
of individuals depending on the gene combi- In MN grouping system, a single pair of
nations of the persons, e.g., AA, AB AO BB gene possesses either M and M antigen or M
BO and 00 These are the genotypes of ABO and N antigen or N and N antigen Thus with
group system Group genotypes represent the MN system the combinations shown in Ta-
group antigens inherited from both the par- ble 5.5 are possible Both M and N antigens
ents and the group phenotype represents the are dominant
effective group factor of an individual result- A weak N2 has been recognised which is
ing from the genotype combination in him. a weak antigen. Being weak it evades detec-
AA genotype is_presented as A phenotype tion Hence, its presence can be assumed as
in the following case -
AO genotype is also presented as A phe-
notype as the 0 genotype does not represent
any antigen and is silent Father Mother
MN 2 MM
Similarly, BB and BO genotypes are pre-
sented as B phenotype t t
AB genotype is presented as AB pheno- ~
Child
type as both A and B antigens nmintain their MN 2
char-acters in the individual
00 genotype is presented as 0 pheno- As the N.} antigen in the above case may
type go undetected because it is a weak antigen,
With their spennatozoon and ovum, the it may be wrongly taken that the phenotype
parents contribute one genotype each out of and genotype of the child is M and MM re-
two present in him or her. Thus. in the child spectively. though actually the phenotype and
there will be two genotype antigens again. genotype of the child is MN? and MN')· Simi-
Mating between above genotypes/phenotypes larly, the N.} being weak will go undetected
will produce children having genotypes and in the putative father. It will hence appear
phenotypes as shown in Table. 5 . ~ See also that the phenotype and the genotype of the
page 284 in identification chapter. putative father are M and MM respectively.
Table 5.6: MN phenotype and genotype relationship between parents and children
Parents Possible children Impossible children

Phenotype Genotype Genotype Phenotype Genotype Phenotype
M+M MM+MM MM M MN, NN MN,N
M+N MM+NN MN MN MM,NN M, N
N+N NN+NN NN N MM,MN MN, M
·c H _ 1.11

210 I PRINCIPLES O F FORE NSIC M ED IC INE
In this case as the child's blood is wrongly THE RHESUS OR Rh FACTORS

taken to have lVIM genotype, one M factor
will be taken as must have come from each It was seen that when blood from rhesus
parent. But the putative father showing no monkey was injected in rabbits , that resulted
evidence of presence of M factor may be in fonnation of an antibody in the serum of
wrongly excluded from the fathership of the the rabbit which would agglutinate the red
child, though he is actually the father of the cells of the vast majority of the world popula-
child. tion (85% and above of thP. population in an
Distribution of the MN system- area, depending on the geographic distribu-
tion) . The group factors involved are tenned
Gr. M = 28%, Gr. N = 22% and Gr. MN = as rhesus or Rh factors .
50% of the whole population.
Fisher ( 1951) found three pairs of closely
Test for MN system-The MN system related antigenic factors in the Rh system of
can be studied by tube or tile method as in human blood, namely, Cc, Dd and Ee, of which
case of ABO group system. 'd.' is silent and no antibody against ' d' could
be made available, but antibody against each
Ss GROUP SYSTEM
of the others are available. On the basis of
Along with M, N and MN antigens, one of these antigenic factors , according to Fisher,
the two other antigens, namely S or s remains we have 8 phenotypes with 36 possible geno-
closely linked Distribution of S antigen is types in the Rh system of blood grouping of
about 55% and that of s antigen is about 45%. human blood (Table. 5.8).
S is usually linked with M antigen ( 75% ofM
cells have S factor in them). Table. 5.8: Rh phenotypes and genotypes
Phenotypes Genotypes
Table. 5.7: MN and Ss phenotype and
genotype relationship CDE CDECDE, CDECdE, CDECde,
CDeCdE, CDECde, CDecDE,
Phenotypes Genotypes
CDEcde, CDEcDE, CDEcDe ,
MS MSMS,MSMs CDEcde, CDEcdE, CDecdE ,
NS NSNS, NSNs CdecDE, cDeCdE.
MNS MSNS, MSNs, MsNS
CDe CDeCDe , CDeCde, CDecDe,
Ms MsMs
CDecde, CdecDe.
Ns NsNs
MNs MsNs cDE cDEcde, cDEcDe , cDEcDE ,
cDEcdE, cDEcdE, cDecdE
As MN and Ss systems are closely linked, CdE CdECdE, CdECde, CdEcdE ,
taking bo th the systems together the follow- CdEcde, CdecdE.
ing phenotypes and genotypes are possible
(Table . 5. 7). S antigen is dominant. Anti-S is Cde ·. CdeCde, Cdecde.
available. But anti-Ss is very very rare. cDe c·DecDe, cDecde.
Presence of Ss factors in blood can be cdE . . ·..odEcdE, cdEcde
studied either by tube method or by tile .'... 'c'di3cde.
cde
method. ',

chapter 5: IDENTIFICATION FRO M TRACE SU BSTAN CES & THEIR OTHER EVIDENTIAL VALUES I 211
Antibodies for Rh antigens do not occur Rh ALLELES

normally in a man. It never occurs in an Rh
+ve person. In Rh -ve subjects, Rh antibody Some rare antigenic factors are sometimes
may appear due to Rh +ve transfusion or when allied with the Rh antigens. The followings
a Rh -ve mother conceives a child with Rh are well in record -
factors present in the child from the father. 1. C"', cu, C" and ex are the alleles ofC an-
Tests for Rh factor. Tube technique is fol- tigen.
lowed. When tested forD antigen, an ti-D sera 2. Du is an allele of D antigen.
in saline and anti-D sera in albmnin are used .
3. G or rfi is a complex allele related with
Clumping is more prominent when anti-D
adjacent parts of substance of C and D
sera in albumin is used . Control tests with
antigens.
known Rh-D +ve and Rh-D -ve cells are done
simultaneously in the same process, using 4. rM is an allele related to G or ~.
same antisera. Incubation for a period of 1 5. rL allele may be related to c and e.
hour at 37oC may be necessary. 6. Eu and Ew are related to E.
Similarly, tests for other Rh factors like 7. hr is related to e antigen for which anti-
Rh-C or Rh-E, etc. may be perfonned. body is present in some Bantu females.
For the Rh system the Intemational So- 8. ce 5 or v is related to cDe or cde, a type
ciety of Blood Transfusion recognises both present in some negroid population.
Fisher-Race technology wherein single let- 9. e" orv 5 is related to v or ces antigen found
ters are used to denote antigens and also a in negroids.
numerical system where Rh system is basi-
10. D_ is related to D antigen.
cally denoted as 004, along with 3 digit
nmnber denoting particular antigen, as given 11. De- is related to C, D, c, d.
below- · 12. RhA, RhB, Rhc, and RhD, all are related
to D antigen.
Table. 5.9: ISBT nos. of Rh antigens {Fisher-Race)
Fisher-Race Antigen /SBT Number THE KELL SYSTEM
D 004001 This system is comprised of the following

c 004002 phenotypes and genotypes-
E 004003 Table. 5.10: Kell system phenotypes and genotypes

c 004004 Phenotypes Genotypes
e 004005
K +ve KK and Kk
Apart from the table as explained above, . K-ve kl<
a shorthand terminology is also used-R 1 for
Ce with D, R 2 for cE with D, r for ce in the KK is very rare but is helpful for exclu-
absence of D. Rh(D) typing tests are persion of paternity. Most persons have kk geno-
formed on all pattems and the donors or per- type. Hence, use of anti-k does not add much
sons concerned, to establish their status as to the exclusion of paternity. Kp 6 and Kpb are _
Rh(D) positive or negative. variants ofK

212/ PRINCIPLES OF FORENSIC MEDICINE
THE DUFFY SYSTEM (Fy) HAPTOGLOBINS (Hp)
The antigens are Fy (a+ b+), Fy (a+ b-), Haptoglobins are haemoglobin binding pro-
Fy (a- b +) teins which are present ii1 human serum.
Their genotypes are Hp 1 Hp 1, Hp 2 Hpl and
Hp 2Hp 2 . The different types ofhaptoglobins
THE LUTHERAN SYSTEM (Lu) can be identified from different characteris-
tic bands produced by analysis of human se-
Lu<a+l and LuCa-l have applied importance. Lub rum by gel electrophoresis. Haptoglobin is
is another variety but is very common and generally absent in the serum of a newborn
has very little forensic significance. Pheno- infant. But by 6 months of age, m.ost infants
type Luf"+ > may have genotype Lu8 Lu" or (97%) have it. Haptoglobins have irmnense
Lu"Luh. Phenotype Lura- >has LuhLuh geno- value in paternity detennination. It can add
type. 6.29% to the exclusion value achieved by the
other methods and it itselfhas 18 . 07~ exclu-
sion capacity.
THE KIDD SYSTEM (Jk) · In starch gel electrophoresis, Hp 1 - 1
shows a band, a little behind the band for
The antigens are Jk" and Jkb. The antibod- haemoglobin. Hp 2- 2 develops slow moving
ies are anti-Jk" and anti-Jkb These are very bands. Hp 2 - 1 bands have intennediate
rare. mobility.
Gm FACTORS IN BLOOD SERUM

ANTIGENIC FACTORS INHERITED IN THE
SERUM Gm 1 antigen is present in the serum of 60%
ofEu.ropeans. Gm ( 1, 5) is present in all Afri-
Serum protein polymorphisms- some serum cans. Their p resence is detected by Gr. 0- D
proteins show polymorphisms with allele +ve cells sensitized by incomplete an ti-D se-
having sufficient frequency differences which rum and agglutinated by anti-Gm serum
is helpful for blood typing. Transferrin ( Tf)
and group specific components (Gc) were al- THE RED CELL ENZYME SYSTEM FOR
most routinely used before the advent ofDNA IDENTIFICATION PURPOSES
typing. Haptoglobin was the most widely used
polymorphic serum protein, in Forensic in- A good many enzymes of the RBCs show in-
vestigation Haptoglobin is a Hb binding pro- herited variations which can be detected by
tein in the a.-globulin fraction of serum. The starch gel electrophoresis test at 4°C, carried
alleles of haptoglobin can be separated by on over rather a long period, followed by sub-
electrophoresis on a. gradient polyacrylamide sequent application of a reaction mixture .
-.. gel, where concentration of polyacrylamide Examples of these enzymes are phosphoglu-
varies between 5% at the top and 30% at the comutase (PHM), red cell acid phosphatase
bottom giving enhanced separation of mole cu.- (AP), adenosine de-aminase (ADA) and ade-
lar sieving. nylate kinase CAE).

In the PGM system PGM 1 and PGM2 are Exclusion of patern ity
known which may give phenotype pattem of
If at any stage of blood group investigations ,
PG~II - 1 , PGM2 - 1 and PGM2 - 2 . PGM 1 - t is
the putative father shows presence or ab-
most frequent (about 56%).
sence of some group factor or red cell enzyme
Identification of the above system de- factor which, giving due consideration to the
pends on- blood group and enzyme factors present in
1. The change in the structure affects the the mother, show incompatibility with those
net changes of isoenzymes . of the child, then that conclusively rules him
2. The isoenzymes can be separated by sim- out to be the father of the child and the dis-
ple electrophoresis. pute is settled (see Table 5.11). The chance
3. The locations of the separated isoenzymes of exclusion increases for non-fathers , when
can be visualised by reactions that depend more and more blood group and other rel-
on specific enzyme activity. evant tests are perfonned.
Starch gel was the usual separation me-
dium, but cellulose acet.ate, polyacrylamide Table. 5.11 : Paternity exclusion chances with different
and agarose can also be used. A biochemical blood group tests
detection system is used in which the enzyme
Grouping system Exclusion rate Cumulative
reduces nicotinamide adenine dinucleotide
phosphate CNADP) to NADPH with concomi- for each system exclusion rate
tant conversion of MTI' tetrazolium to the ABO 17.6% 17.6%
purple coloured fonnaran in the presence of
phenazyne methosulpate (PMS). MNSs 32.05% 44.01%
Some of the enzymes like ESD and EAP Rh 28.00% 59.68%

can hydrolyse esters to produce fluorescent Kell 3.34% 61 .08%
compound that can be visualized under UV
light. Duffy 4.81% 62.95%
A variant of electrophoresis is iso-electro- Lutheran 3.33% 64.18%

focusi ng (IEF ) where pH gradient is fom1ed Kidd 2.86% 65.2%
during the electrophoresis, and molecules
move till the point in the gel at which they Hp 18.07% 71 .49%
carry no charge. IEF produces sharper bases Gc 15.86% 76.01%
than slab gel electrophoresis.
Gm(1} 6.47% 77.56%
Attempt to PGM separation by using IEF
gave surprising result-the discovery of 2 Ag 14.22% 80.75%
r:~ore alleles which could not be separated by PGM 15.32% 83.70%
starch gel electrophoresis. Each of the alleles
:i~tectable by starch gel electrophoresis has
AK 4.20% 84.38%
:wo alternate fonns "+" and "-" alleles . Thus
±€ 10 phenotypes are comprised of the 4 ho- On the other hand, performance of more
:::..: zygous form-PGM- 1+, PGM- 1 -, and more tests with similarity in the groups
PG~I--- . PGM- - with their heterozygous ex-
2
of putative father and child, increases the
;: re-:;sions. force in the suggestion that the putative fa-

ther may actually be the father of the child of~- chains. After birth Hb-F is rapidly re-
in question. The defendant lawyer may take placed by HB-A and a declining trace ofHb-F
the plea of the fact that, with the present remains. Its presence in the blood indicates
knowledge and practice about 15% non-fa- foetal blood. The Hb-F can be detected by elec-
thers cannot be excluded as yet . While trophoresis along with the detection of its
putting or facing such an argument, it should property to resist alkali denaturation. To
he remembered that, the force of the sugges- present varieties of nonnal Hb-
tion of the person's beiug the father is in- There ru·e 3 varieties of nonnal haemo-
creased, if we take into consideration that, globins:
the mother of the chiJd, while pointing him
1. Haemoglobin A -Here the molecule ofHb
as the father of the child, did not have any
contains two different pairs of polypep-
idea about his blood group pattems and that
tide chains. The ones in each chain are
the mother has pointed to such a person
similar to each other but varies with the
whose blood examination also strongly sug-
chains of the other pair. The pairs of
gests that he could be the father of the child.
chains are known as a- and b- chains.
Inheritance ofhaemoglobin variants also
2. Haemoglobin A 2 -The Hb contains 2a
may help paternity detennination. polypeptide chains and two other polypep-
See also page 214 below. tide chains which are different from b-
chains and are termed as d-chains. It.s
Paternity and Maternity Determination nonnal presence is in 2-3% of the total
(or Exclusion) by DNA Test haemo.globin .
See pages 184,656-657. 3. Haemoglobin F -Hb-F or foetal haemo-
globin is present in newborn foetus up to
the extent of70-80% (maximum), the rest
FORENSIC ASPECTS OF ABNORMAL being adult Hb. As the infant grows in
HAEMOGLOBIN$ age the percentage ofHb-F decreases and
that ofLhe adult variety increases . By two
Screening and confinnation of blood can be years of age, blood will not have any
done by assessing the state of blood and its Hb-F. In foetal Hb, two of the polypep-
variants which is discriminatory for determi- tide chains are of'a' variety and two are
nation of patemity and also useful for other different and are tem1ed as y type.
purposes. Haemoglobin is a protein fonned
by two parts of polypeptide chains, Hb has
many variants with same structure for one ABNORMAL HAEMOGLOBIN$
pair of polypeptide chains, which is tenned
as cx.Hb. The dominant fonn of haemoglobin L In haemoglobin H (J3 4 ) and haemoglobin
found in adults in Hb-A which is composed of Barts (y4 ), the nonnal polypeptide chains
two ex.- and P- chains. About 2-3% of human are abnonnally conjugated.
adult Hb consists of a variant called Hb-A 2 in 2. In haemoglobin S, haemoglobin C, hae-
which P- chains are replaced by 28- chains, a moglobin E and haemoglobin D f'luljab there
variant of~- chain. Another important vari- are substitution of some amino acids at
ant is Hb-F which is present in 70-80% offoe- some points by some others which are
tal blood. Hb-F has a pairofy- chains instead not there in nonnal haemoglobin.

chapter 5: IDENTIFICATION FROM TRACE SUBSTANCES&. THEIR OTHER EVIDENTIAL VALUES I 215
The abnormal haemoglobins are variants CIVIL importances :

of adult haemoglobin . Hence , they become 1. Compensation on the ground of acquired
conspicuous only after about 6 months of sterility
binh.Abnormal haemoglobins can be detected 2. Disputed paternity
by paper electrophoresis . The foetal Hb can 3. Legitimacy
be differentiated by its characteristics : 1. Al-
4. Artificial insemination
kali resista.<'lce and 2. Ultra-violet absorption
5. Compensation on the ground of failure
curve. Sickled cells can be demonstrated un-
of vasectomy cases, leading to pregnancy
der the microscope by reducing the Hb by
of the wife.
additi on of 2% solution of sodium
6. Divorce cases- non-ejaculation amounts
metabisulphite and incubating the mixture
to impotence.
on a glass slide, in a moist chamber, at 37°C
for Y2 hour. Crescent or sickle shaped RBCs CRIMINAL importances : In relation to
will be seen, when the slide is examined un- sex offence cases
der a microscope after this time. 1. Concerning commission of sex offence.
2. Identification of the offender.
Medicolegal aspects of abnormal
haemoglobins EXAMINATION OF SEMINAL FLUID
1. Haemoglobin A 1 and ~ are normal vari- Physical appearance: When fresh and col-
eties in adults and children above 2 years lected in a glass container, seminal fluid is
of::tge. pale-white or greyish white, thick, viscid fluid
having a characteristic smell. On standing,
2. Haemoglobin F is n orrnal in new-boms
the fluid loses viscidity and becomes thin. It
and in decreasing rates, up to the age of
consists of complex composition, produced by
2 years, by which time it is totally re-
male sex organs. There is a cellular compo-
moved. This point may be helpful also to nent spem1atozoa and fluid component called
determine the age of infants and yom1g seminal plasma. Head of spermatozoa con-
children. tains the DNA.
3. Abnormal haemoglobins have importance When dried on cloth, the area appears
as being natural cause of death. slightly glistening, starchy hard in feeling,
4. Inheritance of abnonnal haemoglobins in·egular in shape and distribution, is whit-
have importance in deciding of paternity ish on dark clothes, and has fluorescence prop-
and maternity disputes. erty when examined under ultraviolet light
5. Abnormal haemoglobins have also impor- in a dark room
tance for identification of a person in Quantity in each ejaculation is about 4-5
other circumstances. ml after a period of abstinence.
Chemistry of seminal fluid: Seminal fluid
is alkaline.
MEDlCOLEGAlASPECTS OF
EXAMINATION OF SEMINAL FlUID The following chemicals are present in
spennatozoa and seminal plasma;
Examination ofseminal fluid is importauton In SPERMATOZOA-
many accounts. l. Lipoglycoprotein

216! PRINCIPLES OF FORENSIC MEDICINE
2. Hyaluronidase 2. BARBARIO'S test: The dried stain extract

3. Deoxyribonucleoprotein on the glass slide is covered with a cover
4. Other enzymes. slip and through the side of the cover slip
a drop of saturated aqueous or alcoholic
In seminal PLASMA-
solution of picric acid ito "' :..:.ed to get yel-
1. Choline lowish, long, needle shaped spermine
2. Spennine picrate crystals which appear very rap-
3. Citric acid idly and tells about the presence of
4. Sorbitol spennine in the stain extract.
5. Prostaglandin 3. ACID PHOSPHATASE test: Acid phos-
6. Inositol phatase is present in almost all body flu-
7. Phosphatases, proteases and other en- ids. But its concentration in seminal fluid
zymes. is maximum (about 20 t.o 400 times more
than normal of about 20 units present in
The prostate is the source of the enzyme
other body fluids ).
acid phosphatase and the protein~prostate
specific antigen or P 30 protein . After ejacula- The stained area is moistened and soaked
tion during intercourse semen is lost by with a blotting paper. The blotting paper
drainage and by biochemical change. Phasic is sprayed or treated with sodium alpha-
microscopical examination of vaginal swab naphthylphosphate and fast black K (fast
samples shows sequence of changes with blue B) dye. A purple blue colour appears
time. Damage begins with tails soon. About if tl1ere is acid phosphatase. Acid phos-
25% of spen:natozoa will have no tails by 6-8 phatase of semen origin gives the posi-
hours . By 12 hours there will be loss of tails tive reaction very rapidly (within 1/2
of many spenns and by 24 hours mainly the minute) in comparison with acid phos-
head remains. The timing of these disinte- phatase of other origin.
gration is highly variable. Survival of spenns 4. CREATINE PHOSPHOKINASE: It is also
outside the body depends on environmental present in seminal fluid in a very high
condition. A small stain that dries quickly may concentration.
have intact sperm for months or even for
5. AMMONIUMMOLYBDATE givesyellow-
years.
ish colouration when added to seminal
Chemical tests: stain extract.
1. FLORENCE test: This is the test for pres-
All the chemical tests are screening tests,
ence of choline in the stain extract. The
because many other body fluids also give posi-
stain extract is dried on a glass slide, cov-
tive reaction for these tests. However, ifthese
ered with a cover slip and a drop of potas-
tests are negative , then presence of seminal
sium tri-iodide solution or a solution of
fluid in the stain is excluded . Rapidly posi-
1.65 g KI + 2.54 g Iodine in 30 ml of dis-
tilled water is added by the side of the cover tive acid phosphatase test is a more depend-
slip . Dark brown rhomboid crystals of able one.
choline periodide appear very soon which GEL ELECTROPHORESIS TEST, how-
are seen rmder the microscope, whose sizes ever, gives almost diagnostic result for pres-
are larger than haemin crystals. ence or absence of seminal fluid.

In any case, the conclusive test for se- tail part greyish green-blue . Apart from
men is demonstration of SPERMATOZOA these, gimsa stain may also be used. Then it
with the help of a microscope. Human sper- is washed and counter-stained with an acid
:r..a•ozoa are abou t 55 fl. to 70 f.l. in length with stain, eosin . The tail and the posterior third
slender long tail and a heart-shaped head of of the head takes eosin or reddish stain and
the .:iimensions of about 5 f.l. length and 3.5 f.l. the anterior two third of the head takes very
maximum) breadth. The number of spenna- light or faint, basic or blue stain.
:.)zoa present per ml of seminal fluid , in the
a>erage, is between 60 to 150 million. TEST FOR BLOOD GROUP FACTORS IN
THE SEMEN
SECRETOR&-About 80(k. of the world popu-

MICROSCOPIC EXAMINATION OF lation secrete their blood group specific sub-
SEMEN stances through their body fluids including
sen1en, sputum, urine, sweat, milk, tears, etc.
\.ET TEST-Vaginal fluid or stain extract or The fibres ofthe stained part of the cloth can
swab extract or fresh semen, thinned on stay- be subjected to mixed agglutination test to
ing for some time or by addition of 1% HCl, find out any group specific substance, secreted
is taken in a drop on a glass slide and cov- by the person. This helps in specific identifi-
ered with a cover slip and examined under a cation of the person . The blood of the sus-
microscope. Spennatozoa, in its appearance pect is examined to know his blood group.
described above may be seen, either motile The sputum of the suspect is also examined
or dead. When fresh, 80% of the spennato- to see whether he is actually a secretor, so
zoa are motile. Ifkept in dry glass container, that full value can be given on the said group-
by 24 hours about 10% will be still motile. ing test of seminal fluid .
:.Vlotility is lost in the vaginal canal within
EXAMINATION AND M.L.I.
some hours. But in the uterine cavity they
OF SALIVA STAIN
may snrvive for 2-3 days. Spenns disintegrate
due to decomposition, with separation of the Saliva moistens the mouth . It is secreted
tail at the neck region Gunction of head and from 3 sets of glands on each side of mouth-
tail). In old or decomposed stain, sperms may (a) the sublingual, (b) submandibular and
not be recognized by wet microscopic test. (c) parotid. The saliva from parotid contains
Staining test is necessary in such cases. amylase which helps digestion of carbohy-
drates. Saliva can be an evidence of sexual
STAINING AND MICROSCOPIC offence. Where oral contact is alleged, some-
EXAMINATION OF SEMEN thing like presence of bite marks on sex or-
gans, and cigarette buts discarded at the scene
The dried stain extract on the glass slide is of crime, may be present.
first stained with a basic stain (methylene blue
1. Suspected stain due to saliva can be con-
or haematoxylin) for 20 minutes or
finned by:
:hrist mass tree stain which is utilized by the
!:ea.d which get differently stained (the DNA (a) Presence of buccal squamous cells
;:an- bright crimson). Counter-stained by pic- (microscopic).
-:-:: acid-indigo carmine (PIC) which stains the (b) Detection ofpn~sence of amylase . To

218/ PRINCIPLES OF FORENSIC MEDICINE
test for the presence of amylase, the EXAMINATION OF FAECAL STAINS

stain extract is treated with starch
Faeces is end product of digested food resi-
solution and incubated at 37°C for
due . The characteristic odour of faeces is
1/2 hour. Then a drop of gram's io- mainly due to skatole.
dine is added. If the stain was due
to saliva, then there will not be any Faecal stains can be confirmed by micro-
scopic examination and by detecting uro-
bluish discolouration, because amy-
bilinogen by its fluorescent reac.tion to
lase digests the starch partly to dex-
edelman's reagent. Vegetable cells and mus-
trine an~ then to maltose. If the
cle fibres will be seen, if it is a faecal stain.
stain is not due to saliva, then there
From faecal stains group specific substances
will be bluish discolouration on ad- can be detected . Tests for faeces are neces-
dition of gram's iodine , after incu- sary in alleged sodomy cases wben seminal
bation of the extract with starch. fluid may be detected. The DNA and other
2. From buccal mucosal cells present in sa- tests of semen may help to identity the of-
liva. sex can be detennined (Barr bodies ). fender. Poisons may be detected from stool
3. The group of the persons can be known in poisoning cases.
by mixed agglutination test with the buc- TESTS FOR URINE - Stain due to urine
cal squamous cells or the fibres from the may be known by using urease test and also
stained part of the cloth, in secretors. testing the stain for different constituents of
(Saliva containsABH group substance in urine. Examination of urine may give blood
secretors which can be detected by proper group of the person ifhe is a secretor . Many
tests, as mentioned above). poisons are excreted through urine and can
be detected in the urine. High amount of urea
4. Some poisons are secreted in the sputum .
in urine is the by-product of nom1al meta-
bolic process . A test showing high level of urea
EXAMINATION OF VAGINAL FLUID in a fluid is important as screening test. Same
In a case of rape in addition to detection of 1. is true for creatinine , which fonns a red com-
semen and 2. blood , 3. group specific sub- pound with picric acid (Jaffe test ). The spe-
stances like ABH and PGMl can also be de- cific odour of urine is enhanced by heating.
tected from the vaginal fluid stain, if the per- EXAMINATION OF SKIN may help to
) son is a secretor. 4. Examination of vaginal
epithelial cells is a good way to know the ac-
know the sex , group of the person and detec-
tion of some poisons.
tual sex in gonadal dysgenesis cases. 5. Pres- EXAMINATION OF TOOTH PULP -
ence of vaginal epithelium cells on the glans For sex and blood group and DNA typing.
of the penis of the accused supports sexual
EXAMINATION OF NAILS AND DAN-
intercourse. The glans is rubbed with a moist
DRUFF --For blood group .
blotter and subjected to the vapour of iodine.
The blotter becomes partly brown if vaginal From nails, poisons (heavy metal, like
epithelium cells are present because they arsenic) can be detected. Debris on the nail
contain glycogen which turns brown due to beds may show presence of foreign tissue and
iodine . 6. Vaginal stain extract should also blood, which may give sex and blood group of
be examined for poisons in a suspected case the person concen1ed.
of criminal abortion. DNA test is also a very N.B.: DNA profile may be studied from ex-
important test. tensive sources of body materials.

chapter 5: IDENTIFICATIOI'J FROM TRACE SUBST.'\NCES & THE'IR OTHER EViDENTIAL VALUES I 219
• Taylor's Principles and practice of Medical Jurispru-

dence (1984). 13th Edn. Ed. by Mant, A. K.
• Boorman, K. E. Dood, B. E. - Introduction to blood • Thomas. F. eta/ (1963). The demonstration of recent
group serology, 2nd Ed. 1961. sexual intercourse in the ma!e by the lugol method,
• Coombs, R.R.A. and Dodd, B.(1 961)- Possible appli- Med. Sc. law, 3 : 169.
. cation of the principle of mixed aggtutinat:on in the • Holmgren P. Carlsson B, Zack,isson AL, Lindblom B,
identification of blood stains, Medicine, Science. Law Dahl ML, Scordo MG. Drwd H, Ahlner J.
- 1 : 359. Enantioselective analysis of citalopram and its
• Gulliford, B.J. et al (1 964)- Precipitin reaction info- metabolites in post-mortem blood and genotyping
rensic problems, Nature- 201 : 1092. for CYP206 and CYP2C1 g_ J Anal Toxicol. 2004 :
• Gulliford, B.J (1966) - Haptoglobin types in dried 28(2):94-104.
blood stains. Nature. 2'11 : 872 • Roux C, Gates K, MaynRrd P. Lennard C, Database
• Gulliford, B.J. (1 967)- DeterminatiOn of phosphoglu- for Adhes1ve Tape Analysis- Establishing the Eviden-
comutase types in blood stains. J. of Forensic Sci- tial Value of Specific Techniques, Proceedings of the
ence Society, 7 : 131 . 15th tv1eetmg of the International Assodatinn of Fo-
• Glaister's Med1cal Junsprudence and Toxicology rensic Sciences, IAFS, Los Angeles, (E5).
(1973) -13th Ed. by Rentoul, E. and Smith, Hamil- • Woodland NB, Winkler IG. Hower RL. Detectron o1
ton. gene conversion associated with Milienherger bbod
• Huntsman. R. G., Lehman, H. (1963). Detection of grCJup polymorphism, Transfusion: 52nd Annual Meet-
aonormal haemoglobm in !Jiood ;;tains. Med1cine, ing uf the American Associated of Blood Banks, The
Science and Law- 3I : 5q American Association of Blood Banks, San Francisco
(E3).
• Kind, S. S. (1960) - Absorption elution grouping of
dried blood smears, nature, 185: 397. • BelliS, Witcombe D, Wallach M, Smith N, Characteri-
• McWright, C.G ( l 961 ). Study of group specific sub- sation of lmmunodorninant Gametocyte Antigens of
stances in kerat1niseu tissues, J. for Sc. 6 : 351 . EimeriA Maxima, GottestPrn B, H~mphill A, Muller N,
~peron S, Sager H (eds). Vaccines Against Animal
• Mouern Trends in F-orensic Medicine- Vol I, (1953).
Ed. by Simp con, C.K. Coccidioses, Eu10pean Union CO~ 1820, Interlaken,
Swit7eriand, (E3).
• Modern Trends in Forensic Meoicine- Vol. II (1967),
Ed. by Simp:;on, C. K. ,. Kau Bnnlon and Kim-An IJeberrnan, Basics of DNA
Fingerprinting.
• Modern Trends in Forensic Medicine- W.. ll: {1973).
Ed by Mant, K. • Burke, Terry-DNA ungerprinting a~proaches and ap-
• Nickol! s, l. C., Pereira, M. (1962). A study of modern plicatims. Fi1st lnrernational Sympo.>ium on DNA fin-
methods of grouping dried hlood stains, Med., Sc., gerprinting, Bern, Switzerland, Oct 1990.
Law. 2 : 172. • Lee Henry and RE Gaensslr-m, eds. DN4 and Other
• Satfe1 stein, A. (1g76). Criminalistic:;: An introduction Polymorphism in Forensic Science, Chicago Year book-
to Forensic Science. Medical 1991 .
• Shapiro, M. (1 960), Serology- Genetics of the new • Kind, SS, 1960 - Absorption-elusion grouping of
blood factor hrs, J. Forensic Medicine. 7 : 96. dried blood stain and fabrics, Nature- 18 7: 789-790.
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Short Notes
Possible Qul)stions
Benzedine, Phenophthalein, Haemin, Haemochro-
Theoretical
mogen crystals, Spectroscopic exam ., Florence,
1. How disputed paternity cases are settled? Barbarios, Acid phosphatase tests; Precipitin, Mixed
2. Vv'hat do you understand by trace evidence? How agglutination and absorption- Elution test, Secretors,
frace evidences help identification of a person? Haptoglobins, PGM.
NOTES

The purpose of life is to propagate life. In in all senses. It (The philosophy of thanatol-
every family, from the richest to the poor- ogy) inherits the consideration of the condi-
est; in every society, from the most civilized tion of the dying person, distress of the fam-
to the most primitive, addition of a new mem- ily concerned and the social responsibility
ber to the family by way of a new birth is towards the whole affair. Thanatophobia is
rejoiced as a happy occasion, and loss of a the term which means rear of death and other
member with one's death is mourned. These relevant psychological aspects in an indi-
two are the occasions where human beings vidual. The tenn' thanatology is also used in
are least hypocrite. Contrary to birth, death Forensic Medicine but only to the extent of
is an inevitable happening. Something which biological and physical aspects of death and
is so much inevitable, should not ordinarily the period after death of an individual.
cause so much concern. But we know death Coming to the other points, pronounce-
of a human being concerns us, the fellow ment of death of a person, though may appear
human beings, very much. It is more so for easy, it is not exactly so. Death is the most
the doctors . painful event in a family. The doctor has to
A doctor has to (a) prevent death of a per- inform the relatives of the dead, about this
son, (b) pronounce a person dead when his painful event. The infonuation is a tremen-
life tenninates and (c) ascertain the cause of dous shock, a jolt for the family members.
death, time of death, etc. Of these, preven- Naturally, the doctor has to be very cautious.
tion of death is not directly the concern of He must be satisfied that, the respiration and
this chapter. the circulation of the person, which have
Thanatology-The word has come from stopped, will not start or cannot be started
the Greek word "Thanatos" which means again to function independently. It had hap-
death and personification of dead Thanatol- pened sometimes that, death was declared
ogy means scientific study or knowledge about prematurely. Such a misdiagnosis may be dis-
death, both in academic and social point of astrous for the professional life of a doctor.
·dew. including changes that occurs with and Now, then the question arises that, on
after death. Taking death as inevitable and which basis, the event of death will be de-
·.:.:rimate end oflife making it (death), is aimed cided by the doctor. What is the definition of
:0 lJe made as painless an event as possible, death?
222 I PRINCIPL~S OF FOPENSIC MEDIC INE
Definitions of death riod the artificial respiratory aid is withdrawn.

whether the doctor by such an act will involv~
Legal definition- Law has uniform definition himself with the offence of culpable homicide
of death . By death, Black's law dictionary not amounting to murder or at least, if he by
means '·cessation oflife or ceasing to exist". such a step makes himself liable for causing
death of the patient by rash and negligent act.
Australian law which has defined death
But then the problem with the doctor is that,
as ·'irreversible cessation of circulation in the
with hope he has to apply those artificial life
body of a person or irreversible cessation of
sustaining aids, which may not always give
all functions of the brain of the person'' is
the expected result to revive the patient. Be-
applicable or accepted by the whole of Aus-
ing satisfied that the vital organs will not
tralia except Western Australia. This law
reswne functioning by their own, even if the
gives a feeling as if :fi.mctions of brain and
aids are continued for an unlimited period, the
heart and lungs are not interlinked or de-
doctor has to, at one stage, withdraw these
pendent on each other. though it can be said
extraneous aids. But on the other side, the
that it is obvious and needs no mention. Vari-
relatives of the deceased feel puzzled and ag-
ous religious sectors have their say to define,
grieved if the doctor withdraws the life sup-
which are often based on their spiritual ide-
ports aud aids without any further deteriora-
alism. They have honestly tried to accommo-
tion in the condition of the patient. Thus, dec-
date themselves with reality in some way or
laration of C.t \~hand the moment of death is
other. Some of them have even expressed
very important legally.
frankly that to define death is the job ol a
medical person and it does not fall into their In this context it can be said that since
spiritual or religious domain . more than a decade "Brain-death'' has occu-
Age-long Physicians' conception of death pied a very important position particularly
is "Total stoppage of circulation with conse- in tbe wake of transplantation of organs from
quent cessation of animal and vital function". "living cadavers" as a therapeutic aid to save
These definitions may not solve all legal prob- others lives. This is discussed below to the
lems. With the advent of science, nowadays, extent required by a man of Forensic Medi-
maintenance of circulation with artificial aids cine.
has become a commoa event in hospitals. However, due to various possible problems
Sustaining life by such artificial maintenance in the comt of law. conceming the moment of
of circulation inherits certain legal implica- death of a person, a comprehensive definition
tions. The same is true in question of mainte- of death has been attempted. It is better to
nance of respiration, where the patient needs designate it as medicolegal definition of death.
artificial respiration for the continuance oflife. Though brai.n-death now to a great extent and
The necessity for such artificial circulatory or in some circumstances supervenes over this
respiratory aids is that, the natural circula-
definition, the ~dicolegal definition has its
tion or respiration may be established after
own importance and place in cases of litiga-
the artificial aid is continued for sometime.
tion or possible litigation. and particularly as
But, as it so happens in many cases. natural
it has nothing to contradict brain-death.
respiration may not retum even after use of
artificial respiration for quite a long period, :MEDICOLEGAL DEFINITION of death-
say for a week or two or even more. Hence, Death is pennanent and irreversible cessa-
contradiction arises, rega.niing, if at any pe- tion of functions of the three interlinked vi-

chapter 6: DEATH AND POST MORTEM CHANGES I 223
tal systems of the body (the tripod of life), organ from another body to replace a penna-
namely, the nervous, circulatory and respi- nently damaged organ of a living subject. This
ratory systems. is quite possible with a sparable organ from
a healthy individual, as in case of transplan-
This definition essentially requiref'; that a
tation of a kidney from a living donor. Ifboth
doctor before going to certify death except
kidneys of an individual are functioning
where brain-death certification is necessary
healthily, then one ofthe two can be donated
(for which there is specific guidelines), must
to a person whose both the kidneys are dam-
be satisfied that the functions of these sys-
aged and not functioning. But transplanta-
tems have ceased pennanently and irrevers-
tion ofliver or heart is obviously not possible
ibly. From this definition we also get that, if
from a living subject This inspired to explore
any of these three systems fails, then other
the possibility of transplantation of tissue or
two also will fail (as they are functionally
..., n from a dead body to a living subject
'interlinked'). But this definition also in no way
w~1o is in need of the tissue or the organ.
helps to take the decision as to when the arti-
ficial aids, which are already in use, should be But this proposition of transplanting tis-
withdrawn or, how lop.g should they continue. sue from a dead body is not possible in case
of most of the body organs, due to death of
It is a reality that, the artificial aidK can-
the tissue within a short period of cessation
not be continued for an unlimited period .
of circulation and respiration
These have to be stopped at some point. In
such a crucial and important affair it is bet- Somatic and molecula.r death~Deaths
ter that, if situation is favourable, the deci- commonly referred to with the cessation of
sion of permanent withdrawal of the aids the functions of nervous, circulatory and res-
should be taken in consultation with another piratory systems, are also known as somatic
doctor and only after trial for more than twice deaths or clinical.or systemic deaths. With
that, withdrawal of the artificial aids for short somatic death further supply of oxygen to dif-
periods did not revive the notmal function- ferent organs stops. Due to lack of oxygen
ing of the aided. supply, individual cells of different tissues or
organs die. This death of the individual cells
In ordinary circumstances, however, it
is known as cellular or molecular death In
is sufficient to wait for ten minutes. If no evi-
the absence of circulation and respiration, dif-
dence of function of any of these three sys-
ferent cells die their molecular de aths at dif-
tems is available for a continuous period of
ferent times after somatic death. In the se-
ten minutes, then the patient may be declared
ries of molecular death, death ofbrain cells
dead, because under no circumstances brain stand first. Within five minutes of stoppage
cells can maintain molecular life for more
of circulation and respiration, brain cells are
than ten minutes, if they do not get the sup- to die. Molecular death in muscles starts by
ply of oxygen for that period. the end of the first hour of somatic death and
Beyond the need of certification of death it takes some more hours for all muscle tis-
for cremation and ritual purposes, declara- sues to die. Blood cells and cornea may re-
tion ofthe moment of death has also acquired main alive for 5 hours Organs like, live~;
mm1ense value from a different (therapeu- kidneys and heart die comparatively early.
ticl point of view, i.e., from tissue transplan- Death of the fibrous tissue occurs late. As a
:ation point of view. With progress of science general rule, organs which receive or need
there has been a continuous demand for more blood supply during life, die early in
transplantation ofhealthy tissue or a whole absence of circulation.

So long cellular or molecular death does brain has stopped functioning permanently
not occur, individual ce1ls or tissue , though and irreversibly, then by maintaining circu-
do not respond to physical or mechanical lation and respiration artificially, transplant-
stimulus, respond to chemical or electrical able organs can be suitably removed from
stimuli. This can be easily tested by using such a donor. This possibility gave rise to the
myotic or mydiatric agents on the eye. On necessity of understanding the conception of
application of these agents, the iris muscles "brain-death".
will respond, if ce1lular or molecular death Brain-death: As has already been pointed
has not occurred. out, death of the brain cells occurs earliest
Further during this stage itself, some after the stoppage of the circulation. But the
other muscular reaction may be elicited by process of death may be initiated by the fail-
mechanical action. Quadriceps femoral mus- ure of the function of brain, i.e., in other
cles if hit by some hard blunt objects then words, brain-death in some cases initiates the
the so called 'Zaskos' phenomenon, i.e., ten- process of the somatic death.
don reaction of quadriceps muscle can be ob- To be more certain about inevitable
served by upward movement.of patella . progress towards somatic death , more
Another 'idiomuscular' reaction may be weightage is given on the death of the base
observed due to local 'bulj:;ing of biceps brae hi ofthe brain where the vital centres are lo-
muscle' at the site where it is hit by some cated, than the death of the cerebral cortex,
hard substance . although it is accepted that the vegetative
This gap between the somatic and the existence will not continue for long after the
molecular deaths has helped the process of death of the brain tissue at the cortical level.
organ transplantation from dead bodies. For Thus for applied purposes, brain-death has
the purpose , tissues like blood or cornea may been classified into three types-
be removed from a body soon after somatic (i) Cortical death
death . But those organs which are highly (ii) Brain-stem death
vascular, cannot be left till circulation and (iii) Both cortical and brain-stem death.
respiration stop, as lack of oxygenated blood-
At the stage of brain-death, it is recom-
supply will soon make them unsuitable for
mended that, for the purpose of removal of
the purpose of transplantation. Thus , for
tissues or organs from the dying person, for
transplantation purposes , heart, liver and
transplantation to a needy person, artificial
kidney have to be removed before stoppage
respiration and circulation may be main-
of circulation, i.e., before occun-ence of the
tained in those subjects who are then consi-
"death of these organs". The organ which can-
dered as "living cadavers" due to the fact that
not be used for transplantation is the brain,
brain-death has already occurred in them and
where cells die within a few minutes of stop-
he is to die in any way, or in other words, is
page of circulation or respiration, even
virtually dead. In these subjects, respiration
though their stoppage may be taken as to
and circulation are maintained artificially,
have occurred permanently before brain-
only to keep the cells of the organs living, till
death. Further, if the brain can be kept trans-
their removal for transplantation purpose.
plantable or alive by maintaining circulation
and respiration, there is no reason why the Maintenance of blood circulation and
subject should be taken as going to face in- rhythmic respiratory movement artificially,
evitable death. But if it becomes certain that, for transplantation purposes, is essential af-

ter infalliable diagnosis of brain-stem death. extent to keep his heart and lungs function-
But the diagnosis of brain-stem death need ing artificially.
not depend on the scope of application of so- Definition of brain death: It is irrevers-
phisticated appliances like cerebral angio- ible cessation of functions of brain (cortical ,
graphy or use ofEEG machine . Cautious clini- brain stem or both), but in the truest sense
cal study should be sufficient. The structural cannot be said to be a persistent vegetative
and functional damage of the brain-stem may state of the person.
be diagnosed from the absence of the follow-
After brain-death and before its failure
ing brain-stem reflexes -
influences to cause similar failure of circula-
1. Absence of co meal reflex tory and respiratory systems, functions of
2. Dilated and fixed pupils, not reacting to these two systems must be made to continue
light with artificial aids .
3. Absence ofvestibulo-ocular reflex Traditionally, 'law' and 'medicine' both
4. Absence of cranial UlOtor nerve responses detennined and accepted death of a person
to painful stimuli as loss offunction ofheart, lungs and brain .
5. Absence of cough reflex But with the advance of medical science and
6. Test withdrawal of respiratory aid for half invention of heart-lungs machine etc., and
a minute (ventilator) does not show sign along with, taking advantage of these inven-
of revival of self-respiration. tions, idea of transplantation of different or-
gans cropped up in a case ofbrain-death when
Precautions to be taken to avoid misdiag-
circulatory and respiratory organs could be
nosis-
kept ftmctioning alive by promoting aids for
1. Some of the clinical signs of brain-stem functioning of these two systems. The
death may be there in hypothermia . · "Harvard" criteria of irreversible coma (brain-
Hence, before testing for the above fea- death) and some subsequent events have con-
tures, the temperature of such subjects
tributions so that the states of America first
should be raised to 35°C .
accepted brain-death as indication of death.
2. The diagnosis ofbrain-stemdeath should Today in USA both medical and legal sections
be reached by a team of doctors , consis- accept that definition of'braindeath' is equiva-
ting of a neurologist, anaesthesiologist lent to the definition of'death'. Of course the
and an experienced doctor of the inten- first country to accept 'brain-death' as 'death'
sive care unit of the hospital. is Finland (in 1971 ). In UK brain-stem death
3. The patient should be examined by the is necessary to declare a person dead.
above team of doctors at least twice, with
Antagonists of brain-death theory have
a reasonable gap of period in between.
placed some arguments like (1) an expectant
4. None of the doctors who participates in mother with 'brain-death' had given birth to
the diagnosis ofbrain-death should have normal healthy child, (2) EEG in some brain-
any interest in the transplantation of an death individuals showed some continued ac-
organ, removed from the subject. tivity, (3) and some brain dead subjects main-
It received legal attention and status in tained a normal or near nom1al body tem-
1960s , when it was seen that inspite of irre- perature meaning sustained activity of
versible loss or cessation of all activities of hypothalamus , and (4) some claim tha~even
brain, a person can be resuscitated to the after declaration of brain-death many parts
rF. M. - 151
ofbrain continue to function. However, it is Such a death-like state is known as state of

a fact that some conditions like poisoning suspended animation or apparent death. This
with alcohol, barbttw·ate and some other in- may as such occur due to drowning, electro-
toxicating agents, and prolonged coma caus- cution or exposure to extreme cold (hypother-
ing apparent chronic vegetative state and hy- mia). The state of suspended animation or
pothermia may present a picture like brain- apparent death is said to be practicable. Its
death. It is also a fact that deep coma with practice is popular among th~ Indian 'Yogis'
damage to cortex and brain-stem may even (persons who follow lives of st1;ct principles
continue witb feeble respiration of its own . with physical and mental exorcises and re-
EEG also may be flat in case of deep anaes- straint). Such people demonstrate their out-
thesia and cardiac arrest. fit even by being voluntarily buried alive,
under the earth for hours . Actually, the cir-
However, the protagonists of the theory culation, etc. do not completely stop but is
that "brain-death" is death for all purposes being maintained in their minimum. When
recommend that response to pain, cranial
it is practi3ed voluntarily as by yogis, it is
nerve reflexes (papillary, oculomotor, corneal called voluntary suspended animation and
reflex) and caloric response if negative, these when it occurs spontaneously as in cases of
should be sufficient to declare brain-death, drowning or electrocution, it is called invol-
meaning "death". In addition to thesP 2, untary suspended animation.
isoelectric EEG tests can be perfom1ed at an
interval of24 hours. BiostasiS-.Some organisms can tolerate
variable environmental parameters or
So far donation of organs from a "living
changes without adapting them for their sur-
cadaver'' is concerned (whose brain-death has
vival, like, draught, freezing, change in pH,
occurred but circulation and respiration have pr·essure and temperature.
been maintained artificially), every one in
some countries is an automatic organ donor Cryptobiotie-This is a condition when
by law. Singapore allows an option (to opt out) metabolic state of an organism becomes al-
of this line of thinking_ And consent from most nil.
guardian or next-of-kin is required in many
countries
Tissue or organ transplantation Act as
adapted by the Govt. of West Bengal is ap-
pended as annexure at the end of the book. Natural death means death occurring due to
the natural diseases or pathological condition,
Suspended Animation (Apparent death) old age, debility or devitalisation, in which
death is not intended or attempted and also
It sometimes so happens that due to some does not occur accidentally -
reasons a person may appear to be dead be-
cause of very feeble or minimum functions Sudden death is a death which is not
of his body systems. Even, the functions of known to have been caused hy any trauma,
the nervous system, circulatory system or the poisoning or violent asphyxia, and where
respiratory system may not be perceived by death occurs all on a sudden or within 24
conventional methods, though the person hours of the onset of the temnnal symptoms.
may actually not be dead and the functions Thus, by definition sudden deaths are
of these systems "return" after sometime, mostly natural deaths where deaths occur
either as such or after proper resuscitation. inunediately or within 24 hours of the onset

Fig . 6.1: A case of natural death due to myocardial

infarction
IFig . 6 .2: Distribution and branching of coronary
L__ vessels
_j
Fig. 6.3 : Atheromatous char1ge in the intima of aorta Fig. 6.4: ThickE>nd and hard corllnary vessel
Fig. 6.5: Narrow1ng of coronary vessels due to

atheromotous changes

of the temlinal symptoms. which may be to- 4. Stenosis and insufficiency of valves
tally different from the symptoms, which the 5. Hypertensive heart disease I its compli-
patients were having so long. The definition cations
does not essentially exclude or rule out deaths
6. Inflammatory heart diseases
due to means other than natural diseases ,
but no urniatural cause is apparent. If the 7. Degenerative conditions of heart
cause is diagnosed or known to be unnatu- vasculatures
ral, it can't be termed as sudden death. 8. Rheumatic heart disease
The incidents of sudden death is about 10% 9. Infective conditions of the heart.
of all cases of death. Of these again most of 10. Aortic aneurysm
the deaths are due to cardiovascular or circu-
11. Constrictive pericarditis
latory causes. Next in frequency the cause of
death is the failure of the respiratory system. 12. Pulmonary embolism
Of all cases of sudden deaths about 45% 13. Others , including cardiac arrest.
are due to pathology in the cardiovascular Among the respiratory causes , the
system, about 20% due to pathology of the followings are important-
respiratory system, about 15% due to cen-
! Haemoptysis of different origin
tral nervous system, about 6% due to alimen-
tary causes, about 4% due to genito-urinary 2. Diphtheria, influenza, pneumonia and
causes and rest 10% are due to miscellane- other acute infective conditions
ous causes. 3. Air embolism
Among the cardiovascular causes, most 4. Oedema glottis
frequent are- 5. Pulmonary oedema
1. Myocardial infarction (coronary thrombo- 6. Pleural effusion and collapse of the lungs
sis I ischaemic heart disease) 7. Foreign body in the respiratory passage
2. Stroke 8. Lung abscess, neoplasm and other
3. Congenital heart diseases causes.
Fig. 6.7: Case of sudden death with a few external

Fig. 6.6: Congestion . conso lidation. pleural adhesion supe rficia l injuries which created doubt and
in a case of death due to tuberculosis confusion about the nature of death

:;'\ arrowing of respiratory passage due to

mtemal or external cause like neoplasm
or some growth .
Among the central nervous system
: au;;es. the importants are-
l Different intracranial haemorrhages,
thrombosis
..,
::-.Ieningitis, encephalitis
3 Epilepsy
4. Brain tumour, brain abscess.
Among the gastro-intestinal causes- Fig . 6.8: Rupture of heart in an old myocardial infarc-
tion
1. Haemorrhage in the stomach or the in-
testine due to various pathological con-
Of the above causes, some being quite
ditions.
conunon and being frequently dealt with in a
Strangulation of hernia medicolegal mortuary, need detail discussion
.-. .-\cute appendicitis
v here.
.
-= Intestinal obstruction
Coronary thrombosis and Myocardial
Rupture of liver abscess or enlarged
infardion
spleen
6. Perforation of the stomach or the intes- These are by far the most frequent causes of
tine sudden death as per defmition. Contrary to
7. Acute haemorrhagic pancreatitis. popular belief, Forensic Pathologists have
recorded that, fatal incidence of myocardial
Among the genitourinary causes, those infarction is not limited to elderly subjects
mentionable are-
only. The author has experience to record
1. Rupture of ectopic pregnancy death due to myocardial infarction with ad-
2. Toxaemia in pregnancy vanced vascular atheroma in an young man
3. l:terine haemorrhage due to various rea- of 29 years of age. This is not an isolated ob-
:::ons servation of the present author. On the other
4. Twisting of ovarian cyst hand, it also must be admitted that in medi-
colegal investigations, many cases where
;:,. ~ephrolithiasis
more convincing cause of death is not avail-
6 Chronic nephritis and other pathological able, myocardial involvement is made respon-
conditions. sible, in undesirable haste, in presence of
.-\mong the miscellaneous causes- some degree of atheromatous changes in the
1. Anaphylactic reactions to different drugs coronary vessels .
Wrong blood transfusion Further, complication arises in a case of
:3 Blood dyscrasias death due to fall from a stair or when a driver
dying in a circumstance of vehicular accident,
Sratlli thymolymphaticus
shows infarct in heart, during post-mortem
= \ ·agal inhibition of the heart examination. It is not easy for a forensic pa-
'J Cerebral malaria. thologist to infer, whether the fall from the

stair or the iumrinent vehicular acddent pre- 3. Enzymatic study ofblood, particularly for
cipitated or preceded by the recent myocar- SGOT (serum glutamic-oxaloacetic
dial infarction. transaminase ) and SGPT (serum
Another problem for the forensic patholo- glutamic-pyruvic transaminase l is not
much helpful. The levels of these en-
gist is to ascertain the time of infarction. in
zymes increase during and due to the
relation to the time of death. The problem
process ofinfarction of the myocardium,
lies in the fact that, the post-mortem sam-
i. e ., due to breakdown ofthe myocardial
ples of tissues from the dead body are usu-
cells. On the other hand, due to the >;ame
ally collected late which makes the asceitain-
process the concentration of these en-
ing of the exact time difficult. 'When death
zymes in the myocardium decreases But
occurs very rapidly afte1· an attack then the study ofblood for these enzymes in po!':t-
problem is more acute. because in those cases morten-t samples , may not be fruitful due
the conventional methods ofthe hislological to various reasons including the factors
staining may fail to help, due to death, in one which interferes with the pl'O}Jer inter-
hand and nnnimum detectable pathological pretations of the findings.
changes due to short period_of survival after
4. Macrochemical study-About 1 em thick
the infarction or ischaemia, on the other.
' transverse slices are made acros3 thP.
Conventional haematoxylin-eosin metl1od, ventricles which are mildly washed with
may not be effective for de tection of the cold water, so as to just remove the biood
infarcts of short duration. For this reason, stain and not to disturb ~he enzymes of
studies of blood enzymes and enzyme activi- the cells f•ll the cut surfac8i:'. ;J'h€' slice!:l
ties of the heart musculatm e demon~trable are then dipped into llif solution of 2:3:5
by macroscopic and histochemical methods, triphenyl-tetrazolium-chloride at pH 8.5,
along with other sophisticated tests like fluo- maiHtained by addition of phosphate
rescent microscopic and electro-microscopic buffer and incubated at 37"C for about half
examination of the suspected infarded heart an hour. After Llns period the slices are
musdes, have been continued. and are still treated with 10% fonnol saline which
being explored. ln the proce~ s of di~t~·aosis , fixes the stain and increases the con tra~t
th ,~ r0le of the history of the c·=tse and the bet ween the stained non-i.TJ.farcted and
clinical features must not be underestimated. noLL-stained or less stained infarcted :lr-
eas and can be preserved a;; such . This
Hence in these cases. for proper diagno- macrotest detects infarction as lack of de-
sis, guidelines are- hydrogenase on the surface of the in-
1. To take history of the case-Nan-ation of farcted areas. Tissues from 'infarcted' ar-
the relatives of the deceas~d should be eas thus detected can be collected for his-
recorded a:;; t.o how the tenn1nal event of tological examination-
death occun·ed, whether the deceased S. Histological examination-
had any previous attack or was there
(a) H .E. (haemato:>.:ylin-eo.<:in) method-
anything to suggest that he was prone to The change due to infarction is not
the attack. detectable by this stain bet(n'8 a mini-
2. The signs and symptoms as naiTated by mum period of 6 hours, when the
the relatives and. friend!:' of the deceased myocardial fibres appear more eosi-
as to bow they started and how they pro- nophilic and slightly oedematous.
gressed, are importnnt. Bl1t similar changes are also noticed.

in otherwise healthy heart tissue. (c) Test for malic dehydrogenase stands
due to post-mortem autolysis. in between lactic and succinic dehy-
(bJ Periodic acid schiffreaction-With drogenase in consideration to both
P A. S. the infarcted muscle fibres of the advantage and the disadvantage
the hea1t takes a purplish pink stain, with them.
whereas healthy heart tissue ap- Changes may be detectable by histo-
pears grey-blue. P.A.S. reaction has chemical study within 2 - 3 hours after
art advantage over H .E. staining infarction · For some enzymes, like phos-
method because the fonner is more phorylase, changes due to infarction oc-
specific and hence can he taken as cur within about two minutes after inf-
confirmatory ofinfarci.ion. Bui. this arction, but the changes are very unsta-
method also has the disadvantage ble, which vanish soon aftet· death.
like that of H.E. stain as in P.A. S.
Studies concerning adenosine triphos-
reaction also , the purplish pink stain
phatase, glutaminase and ex-hydroxybu-
does not develop in cases where
tyric dehydrogenase have some plus
death occurs before a lapse of about
points but none is truly encouraging.
6 hours after the iufarction.
7. Fluorescence test-
rcl Phosphotungstic acid haematoxylin
stain-This method has an advan- la) Macro-test -The sliced til'sues are
tage over the H.E. stain, in that it dipped into buffered fluorochrome
demon~=:trates change in the stria- solutions like. acridine orange,
tion pattem of the myocardial fibres coriphosphine or tetracycline solu-
which are more certain <md recog- tion in distilled water (100000 units
nisable than the changes noticed in in 1 litre ). The tissue is then
H .E. stain method. The change in quickly taken out and washed and
the pattem of striation of infarcted examined lmder ultraviolet rays.
fibres is alse not expected to occur The nonnal heart muscle fibres look
due to post-mortem autolysis. But brown and the infarcted ones appear
the disadvantage concerning the green with acridine orange. Early
time required to he lapsod after in- infarcts are also detectable by this
brctimJ. l!annot be oven:ome by this method.
method also, which is 31most same (bl Fluorescence microscopic test-Ei-
as in case of H. E. or P.A.S. method. ther as fixed cryostat section or for-
6. Histochemical examination- malin fixed paraffm section, with
(a) Reduced lactic dehydrogenase is a acridine orange (0.1%) in phosphate
definite change, detectable histo- buffer, infarcted tissue gives the
chemically, but the problem is that. same picture as in ma<:ro-test, with
it also occurs due to post-mortem slight va1iatiun due to variation in
autolysis. the period of survival after infarc-
tion which is not conspicuous in
(bl Histochemically, succinic dehydro-
genase is more specific for infarction macro-test.
than autolysis, but the disadvantage 8. Non-invasive MRl study is conducted on
is that. it. may not be demonstrable dead bodies which in case of infarction
even in established cases of infarc- due to ischaemia may show myocardial
tion. deformation due to the said pathology

9. Miscellaneous tests- ful. But in majority of the cases it may not

(a) Fall of pH in the infarcted muscle, prove rewarding.
(b) presence of C-reactive protein,
Medicolegal aspects
(c) Change in the Na+ : K+ ratio from
1 : 3 to 1 : 2.5, oedematous myofibrils In dealing with such cases, the medicolegist
and n.tptured mitochondria with will not only concern himself with the diag-
swelling, are the other acclaimed nosis of the cause of the changes that occur
early findings of infarction of the in the heart musculature, but also to the de-
hea1t muscle. gree up to which the heart condition can be
made responsible in precipitating death, when
Degenerative conditions of heart and the immediate cause of death is apparently
heart Yasculatures due to something other, for example, some
assault or such a circumstance. Sometimes,
Of the extensive range of degenerative con- as in case of cardiomyopathy of industrial
ditions ofthe myocardium, those important origin, question of compensation may arise,
from medicolegal points of view are the de- where the doctor has to play a very impor-
generations due to toxic agen"ts, e.g., chronic tant role in ascertaining the debility or dam-
alcoholism, and conditions due to various nu- age caused by the industrial exposure. Car-
tritional deficiencies- diomyopathy as such may not cause death
Metallic poisons like arsenic, mercury, but certainly makes the sufferer vulnerable
lead, thalium; inorganic chemicals like phos- to different adversities like infection, with
phorus; vegetable poisons like nicotine and reduced vitality.
many other agents may cause degenerative Rest of the cardiac causes usually do not
cardiomyopathy, if the exposure is for a con- come under the direct purview of the
siderable period. medicolegist, as those conditions do not usu-
Degenerative changes related to starva- ally involve any medicolegal problem.
tion, is simple and are in the line of atrophic
changes, as occur in other organs in case of Pathology oftraumatic shock
starvation. In case of nutritional deficiency
In case of death due to traumatic shock find-
like that of vitamin B l' there may be berib-
ings are available in many organs.
eri heart disease . The same problem of the
heart may occur in case of nutritional defi- In the adrenal gland-There will be swell-
ciency due to chronic alcoholism. Beriberi ing of the cortex, pseudotubular degenera-
heart disease or other heart problems may tion and depletion of stainable lipids.
occur when alcohol is taken in overdose for a There may be pulmonary oedema which
prolonged period. There may be dyspnoea, may lead to renal insufficiency and pulmo-
palpitation, sweating, arrhythmia and atrial nary embolism.
fibrillation. There may be heart failure, which
if mild, as in early cases, not necessarily very There may be histological findings of
much concerning, if alcohol can be with- vacuolation between myofibrils of heart, in
drawn. But in severe cases the condition may the liver (in the initial phase centrilobular in
be irreversible. Where there are such disor- distribution).
ders, as in case of nutritional deficiency of In the kidney vacuolation in the ascend-
thiamine, therapy with the san1e may be helping limb of loop of Henle.

chapter 6: DEATH AN D POST M O RTEM C HA NGES I 233
Air Embolism Pulmonary Oedema

Air embolism may occur in many cases where Apart from sudden deaths which are mostly
there may be direct medicolegal involvement. natural in origin, pulmonary oedema may
Air embolism may occur, ( 1) in case of injury occur due to various reasons like local action
to a large vein, particularly the jugular vein, of irritant inhalants or due to systemic ac-
' 2 lin case of criminal abortion, when air may tion of various asphyxiant poisons It is a con-
enter the circulation through the separated stant finding in case of death due to drown-
and open placental vessels, (3) in people who ing, particularly, wet drowning. Hence, a case
work inside tunnels under water, in an envi- of sudden death due to pulmonary oedema
ronment of compressed air (Caisson's dis- must be dealt very cautiously.
ease), (4) air may be pushed deliberately in-
side the circulatory system of a person to kill Pleural effusion and collapse of the lungs
him/her. 100 ml of air, if enters the circula-
In addition to the natural sudden death due
tory system, should usually be fatal. But a
to this cause, there may be pleural effusion
much lower quantity, as low as 8 ml may
due to injury to the lungs with simultaneous
cause death, if there is a ventricular septal
collapse of the lungs. Pale or serous and
defect or atrial septal defect (patent foramen
chocolate or haemorrhagic pleural effusion
ovale). Air blocks the vessels at different lev-
are the results of various chronic or suba-
els and may cause circulatory obstruction at
different levels , causing tissue anoxia. Trau- cute pathological conditions oflungs or pleu-
rae. But acute pleural effusion, haemotho-
matic air embolism may be either homicidal
rax or pyothorax is not uncommon in usual
or accidental, as in case of injury to the jugu-
medicolegal practices, e.g., death due to
lar vein. During post-mortem examination,
trauma of lungs or pleurae.
there may be presence of frothy blood in the
chambers of the heart and the vessels with Foreign body in the respiratory passage
macro and micro changes in the organs in- is almost exclusively accidental in nature
volved. which causes death by way of choking and
asphyxia.
Oedema Glottis
Lung abscess
This condition draws medicolegal interest
when it is due to inhalation of some corrosive Apart from various natural causes which come
or irritant vapours or due to regurgitation, within the definition of sudden death, lung
inhalation of the vomitus in case of ingestion abscess may a!-: J occur as a result of infec-
of such poison or due to the parenteral use of tion or lung injury or from inhalation of some
some systemic poisons. The condition may also corrosive gas. However, most of these cases
arise due to certain p athological causes . are natural or pathological in origin.
Oedema glottis may cause very rapid death, Different intracranial haemorrhages are
which is mostly accidental, though in some mostly traumatic in origin (pages 490-495) .
cases may be homicidal (very very rare occa- However, natural conditions like blood
sions of homicidal use of some specific poisons) dyscrasias, deficiency diseases and arterio-
and in still rare cases may be suicidal in na- sclerotic state of the intracranial vessels may
ture. In comparison, natural cases of oedema obviously cause intracranial haemorrhages
glottis is much more conunon. at different levels .

Deaths due to epileptic seizure may be to death due to extensive haemorrhage and
natural, but in many instances they may lead shock. Rupture of ectopic pregnancy or death
to accidental death, for example, death due due to this, though is a natural pathological
to drowning or burning during epileptic sei- phenomenon, may often be caused or precipi-
zure, occurring while bathing or cooking re- tated by trauma.
spectively.
Toxemic in pregnancy
Brain abscess and sometimes a tumour-
like lesion may be the sequelae of trauma or This is purely a pathological condition which
intracranial injury. But these are mostly if ends in death, should not create much con-
natural. fusion and there is no necessity of medicole-
gal post-mortem examination . Generally liti-
Haemorrhage and perforation of the gation does not arise in such cases except
stomach end the intestine when a charge of negligence on the part of
These may occur in pathological conditions the doctor in some cases be registered.
like gastric or duodenal ulcer , oesophageal
Uterine haemorrhage
varices ' and due to infective conditions caused
by salmonella or shigella - Apart from the Of the various uterine haemorrhages lead-
pathological conditions, haemorrhage may ing to death, some are of pathological origin
also occur due to trauma of the stomach and like malignant or non-malignant new growth.
intestine, due to ingestion of corrosive or ir- But most of them are related with attempted
ritant poisons , or if accidentally some me- and incomplete abortion where haemorrhage
chanical irritant , a piece of broken glass , a persists and is excessive and leads to death.
nail, a piece ofblade or such things are swal- These conditions are not difficult to diagnose
lowed . Instances are not unknown that and when death occurs in course of abortion,
"magic " perfonners chew and swallow a piece the issue may come under the purview of sec
of glass or a shaving blade and later, have to 314, IPC In these cases there may be accom-
be subjected to operation or even die. panying rupture of the uterus with injury to
Strangulated hernia, acute appendicitis, ::;ome other internal organs. when an instru-
intestinal obstruction, rupture ofliver abscess ment has been used to kill and extract the
or an enlarged spleen, are all purely patho- product of conception .
logical conditions and as such do not bear any Twisting of ovarian cyst, nephrolithiasis
special medicolegal significance . Acute and chronic nephritis are purely pathologi-
haemorrhagic pancreatitis may be of patho- cal conditions and should not create any prob-
logical origin but similar lesions may be ob- lem in their diagnosis , if comes for medicole-
served in death due to exposure to cold . gal post-mortem exanrination.
Rupture of Ectopic pregnancy Ancphylcdic reaction to different drugs
Ectopic pregnancy itself is an accidental ab- This is not a very1.mco1mnon event. Anaphy-
normality. If it is not diagnosed early and lactic reaction being more severe and fatal
proper surgical steps are not taken, then rup- in more number of cases when drugs are
ture of the fallopian tube or the ovary occurs, given parenterally, cautious dealing is the
if the pregnancy was there, and that may lead constant demand, both for the interest of the

chapter 6: DEA.TH AND POST MORTEM CHANGES I 235
- 3.:iEnt's life and Uw safeLy and professional Mismatched blood transfusion

~-::e~st of the treating doctor. Some drugs
.:in: badly popular as being likely to calise
In mismatched blootl Lransfusion there will
ana;:hrlaxis like drugs consisting of foreign he shock, fever. rigor, fall of blood pressure.
~-=:.liD (anti-snake venom. ATS. ADS, etc.),
rapid pulse- The patient may die or may be
;~::::icillin I parenteral preparationl, aspirin.
cured with short or long duration complica-
tions.
: Y preparation of iron and many more- The
; :"": i:.lem in these cases for the autopsy sur- During post-mortem examination ,
?=-:n is that, anaphylactic deaths do not leave clumps of agglutinated RBCs may or may 1•ot
much "finger-print" about the rause of death, be detected in the vessels. There will be
on tbe organs or the tissues. Enthusiastic haemorrhages at diffen~nt levels of different
iiagnosis by the side of the dis.:;ecti.on table crg·ans, e.g., in the subendocardium orin the
~hould be avoided. During post-mortem ex- tissue and calyces of ihe kidneys .
amination, viscera. blood. and tissue from the Histologi~ally, the tubules of the kidneys \Vill
injection site should be preserved. Diagnosis show degenerative cha.ngeswith RBC in them
should depend on the history of the case, tht There v.ill be haemorrhages tmder Lhe se-
general features of shock in the dead body. rous layer of the stomach and at the
absence of any obvious cau::.e of death and u.'ldersurface of the pleurae .
detection of lhe drug in blood. viscera and Materials to be preseroed during post-
the tissue presen•ed from the site of the in- mortem examination-
jection.
!. Kidneys for histological examii1ation.
2. Blood and urine for serological, Liochem.i-
Wrong blood transfusion {also see Ch. 19) cal, microscopic and spectroscopic tests.
The followings are the dangers from blood In addition to the above materials pre-
transfusion· se!-ved from the dead body for proper investi-
1. Mismatched blood transfusion may cause
gation. the followings should also be pre-
sP.nred-
immediate death or death within a short
period But. thP. pE~tient may survive also. 1.Sample of the blood transfused
2 Old stock or transfusion of haemolysed 2. Sample oft!1e blond of the l"ubjed before
blood also cause similar problems. transfusion
3. Transfusion of very cold blood (preserva- 3. Sample ofblood of the subJect after trans-
tion complication), may also be danger- fusion (if deatl. has occurred, then sam-
ple of blood after transfusion and before
ous in the same way.
death, if available) .
4. Transfusion of infected or contaminated
blood may cause immediate problems as In course of investigation, the following
points sl10uld be given due att.ention-
well as delayed problems due to infection.
1. Whether there has been haemolysis af~
5. Excessive or rapid transfusion may cause
ter transfusion and before death . If
overloading effect on the heart.
haemolysis was there, then there would
6. Repeated blo0ri transfusion may cause be (a) Presence of haemoglobin in the
certain pathological conditions which are senm1. In case of postmortem haemoly-
not expected to cowe tmder the purview sis also, there will be presence of Hb in
of the medicolegist. the serum. In such case. spectroscopic test

for meth-haemalbumin should be done. when postmortem examination is held, some

Free haemoglobin changes to hematin available findings should be sufficient to come
during life which combines with the al- to the decisive diagnosis.
bumin to fonn meth-haemalbumin.
(b) In a case where the patient dies after Status Thymo -lymphaticus
some period, estimation of the serum bi-
This is a condition where the thymus gland
lirubin may also be helpful. (c) There will
remains proportionately larger in a few young
be presence ofurobilinogen and urobilin ,
boys , in comparison to the girls or other boys
free haemoglobin and RBC cast in urine.
of their ages and there is also some evidence
(d) Serological test may detect evidence
ofhyperfunction of the thymus with the boys
of neutralisation of the antibody in the
being more childish in appearance than oth-
serum of the subject by the transfused
ers of their age. There is question about the
blood cell antigen. If there was no haemo-
status or even existence of the condition of
lysis, then the cells of the subject may
thymo-lymphaticus. In some cases. there may
become sensitized against the antigen of
be presence of some other interesting find-
the transfused blood and specific anti-
ings, like general hyperfunction of lymph
globulin against the serumafthe donor's
glands all arow1d the body and hypofunction
blood may be formed . Apart from these,
of the adnmal glands .
group tests of all the samples of the avail-
able blood has to be perfonned.
Vagal inhibition of heart (cardiac arrest
When old stock or haemolysed blood or due to vagal stimulation)
very cold blood or infected blood is transfused,
m.ore or less similar clinical features are Vagus is a mixed nerve which has motor sup-
available. The haernatological and biochemi- ply to part of the palate, larynx and pharynx
cal picture , both in the blood and the urine and sensory supply to pharynx, oesophagus
may be the same.' The histological findings and rest of the respiratory tract. Among the
may be less vigorous, particularly in the kid- organs and viscera it supplies are, heart ,
neys and thus microscopic examination of the lungs and stomach . Stimulation of vagus
urine may not show cellular casts. In absence causes inhibition of the heart . If the heart at
of mismatching, the serological findings men- that stage is in anoxic condition, then there
tioned in the earlier paragraph, will not be may be cardiac arrest. Cardiac arrest of va-
there. gal origin is primarily noticed on the opera-
tion table due to insufficient induction or due
Due to excessive and rapid transfusion to low maintenance dose of the anaesthetic
of blood, the heart may be overloaded and agent. Subjects who are oversensitive to vagus
there may be cardiovascular failure and are usually prone to such episode. Other vul-
death. Post-mortem diagnosis of the actual nerable subjects are those who have carotid
cause of death in such cases is very difficult.
sinus overactivity or are thymolymphaticus
young boys . Stimulation of the vagus can
Blood dyscrasias
cause inhibition of the heart rate in one side
Various abnonnalities in the blood and its and bronchospasm on the other. The heart
constituents may cause various problems and thus may as well be in a state of anoxia or
in some cases sudden death may occur due partial anoxia simultaneously. Thus stimu-
to some such problems. The history of the lation of the vagus may quite expectedly cause
case, the terminal signs and symptoms , and ca rdiac arrest. Some persons may become

chapter 6: DEATH AND POST MORTEM CHANGES/ 237
specially prone when the vagus nuclei are ous system. Wl1en there is full unconscious-
~~imulated with painful stimuli carried to the ness giving no response to any sort of stimu-
brain through the sensory nerves. as in cases lus, we term it deep coma When the patient
of being kicked on the scrotum, abdomen or is partially conscious and responds to deep
hit by a fist blow over the precordial area of and painful stimuli, it is partial coma. In ca:;e
the chest or on the neck or during use of in- of deep coma, the reflexes are lost. In case of
~:rument inside the vagina orin the respira- partial coma, the reflexes may be sluggish .
tcry tract. Psychological shock may also give nonnal or even brisk.
;,uch result. A man may go to coma due to--
Cerebral malaria 1. Cerebr al co mpre ssion resulting from
head injury. In head injury cases. cer-
This is a pemicious variety (complication) of ebral compression may be caused due to
malaria caused by the malaria parasite plas- intra-cranial haemorrhages, cerebral
modium Falciparum There may be neuro- oedema, depressed comminuted fracture
genic disturbance of any variety and magni-
2. Cerebral injuries or injuries to the brain-
tude. from drowsiness to coma, twitching of
muscles to convulsion, restlessness to ma- matter at different levels.
nia. There may be hyperpyrexia, dry skin and 3. Infective states like, encephalitis. men -
unequ al pupils. · ingitis, abscess.
Medi colegal importance-The brief clini- 4. Compression caused by a new growth
cal course leading to death. with the stated 5. Metabolic disorders like diabetes. urae-
signs and symptoms, may be confused with nria.
heat hyperpyrexia or some other condition. 6. Lack of circulation in brain as in case of
But the peripheral blood smear picture shows
embolism or occlusion of carotid and Yer-
presence of parasitic rings in more than 5%
tebral arteries.
of the RBCs.
7. The effects of certain drugs and poisons
like, opium, barbiturate, alcohoL chloro-
MODES OF DEATH fonn, CO, C02 , etc.
8. Miscellaneous causes like, epilepsy. hear
TI1e process of death may be initiated by fail- stroke, hypoxia of any origin.
ure of any of the three vital systems of the Post-mortem findings-The general ex-
body- ternal and internal findings are insignificant
1. Failure of the nervous system- Coma The specific cause in the fonu of injury. brain
2. Failure of the circulatory system- Syn- oedema, abscess or new growth may be ob\;-
cope ous during post-mortem examination. Poison-
3. Failure of the 1·espiratory system- Asph- ing may give typical physical signs and may
yxia. also be detected by chemical analysis of the
viscera/organs and blood, preserved from the
COMA dead body.
In coma. there is loss of consciousness which Prognosis of coma depends on. cause. lo-
may be partial or complete, depending on the cation, severity and extent of neurological
degree of involvement of the central uerv- damage, and intensity of coma.

SYNCOPE loss, the body and the organs wi11 look pale.
In case of anoxic condition, some or many of
In :>yncope. there is failure offuncLion of the the signs of asphyxia will be there and that
heart and the circulatory system. m ..<J.y create problem as to whether the heru.t
With circulatory collapse , there is rapid, failed earlier than the respiration ceased or
weak or slow pulse, fall of blood pressuTe; the reverse. In case of poisoning, the post-
there may be air hunger and feeling of op- mortem examination may reveal some macro-
pression in thP chest with ringing in the eaT findings due to the effects of poison and chemi-
and dinmess of vision. Lately, there is cyR- cal exanrinacion will reveal the poison. In case
nosis, eold skin and sweating. Vital centres of syncope due to exhaustion, no specific find-
at the base of the brain fails due to lack of ings may be expected. In such a c?.se rigor
oxygen, due to circulatory failure . mortis appears early and passes off early.
Causes of Syncope - ASPHYXIA
1. Pathology of the heart-This may be in
the myocardium, pGricardium, the heart Death is said to have occurred due to asphyxia
valves , the conduction system of the when , respiratory fm1ction ceases first and
heart and the heart circulation. initiates the process of failme of the other
two vital .systems. In asphyxia, there is pre-
2 Vagal inhibition of thP. heart (see page
vention of exchange of air between the at-
236J.
mosphere and the lungs alveoli and there is
3. Anaemia, particularly. sudden loss of ex- lack of oxygen supply to the tissues.
cessive amolmt of blood If the quantity
of sudden loss of blood due to injury or Asphyxia may be mechanical , toxic, trau-
some disease i::; l/3rd or more of the tomatic or pathological The causes thus are
tal volume of the body blood, then chance as follows-
of death is very high. 1. Mechanical
4. Anoxia-In severe hypoxia, the otheiWise 1. Cons triction around or pressure
healthy heart may fail to fm1 ction nor- over the neck, as in cases of hang-
mally and may stop functioning before the ing, strangulations including throt-
failure of the re~pirat01y centre and be- tling.
fore respiration stops. 2. Closure of the external respiratory
5. Cardiac poisons-They may cause heart crifices, as in case of smothering.
failw·e though the heart may otheiWise 3. Occlusion of the respiratory passage
be healthy. from inside, as in cases of drown-
6. Even when none of the above factors is ing, choking and gagging.
present, simple over-exercise or exhaus- 4. Restriction of the respiratory tnove-
tion may cause syncope. ment caused due to compression
Pos!-morlem findings-The cause, or the over the chest, as in cases of trau-
pathology due to the cause, is more obvious matic asphyxia and overlying.
than the direct effects of syncope. In case of TI. Toxic
diseased condition oft he heart, thP pathology 1. Poisons which depress the respira-
may be detectable macroscopically or micro- tory centres , like- Opium, barbitu-
scopically. In case of vagal inhibition, no spe- rate; C02 , H 2 S, chloroform, bro-
cific signs are expected. In case of severe-blood mides, etc.

2. Respiratory tract initants, like vola- fall of blood pressure, pulse is feeble and
tile irritant poisons or irritant va- slow. Involuntary passage of stool and
pours, e.g., chlorine gas, 802 , va- urine may occur. There is failure of the
pours of HN0 3 , HCl, ammonia gas, vital centres and death.
etc. In asphyxia there is essentially lack of
3. Poisons which affect the pick-up, oxygen supply in all tissues and organs of the
carriage, and diffusion of oxygen at body. Depending on the cause, the tissue
the tissue level, like, phosgene, CO, anoxia are of 4 types.
cyanides. 1.Anoxic anoxia-, Due to lack of oxygen in
4. Lack of oxygen in the inhaled air. the lung to be absorbed by blood and sup-
5. Poisons which cause paralysis of the ply the different tissues. Thus mechanical
respiratory muscles, like muscle re- ~;;;phyxia is one of the cause of anoxic as-
laxants, curare. cobra snake venoll!. phyxia. Example of others are lack of oxy-
ill. Traumatic gen in the respired air, i.e. , vitiated air.
L Injury to both lungs. ' 2. Anaemic anoxia: Oxygen canying capac-
2. Pulmonary embolism _ Fat and air ity of blood is less due to anaemia of any
origin like blood loss, low haemoglobin
emboli may be of traumatic origin.
concentration .
IV. Pathological causeS-Infective conditions
3. Stagnant anoxia: Blood though properly
and new growth of the lungs or in the
oxygenated in lung can not reach the tis-
respiratory tract.
sue to supply oxygen. This is actually a
Stages of asphyxia: The progress of as- defect in transportation of blood i.e., of
phyxia manifests in three phases. These are: circulatory defect origin, e.g., circulatory
1. State of dyspnoea._Initially, increased collapse or congestion and oedema of an
C0 2 level in the blood causes respiratory organ.
stimulation and the rate and depth of the 4. Histotoxic anoxia: Here blood is properly
respiration is increased. There is breath- oxygenated in lungs, carried to different
lessness, feeling ofoppression in the chest organs, but due some reasons, exchange
and headache. There is increased pulse of oxygen cannot occur at tissue. This
rate and raised blood pressure. Mild de- may occur due to some toxic action of
gree cyanosis may be noticed. some agent at the tissue level, which disa-
2. Stage of convulsion_The level of C02 in bles the uptake capacity of O:l!..'Ygen by the
the blood is further increased. The pulse cells from the blood. (For further details
rate and the blood pressure are still high. see chapter 40 page 903, chapter 39 page
The neck veins are engorged. There is 892-894).
marked cyanosis . Expiratory effort is Pathogenesis of asphyxiO-.In acute cases,
more prominent. There is ronvulsion.
the process of asphyxia progresses very rap-
3. Stage of respiratory exhaustion_The idly. The increased C02 tension in the blood
respiratory centre is depressed. There is causes capillary dilatation and loss of tonic-
gasping respiration, the rate is much di- ity of the vascular wall. This leads to stasis
minished. Muscles are relaxed, reflexes of blood. On one hand, the organs are con-
are lost or very sluggish, there are deep gested and on the other, increased penne-
cyanosis, widely dilated pupils. There is ability of the capillary wall due to asphyxia .

causes oedema of the organs. The sum effect

of capillary dilatation, stasis and congestion
is low venous return. This further aggravates
the lack of oxygen and increase of C02 in the
blood which in turn exerts its effects as de-
scribed above. Hence, the progress towards
the final stage is very rapid, if the primary
cause of the asphyxia continues .
Stasis of blood and distension of capillar-
ies cause their rupture and leakage of blood
iri the tissue. High C02 tension also increases
the capillary permeability and leakage of Fig. 6.9: Tardieu's spots on the surface of lung
whole blood in the tissue . Thus, minute
haemorrhagic spots appear in the tissue
eyeballs and the tongue. In some cases there
spaces which are known as petechial haemor-
may be involuntary discharge of faeces and
rhagic spots or Tardieu's spots . These are
urine, and in males, in some cases, there is
pinhead size or slightly larger haemorrhagic
seminal disch arge. Externally, evidence of
spots, more conspicuous at the under surface
of pleura, pericardium and epidermis . mode of asphyxiation may be present in some
cases, like presence ofligature marks in stran-
Delayed death : In hypoxic state, brain- gulation and hanging, dribbling of saliva in
death may not occur immediately. The hy- hanging, abrasions and bruises around the
poxia may first affect the cerebral cortex. A mouth and nose in case of smothering and
person may be kept "survived" in such a state, on the neck in case ofthrottling, and copious
with artificial aids. But cortical hypoxia or fine white froth in case of drowning.
cortical death ultimately causes failure of vi-
Internal findings -The organs are in gen-
tal centres at the base of brain causing death
if and when the artificial aids are withdrawn eral congested. Congestion is more marked
or even while these are still continued (a veg- in deaths due to asphyxia of short duration
etative state). That is the reason why even than of long duration. The lungs are con-
the cortex is in a state of hypoxia or though gested, oedematous with presence of
cortical death has occured somatic death may Tardieu's spots at the undersurface of pleura,
take some more time to come (see also brain- particularly at the interfaces of lobes .
death in this chapter). Tardieu's spots are also present at the
undersurface of the pericardium and in the
Post-mortem features in case of death due brain and meninges. Vessels contain dark
to asphyxia - fluid blood. In more number of cases, the
External features -The postmortem right side chambers of the heart contain blood
staining is bluish and prominent. Cyanosis is and the left side chambers are empty. Accord-
evident at the fingertips, nail-beds, ear ing to the specific cau~e of asphyxia, there
lobules and lips. Face may be congested and will be presence of specific signs in different
in some cases of violent asphyxial deaths , organs like lungs, trachea and larynx as in
there will be presence ofTardieu's spots over cases of death due to drowning and
the forehead, eyelids and conjunctiva. In some strangulations. Similarly, there will be addi-
cases, depending on the mode and process of tional findings in the structures of the neck,
asphyxiation, there may be protrusion of the inside the mouth cavity and the chest wall,

240 I PRINCIPLES OF FORENSIC-MEDICINE
causes oedema of the organs . The sum effect

of capillary dilatation, stasis and congestion
is low venous return. This further aggravates
the lack of oxygen and increase of C0 2 in the
blood which in turn exerts its effects as de-
scribed above. Hence, the progress towards
the final stage is very rapid, if the primary
cause of the asphyxia continues.
Stasis of blood and distension of capillar-
ies cause their rupture and leakage of blood
iii the tissue. High C02 tension also increases
the capillary permeability and leakage of Fig. 6.9: Tardieu's spots on the surface of lung
whole blood in the tissue. Thus, minute
haemorrhagic spots appear in the tissue
eyeballs and the tongue. In some cases there
spaces which are known as petechial haemor-
may be involuntary discharge of faeces and
rhagic spots or Tardieu's spots . These are
urine, and in males, in some cases, there is
pinhead size or slightly larger haemorrhagic
seminal discharge. Externally, evidence of
spots, more conspicuous at the under surface
of pleura, pericardium and epidermis . mode of asphyxiation may be present in some
cases, like presence ofligature marks in stran-
Delayed death : In hypoxic state, brain- gulation and hanging, dribbling of saliva in
death may not occur immediately. The hy- hanging , abrasions and bruises around the
poxia may first affect the cerebral cortex. A mouth and nose in case of smothering and
person may be kept "survived" in such a state, on the neck in case of throttling, and copious
~ith artificial aids. But cortical hypoxia or fine white froth in case of drowning.
cortical death ultimately causes failure of vi-
Internal findings -The organs are in gen-
tal centres at the base of brain causing death
if and when the artificial aids are withdrawn eral congested. Congestion is more marked
or even while these are still continued (a veg- in deaths due to asphyxia of short duration
etative state). That is the reason why even than of long duration. The lungs are con-
the cortex is in a state of hypoxia or though gested, oedematous with presence of
cortical death has occured somatic death may Tardieu's spots at the undersurface of pleura,
take son1e more time to come (see also brain- particularly at the interfaces of lobes .
death in this chapter). Tardieu's spots are a lso present at the
undersurface of the pericardium and in the
Post-mortem features in case ofdeath due brain and meninges. Vessels contain dark
to asphyxia- fluid blood. In more number of cases, the
External features -The postmortem right side chambers of the heart contain blood
stai.ning is bluish and prominent. Cyanosis is and the left side chambers are empty. Accord-
evident at the fingertips, nail-beds, ear ing to the specific cau!3e of asphyxia, there
lobules and lips. Face may be congested and will be presence of specific signs in different
in some cases of violent asphyxial deaths , organs like lungs, trachea and larynx as in
there will be presence ofTardieu's spots over cases of death due to drowning an d
the forehead, eyelids and conjunctiva. In some strangulations. Similarly, there will be addi-
cases, depending on the mode and process of tional findings in the structures of the neck,
asphyxiation, there may be protrusion of the inside the mouth cavity and the chest wall,

in cases of compression ofneck, smothering Diagnosis of death which depends on

ru d traumatic asphyxia respectively. For de- changes occur in the body after death was
tl::c of those dings see the chapter of vio- never a comfortable and easy job till the in-
lent aspny..Uw deb.'ilis. vention of stethoscope. In the 17th and early
Asphyxial Stigmata : Some of the authors 18th century various laymen's tests were per-
who do not accept that asphyxia is a separate formed and methods were used to be followed
pathological entity, like tq designate signs, much to the discomfort of the doctor and the
symptoms and changes in the tissue and or- relatives and society which may now-a-days
gan due to asphyxia, as "Asphyxial Stigmata". be considered silly. But even today some lay-
The difference in nominclature appears para- men's tests are performed to diagnose death
doxical. · or cessation of functions of different systems.
For laymen many of them bear some rea-
soning and meaning. It was in mid-18th cen-
CHANGES AfTER DEATH OR DtFFBtENT tury, the German doctors declared that pu-
SIGNS OF DEATH trefaction of dead bodies is only dependable
sign of death. As we shall see in the coming
Some of the changes which occur after death
pages, we are still unable to get rid of this
are related to somatic death and some are
thinking, when transplantation of organ or
related to molecular death. Some of them are
tissue from brain-dead person is so frequent
conspicuous immediately, some come early
nowadays, which needs earliest possible di-
and the rest appear late.
agnosis of death (even the state of virtual
1. Immediate changes- death).
(a) Stoppage of function of nervous sys-
tem
IMMEDIATE CHANGES
(b) Stoppage of respiration
(c) Stoppage of circulation. Stoppage of fundions of nervous system
2. Early changes- With death all functions of the nervous sys-
(a) Facial pallor tem cease. The subject has no sense. There
(b) Loss of elasticity of the skin with is loss of both sensory and motor functions.
decrease in the facial creases There is loss of reflexes; no response and no
(c) Primacy relaxation 9f the muscles tonicity of the muscles. Pupils are widely di-
(d) Contact pallor and contact flattening lated.
(e) Changes in the eye
Stoppage of respiration
(f) Cooling of the body
(g) Post-mortem staining (lividity) With somatic death, there is total stoppage
(h) Rigor mortis or postmortem rigidity. of respiration which can be established by the
3. Late changes-
followil_lg tests:
(a) Putrefaction or ordinary decompo- 1. Inspection-No respiratory movement
sition will be visible.
(b) Adepocere chang&-a modified form 2. Palpation-Respiratory movement can't
of decomposition be appreciated.
(c) Mummifi..cation-another form of 3. Auscultation-No breathing sound can be
modified decomposition. heard from any part of either lung.

4. Feather test-If a downy feather or a few absence of heart beat which is absent if
cotton fibres are held in front of nose, circulation has ceased. When the circu-
then, if respiration is continuing, it will lation is feeble and when there is exces-
rhythmically move with the inspiration sive deposition of fatty tissue over the
and expiration. If respiration has ceased, area, auscultation may miss such heart
then there will be no movement of the beats.
feather or the cotton fibres. 3. Diaphanous or transillumination test-
5. Mirror test- The shining surface (reflect- If, in a dark room the outstretched hand
ing surface of a mirror) is held in front of is held against some bright light-rays,
the nose and mouth of the person. If res- then in presence of circulation, the hand
piration is continuing, then the shining will appear pinkish and transluscent. If
surface of the mirror will partly become circulation ceases, then the hand will ap-
hazy due to condensation of the moisture pear yellowish and opaque.
in the expired air on the cold shining sur- 4. Magnus test-It is a very satisfactory lay-
face of the mirror. If respiration has man's test for circulation. Veins run su-
ceased, then there will be no hazy appear- perficial to the arteries. Ligature is ap-
ance of the surface ofthe mirror, for ob- plied on a finger sufficiently tightly to
vious reason. compress the superficial veins but not the
6. Winslow's test-A small bowl with water deeper arteries. If circulation is continu-
is placed over the chest of the subject with ing, then after a while the part of the fin-
arrangement of some light rays falling ger distal to the ligature will appear swol-
len and bluish due to venous obstruction
on the surface of the water in the bowl
Slightest moveme~t of the chest wall, and accumulation of the reduced blood
in the distal part. If circulation ceases,
even due to feeble respiration which can-
then-there will not be any such change.
not be appreciated as such, will disturb
the plain of the surface of the water, 5. Icard's tesh in this test, 1 ml of 20% al-
which can be well marked from the rays kaline fluorescein solution is injected ei-
oflight reflected from the surface of wa- ther in the dermis or subcutaneously. If
ter. circulation does not stop, then in case of
intra-dennal injection, the area of yellow-
Stoppage of ciradation ish discolouration spreads locally and in
case of subcutaneous injection, the dye
The following tests may be performed to travels to the distant parts of the body
know, if the circulation has ceased or is conti- and yello"{ish.discolouration appears in
nuing- the etpjunctiva
1. Radial, brachial, femoral and carotid pul~ 6. Pressure test-In case the circulation is
sations will be absent if the circulation continuing, if pressure is applied on the
has stopped. In case of very feeble circu- nail of a finger, then it becomes pale but
lation, these pulsations are very weak and soon becomes red on release of the pres-
may not be perceived. sure. In case.t>f..cessation of circulation,
2. Auscultation of heart-The whole preoor- pressure eauses_.paleness of the nail, which
dial area and particularly the area over takes much more time to return to its
the apex is auscultated, for presence or normal colour on release of pressure.

chapter 6: DEATH AND POST MORTEM CHANGES l 243
Cut test-If circulation is continuing, then 3. Primary relaxation or flaccidity of the

there is active bleeding from a small su- muscle::r- After death muscles loose their
perficial cut. But if circulation has ceased, tonicity and become flaccid. Joints are
then such a small superficial cut may loose and the chest wall flattens . During
cause very minor degree oozing of blood this stage ofrelaxation, the muscular tis-
but no free active bleeding. sues are still alive; their chemical reac-
~ Heat test-If a small area of the skin is tion is still alkaline and they still respond
brought in contact with some hot object, to electrical stimuli
say of about 100°C, then at the site of 4. Contact flattening and pallor-During
oontact there will be blister fonnation sur- the stage of primary relaxation of mus-
rounded by a red ring. If the period of cles of the body, the areas which remain
contact is very short, then there may not in contact with the ground, become flat
be any blister formation but there will and the blood from vessels ofthese areas
be redness over _the area of contact. are pressed out. During the stage of rigor
These happen if circulation is continuing. mortis, the areas continue to be flat, as
Ifcirculation stops, these changes will not rigor appears in those muscles in their
be there. Instead, the area of contact will flattened state and the drainage ofblood
beoome dry, firm without any redness and from the vessels of the areas make the
blister formation. areas pale which continue to be so even
9. E.C.G. test -By E.C.G. test, very weak after formation of postmortem staining
functions of the heart muscles and the in the surrounding areas.
electrical conductivity there, are detect- Medicolegal importance-From the con-
able. In case of cessation of circulation, tact flattening and pallor, the position of
the E .C.G. curve is absent with presence the body in which it stayed for some time
of flat line only, on the baseline without after death can be understood.
any elevation and depression. 5. Changes in the eye -
(a) With death, the corneal and
EARLY CHANGES ARER DEATH pupillary reflexes are lost. But the
pupils still react for sometime to
1. Facial pallor (Pallor nw7tis)-After death, myotic and mydriatic agents. The
due to stoppage of circulation, blood pupils nonnally dilate moderately
drains from the capillaries and small ves- after death. The diameters are usu-
sels to big ones. This is why, generally ally about 5 nun during life (range
the face appears pa1e and bloodless, but of the diameter of the pupils is 2 - 9
in case of agonising death and where mm).
there is obstruction of venous return due (b) With death, the eyelids usually close
to compression over the neck or below, due to loss of tone ofthe muscles of
as in case of strangulations etc., the face the eyelids. . .
is congested and cyanotic. (c) Haziness of the cornea-This occurs
2. Loss of elasticity of the skin with ironing in two phases, when the eyelids are
of the facial creases- These occur due to not closed. (i) When the eyes are
loss of tonicity of the skin muscles includ- open, then within about 15 minutes
ing those of the face. The face looks the corneas beoome hazy due to dry-
younger. ing or desiccation and deposition of

dust and debris over them This hazi- hours, the exposed white parts of the
ness is transient and passes off, if a eyeballs become yellowish and
drop of water is poured on the cor-· within 2 - 3 days, the areas become
nea. (ii) But the cornea becomes per- brown. In the two sides, 4 such dis-
manently hazy after bout 10 - 12 coloured areas can be noticed, two ·
hours of death, due to decomposition. in each eye. Each discoloured area
(d) Shape of the pupils- Ordinarily, is triangular in shape with the base
they are circular. But, as after death, on the limbus, the apex at the lat-
there is loss of tone and elasticity of eral and medial canthuses and the
the ciliary muscles, the shape ofthe two other sides of the triangle are
pupil can be changed which may formed by the margins of the upper
persist during the stage of rigor and lower eyelids. These are situ-
mortis of the muscles. As the nerv- ated on both sides of the cornea of
ous control over the pupils is lost each eye.
after death, the sizes and shapes of Changes in the retina-Several changes
the pupils of the two· sides may be occur in the retina and the choroidal plexus,
different. It has been already men- which start almost immediately after death
tioned earlier that the pupils re- (within few seconds) and continue for about
spond to the application of the mi- 12 hours.
otic and mydriatic agents for an hour Within 10 to 15 seconds, the retinal veins
or two after death. appear segmented. For a minute or two, the
(e) Loss of occular tension-Occular segments in the veins have a tendency to shift
tension falls rapidly after death and towards the centre and then they become
within about half an hour it becomes static.
zero . For the first 2 hours, the retina appears
(f) Taches Noire Scleroitiques-This is pale and the area around the disc looks yel-
a change in the sclera which occurs lowish. Same change occurs around the
when the eyes remain open. It is the macula, and the macula now is deeper in col-
result of drying and desiccation of
the exposed conjuctiva and the
sclera underneath. Within 2 - 3
__
Fig. 6.1 o: Taches Noire Scleroitique __.

our. The nonnal mottled reddish appearance assessable from the segmentation of the
of the choroidal plexus is retained till this vessels of the retina. But then, it is of mini-
period. Then the mottling appearance of the mum significance, from practical medicole-
plexus gradually becomes hazy by about 3 gal necessity point of view, to know whether
hours after death and by about 5th hour, the death of a person has occurred 30 seconds
mottling disappears with homogeneous ap- or 2 minutes back.
pearance of the eye background. By then the
area is pale in appearance. By 6th hour, the Changes in the eye other than those in
disc outline also becomes hazy. By now, the the retina, are less important for the pur-
smaller vessels are not recognisable and only pose of estimation of time of death.
the large segmented vessels can be recog-
COOLING OF THE DEAD BODY
nised. The yellowish discolouration expands,
(Algor Mortis)
which reaches the periphery of the retina
between 7 - 10 hours . The disc outline is The first medicolegal use of the recording of
blurred now. By 12 hours after death, the body temperature, it can be said, was made
area for the disc can be k,nown only by some by Dowler ( 1849- 50), the purpose being con-
convergent segmented vessels. After this firmation of death of a person. But today,
period, nothing in the retina ~an be recog- recording of temperature of the dead bodies
nised except a dark brown spot representing has its medicolegal importance in connection
the macula. with determination oftime of death.
The changes occurring in the eyes are However, for the purpose of estimation
early changes. In ordinary practice, these of time passed after death, it is not a good
changes do not come to much assistance for method even in a cold country where of course
determination of time passed after death. No it is more relevant.
doubt, the changes in the retina maintain
chronology. If those changes could be stud- Sometime after death the body tempera-
ture of the cadaver falls and after some hours,
ied by an experienced ophthalmologist, then
it tends to be equal to the temperature of its
those could be good criteria for estimation
immediate environment.
of time of death for the first 10 - 12 hours
after death. Study of retinal changes require The different ways of loss of the body heat
u se of ophthalmoscope , and in practice it is -The fall of temperature of the cadaver oc-
never done yet , in any part of our country. curs due to the facts that, after death there
Firstly , use of ophthalmoscope is considered is no heat generation , due to loss of all physi-
a cumbersome process; secondly , the study cal , chemical and metabolic functions of the
requires some :degree of expertisation ; body, and there is constant loss of the body
th irdly , for the first few hours after death, heat untill it comes to the level of the envi-
some other external changes like appear- ronmental temperature , as the heat regulat-
ance and distribution of rig~. m.ortis , posting centre is inactive.
mortem staining, cooling of the body, etc. Loss of the body heat occurs by ways of
may help to asse~s the time of death with conduction , radiation and evaporation (a form
more or less same degree of satisfaction. of convection), when the body is in the at-
Some internal findings also help directly or mospheric environment, and by ways of con-
indirectly. No doubt, the earliest definite duction and convection when the body is in
changes in terms of seconds and minutes is the water medium.

246 f PRINCIPLES OF FORENSIC MEDICINE
Though Newton's law says that, loss of curve is presented as the initial plateau. Then
heat of a body is directly proportional to the there is sharp fall of the temperature for about
temperature difference between the surface 9 to 12 hours. After this period the rate of
of the body and its surrounding at an instant fall again diminishes, as, by that time, the
time, this theory is not useful in case of fix- body temperature (inner core) almost comes
ing up the rate offall of body temperature of to the level of that of the environment. Thus,
a cadaver, because the law is for a body in the last part of the curve, which represents
which there is no qualitative difference be- the terminal phase ofloss ofbody heat, runs
tween the surface and the depth of the body, slightly above the base line or the axis (where
whereas in case of a dead body there are defi- the axis represents the time lapsed after death
nite differences in qua~ity of the different in hour and the ordinate represents the body
strata from the surface to the depth of the temperature or the body temperature in ex-
body. This brings a difference between the cess of the environmental temperature). For
rate of fall of the body temperature at differ- the purpose of estimation of time passed af-
ent hours after death. Previously, it was gen- ter death, the measurement of the inner core
erally thought that, other factors remaining temperature is important and more reliable
constant, the rate of fall of the body tempera- than the outer core temperature.
ture is same all along after death, starting Site of the body used to record the inner
from the moment of death. This would give a core temperature -
simple (exponential) curve for the hourly fall
1. Rectum - 4" above the anus
of the body temperature. But in reality it does
not happen so. After death the surface (outer 2. Subhepatic.
core) temperature falls rather rapidly for some Methods of measurement ofthe inner core
time. But during this period, the loss ofheat temperature- Chemical thermometer with
from the depth (inner core ) of the body is graduation ranging from ooc to 50°C is re-
rather negligible. This is due to the thick- quired. But instead of a thermometer a
ness of the skin and the subcutanec'.ls tissue thermo-couple probe is better recommended
which are very good insulator for heat. How- with digital read-out or a printed record. For
ever, some hours after death, by the time measurement of the intra-rectal tempera-
there has been reasonable fall of the surface ture, the bulb of the thermometer is intro-
temperature, a const ant rate of flow ofheat duced 4" inside the rectum. For measure-
from inside the body establishes. It is then, ment of the intra-abdominal, subhepatic tem-
that the fall of temperature at the inner core perature, a small slit like incision is given on
of the body, achieves a regular and constant the right side of the abdominal wall in front
pattern. Thus, if we take into consideration and the bulb of the thermometer is inserted
the rate of fall of the inner core temperature 4" inside the abdomen through the incised
of the body, then we do not get actually a opening. Hourly temperature is recorded
simple (exponential) curve for the fall oftem- without withdrawing the thermometer, so
perature. Instead, in such a case we get a that, there will not be additional loss of tem-
sigmoid or inverted 'S' shaped curve. Such a perature locally and thus there will not be
curve is indicative of practically no loss of wrong result.
heat or fall of the inner core temperature for In any case environmental temperature
the first two or three hours , which in the should be recorded with a chemical thermom-

eter , more frequently to see the temperature In tropical countries , measurement of the
variation in the environment and the way it body temperature is not a good criterion for
occurs. Amaxi-mini themwmeter should also the purpose of determination of the time of
be used to see the maximum rise and fall of death, because the difference between the
environmental temperature influencing the body temperature during death and the at-
process of cooling of the dead body. mospheric temperature is not very high.' For
this reason, Marshall and Hore formula is
Practical utility of the study of loss of the not applicable in our country except in some
body heat for the purpose of estimation of hilly regions and when the atmospheric tem-
time passed after death perature is low (nearing G0°F). For the rest
of our country, the rate of fall of the body
Hourly recording of the body temperature is temperature is taken on an average to be
of more value for the purpose of determina- about 0.4°C or 0. 7°F , in summer, per hour.
tion ofthe time of death ~cold or temperate
countries, where the difference between the In any case, the temperature of the dead
body temperature at the time of death of the body at the time of death is not known. It
person and the atmospheric temperature at has to be assumed as normal if there is no
that instant is quite reasonable. For temper- other thing to suspect a higher or lower tem-
ate ·countries, Marshall and Hore formula is perature. Similarly, the environmental tem-
applicable with reasonable satisfaction. The perature with its variation is not known.
ideal conditions for the use of this formula
Factors which influence the cooling of a
are as follows:
dead body ·
(a) The atmospheric temperature
should be around GOoF (15.S°C ) 1. Atmospheric temperature- The more is
(b) The body should ideally be uncov-
the difference between the temperature
of the dead body and the atmospheric
ered
temperature , the more is the rate of fall
(c) The limbs should be outstretched of the body temperature. Thus, other fac-
(d) The formula gives different rates of tors remaining constant, whatever may
fall ofbody temperature, for subjects be this difference (i.e., whatever may be
of different body built, as follows : the atmospheric temperature) the total
time taken for the dead body to come
Table 6.1 : Rate of cooling of OOad bOOj as per Marshall down to the atmospheric temperature
and ore fom per hour Qn tr'l outstretched naked bcrly} will remain oonstant.
Time passed I l
Thinfy b:Rit AV81'8ge built Fatty built 2. Media of disposal of the dead body-The
after d69th subjeds subiads l sub}eds rate of cooling of the dead body differs
(thlcJ<) according to the temperature of the place
H•F 1•f t•F
- where the body rests-whether it stays
Up to 3hour in the atmosphere, or in the water (as in
3+to6hoo' H•F 2•F H•F I
cases of drowned dead bodies) or is kept
under the ground (i.e., buried). Optimum
6+to9hol6 2t•F 2•F 1f•f I cooling becomes at the earliest in water
9+to 12holr H..F H•F H·F I medium and at the latest in case of bur-
ied dead bodies . The ratio ofthe rates of
12+ to 15 hoof H•F W;rF t•F
fall of the body temperature in the three

media is, water : air : grave :: 4 : 2 : 1. for a longer period. In this regard qualities
The rate is maximum in water, because of the clothings exert further influences. If
there the loss of body heat is due to both the covering clothes are wet, then loss of
conduction and convection, both being body heat will be a quicker process.
very efficient means ofheat loss. The rate 7. Air movement-Better air movement
is moderate in air, because here the heat over the surface of the dead body causes
loss occurs partly (not fully), by conduc- quick fall of the temperature, by way of
tion (through the parts of the body which increased evaporation of the body fluid.
touches the ground or some other mate-
8. Dry weather-Dry weather by itself ac-
rials), partly by convection (i.e., evapora-
celerates the rate of heat loss, by way of
tion of the body fluid) , and partly by ra-
promoting evaporation of the body fluid.
diation (through the parts of the body
which is not in contact with the ground 9. Position and posture of the body-In a
or other substance). In a buried body, the body with outstretched limbs, the loss of
only effective means of loss of body heat the body heat is rapid because, in such a
is by way of conduction. · posture, a greater surface area of the body
3. Body built-A thinly built dead body loses is exposed for the loss of heat.
heat rapidly. For an average built body, 10. Post-mortem caloricity -There are cer-
the rate ofloss is moderate and for a fatty tain factors which, instead of promoting
body the retention of the body heat is for the process of cooling of the body, act in
the longest period. Roughly, for a thinly such a way that the body temperature is
built body, the optimum loss occurs by either high at the time of death or is in-
about 20 ho~ , for an average built or creased for some time after death, so
moderately built body this time is about that, at a particular time after death, the
30 hours and for a fatty body it is about body may appear disproportionately
40 hours. warmer than what it should have been.
These conditions are -
4. Sex- Female bodies retain body heat for
a comparatively longer period. This is be- (a) Post-mortem glycogenolysis-This is
cause of the preponderance of the subcu- a compulsory phenomenon which
taneous fatty tissue in them which in- occurs in all the dead bodies and
which starts soon after death (actu-
creases the insulating capacity of the sub-
ally continues from life to some time
cutaneous tissue.
after death till glycogen for lysis is
· 5. Age-Rate ofloss of the body heat is com- available). In an average adult, post-
paratively more in cases of infants, young mortem glycogenolysis produces up
children and very old subjects, than in to 140 calories which can increase
adults. This is so because in these sub- the body temperature at an instant
jects, the surface area of the body is more time by 3.6°F or about 2°C. Hence,
in comparison to the body volume. So, so far the inner core temperature
heat loss in them occurs through a of the body is concerned, when the
greater surface (compared to body vol- body is yet to lose heat due to the
ume), resulting in the higher rate ofloss. insulating subcutaneous tissue,
6. Clothings or coverings ofthe body-A body there may be virtual rise of the tem-
well covered with clothes retains the heat perature of the body.

(b) Causes ofdeath- Medicolegal importances of cooling of

(i) If death occurs due to infectious dead body
diseases or septicaemia, 1. Cooling of the body is a sign of death.
bacteremia, then there may be 2. From cooling of the body, time of death
high temperature of the body of the dead can be roughly estimated.
at the time of death and there
may even be post-mortem pro- Time passed after death in hours =
duction ofheat by the action of Fall ofbody (rectal) temperature
the infective organisms.
Rate of fall of body temperature per hr
(ii) When death is preceded by se-
However, as has already been pointed out,
vere convulsion, that causes
measurement of the body temperature
increase in the body tempera-
for the purpose of estimation of the time
ture to a reasonable degree of death is useful only in the cold or tem-
before death, as ip. case of death perate countries, where the difference be-
due to strychnine poisoning. In tween the body and the atmospheric tem-
case of death due to tetanus, perature is countable. This method of de-
also convulsion is responsible termination of time of death is not very
for the post-mortem caloricity. useful in our country or in any tropical
(iii) Death due to heat stroke-In country. Further, during estimation of
case of death due to heat or sun time passed after death, by this criterion,
it must be remembered that, various fac-
stroke, there is hyperpyrexia at
tors influence the rate ofloss ofbody heat
the time of death. Hence the
after death. Even, a body left for 24 hours
temperature of the body may after death will be subjected to alteration
continue to rise more than the· of the atmospheric temperature during
usual normal, at the time of the day and night hours. This means that,
death which may continue for if the body is not preserved at a particu-
some time after death. lar temperature, then it is subjected to
(c) High atmospheric temperature-In the influence of even hourly fluctuation
tropical countries in summer, dur- of the environmental temperature.
ing the day hours, the atmospheric It is not a good or dependable method
temperature may remain higher even in t emperate countries where the
environme~.:al temperature being low,
than the body temperature at death.
the difference in body and environmen-
In such a condition, during the peak
tal temperature is high. This method
hot hours of the day, the dead body
should not be used as a single yardstick
may absorb some heat and the tem- to know the time of death. It is not rec-
perature of the body may even be ommended in that way.
more than the normal at death, if
3. Early cooling of the dead body delays the
the body is laid exposed under the
processes of rigor mortis and decomposi-
sun particularly. However, when the tion. On the other hand, if the body heat
day's temperature falls and during is preserved well for a longer period, then
the night hours, the body tempera- both the processes of decomposition and
ture also falls. rigor mortis start early.

tion ofthe body is disturbed or altered after

fixation ofthe staining, then the staining will
not be disturbed and will remain more or less
(Synonyms -post-mortem hypostasis, livor the same , though the colour may slightly fade
mortis, vivices, suggilation, post-mortem in intensity . After fixation of the staining, if
staining). the position of the body is reversed, then
It is another early change of the body af- there will not be any remarkable resettling
ter death. It is the discolouration that occurs of the blood in the newly assumed dependant
due to settling of-blood after death. parts. However, mild degree of resettling of
the blood with an appearance of faint post-
Definition -It is bluish-purple or reddish-
mortem staining over the new dependant
purple discolouration due to capillo-venous
parts is not impossible. But, if the position of
distention with blood at the undersurface of
the body is reversed after formation of the
skin of the dependant parts of the body for
staining but before its fixation, then there
settling of blood in those areas due to the
may be total resettling of the blood with for-
pull of gravity, when circulatioJl to keep the
mation of postmortem staining at the
blood in motion ceases.
undersurface of the newly assumed depend-
In some specific circumstances the col- ant parts of the body.
our of the post-mortem staining may vary,
which has been discussed under the heading According to some (Spitz and Fisher), the
medicolegal importances. process starts immediately after death, takes
2 hours to appear externally and is ~ell de-
Formation of the post-mortem staining-
veloped between 8-10 hours, and after that it
When the body is left undisturbed without
fixes (see below).
change of its position, the staining starts ap-
pearing in small patches at the dependant Fixation of the post-mortem staining was
parts of the body,by the end of the first hour for a long period thought to be due to intra-
after death. In a body, which lies in supine vascular coagulation of the settled blood. But
position the stained patches first appear over in reality , very little clotting of the blood is
the back of the shoulders and posterior as- seen in the small veins and capillaries during
pects of the flanks of the abdomen . Gradu- post-mortem examination . During dissection
ally the small patches increase ~ size and of the body, though passive, there is free ooz-
coalesce with each other to forni uniformly ing of blood from the margins of the dissec-
tion or incision. However, post-mortem clots
stained large areas on the back of the trunk
may be present in the large vessels and in the
and also on the back of the limbs, if the body
chambers of the heart . This sufficiently indi-
is in supine position. For completion of the
cates that, though postmortem clotting ofblood
spreading of the post-mortem staining , it
occurs, it does not remain clotted in the
takes about 5 - 6 hours . After formation, the
smaller ves.sels. This is due to liquefaction of
staining gets fixed over the areas.
the post-mortem clots in the smaller vessels
Fixation of the post-mortem staining- and capillaries due to the action of fibrinolysin ,
After complete formation of the postmortem liberated from the vascular endothelium and
staining, if the body is still left undisturbed from serous surfaces like pleura , at the time
for a period of another 5 - 6 hours , then the of death as a part of the death reaction . In
staining over the areas gets fixed. If the posi- some deaths due to certain infections and

Chaplrlr 6;- DEATH ANP POST MORTEM CHANGES I 251
IFig. 6.12: Usual distribution of PM staining and

j Fig. 6.13: PM staining with contact pallor
t__ ~lo_r-------~- ---------' '-- -
Fig. 6.14: Post-mortem staining with contact pallor- Fig. 6.15: Absence of PM staining on pressure areas I
l _ ____!!! Courtesy: Prof. TK Bose _ _ _ _~ for brassiere and petticoat ligature _j
Fig. 6.17: Post-mortem staining and contact- ~

I I
indicative of position of the dead body after
death

cachexia before death, fibrinolytic effect on the Some specific phenomena related to the
clotted blood inside the vessels may fail Fur- post-mortem staining
ther in great vessels and inside the chambers
1. As post-mortem staining occurs exter-
of the heart also we find post-mortem clots as
nally on the dependant parts of the body,
in these places the size of the clot is propor-
it also occurs at the dependant parts of
tionately large in comparison to quantity of
all the internal organs , the blood of these
liberated fibrinolysin. So fixation of post-
organs settling at their dependant parts.
mortem staining is not due to clotting ofblood
settled in the capillaries of the body. Actually, 2. The staining beromes discoloured and the
fixation ofpost-mortem stainingoocurs mainly area of distribution gets disturbed , once
due to certain physical factors . Firstly, after decomposition starts in the body.
the formation of the post-mortem staining 3. Post-mortem staining is an intra-vascu-
blood cannot easily pass out of the concerned lar phenomenon and there is no extrava-
capillaries due to the capillary action . Sec- sation of blood in the area.
ondly, by the time there has 'been total set- 4. The areas of the dependant parts which
tling of the blood , rigor mortis is well estab- remain in direct contact with the ground
lished all around the body. This change in the or the bed, do not show any staining and
muscles obliterates the big vessels passing appear rather pale than what these ar-
through them Hence, after this period, the eas were during life. This phenomenon
blood cannot pass through these vessels to is known as CONTACT PALLOR. This
settle in the small venules and capillaries in a occurs due to the fact that these areas
new area. Thirdly, after the full establishment being in direct contact with the ground,
of rigor mortis the venules, etc. lie almost etc. the vessels in these areas remain
empty and compressed in the rigid muscles at pressurised and do not get any scope to
that time and cannot be easily distended by be distended by the settling blood.
the resettling blood. Rather, whatever amount ofblood these
Bluish discolou.ration of the affected area vessels contains, is compressed out. The
is not due to asphyxia . As we know that 5 g% areas of contact pallor is similar with the
of reduced haemoglobin is needed to have the areas of contact flattening (see rigor
colour of the blood so changed. The reason mortis).
behind such colouration of the affected area 5. In drowning cases either the staining ap-
is that, in dead bodies oxygen dissociation pears on the face and the neck or it does
continues and there may be reflux of deoxy- not appear at all. When the body remains
genated venous blood into the capillaries. So submerged in water for some hours with-
blood in capillaries, including that which has out being disturbed by waves or flow of
settled on dependent parts, is reddish purple water, the head being the heaviest part
or purple (in fair complexioned persons , of the body assumes lower level in com-
which appears somewhat more bluish in dark parison with rest of the body and the
complexioned subjects ). blood settles over the head and neck and
Isolated patches of post-mortem stain the staining becomes apparent over the
may also appear even at a later period than face and the neck. But, in flowing water
what is usual, due to squeezing ofblood from or due to strong waves , the position of
vessels in muscles going to the state of rigor the body constantly changes Hence , in
mortis . these cases , there is no fixed dependant

chapter 6: DEATH AND POST MORTEM CHANGES j 253
partofthe body, so as to allow settling of Medicolegal importances

blood in any part. Hence, in such circum-
1. Formation of post-mortem staining is a
stances there will not be fonnation of the
sign of death as it forms only after the
post-mortem staining in any part of the
cessation ofcirculation. But ante-mortem
drowned dead body. ·
hypostasis may be there during the ter-
6. Ante-mortem hypostasis may be fanned minal phase of a living subject whose cir-
in a person with feeble circulation, if he culation has become very feeble and who
does not change his position for some is unable to change his position and has
hours. stayed in one position for a long period.
In myocardium, post-mortem staining 2. From the formation, size, extension and
may be mistaken for inflanunatory change fixation of the post-mortem staining, time
due to infarction; in lungs, for pneumonia; passed after death can be roughly as-
and in lower coils of intestines, for false haem- sessed. At the dependant aspects of the
orrhage or infection. body, it starts appearing in small patches
Factors influencing the formation of the by the end of the first hour. Post-mortem
post-mortem staining- staining is complete by about 6 hours af-
ter death. Fixation of the post-mortem
!. Fixed, undisturbed positioning of the
staining occurs by about another 5 - 6
dead body, for some hours after death is
hours after its fonnation.
necessary. If the position of the body is
disturbed, then there will be either no 3. Cause of death-From the distribution
formation of the post-mortem staining or and the colour of post-mortem staining
the staining will be faint and may have some idea about the cause of death can
extended distribution. be made.
2: Due to excessive loss of blood during or (a) From the distribution of the post-
before death or in severely anaemic sub- mortem staining-In cases of death
jects, post-mortem staining may not be due to hanging, if the body remains
appreciable. suspended in the upright position
for a few hours, then post-mortem
3. Post-mortem staining is more prominent
staining will appear in the lower
in fair-complexioned persons and is less
limbs, lower parts ofthe upper limbs
conspicuous in dark-compleXioned per-
and at the upper margin of the liga-
sons.
ture mark on the neck. When the
4. Post-mortem staining is well formed in body is suspended in the upright po-
case of death due to asphyxia. sition, the limbs are the dependant
5. Post-mortem staining is more prominent parts of the body. The blood from
on front and sides of neck, finger-nail buds the head cannot run down beyond
and ear lobules. the upper margin of the ligature and
6. Where post-mortem staining is intense hence, post-mortem staining also
and pull of gravity is high, the blood ac- appears at the upper margin of the.
cumulated in the capillaries, may cause ligature mark.
rupture of the capillaries and there is pro- Though in cases of death due to
duction of blackish haemorrhagic areas, hanging, if the body remains sus-
one to several nun in diameter in sizes pended for some hours after death
(as in legs in case ofhanging). in the upright position, the postmor-

l'-~ . -.,.•,.;
., , ·;·- { ··-\ ··-.r; . . ;/::i •<
·Pasi-mortem.sistnlng .·
,· ~
,. . •>;>
F6etures .
<
' ~- . . .:; '

· Broise
\ ' /.:··' ;
1. Situation On the dependant parts of the dead body Anywhere.

2. Tissue level Under surface of the skin and the skin Subcutaneous tissue level externally
level externally
3. Surface (a) Not elevated (a) May be slightly elevated
(b) Cuticles not damaged (b) Cuticles may be damaged in the
form of abrasion
4. Margin Sharp and clearly defined Diffused margin
5. Colour Bluish or reddish purple normally Reddish when fresh which changes
Specific colour in some specific in colour with time
poisoning death cases
6. Cause Due to capillo-venous distension with Due to extravasation of blood from
blood capillaries
7. Nature of the change Post-mortem Ante-mortem
8. Effect of pressure Pressed spot appears pale !\('! ;hange on application of pressure
-
9. Cut section Cut surface shows oozing of blood from Cut surface shows evidence of haemorr-
the smaller vessels which can be hage in the tissue which cannot be
cleaned by washing washed out (in dead bodies)
10. Microscopic study Engorgement of capillaries Extravasation of blood, cellular
infiltration, etc.
11 . Enzymatic study No change Change in the level of certain enzyme,
in the affected area
12. Medico-legal Tells ~bout the time of death and position Tells about the nature of injury, weapon
iflllOrtance of the dead body used etc.
·'
,.
Features _Post-mortem staini~g Congestion .
'"
1. Situation Dependant part of the organ Whole or any part of the organ, affected
with the pathology
2. Cut surface Oozing of blood from the distended Exudation of fluid, mixed with blood
capillaries from the cut surface
3. Swelling or oedema Nil
4. In case of stomach Depending on ridges.and creases of the
and intestine, when stor:ncr:h and intestif19 there will be lines
stretched and ,areas of discolouration and paleness
5. Cause Passive capillovenous distension Due to .some pathology in the organ
6. Nature of the change Ahte-rhbrtein
--------~~------L-~·~-~~·~-~
-~-~·-~----------~-~~~·-~-------------

tern staining will appear on the (vii) In case of drowning death and
limbs and upper margin ofthe liga- submersion of the body for
ture mark, yet presence of post- some period in water, the post-
mortem staining over these areas mortem staining at some places
of the body should not alone essen- may be red due to formation of
tially mean tha~ death was due to oxyhaemoglobin in the blood in
hanging. Because, if a person is sus- the surface capillaries, due to
pended in upright position with a absorption of oxygen through
ligature around the neck, after be- the body surface from the wa-
ing killed by some other means, then ter.
also the distribution of the post- (viii) In case of death from burning
mortem staining will be similar. inside a closed room the stain-
Post mortem staining is just a POST- ing may be bright red or pink-
MORTEM·PHENOMENON. ishdue to formation ofcarboxy-
(b) From the colour. of the post-mortem haemoglobin for inhalation of
staining-The normal colour of the CO, a product of incomplete
post-mortem staining is either blu- combustion of carbonaceous
ish or reddish purple. But in some materials.
specific causes of death the colour. 4. From the distribution ofthepost-mortem
of the post-mortem staining may be staining the position in which the body
different than the usual. was left for some hours after death can
(i) In death due to HCN poison- be known. If the distributionofthe stain-
ing the colour of the posting does not match with the position of
mortem staining is cherry red the body in which it was discovered, then
or pinkish it can be deduced that, the body was
(ii) In cyanide salt poisoning it is moved or manipulated at least some
bright scarlet or violet hours after death.
(iii) In CO poisoning the staining is 5. Post-mortem staining, particularly when
pinkish patchy and small in the early phase of
(iv) In case of phosphorus, pot. its formation, may be confused with
chlorate, nitrate and anilin~ it bruise.
is chocolate brown. In case of 6. Post-mortemstaining, particularly of the
phosphorus poisoning the col- internal organs, may be confused with
our is dark brown congestion of the organs.
(v) In case of ~S poisoning the 7. Haemorrhagic spotson skin of some parts
colour is greenish blu~ due to of the body, due to blood dyscrasias, may
partial formation of sulpluneth- be mistaken for post-mortem staining
haemoglobin. Post-mortem staining is on the depend-
(vi) In case of death due to expo- ant parts of the body, and when the body
sure to cold, the colour of the is in supine or prone position are sym-
staining is bright red due to metrical in distribution on both sides.
non-utilisation of the oxygen- 8. Some extraneous colour or stain may be
ated blood, due to lack of meta- mistaken as post-mortem staining. These
bolic functions ofthe body. extraneou~ stains or colours can be wiped

out or rubbed or washed out. But the post- ATP causes liberation of energy which causes
mortem staining cannot be so done. contraction of the muscle fibres with exten-
Moreover, the distribution of the stain sion of the actin filaments more inside the
should also be differentiating. myosin filaments . During muscle contraction
sliding of these two filaments over each other
causes shortening of the sarcomere . The sar-
RIGOR MORTtS OR CADAVERIC comere cannot relax till myosin filaments are
RIGtOilY not released from actin filaments for which
ATP is necessary. ATP helps reloading of sar-
The phase of primary relaxation of the mus- coplasmic reticulum of sarcomere with cal-
cles continues for an hour or more after death. cium. When muscle relaxes myosin head re-
After lapse of this period, the muscles of the turns to their active (high energy) position and
body gradually become stiff or. rigid. This ri- are re~dy for contraction recourse in conjunc-
gidity of the muscles after death indicates tion with actin filaments. During this phase
molecular death of the concerned muscles. calcium ions remain idle in the sarcomere and
Definition-Rigor mortis is that state of may ultimately bind with filaments regulatory
the muscles of a dead body when they be- protein. By now as the head of the myosin
come stiff or rigid with some degree of short- filament is ready for the process to bind with
ening. actin filament, that occurs with formation of
actomyosin complex.
Mechanism offormation ofrigor mortis -
Muscle fibres contain bundles of myofibrils During life very soon there is re-synthe-
which consist of two types of protein fila- sis of ATP , from the ADP and phosphate by
ments, actin and myosin . These two types of the process .o fphoS-phorylation , with the help
protein filaments are arranged in the of energy liberated due to the breakdown of
myofibrils as interdigitating arrays , one type glycogen to lactic acid.
of the filaments extending in between the fila- After death there is continuous break
ments of the other type. In the arrangement down of the ATP. For some time, so long gly-
the myosin filaments have lateral projections. cogen is available in the muscle , there is re-
Thus they form the contractile units of mus- synthesis of ATP . Due to breakdown , there
cle fibres comprising of two types of bands of is constant decrease in the level of glycogen
filaments (actin and myosin). in the muscle . In this process, once the mus-
At rest , during life , the interdigitation of cle glycogen is exhausted , no further re-syn-
the filaments is of small extent. The muscle thesis of ATP is possible and the muscle loses
fibres also appear soft and supple. Maintenance softness , t-.1 lasticity and extensibility due to
of softness , suppleness and extensibility of the formation of viscid acto-myosin complex in
muscles is due to the presence of ATP (adeno- which both actin and myosin filaments take
sine-triphosphate )above a certain level. When part, giving rise to the formation of the state
the level of the ATP falls below this critical of rigor mortis in the muscle.
value , there is contraction of the muscle fi- Now that, as calcium is not available for
bres . With nervous stimulation, breakdown renewal of the cycle in absence of ATP, the
of ATP oreurs to ADP (adenosine-di-phosphate) actomyosin complex becomes semipermanent
and phosphate. This process of breakdown of till it is broken or destroyed due to decompo-

chapter 6: DE ATH AND PO ST M ORTEM CHANGES I 257
sition, when recycling of ATP is no more pos- small muscles of fingers and toes. In sum-
sible. Till that period the muscles will be in mer, after about 12 - 18 hours' stay, rigor
the state of rigor with loss of softness, elas- mortis passes off in the order of its appear-
ticity and extensibility due to formation of ance. Among the whole body, its stay is maxi-
viscid actomyosin complex. mum in the muscles of the lower limbs.
In rigor mortis , there is stiffening of the Period of stay of rigor mortis--In sum-
muscles with loss of elasticity and extensibil- mer, it takes 1 hour to appear and another 3
ity with only mild degree shortening of the - 4 hours for all-round distribution. Du ring
muscle fibres . this season the average period of stay of rigor
The extent of rigidity achieved is related mortis is between 12 to 18 hours.
with the extent ofbreakdown of the ATP. With In winter, it takes about 2 - 3 hours to
30% breakdown of the ATP, there is 15% loss appear and another 4- 6 hours for all-round
of extensibility of the muscles. When break- distribution, with an average period of stay
down of ATP is· optimum, then loss of exten- for about 24 - 48 hours.
sibility of the muscles is 66%. In cold countries the above timings are
The muscles again become soft, during prolonged according to the temperature of the
the stage of secondary relaxation, due to de- countries.
composition. Some features observed during the pe-
Rigor mortis occurs both in the volun- riod of stay of rigor mortis-
tary and in the involuntary muscles. It oc- 1. Due to rigidity of the heart muscles dur-
curs earlier in the involuntary or smooth ing rigor mortis, there is emptying of the
muscles , than in the voluntary or striated chambers of the heart.
muscles. In the voluntary muscles, though 2. Pupils are constricted due to rigor mor-
breakdown of the ATP starts everywhere at tis of the muscles of the iris.
a time, rigidity is generally noticed earlier in
3. There is goose skin appearance of the
the smaller group of muscles than in the
body due to rigor mortis of the erector
larger on es. The small muscles of the hands
pilae muscles.
and feet are exceptions, where the rigidity
comes last.
Onset of rigor mortis-In the summer
season in our country, rigor mortis first ap-
pears in the heart muscle towards the end of
the first hour after death. During this sea-
son again, among the voluntary muscles ,
rigor mortis first appears in the muscles of
the eye lids (orbicularis oculi), by the end of
the first hour after death. Rigidity spreads
gradually, within about the next three hours,
chronologically, in the muscles of face, neck,
aw, thorax, upper limb (from shoulder to the
wrist ), the abdomen, and lower limb (from Fig. 6.18: Demonstration of RM by pressure over
lower jaw
the hip to the ankle). It comes last in the
"C' I - 171

atmospheric temperature it comes late

and stays longer.
5. In death due to exhaustive disease, or
when convulsion precedes death, rigor
mortis appears and passes off early.
6. In deaths due to wasting diseases, rigor
mortis comes early and passes off early.
7. In death due to septicemia also it occurs
early.
Fig. 6.19: Demonstration of rigor mortis at knee joint 8. In death due to strychnine and HCN poi-
soning, rigor mortis comes early and goes
late.
4. Due to rigor mortis in the muscles of the
9. In death due to asphyxia; hanging, CO
seminal vesicles, there is post-mortem
poisoning and where severe haemor-
ejaculation of seminal fluid in ~es.
rhage precedes death, RM comes late.
5. Due to rigor mortis in the muscles of the
spermatic cord, the testicles are drawn Medicolegal importances of rigor mortis
up near the external rings.
1. It is a sign of death.
6. · Contact flattenning continues during the
2. During the early phase after death, rigor
stage of rigor mortis over those areas
mortis gives good idea about the time of
which were in contact with the ground,
death. During summer, if the whole body
even though the position of the body
is in the state of primary relaxation, then
might have been changed after the for-
death must have occurred within the last
mation of the rigor mortis.
1 hour, If rigor mortis is present in the
7. Rigor mortis in the uterine muscle can- face alone, then death has occurred about
not expel out the foetus from a gravid an hour back. If it is present in the upper
uterus. limb and chest and not in the abdomen
Factors which influence the formation and lower limb, then death might have
and stay of rigor morti~ occurred about 2 - 3 hours back. If it is
1. Age-Rigor mortis does not develop in a present all-around the body, then death
foetus of less than 7 months intra-uter- might have occurred between 4- 18 hours
ine age. back.
2. It occurs early in children. In winte1. ~eason, the above timings are
roughly doubled.
3. Physique of the subject-Rigor mortis
comes early and passes off early in thinly 3. From rigid -eo~tact flattenning, the posi-
built subjects with weak nn;t~ature. In tion in .\,Vhich the dead body was lying for
well-built subjects with strong muscula- some hours after death, can be known.
ture, it comes late and stays longer. 4. Rigor mortis indicates molecular death
4. Atmospheric temperature-At high at- of the ~~~ involved.
mospheric temperature rigor mortis 5. Some conditions occurring in dead bod-
comes ~~rly and passes of(M~~~ epld ie.s ~~ ff..~~fused with rigor mortis.

·l
Fig. 6.20: Demonstration of

rigor mortis at
knee jt.
Fig. 6.21 : Demonstration of

rigor mortis in
finger.
Fig. 6.22: Demonstration of

rigor mortis in
finger.

These are: death can be guessed. In case of a

(a) Cadaveric spasm or instantaneous dead body, ifthe hand is found flexed
rigor in a state ofcadaveric spasm and the
(b) Heat stiffening of the dead body grip contains sand, mud, gravel or
weed, which are present at the bot-
(c) Cold stiffening of the dead body
tom of the pond or lake from where
(d) Gas stiffening ofthe dead body. the body was recovered, then it in-
(a) Cadaveric spasm (Synonyms-In- dicates that at the time of death, the
stantaneous rigor, cataleptic rigid- subject was at the bottom of the
ity, instantaneous rigidity)-lt is a pond or the tank where he might
condition in a dead body in which have tightly gripped the bottom at
the muscles of the body which were the time of his death. Hence, with
in a state of strong contraction im- such findings in such a dead body, it
mediately before death, continues to can be safely deduced that, the per-
be so contracted at the moment of son must have died when he was at
death and after death, ~thout pass- the bottom of the pond or tank or,
ing through the stage of primary re- in other words, his death was due
laxation. Thus, it is not just stiffen- to drowning in that pond or tank. In
ing of muscles like rigor mortis. The a case of death due to stab injury
muscles are in a state of contraction over an approachable vital part of
in cadaveric spasm. The spasm in- the body, if the weapon used (say a
volves one or a group of muscles of dagger) is found in the tight grip (ca-
the body usually, but occasionally daveric spasm) of the hand and if the
the involvement is more extensive position of the weapon in the hand
and though very very rare, in pecu- is matching with commission of sui-
liar circumstances muscles of the cide by using that weapon, then it
whole body may be involved. The can be taken that, the person might
spasmodic contraction of the mus- have conunitted suicide by using the
cles reflects ante-mortem state of weapon present in his hand. Simi-
excitement of mind, fatigue, nerv- larly, in the hand of the deceased
ous exhaustion and violent form of which is flexed in a state of cadav-
death. eric spasm, if we find foreign scalp
It is a rarely found condition, formed hair, some fibres of a cloth not used
at the moment of death and persists by the deceased or some foreign ar-
till rigor mortis starts. ticle like button of a shirt, we can
Medicolegal importances-Cadav- reasonably presume that those ar-
eric spasm being an ante-mortem ticles belong to the assailant or one
phenomenon in origin forms at the of the many assailants with whom
moment of death which continues he had a struggle at the time ofhis
after death, reflects the last act of death. Thus, from such a case, not
the subject, performed at the time only the homicidal nature of the
of his death. Thus from the cadav- death is concluded, but also some
eric spasm, sometimes the cause of clue about the assailant is avail-
death and sometimes the nature of able.

(b) Heat stiffening-If death occurs due phere for a reasonable period. Here
to 2nd and 3rd degree of burn inju- stiffening occurs due to, (i) freezing
ries or if a dead body is subjected to ofbody fluids , particularly at the tis-
exposure to more than 65°C, then sue level and in the fluid of synovial
there will be coagulation of the mus- sacs of the joints and, (ii) due to hard-
cle protein, and the body will be stiff €ming of the subcutaneous fatty tis-
with contraction of the muscles, in sue. It is not difficult to know if the
which the flexor muscles take up- stiffening is due to exposure to cold.
per hand , giving rise to a condition If the stiffening is due to cold, then
which is known as pugilistic or box- the body temperature will be below
er's or fencing attitude of the body. ooc; there will be cracking sound or
It is not necessary that, the burn- crepitation, ifthejoints are manipu-
ing or exposure to heat should be lated; and the body will be flaccid if
ante-mortem in occurrence. kept in ordinary atmospheric tem-
(c) Cold stiffening- This occurs when a perature for some period after which
body remains in·extreme cold atmos- rigor mortis appears.
Table 6.4: Differ~ncesbe~ Rigor Mortis and Cadaveric spasm

Points Rigor Moros Cadaveric spasm
1. Onset Within 1or2hoursafterdeath Instantaneous with death
2. Muscle involved All muscles of the body are affected Selected voluntary muscles which were
gradually in a state of contraction at the time of death
3. Primary flaccidity Precedes RM Does not come in the affected muscles
4. Intensity of rigidity/ Comparatively moderate Comparatively very strong
contraction
5. Death of the muscles Molecular death of muscles occur No molecular death of the muscles
6. Duration of stay About 12-18 hours in summar A few hours until replaced by rigor
24-48 hours in winter mortis. But in the experience of many, it
starts from the moment of death and
continues till rigor mortis continues to be
present
7. Predisposing factor Nil Excitement, fear, fatigue, exhaustion along ·
with contraction of muscles during death
8. Body temperature Low Comparatively high
9. Muscle reaction Acidic Alkaline
10. Reaction to stimulus Does not respond Responds
11. Mechanism of formation Breakdown of ATP below critical level Not known exactly
12. Medico-legal Mostly helps to know the time of death Speaks sometimes about the cause of
importance death and sometimes about the nature of
death (whether suicidal, homicidal, etc.)

.~ ,,
l .1
Table 6.5: Differences between Rigor Mortis and Heat stiffening
~ .Points ' Rigour Mortis Heat stiffening
1. Degree of stiffness Moderate High
2. Time offonnation 1 or 2 hours to 4 hours after death May be ante-mortem or post-mortem.
Formed due to contact with heat
3. Role of heat Atmospheric high temperature enhances Occurs at a temperature above 65°C
the process
4''.. Mechanism of formation Due to breakdown of ATP of muscle Due to heat coagulation of muscle protein
5. External appearance Nothing specific Signs of exposure to heat will be there, e.g.,
buming, blackening, blister formation, etc.
r\ ·:
.. '!. .r Table 6.6: Differences between Primary and Secondary relaxation of muscles
Points Primary relaxation Seconriary relaxation
1. Time of occurrence Immediately after death After rigor mortis passes off and decompo-
sition occurs
2. Death of muscle tissue Has not occurred Molecular death of muscles have occurred
3. Response to stimuli Responds Does not respond
4. Other external features Nothing particular Signs of decomposition are there
5. Body temperature Nearer to the normal of 98.4 oF Low body temperature
(d) Gas stiffening occurs during the monia. The muscles at this phase stand de-
stage of decomposition when the composed and they will not respond to any
cause of stiffening is very ubvious sort of stimulus.
from the discolouration, swelling and
foul smell.
Secondary relaxation of muscles-After 0
some hours of stay, rigor mortis or rigidity
of the muscles passes over and the body be- After death, the body's protective functions
comes relaxed or flaccid for the second time. are absent and its defence barrier is lost.
This is secondary relaxation or secondary Saprophytic micro-organisms which cannot
flaccidity of the muscles. In fact, secondary invade the body during life, physical and
relaxation occurs only with the onset of de- chemical agents which are present in the
composition or putrefaction of the dead body. environment, all act on the dead body. Fur--
During this phase of the dead body, other ther, some body chemicals and enzymes
signs of putrefaction will be there. Apart from which are helpful agents during life and take
those signs, the reaction of the muscles will part in different metabolic processes, in the
again be alkaline due to brea,kdown of pro- absence of physiological control after death,
tein with liberation and accumulation of am- start acting adverSely.

~· Table 6.5: Differences between Rigor Mortis and Heat stiffening

'I Points Rigour Mortis Heat stiffening
1' Degree of stiffness Moderate High

2. Time of fonnation 1 or 2 hours to 4 hours after death May be ante-mortem or post-mortem.
Fanned due to contact with heat
3. Role of heat Atmospheric high temperature enhances Occurs at a temperature above 65°C
the process
4. Mechanism of formation Due to breakdown of ATP of muscle Due to heat coagulation of muscle protein
5. External appearance Nothing specific Signs of exposure to heat will be there, e.g
burning, blackening, blisterfonnation, elc
r.. >. -. Tabte 6.6: Differences between Primary and Secondary relaxation of muscles
~ Points Primary relaxation Secondary relaxation
1. Time of occurrence Immediately after death After rigor mortis passes off and cieca'Jllo-
sition occurs
2. Death of muscle tissue Has not occurred Molecular death of muscles have occurred
3. Response to stimuli Responds Does not respond
4. Other external features Nothing particular Signs of decomposition are there
5. Body temperature Nearer to the nonnal of 98.4 oF Low body temperature .
(d) Gas stiffening occurs during the mania. The muscles at this phase stand de-
stage of decomposition when the composed and they will not respond to any
cause of stiffening is very c..bvious sort of stimulus.
foul smell.
Secondary relaxation of muscles-After PUTPEFAC lO
composition or putrefaction of the dead body. environment, all act on the dead body. Fur-
again be alkaline due to bre&kdown of pro- absence of physiological control after death,
tein with liberation and accumulation of am- start acting a:dvt:lr8ely.

•
r -~
1-.c •, ' "Table 6.5: Differences between Rigor Mortis and Heat stiffening
t -
Points ' ',· . Rigour Mortis Heat stiffen
1. Degree Of stiffness Moderate High
2. Time of formation 1 or 2 hours to 4 hours after death May be ante-mortem or post-froBn
Formed due to contact with heat
1 Role of heat Atmospheric high temperature enhances Occurs at a temperature above ss·;:,
the process
'1.1,:' Mechanism of formation Due to breakdown of ATP of muscle Due to heat coagulation of muscle proE~-
5. External appearance Nothing specific Signs of exposure to heat will be there e =
burning, blackening, blister formation
r
I
~
-"
rr·,:, ·- Tabfe
.,
6.6:'Differehces between Primary and Secondary relaxation of muscles
'
POrhts "'l '

Primary relaxation Secondary relaxation
-~
1. Time of occurrence Immediately after death After rigor mortis passes off and decoo'1»-
sition occurs
2. Death of muscle tissue Has not occurred Molecular death of muscles have OCCt.JTeO
3. · Response to stimuli Responds Does not respond
.{ Other external features Nothing particular Signs of decomposition are there
5; Body temperature Nearer to the normal of 98.4 •F Low body temperatur~
(d) Gas stiffening occurs during the monia. The muscles at this phase stand de-
stage of decomposition when the composed and they wiil not respond to any
cause of stiffening is very obvious sort of stimulus.
foul smell.
Secondary relaxation of muscles-After
composition or putrefaction of the dead body. environment, all act on the dead body. Fur---
again be alkaline due to brea,kdown of pro- absence of physiological control after death,
tein with liberation and accumulation of am- start acting adversely.

Thus, after death, the dead body is sub- pretty long period. The ordinary decomposi-
jected to wear and tear. Up to a certain pe- tion is also termed putrefaction and the two
riod, while some changes like rigor mortis, varieties of modified decomposition are
continues in the dead body, its gross struc- known as adepocere change and mummifica-
ture is maintained. But with further progress tion.
of time beyond the phase of rigor mortis the In putrefaction there is decomposition of
tissue composition and the gross structure body proteins by anaerobic microorganisms
of the body start breaking down in the proc- (termed putrefying bacteria). The process
ess of wear and tear due to the above rea- usually results in production of amines ,
sons. This is decomposition or putrefaction namely putrescine and cadaverine which
of dead bodies .. This process continues till have a putrid odour (also see below). Materi-
total destruction of all the body parts takes als which are subjected to putrefaction are
place. called putrescibles.
Definition- Decomposition can be defined Micro-organism responsible for decompo-
as a process by which the complex organic sition are anaerobic spore bearing bacilli, col-
body tissues breakdown to simpler inorganic iform organisms, micrococci. Cl. Welchii, B.
compounds or elements, due to the action of Coli, Staphylococcus, Non-haemolytic strep-
ferments produced by the saprophytic micro- tococcus , diptheroids, and proteus are the
organisms or due to autolysis. The process important ones. Some of these are normal
leads to discolouration of dead body, evolu- inhabitants ofGI tract and respiratory tract.
tion offoul smelling gas, swelling of the dea'd Clostridium Welchii predominates. Increase
body with gradual and total destruction of the in hydrogen ion and rapid decrease of oxy-
different body parts. gen favours growth of anaerobic organisms.
Decomposition is the normal fate of an Status of autolysis-In absence of any
undisposed dead body. Under certain specific micro-organism also , there will be decompo- ·
environment al conditions modified decomposition of the dead body, e.g., aseptic autolysis
sition of the dead body occurs, in which cases, occurring in dead foetus in mother's womb.
instead of early and total destruction of the
Different gases which are produced dur-
dead body, the dead body is preserved for a
ing decomposition-As the process of putre-
faction progresses, some gases are evolved.
These are H 2 S (Hydrogen sulphide), Phos-
phoretted hydrogen, C02 , CO, marsh gas and
NH 3 . Some of these gases and mercaptans
amines produced cause offensive odour.
External signs of decomposition (in sum-
mer)-The first external sign of decomposi-
tion appears over the right iliac fossa of the
abdomen. A greenish discolopration appears
there. Cl. Welchii are most abundant at the
iliocaecal zone·ofthe intestinal tract. During
. Fig. 6.23 : Signs of early decompdslti06~·gree nish life they are 4lot very active and cannot in-
discolouration over right iliac fQSsa
vade through the living-tissue. After death;

when the tissue barrier is lost, they can in- Breasts in females, scrotum and penis in
vade through the intestinal wall. They also males, are swollen. Tongue is swollen and
reach the blood vessels. They break the tis- protruded. On the second day, blisters form
sue structure and produce H 2 S gas. The gas due to presence of gas in the vessels. Rup-
combines with the haemoglobin ofblood and ture of blisters occurs. Cuticle gets denuded.
forms sulphmethaemoglobin which discolours Between 48- 72 hours-There is prolapse
the vessels and the surrounding tissue . Dif- of uterus and anus. Post-mortem delivery of
fusion of gas and invasion of the nearby tis- foetus occurs from the gravid uterus. Both
sue by the organism gradually cause spread- ante-mortem and post-mortem wounds ooze.
ing of the discolouration over a wider area of Post-mortem staining gets displaced from the
the abdomen. In this country, this first original stained areas. Eye balls protrude.
change of greenish discolouration occurs ex- Face is extremely swollen, discoloured and
ternally over the right iliac fossa of the abdo- the subject is not identifiable from the face.
men of the dead body by about 12 hours after Hair and nails become loose and may be taken
death , in summer. Rigor mortis is still out easily.
present in different parts of the body. In win-
Between 3 - 5 days-Abdomen bursts.
ter, this change appears between 36 to 48
Swelling of the body passes over due to es-
hours after death. The discolouration gradu-
cape of gas through the damaged body parts.
ally spreads. First, the discolouration is dis-
Teeth become loose. Skull sutures separate
tributed in patches, which gradually coalesce
and decomposed liquified brain substance
and becomes continuous. The discolouration
comes out, specially in infants.
first spreads all over the abdomen, then over
face , neck and thorax and lastly on limbs. Between 5 - 10 days-Colliquative change
(liquefaction) occurs during this period. Soft
Invasion of blood vessels by the organ-
firm tissues change to thick semisolid black
isms and production of H 2 S gas and forma-
mass. Lately, same thing occurs to cartilages
tion of sulphmethaemoglobin there, causes
greenish brown staining of the inner walls of and ligaments.
the vessels . This makes the superficial veins Skeletonisation of the body-
prominent and colourful. This phenomenon Skeletonisation of the dead body takes vary-
in the smaller superficial branches of the ing time depending on various factors . In
vessels and the local tissue gives a marbled buried dead bodies, total skeletonisation may
appearance of the skin of the area. Marbling take even 1 year. When disposed off carelessly
of the skin becomes prominent by 36 - 48 on land or water, skeletonisation may occur
hours after death in summer. Further within a few months.
changes occur as follows: Destruction ofbones ordinarily takes sev-
Between 12 - 24 hours-Gas accumulates eral years. In adverse_cii:cumstances like,
inside the abdominal cavity. The abdomen is when disposed of in a damp area or when
tense. Blood-tinged froth comes out through aquatic or terrestrial animals eat up parts of
the nose and mouth. the bones, destruction of the bones may oc-
Between 24 - 48 hours-Gas accumulates cur quite early. On the other hand, when
in the tissues which appear bloated. Subcu- some bones are preserved suitably, they may
taneous tissue becomes emphysematous. remain intact for hundreds of years.

chapter 6: DEATH AND POST M O RTEM CHANGES I 265
- - -
• __ - ·- -..;. -- .. - - ~ ._,.. •• ~·lj, -'"- ~..... .;:•
., ... '·-
Fig. 6.25: Marbling appearance of skin without any

other signs of advanced decomposition
Fig. 6.24: PM blister formation and early appearance
of marbling of skin (prominence of
superficial veins)
Fig. 6.26: Marbling of skin and extreme swelling of body; Fig. 6.27: Extreme swelling and marbling of skin with
moderate decomposition discolouration and denudation of cuticle at
places
Fig. 6.29: Third day decomposition state in a dead body

recovered from water in autumn in Kolkata
Features-( 1) Swelling , (2) Peeling of
Fig. 6.28: Advanced decomposition changes; see also peidermis , (3) Swelling of scrotum and penis
Fig . 6.29 (4) Marbling

Fig. 6.31 : Early decomposition , laying of eggs on eyes

by fly
Fig. 6.33 : Marbling of skin
Fig . 6.34: Extreme degree decomposition of the body

but hands are not yet decomposed . May be
the result of some adverse effect like gnawing
by animals of the body Fig . 6.35: Same body as in Fig. 6.34

Fig. 6.36: Advanced decomposition with colliquative Fig. 6.37: As in Fig . 6.36 mark the evidence of ante-
I changes mortem haemorrhage on Rt. side of hand
Internal changes due to decomposition Gall bladde~Decomposition of gall blad-

(in summer} · der starts with diffusion of bile to the sur-
rounding tissue including the inferior surface
Larynx and trachea-Decomposition starts
of the liver. This occurs by about 24 hours
between 12 - 24 hours in summer (2 - 3 days
after death or even earlier. The gall bladder
in winter). Mucous membrane ofthe larynx
collapses. But total disintegration does not
and trachea first appears brownish and then
occur very early.
greenish and gets softened. The mucous
membrane may be denuded. Omentum I mesentery- Decomposition
becomes quite obvious between 2 - 3 days in
Stomach and intestine-Decomposition
summer with greyish green appearance. Ul-
starts between 24 - 36 hour in summer ( 3 - 5
timately the mesentery looks blackish
days in winter). At first there is dark red
patches in the posterior wall, which gradu- Brain-Decomposition of the adult brain
ally spreads to the anterior wall. Then, there starts between 24 - 48 hours after death in
is formation of gas blebs, cysts and then the sunnner when it appears soft and pulpy. By
stomach becomes soft, dark brown and last~y the third day the brain appears pasty. Between
changes to a dark poulticeous. mass.
Live~Decomposition in liver starts be-
tween 12 - 24 hours after death in summer.
At the beginning, the liver is soft and flabby.
Blisters appear on the surface. On the sec-
ond or third day, accumulation of decomposi-
tion gas gives honey-comb appearance of the
cut section of the liver. Such a liver is more
popularly called a "foamy live,;'. The liver
gradually reduces in size, darkens in colour
and ultimately reduces to a coal-black ~)f.~ J: '.t:-q_, ··~·1 ~'. Ll.
Fig. 6.38: N,ea,rin9, skeletonisation
poulticeous mass.

Fig. 6.40: Much advanced decomposition nearing

Fig . 6.39: Attempt of arrangement of body skeleton skeletonisation
Fig. 6.41 : Partial decomposition and partial adepocere Fig. 6.42: Some adepocere change with skeletoni-
change in the body sation
Fig. 6.43: Part adepocere change, part skeletonisa-

tion Fig. 6 .44: Adepocere change in dead body

3 - 4 days it liquefies. Decomposition of the Prostate-It is the organ in males which

infant brain occurs early due to some areas decomposes last. However, an enlarged and
remaining unprotected due to the fontanelles. diseased prostate decomposes comparatively
early.
Heart-In the 2nd and 3rd days, the heart
becomes soft and brownish. It also reduces Uteru~In females, this is the organ to
in size and weight. Bullae containing decom- decompose last. A gravid uterus of course,
position gas appear at the undersurface of the decomposes earlier than a non-gravid uterus.
pericardium The chambers of the heart con- A parus non-gravid uterus decomposes later
tain frothy blood. "Miliary plaques" which than a gravid uterus and a nulliparous uterus
appear like small white granules are rarely decomposes last.
found over epicardium and endocardium (ex- Prostate and uterus being the last organs
act cause is still not known). to decompose, help to know sex of dead bod-
ies from soft tissue, in very advanced state of
Lung~By the 2nd and 3rd day, the lungs
decomposition where no other soft tissue is
show signs of decomposition like deepening
in proper anatomical form to tell about the
of the colour, partial collapse a.rl.d appearance
sex of the persons.
of bullae of gas on the surface and is less elas-
tic and less spongy. With the progress of time Factors which influence the process of
these changes increase in degree. Ultimately putrefaction
the lungs totally collapse, become very small
The factors can be divided into external fac-
in size and appear blackish.
tors and internal factors .
Kidney~By the 2nd and 3rd days, the
External factors (not related with the con-
kidneys are reddish brown in colour, soft in
dition of the dead body)-
consistency and greasy to touch. Gradually
the colour darkens, size reduces, and soft- 1. Atmospheric or environmental tem-
ness increases.
perature-High atmospheric-or environ-
mental temperature promotes early de-
Diaphragm-Being fibromuscular in mor- composition. The optimum range oftem-
phology, it resists putrefaction for a longer perature for decomposition is 21 oc- 38°C.
period. It is only after some days that it be- Beyond this range decomposition occurs
comes soft and disintegrates. at a low rate, at above 10°C and below
Blood vessel~ Though decomposition of 45°C. Decomposition virtually ceases be-
low ooc and above 48°C. Optimum tem-
the blood cells stains the walls of the vessels
perature helps decomposition in two
early and makes them prominent externally,
ways, (i) by chemical breakdown of the
yet the vessels or the vascular walls resist
tissues and (ii) by promoting the growth
decomposition for a pretty long period.
of the organisms r~sponsible for decom-
Urinary bladder-Generally speaking, position.
urinary bladder resists decomposition for a 2. Moisture-Presence of moisture pro-
long period. In case of cystitis or infection of motes decomposition by promoting the
the urinary tract (upper), decomposition oc- growth of the organisms. In absence of
curs early. Full bladder decomposes earlier moisture, growth of the organisms will
than empty bladder. not be rapid. If the body dries up quickly,

- - - - ~-~--~------------
270 I PRINCIPLES OF FORENSIC MEDl<::;INE
it will prevent putrefaction and will cause 6. Invasion of the body by animals and in-
mummification of the body. sects-
3. Air-{ a) Stagnant air promotes decompo- (a) In water, fish and other aquatic ani-
sition (b) Air movement retards the proc- mals like crabs , tortoise may injure
ess of decomposition by evaporating the the dead body helping invasion of the
body fluid and cooling the dead body. body by bacteria which enhances
4. Clothing-In summer , clothings may decomposition.
slightly reduce the rate of decomposition (b) On land, dogs and jackals may partly
by preventing invasion of the body by air- destroy the dead body and that
borne organisms. In winter, if the body causes early decomposition.
is covered with clothings then, that will (c) Invasion of the dead body by mag-
help the process of decomposition by re- gots is an important cause of early
taining the body heat for a longer period decomposition and destruction of
and helping growth of the organisms and the dead body. Maggots are larvae
the chemical process of breakdown of the of flies. "Forensic entomology" stud-
tissue. ies the various aspects of invasion
5. Environment-If the body is submerged of the dead bodies by maggots. Usu-
in water, then generally speaking, the ally three types of flies deposit or
process of decomposition is slow , due to lay r ;gs over the moist areas of the
d~ad body or nearby, e.g., common
early cooling of the body. But the rate of
decomposition enhances once the body is house fly , green bottle fly and blue
bottle fly . They lay eggs near the
taken out of the water, because then the
nasal or mouth openings, near the
body is saturated with water and also
canthuses of the eyes or near the
gets the effect ofhigher atmospheric tem-
axillary folds. Laying of eggs may be
perature . The sum effect of the two is
as early as 8 - 9 hours after death .
the cause of rapid growth of the organ-
isms. (See decomposition in water). The common housefly, however, does not
usually lay eggs directly on the dead body.
Casper's Rule- The extent of decomposi-
But the green bottle or blue bottle variety
tion in air (atmospheric environment ) in
does. The two latter varieties lay eggs usu-
one week will be like that of2 weeks in
ally before tlie starting of putrefaction. Hatch-
water and that of8 weeks in a deeply well
ing from ihe eggs occur between 10 to 12
buried dead body .
hours. The'finit change in the cuticular layer
However, in buried dead bodies , the rate of these two 't ypes oflarvae or maggots occur
of decomposition varies according to the after about 12'hours . A sirllilar second change
depth ofthe grave. In sutface burial, the in the larva occuhl after about 2 - 3 days stay
rate of decomposition is' mote than in in the secc)rid stage. In the 3rd stage the larva
deep burial, because of abundance ofbac- is larger' irf'size and is voracious eater. In
teria in surface soil iri:'cOniparisoh to deep this stage if. .Stays for about 6 days . Then in
/·
1
soil. Drainage of the :·a:rt3a; •permeability the dark, 'iHri6ves away from the body to take
of soil arid {Juality ana tYJ>e M coffinused shelter un~ef'll'l.'~ surface layer of the soil,
also niatte~ in obv'i:6us ~~ · where it hiOUlds to pupa. It takes about 7 - 8

days to mould once more to change to adult estimation of time since death the most ma-
fly. tured state of the maggots of the particular
In case of common house fly, hatching of fly has to be identified. It is not unlikely that
the eggs occurs after about 10 - 12 hours of more than one variety of flies will lay eggs
laying. The first change in the larva occurs on the same dead body and even on the same
in a day or two. The second change occurs in spot of the body. Another important point is
a day or two more. The larva or the maggot that invasion of the dead body enhances the
continues for 2 - 3 days in this stage. Then it process of destruction of the putrefied body
moulds to pupa at some hidden place and which has to be taken into account during
takes about a week to change to an adult fly. estimation oftime passed after death. In any
case, estimation of time of death from ento-
Hence to ·determine time of death from mological study is not easy and certain.
the entomological study, one has to identifY 1\c:~wer, the additional damage it causes to
the variety of the maggot and in which stage the dead body may give an altered picture
it is present in the body. The larva of blue or which if not given due consideration may lead
green bottle fly are larger (t") than those of to erroneous determination of time of death.
the common house fly (not larger than !").
The green and blue bottle flies lay eggs in Internal factors (body factors) influencing
and around summer season. Each of them decomposition-
can lay about 1 - 2 thousands of eggs. Com- !. Age--In case of intra-uterine deaths, de-
mon house fly lays only about 100 - 150 eggs composition is aseptic and is only by way
at a time. of autolysis (for findings please see Chap-
To estimate time of death from entomo- ter 26, page 673). In still born foetuses
logical study a few more points may be re- or infants who have not taken any breath
membered These are- nor are given any food, decomposition
occurs from outside, as in them there is
The blue bottle flies ( Calliphora
no scope of any bacteria being in their
Erythrocaphila, C. Vinia or C. Vomitoria) and
lungs and GI tract. Hence, in these cases
green bottle flies (Lucilia Caesar, L Cericata,
the process of decomposition is slow,
L Cuprina) like to lay eggs only during the
though fluid content of these bodies is
day hours and not at night. They are attracted
more than the others.
by the putrid smell of the dead body emitted
by the dead body at the initial phase. It is 2. Sex-Sex does not have much to influ-
thought that they may even be attracted to ence the process of decomposition, ex-
fresh body. But caliphora do notget attracted cept that, a female body, by virtue of its
by fresh body .except when there will be any abundant subcutaneous fatty tissue, re-
vomitus, blood or open injury on the dead tains body heat for a longer period which
body. They choose to lay eggs on damp areas may enhance the process of decomposi-
of the body. Among other favourable condition a little.
tions' for oviposition are low atmosph.eric tem- 3. Condition{lfthe body-A thin emaciated
perature, humid condition an,q-tl}e dead body body decomposes late in comparison to a
being under a shade in a sunny. flay. Sunrays well nourished bulky body due to less
and extremely high atmospheric temperature fluid content in the former, which does
and rainfall on the body are not suitable. For not promote growth of the organisms.

272 I PRINCIPLES OF FORENSIC MEDIGWE- (
Rigor Loss of body heat

37.5
c ----- --------
Rigor mortis
Putrefaction
Decom
Time in Hours
after death
3 6 12 18 48 72 96
Rg . 6.45 : Graph showing pattern of loss of body heat, onset and disappearance of rigor
mortis , post-mortem staining and onset of decomposition in summer
4. Causeofdeath -Whend~ath is due to in- therefore maximum there. However, accu-

fection or septicaemia, decomposition is mulation of gas occurs first in the scrotum,
rapid for obvious reason. as that part of the body is at the highest level.
5. Surface injury on the body -Dead body Factors which influence decomposition in
having external injuries (either ante- water-
mortem or post-mortem) will decompose 1. Water temperature .
earlier, because the injured areas will
2. Stagnancy of water-In stagnant water
allow invasion of the body by additional
decomposition is rapid than in flowing
bacteria from outside.
water, because, in the later case, water
6. Sudden death delays decomposition to an constantly washes out the organisms
extent. · from the surface of the body.
7. Exsanguination delays decomposition. 3. Quality of the water-The process of de-
8. Widespread infection, anasarca ,oedema- composition is slow in fresh water and
tous body and congestive cardiac failure early in polluted water.
enhance the process of decomposition. 4. Aquatic animals-Aquatic animals includ-
ing fish may cause postmortem injury or
Decomposition in water and floatation of mutilation of the dead body which will
a dead body favour the process of decomposition by
Usually the process of decomposition in wa- allowing invasion of the body by organ-
ter is slow due to early cooling of the body . isms, through the injuries or the muti-
But once the body is removed from the wa- lated areas.
ter the process is very rapid , due to the facts
Floatation of a dead body on water
that, such a dead body is saturated with wa-
ter and gets optimum temperature in air for In our country, floatation of a dead body on
the growth of the micro-organisms. In sub- water occurs usually by 24 hours after death
m rged dead bodies decomposition starts in summer. In winter it takes about 2 - 3 days
early in head and face because head and face to float. In cold or temperate countries , time
being the heaviest part of the body assumes required for floatation is about 2 - 3 days in
lowest level in water and amount of blood is summer and 1- 2 weeks in winter.

chapter 6: DEATH A ND POST M O RTEM CHANG ES I 273
The following factors influence floatation Definition-In mummification, there is

of a dead body on water: rapid drying of the dead body due to environ-
1. Decomposition-Early decomposition mental factors, when the soft tissues become
causes early floatation of the dead body, dark, hard and stay preserved. The dry, hard
because accumulation of gas in the tis- skin gets almost adhered to with the under-
sue increases the buoyancy of the body. lying bones.
2. uatc, '-Floatation occurs early due In mummification, the skin becomes
to higher specific gravity of saline water. somewhat transluscent due to absorption of
3. Stagnant water-Promotes early floata- the liquefied subcutaneous fat. Due to mum-
tion by way of causing early decomposi- mification the intemal organs redU;ce in
tion. · their sizes so much that, they may not re-
main easily identifiable. Reduction in their
4. Clothings-Help early floatation because,
sizes is gross because their water content
these are lighter than water due to con-
as such is very high, which when is totally
taining air bubbles in between the spaces
absorbed and evaporated due to mummifi-
of the fabrics.
cation, leaves negligible volume of the solid
5. Sex- Female bodies are lighter because substances in them.
of more fat content and so female bodies
float early. Destruction of such a body occurs late.
When left as such in the same environmen-
6. Season- Summer helps early floatation tal condition, in course of months and years,
and winter delays the process. Seasons the soft tissues change to dust.
act indirectly by way of influencing de-
composition. Time required for mummification change
to occur-
Medicolegal importances of decomposi-
tion- Depending on the extent of availability
of the favourable conditions, time required
1. Decomposition is the surest sign of death.
for murnrriification change to occ1;1r varies
2. From the stage of decomposition time between 3 weeks to 3 months roughly.
passed after death can be assessed.
Factors favouring mummification chan-
3. Advanced decomposition obliterates the ge-
identity of the deceased.
1. Hot atmosphere-as in the deserts of the
4. Advanced decomposition also obliterates tropics.
the cause of death of the deceased.
2. Dry atmospher&-Mummification can-
not occur in high humid condition of the
atmosphere.
3. Free air.movement.;-helps rapid evapo-
When due to environmental conditions, there ration _o f the body fluid. .
is drying or desiccation of the soft tissues of 4. · Contact of the .body ·with- absorbing :rn8~
the body, the process of normal decomposi-· . dia-e.g.: a ·d~ad body lying on the san~, ···
tion or putrefaction of the dead body is pre- infant body covered with a dry ahs-o:r:b- ·
vented as the _growth of the mic;ro-organisms ing towel, dries up early for rapid absorp-
is retarded. . . . tion of body fluid.
"' M -181
274 I PRINCIPLES OF 'FORENSIC MEDICINE
Medicolegal importances destroyed, injuries can be detected after

1. It is one of the surest signs of death. a long period even though the injuries
are limited within the soft tissue and have
2. It also gives a rough idea about the time
not involved the bones.
passed after death. In estimating the time
passed after death, the degree of influ- 5. The place of disposal of the dead body af-
ence of the factors which favour the ter death, can be guessed (dry, hot place
change, must be taken into account. with absorbing type of soil, etc.).
3. Identification of the dead body-Once mu-
rrunification has occurred in a dead body,
its identification is possible even after a
long period because the body is not Adepocere change in the dead body is another
grossly destroyed and many identification modification of decomposition.
features like old scars, deformities, tat- What is adepocere fonnation-lt is the
too marks, may be detected after a long formation of soft, whitish, crumbly, waxy and
time. greasy material occurring in fatty or fat con-
4. Cause of death-As the body is not grossly taining tissues of a dead body.
Preservation of parts of dead bodies by formalinisation and mummification (human body parts removed
from a lake showed evidence of dissection for anatomy training (clandestine)
Fig . 6.46: Mummification of part of the body

earlier
L ~· 6.41, As ;o F~. 6_.4_7~-----'
.Fig.' 6.48: ~eft-upper limb

• • •• # • ~-
---'""-~-' .__ ___ -- -- ----------'"""'
Fig . 6.49: Right leg and foot

chapter 6: DEATH AND POST MO RTEM CHANG ES I 275
Fig. 6.51 : As in Fig . 6.50
Fig. 6.54: Mutilated decomposed dead body Fig. 6 .55: Adepocere change (closer view)
Fig . 6.56: Egyptian way of

mummification -
Age -old
successful a
process to
preserve dead
bodies

27-6 I PRINCIPLES OF FORENSIC MEDICINE
For some period, this change was used nia. Being chemically stable it remains un-
to be termed as saponjfication, on the ground changed for a long period.
and belief that the change occurs due to for- Distri bution- At first it appears in
mation of soap in the fatty tissue. This idea patches and then gradually increases in size
now stands rejected and the original name to be continuous over wider areas. The
"adepocere change" is again in use. This term change is well marked over those body parts
indicates that the properties of the changed where there is excess deposition of fatty tis-
fatty tissue are partly in between those of fat sue, e . g., on the cheek , over the female
and wax Some calcium soap is formed in the breasts and buttock. In case of a female body,
process involving .the change, but only as a this change will be seen almost all over the
by-product. Hence, soap formation is not the body due to presence of good amount of sub-
primary change. cutaneous fat in the body. The change is no-
Time required for adepocere formation- ticed in organs with fatty degeneration of the
In hot and moist environment it is ·seen to tissue, e.g., a fatty liver.
occur sporadically by the end of the first week Fate of the body-Usual decomposition
(earliest recorded- in 3 days). In cold envi- is prevented due to-( a) adepocere change is
ronment sporadic change takes 3 weeks to rather chemically stable, (b) the process of
occur. Completion of the process may take 3 adepocere formation utilizes most of the fluid
months. from the other adjacent tissue and thus other
The mechanism of adepocere formation- tissue becomes desiccated and hence, are not
Adepocere consists mainly of fatty acids grossly invaded by the organisms. These pre-
formed due to postmortem chemical reactions vent putrefaction changes in them. As a re-
of hydrolysis and hydrogenation ofbody fats. sult, the body stays preserved for a long pe-
The process needs water and at the initial riod.
phase utilizes the body fluid. Hence, we find Adepocere change may occur both in
other soft tissues being mummified and ad- embalmed, or non-preserved dead bodies.
mixed with it. Normally, the body fat con-
Factors which influence adepocere forma-
tains only about 0.5% free fatty acids. But in
tion-
adepocere change, this figure may rise to 70%
or more. So, the chemical reaction essentially 1. Atmospheric or environmental tempera-
involves change of fat to higher fatty acids tu re-Heat favours and cold retards the
like p almitic acid, stearic acid and process of adepocere change in a body.
hydroxystearic acid, mostly palmitic acid. High atmospheric temperature helps in
two ways: (a) It directly promotes the
Appearance, physical and chemical p rop- chemical re actions required for the
erties-The change is whitish or greyish white change (b) High atmospheric tempera-
in colour, .has a sweet ~anc'id smelL. soft and ture helps invasion of the fatty tissue by
WaXy .in consistency :when fresh,, but b~ttle Claustradium Welchii, which lib~rates
~hen old It buins ·with y~llowish fl~me. Af- lecithinase that helps breakdown of the ·
ter this chan~, the body buoyancy is increased fat cells .
.and the b~dy.floats on wat()r. .
2. Mositure-Moisture or for that purpose,
It dis~olves in ether and ·alcohol. When water is es~ential for the.c~emical reac.-
treated with KOii, it iiberates a little ammoc tion to occur. Intrinsic fluid (fluid present .

in the body tissue) is used at the initial 5. Here also, some idea about the place of
phase for the starting of the process. But, disposal of the body can be made, which
for completion of the change, presence should be a warm place with high humid-
ofwater in the environment or presence ity or presence of moisture or water.
of moisture in the air is necessary. After
the body fluid from different tissues has
been utilized they (other than fatty tis- CHANGES IN THE BLOOD AND C.S f.
sue) become partly dry for which usual
decomposition or putrefaction cannot (See estimation of time of death, below)
progress in them.
3. Air movement-This retards the process
of adepocere formation, (a) by evapora- ESTIMATION Of THE TIME OF DEATH
tion of the body fluid , and (b) by reducing
the body temperature in this way. Estimation of time of death is a part of medi-
4. Running water- In case of a submerged colegal inferences drawn after post-mortem
body, running water retards the process examination of dead bodies. But in reality,
of adepocere formation by constantly the investigating police officer is more con-
washing out the electrolytes from the sur- cerned with the time of assault than the time
face of the body which are necessary for of death. That helps the investigating officer
completion of the change. to locate an accused and to verify any alibi of
Rancidification ofbody fat - The usual fate the accused. However, estimation of time
of fats or oil in the long run is rancidifi- since death can directly or indirectly help to
cation due or liquefaction . This is also find out the time of assault . For example, it
true for fat of a dead body. This occurs can help directly , when the death is instan-
due to hydrolysis and oxygenation of fat . taneous with the assault or when it occurs
The rancidified fat emits a disagreeable immediately after an assault. It can help in-
rancid smell . Rancidification does not directly to find out the time of assault by ad-
help preservation of the dead body as ditional findings related with the stage of
adepocere does. healing uf an injury , which is equal to the
Medicolegal importances of adepoce·re period for which the victim survived after
change- sustaining the injury. Thus, time of death has
1. It is another surest sign of death. legal importance in any way.
2. It also gives rough idea about the time Various methods have been tried to find
passed after death. out the time of death. These include study of
3. As the body and its contour is well pre- physical , chemical , biochemical , histologica,l
served, identification of the subject is pos- and enzymatic changes which occur progres-
sible even after a long period. sively in ·a dead body.
4. Similarly, as the hody is not destroyed, For all practical purposes, even after
the injuries over the body remains intact adapting all possible methods, in many cases
and lillChanged and these can be recog- only gross estimation of this time interval
nised even after long period. Thus the may be possible. In most cases in this coun-
cause of death can be ascertained in such try, time of death is usually estimated from
cases. the physical changes noticeable in the dead

278 I PRJNCIPLEs OF FORENSIC MEDICtNE
· body. This necessitates use of a wide range timation of time of death. But the pos si-
for ·the estimated time of death. The legal ble physiological and pathological varia-
importance of the time of death has encour- tions ofbody temperature at death, which
aged attempts of its precise estimation, by greatly depend on the body intrinsic fac-
use of other methods like study of chemical, tors like, state of health and physical,
biochemical, histological and enzymatic metabolic and bacterial activities, and the
changes. But in reality, there is no depend- various extrinsic factors , as also the vari-
able method to narrow down much the range ation of temperature at different depth
of the estimated time lapsed after death. This or rectum, make it only a less depend-
is so because, the biological processes never able method.
follow a fixed rule. They vary during life and 4. Changes in the eye-A good many
at death, from place to place and person to changes occur in the eye after death (see
person, depending on sex, ag~, body built, page 177, 243-245). Among them, those
nutrition, personal reaction, geographic lo- which are easy to study and record, do
cation and climatic condition, etc. ·Thus, it not give satisfactory result in the esti-
may be risky to fix up a narrow range of time, mation of time lapsed after death , and
passed after death, in all cases which may be those findings which are quite depend-
at the cost of the interest of the case. Hence, able for the purpose are quite difficult to
it is advisable to use a range, reasonably wide, study. Changes in the retina is in the sec-
as necessary, giving due consideration to the ond category and all other changes are
·variable biological factors . in the first category.
Physical changes useful for estimation of Biochemical estimation of some of the
time of death- constituents of the vitreous humor has
1. Death synchronizes with stoppage of cir- been attempted without much success.
culation, respiration and function of the These .are: ·
nervous system. (a) Level of ascorbic acid-Its level in
·2. OtJler physical changes which are appar- the vitreous falls after.death. But the
ent inrrnediately after death, are related initial level during life or at the time
with these three primary phenomena of of death is extremely var iable:
df)ath and these are flaccid condition of Hence , measurement of its ·ievel,
muscles, loss of elasticity of skin, change only after death, may not be of any
of facial appearance and absence of the use.
'look'. (b) Level of pyruvic acid-Its level also
When, with these changes, a dead body falls after death. But the rate of fall
is still warm, not rigid, without any per- is very slow and hence, not so help- ·
manent haziness of cornea, the death of ful for estimation of time passed af-
the person possibly has occurred within ter death.
the last 1 hour, if the season is summer (c) Level of potassium-Its level rises
and within the last 2 hours (with some to a moderate exteu~ constantly, for
degree loss of surface temperature), if the about 100 hours after death. It is
season is winter. thought by some to be to some ex-
. 3. · Cooling of the dead body was once extent a helpful method, more useful
pected to be a countable criterion for es- in cold or temperate countries. Dur-

chapter~: DEATH AND POST MORTEM CHANGES. I 279
ing the later phase i.e .. , by 3rd and Thus, among the delayed changes after
. 4th da:ys, the time of death estimated . death (and after rigor mortis), this.change
may have an error of± 4 - 7 hours. is the ·sirigle best one for the purpose of
But tl,lis figure is not dependable. It estimatio~ of time ofdeath. However, due
has been seen that 95% of authors conside:r:ation has to be given o~ the fac- ·
differ in their results in the estima- tors which influen~e the appearance of
tion.oftime passed after de1fth and different putrefactive ch~nge.s (see page
the extent of variation is quite high 269-273).
(sev~~al .hours). An_oth~r negative 8. · St~dy of entomology is ~ very ·cumber-
point of this meth9d of estimation . some process. So many factors are in-· .
of time of death is marked when it volved in this study that. chan6e of error ·
is noticed that vitreous extracted .is more~ ruie. than . a possibility.
from tWo eyes of the same body give~ · 9. Adepocere change and mummification of
different values _o fpotassium though the dead body - These are the chang~s
extracted at th~ same time.' Prob~ which can give, some rough idea only, ·
ably the method of extraction of vit- about the time passed after death, with a
nious may also be responsible in gross range in termS of days rujd ·weeks
such cases. (se'e page 27f?) ..
5. . Post-l!lortem staining and tim~ of death lO. Chemical and bioChemical changes in the
(see page 250)-The extent of appearance . blood 'for knowing the tiine of d~ath-
. and its fixation give some ·~dea about the After death:.gradu.ally ~h.e -blo~d pH faUs
time passed after death during the early due to glycogenolysis, glycolysis, termi- .
part. The range of the esti~ated _time has · nru acciimuiation of C02, lactic acid,.phos-
to be reasonably wide (see page 277). An .phoric acid and splitting of axriip.o acids
advantage oftaking.this change into ac~ and. fatty acids. This change in .tbe pH -is .
count is that, time of formation of.post~ . inost marked during .the. stage o.f rigor·
.. 1~10rtem staining arid its fixation·do no·t mortis ~f the muscles. When secondary
. depend on so many fac~ors like·tempP.ra- ~laxation if!. the muscle 'sup~e~es d~e
. ture, humidity;·_body bu'ilt, etc.',, as other to putrefaction.o~the muscles ; the blood
~hanges do. pH rises again because of the accumula-
·6. · Rigor mortis- Fonn~ti<;m o~ rigor mortis . tion or" ammonia due to breakdown of .
·and its distribution or its passing away, enzymatic .proteins.
·are.probably the inost pdpular among the . Soon after death, plasma and RBC chlo-
· physical changes which are· taken into ride levels are equal (about 74 mEq.lli-
· account f~r-estimatio~ of time of death, : tre). By the end of the 3rd day after death,·
· at the time ofpost-mqrtem examination th~ levels .drop to half due to exti"a~v~s
(see page 2.57~258). Butthe probiem lies cular diffusion. By this. time the value 'of
in 'the f~ct that when rigor mortis -is magnesium in t4e whole blood rises 8 fold
a
'pni.sent all over the. body, :reasonably due to diffusion from outside the vessels.
wide range of the estimated time of ~eath . The 'level of·potassium also rises due .to
has to be given. · diffusion from the v'a scular endothelium.
7. Putrefaction-Diffe't ent plilfrefactive By ab(1}llt 12 hours after death, the 'level
changes occur; maintairiinga chronology. of amino acid nitrogen in blood is abOut

10 mg% ; that of NPN is about ing studies of different chemical and bio-
40 mg% ; and that of creatine is about chemical constituents of blood and also
10 mg% . In another series of study, the CSF (see below), may not be usefully ap·
levels of these constituents in blood, af- plicable in our country over a vast area,
ter 10 hours of death were recorded as barring a few months in winter.
NPN - 50 mg% , amino acid nitrogen - 12. Biochemical study of CSF cOnstituents-
14 mg% , creatine - 5 mg% , inorganic As in case of blood, similar study ofNPN ,
phosphorus- 15 mg% . amino acid nitrogen, creatine and phos-
The blood sugar tends to rise after death, phorus levels in CSF has also been tried
for at least up to 12 hours , due to glycog- with the same purpose of determination
enolysis in liver which can be appreciated of time of death from their levels . The
from the analysis of blood from the infe- results are almost same with those of
rior vena cava and right side chambers of blood. But it is said that CSF analysis for
the heart. But extreme variation of blood this purpose is more dependable than that
sugar level during life makes its estima- ofblood because tl}e levels of the constitu-
tion after death unsuitable for the purpose ents in CSF are less vulnerable to varia-
of determination of time of death. How- tions due to less interference by
ever, as the lungs act as good barriers for artefactual factors .
transmission of blood from the right side 13. Estimation of time of death from the
of the heart containing high quantity of stomach content-From the state of di-
sugar, simultaneous study of blood sugar gestion of food in the stomach and the
from a vessel on the other side of the lungs, approximate quantity of food substance
e.g. , from the carotid artery or abdominal emptied from the stomach, it can be
aorta, may be useful. roughly guessed as to for what period the
person survived after taking his last
11. Study of blood enzymes-Different en- meal. ·Then, if the time of his last meal
zymes rise sharply for some hours after can be known, the approximate time of
death. The rise then continues for 2 - 3 his death can be made out indirectly. For
days more, but at a low rate and to a small this, we are to know the qualitY, quan-
extent only. Peak levels of amylase and tity and the time of the last meal of the
phosphatase are achieved between 36 to deceased and whether he suffered from
48 hours . For transaminase it is 48 • 60 any such condition (disease or othezwise)
hours and for lactic dehydrogenase it is which may influence the nonnal tinie of
about the 4th day after death . For us, in emptying of his stomach .
this country, the problem in using the Normal emptying time of the stomach for
peak levels at different time intervals is an average Indian mixed diet (full meal)
that, these are the figures of temperate is as follows:
countries where the changes due to gen- Half of the food passes out through the
eral decomposition start quite late. In our pylorus by 45 minutes to 1 hour. Half of
country, particularly in summer, the the rest, by the next hoirr and half of the
process of decomposition is much ad- rest in the 3rd hour and the remains
vanced by the 3rd/4th day after death and within the next hour. So , for an average
most of the values recorded by the scien- mixed ·diet, total time taken is about 4
tists in the western countries concern- hours or at times 1 hour
. ·.·.··' 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
chapter 6: DEATH AND POST M ORTEM CH A NGES I 281
Diet: predominantly of carbohydrate food in such a dead body discovered at 7 AM

passes out ofthe stomach earliest; those in the morning, the bladder is seen to be
predominantly of protein, take some time very much full then, the inference should
more. Food containing much of fat emp- be that, he might have died before the
ties last. time of his usual leaving the bed, because
In certain conditions, emptying of the usually the first work done by a person
stomach is delayed, e.g., in case of pyloric when he leaves bed in the morning is
stenosis; subjects in whom gastro-jejunos- that, he evacuates his bladder. If on the
tomy operation has been performed; in other hand it is seen that the bladder is
head injury cases; in unconscious or semi- empty, then it can be said that he might
conscious subjects and if the person is in have died some time between his usual
a state of mental depression and sometime ofleaving the bed and 7-00 AM.
times due to physical exhaustion. 16. Growth of facial hair in subjects who are
14. Content of the intestine- The digested food habituated to regular shaving-Growth of
residue reaches the ascending colon by hair after cutting or shaving, occurs at a
about 6 - 8 hours, the left flexure of the rate of 0.4 mm per day. Hence, in a per-
transverse colon by about 9- 10 hours and son who is in the habit of shaving, from
the measurement ofhis facial hair, it can
the pelvic colon by about 12 hours after
be said, for what period he survived after
the meal is taken. In the pelvic colon, the
remains may stay as faeces for up to 12 his last shave. And if we know the time of
hours. From the content of the pelvic co- his last shave, then from that we can ill-
lon and the rectum, it can be said, if the directly calculate out the time ofhis death.
person attended the nature's call within 17. Changes in the bone marrow-Within an
last few hours or not. If a dead body is hour of death, nuclei of the neutrophils
discovered, say at 7 AM in the morning in the bone marrow start swelling. By 4 -
hour and if during dissection of the dead 5 hours after death the nucle i are
body it is seen that the bowel is empty roundish. By 10 - 12 hours the outline of
and if it is further known as to when the the neutrophils are lost.
person attends the nature's call habitu- 18. Circumstantial evidences-Pocket arti-
ally, which is say at 5-30 AM every morn- cles like letters , diary, cinema-show
ing, then it can be more or less rightly ticket etc. may indicate in some way the
deduced that the person might have died date and time up to which the person sur-
between 5-30AM to7-00AM in the morn- vived. In some circumstances of death,
ing. On the other hand, if the bowel is the wrist w:..:;ch may stop functioning and
found to be full then, it can be deduced thus may indicate the date and exact time
that his death might have occurred before of death. Some idea about the earliest
5-30 AM in the morning. These deductions possible period of death can be made from
get further value, if the other findings in the newspaper present by the side of the
the body corroborate to these inferences. dead body.
15. Condition of the urinacy bladder--8imi- 19. Estimation of radioactivity of Cl4 (radio-
lar as in case of drawipg inferences from active carbon)-Radioactive carbon is de-
the bowel contents , the content of the uri- posited in living tissue and maintains a
nary bladder may help to make some idea near equilibrium level all along the _life.
about the time of death in some cases. If After death there is no further deposi-

. tion of C 14 and its concentration and arsenic in the soil, then the dead body
strength gradually decrease in the or- may stay preserved for a long period in
ganic substances. In bone it reaches its the grave.
half-life strength in about 5,600 years .
Examination of the bones of a person who
Artificial preservation of dead bodies
died several years back, . to study the
strength of Cl4 in the bones, may give Dead bodies may be preserved artificially in
some idea as to when the person died. various ways. These are:
Analysis ofpericardial fluid and syno- 1. By freezing the body below 0°C. At - l7°C/
vial sac fluid have no meaningful con- -18°C the body may be preserved intact
tribution to ascertain time of death.
for years or rather for unlimited period.
2. By embalming-In this process the con-
tent of the intestine is syringed out or
taken out by some other means (suction).
Preservation ofdead bodies may ocetir natu-
Then foiJIUlline is injected in the system
. rally, if disposed off in favourable environ-
mental condition. Dead bodies may also be through some important vessels and the
preserved artificially. whole body is dipped in formalin solution
for some period. The evacuation of the
Natural preserV-ation of the dead bod!es intestine dears out the prevailing organ- ·
isms and the formalin fixes the t.i ssue
1. When a dead body lies in the arctic re-
protein and renders it unsuitable for bac-
gion or as in the cases of the expedi-
tionists , when such a person dies at a very terial invasion to cause further destruc-
high altitude, where temperature is very tion. Autolysis is also prevented due to
low all along the year, the dead body will chemical fixation ~f the tissue, In em-
get frozen and will stay preserved for balming fluid formalin is .the main c.;m-
years, rather for unlimited period. The stituents (1.5 litre offormalin in 10 litres
dead body of John Melory who tried to of water). Other agents u8~d with tl?-is are
scale Mt. Everest in the early part of the sodium citrate abOut 1 kg; N aCl about
past century (20th), has been detected 0.75 kg, Glycerine about ¥2 litre. Na-bo-
fresh from the ice of high altitude , on 1. rate about :th litre: Injection of embalm-
5. 1999. ing· fluid-:-the einbalming sol~tion' may
2. In case of mummification of a dead body, he injected in various ·ways.· It may be
when it was disposed off in a suitable at- pumped under pressure through the ar-
mospheric condition, the gross appearance ~ries ofthigh or arm. It m~y be injected
of the dead body is maintained and the with the help of a bulb with a valve in-
· body remains preserved for a long period. · side the bulb quite similar to Higginsons
. 3. . Same thing happens in case of adepocere · syringe, used.for inducing abortion. The
change in a dead body which also occurs liquid may be simply injected with the
naturally, when the dead body is disposed help of gravitatj.onal force keeping the ·
offiri a favourable environment. The body container at reasonably higher leyel,
is preserved for a long time. through a connector tube and needle or
a
4. If a dead body is buried in grave , where with the help of a machine ..'fhe fluid con- ·
there is high concentration of lime or . tains anticoagulant (sodium. citrate)

which helps free flow of the fluid up to complex process including mummifica-
capillary level; where if gets diffused in tion of the body. In that process there
the tissue. used to be .a supervisor to supervise the
In any case G.I. tract content has to be job, a cutter who used to cut the required
evacuated and phenol and methanol may parts of the body, and an embalmer to
be injected along with the embalming inject liquid preservative in the body.' Th,e
fluid for injecting insid-e abdominal and body was stripped and placed on a board.
chest cavity. The brain 'cavity was emptied through
3. By treating the dead body with certain Iiose and then filled ag~in with resi~ or
other chemical agents like, arsenical cloth. The chest was cut, all organs fro~
preparations; whiCh prevents baCterial ac- inside were removed except heart, placed
. i~ a Ca!lOpic jar with some drying agent
_tion on the b<;>dy and also prevents au-
.tolysis. '~atron". Then in right time placed in ab-
d,omen or tied with leg. Natron was a natu.-
4. Plastination-This technique of preser- . ·
ral drying agent. The body in such a state
· _vation of dead bodies is practised in
was dried for about 40 days. The. body
Anatomy departments for academic pur- :
cavity was packed with saw dust, lirie:ri,
pose. The body water and fat are replaced
· salt or ash arid.the cut sewed and sealed
by some plastics. The specimen obtained
with WaX or metal. The eye socket was .
after this do not decay or smell. mi- The filled with linen or fake .eye balls .. 'Oie
?roscopic featru:es are also retained. body was clea:llE?d and wrapped With thick
The water and lipid in the bod~ or body c,over,. say. t~ick lin.en or some either mac
parts to be preserve_d are replaced by.Clir- terial. A mast w·as placed over .tlie body .
.· able polymerS like silicon, polyester or 'It was then put\n 'sacroph~gus', a type ·
-~bber. In the 1st step the tissue of the ' .
of c<;>ffin, with .several layers of c_a skets
body or body parts are fixed by ~mbalni and lastly restei:l in a tomb. This was the
ing with formalin. Then it is placed in an most depend~ble Il_leth?d- Apart from ~his .
· acetone bath in a frozen state. Next it is some 'were preserved by injecting cedar
· placed in a bath of polymer, e,g., silicon, oil through the rectum and the ·body was
polyester or rubber. Acetone is boiled arid .- the~ drie.d. In some cases they used some ·
· v-aporised out from the cells by creating liquid· other .than cedar oil to inject per
vaCU:um. Then the empty c~llular spaces rectum and dried the body_
are ·occupied· by .the pol:Ym~r. To harden
the polymer, the whol~ thing is then Dealing/disposing a dead body-A dead
treated by heat or UV .light. The body b.ody may either be preserved, if necessa,ry, .
• • ·"· L ~ .1 . •
or it inay'tle disposed offl~wfullyo_ · ··
stays preserved for ~pe.~~4Juture ~tudy.
5. Ancient Egyptian way to preserve the Pres~rvation: .
· dead body-In old ages Egyptians be- 1. By empalming on, being a~~horised. · · . _. 0
lieved that earthlyb9d.Y: 1:1,se5l to be a link · 2. ·, By embalming after autopsy till r~ceiver
0
of sp.iritual e~iste:r:tce after; ~e~th. They ·or .Cl'aimer !reaches. ·

used to preserve .thel:WQY;sQ. that "the 3. .. If t~e anbV~ :two. are n~t pra:ctieable
spirit" couid get,{o!ld·au~fifi.I)k.·after,life . then to pmse~ body in sealed con-
They lised to presetv.~thedood body in a tainer.

Disposal : the basis of his successive death his wife

1. By cremation ~After collecting death cer- should get the property. But if the elder son
tificate to carry the body with authority has died earlier than the father then at the
to the place of cremation and then pro- time of death, the father had only one living
cure a certificate of cremation after it is successor of his property, i.e., his younger
done. son. He will enjoy the property and not the
wife of the elder son.
2. By ,burial -The same procedure as above
for cremation has to be followed except To presume who survived whom, among
that instead of cremation the dead body the dead father and his dead son (or in simi-
is buried in the bUrial ground. lar cases), in addition to the post-mortem re-
N.B. In both cases if expressed then the port (particularly, if the post-mortem report
desire about some ritual practice fails to decide who might have died earlier
has to be allowed according to the and who later ), further opinion is sought for
desire in individual cases. (The con- from the doctor on this aspect . To opine on
sent of the next-of-kin is important). · this part of the problem, the doctor may fol-
low certain guidelines . These are as follows :
3. By donation of the dead body to an insti-
tution for research and study. 1. .I n case, the deaths have occurred due to
injury, the involvement of the vital or-
gans, severity of the wounds and amount
ofhaemorrhage should be.given due con-
sideration.
Two persons ofone family may die in a com-
mon circumstance. In .such a case, for the 2. In case of poisoning deaths, general body
puqiose of succession of·properties of one or condition and age should be taken into
both ofthe .deceased persons, it may be nee- . account. So ·far age is concerned, some
. essary to know who died.ea~lier and who died poisons are tolerated well by the elders
·later, ·i.e. 1 who survived · whom. By post- and some by the youngers, e.g., adults
mortem examination'it .rruiy no~ be possible · tolerate opium group of drugs better than
'to say who' died e'a rlier and who later, if the children and children tolerate belladona
deaths have occU.rred with a gap of a few min- gtoup of dmgs bett~r thfU} the' adults.
.. utt:)S only. In such ·a case'; it has to be pre~ 3. In drowning deaths, a swinuner ~urvives
surned .who · might have ·s urvived whom, so a non-swiinrner. ·When both are swim-
· that the problem of sp.ccession of property mers of same category, then the male is
c~ be solved on that basis . If we take exam- expected to survive a female as males can
ple of a family of a father and his two 'sons, withstand exhaustion for a longer period.
the elder of whom is a married man and if in When both are non-swinuners·, then the
a common circumstance of a train accident female ·should die later, as lier oxygen
the ~ather 3f1d the-elder son die, the~ for the requirement is less than a man.
purpose of succeE}sion of the property· of the .4.- In circumstances .of conflagration, where
father, it will be necessary to know whether there were deaths dl,ie to proQ.uct~on of
the father died earlier than the elder son or irrespirable gases like, CO or C02 , a
the .elder son died earlier. This may mean a woman should die later than a inan, be-
. lot. If the father died e~rlier, then even for a cause of the same re~son 'that, oxygen
few miriutes the elder son became the natu- requirement of a woman is less than that
ral successor of his father's. property and on ·of a man.

chapter 6: DEATH AND POST MORTEM CHANGES/ 285
5. In case of exposure to heat, adults are who are expected to hear about him if he
more likely to succumb earlier than eld- would be alive, then such a person will be
erly and young subjects. But extensive generally taken to be dead and the burden
burn injuries are more quickly danger- to prove -that he is alive, lies with the per-
ous for children. son who claims so ..
6. Young and old subjects are more suscep- Note: Sec. 107 ofth_e Indian Evidence act
tible to exposure to cold. presumes a person to be alive un- .
7. In case of death ofboth mother and child less the contrary is proved by the
during delivery, usually the mother sur- person who claims him to be dead
vives the new born child, but not as a and Sec. 108 of the Indian Evidence
rule. Act presumes under certain condi-
8. Women stand deprivation of food better tion that a person in question is dead,
than men. Healthy subjects stand star- if the contrary is not proved by any
other person who claims the person
vation better than weak and ailing sub-
!n question to be alive.
jects.
9. Age-Adults stand gene;ral adversities Proformas of death certificates as pre-
better than youngers and olds. scribed and made compulsory by the Govt.
has been appended as appendix at the end
10. Males stand general adversities better
part of the book v, see page 956-958 .
than females.
11. General health-Healthy individuals gen-
erally stand adversities better than weak Raferances
and ailing subjects.
• Adepocere formation in relatively dry environment, by
W. E. Evans. in Medicine Science and Law-1963-
PRESUMPTION OF DEATH 3rd val.
• ·Biochemical changes in cadaver sera, by J. B.
This is a legal issue which, strictly speaking, Enticknap, in J. of F. Med. 1960, Vol. 6.
does not have any medical implication or in-
• Rectal cooling after death and its mathematical ex-
volvement. It is in con:r:tection with inhent-
·pression-byT. K. Marshal and F. E. Hoare, J. For. Sc.
ance or succession of property of a person,
1960, Vol. 7.
missing for a long period.
• Essentials of Forensic Medicine-by C. J. Polson, D.
For the purpose ofinheritance Of prop- J. Gee, Bernard Knight, 1.985 Edn.
erty or such matters, section 107 of the evi-
• Forensic Medicine-by S. Smith, F. S. Fidde, 1976.
dence act provides that, in question of a miss-
• . Glaister's Medical Jurisprudence and Toxicology-
ing person being alive or dead, (within 30
Ed . Edgar Rentoul and Hamilton Smith -1973.
years), if it is shown that the said person
was alive within this period then, if an in- • Legal Medicine-by _Gonzales, Vance, Helpern,
terested party intend~ to claim at the mate- Umberger, 1954.
rial time that the said person is dead, theri • Levels of Potassium i.n the vitreous humour. after
it becomes his responsibility to prove that · death, B. Hughes and H. S. Ban~s in,' Med. Sc, and
the person is dead at. the material time ·of Law 1~65, Vol. 5
the claim. Sec. 108 of the evidence act states • Modern trends in Forensic Medicine-Val. 1; by Keith
that in quest~on whether the person is alive Si.mpson, 1953,
-or dead, if it is proved that the s.aid person •· . (Oh the) Mortality of Leucocyte and t~e time lapsed
has n ot been heard. of_ for 7 years by theni . after death; J. leg. Med. _Jap. l958, Vol. 12.

28[, I PRINCIPLES OF FORENSIC MEDICJNE
• Post-mortem changes in the muscles, by J. R. Benda!, Questions

in the structure and function of muscles, 1960, Vol. 3.
• Post-mortem glycogenolysis in muscles, by J. R. Theoretical
Benda!, in the structure and function of muscles, 1960, 1. How do you determine time passed after death ?
Vol. 3. 2. What are the changes due to decomposition ?
• · .Post-mortem temperature and the time of death, by 3. What is rigor mortis, how is it formed ? How do you
G.S.W. De Saram et.al. in J. of Crim. Law and crimi- differentiate between RM and cadaveric spasm/heat
nology, 1955-56, Vol. 6. stiffening/cold stiffening ?
• Problems in estimating Post-mortem intervals, by G. 4. What are the immediate changes after death ? How
T. Mann, in J. For: Sc. 1960, Vol. 5.. do you test for stoppage of nervous function, circula-
tion and respiration ?
• Study of estimation of time of death from Rigor Mar-
·tis -I. Roy dissertation work for M.D., 1985. Short Notes
• Kugelberg FC, Alkass K, KingbiickM, Carlsson B, Druid 1. Suspended animation; Primary flaccidity; Changes in
· H. Influence of blood loss on the pharmacokinetics of the retina; Postmortem caloricity; Changes in blood
and CSF after death, Cadaveric spasm; Sudden death;
citalopram. Forensic Sci Int. 2006; 161 (Z-3): 163-8
Vagal inhibition of heart; Status lymphaticus;
• Holmgren P. Druid H, Holmgren A, Ahlner J. Stability Adepocere change; Mummification; Presumption of
of drugs in stored postmortem fe:moral blood and survivorship; Natural and artificial preservation of dead
vitreous humour. J Forensic Sci. 2004; 49(4) :820-5. bodies, Post mortem lividity, Forensic entemology.
• Druid H. Estimation of the time since death in prac- 2. What are t: : Medicolegal importances of-Post-
tice. Scand J Forensic Sci 1999;5:3-5. mortem livi J. c"{; Adepocere change, Mummification ?
• Roger Byard, Tracey Corney Card Henderson, Joson 3. Differentiate between-Rigor mortis and cadaveric
Payene James; Encyclopedia of Forensic and Legal spasm/heat stiffening/cold stiffening; Post-mortem
Medicine- 2005. lividity and bruise/Congestion; primary relaxation and
secondary relaxation.
• Warner U, Spitz Danel J., Spitz Ramsey Clark, Russel
4. Factors.which influence -Cooling of the body; Rigor
S. Fisher; Spitz and Fisher's Medicolegallnvestigadon
mortis; Post-mortem staining; Decomposition; De-
of Death- 2006.
composition in water; Adepocere change; Mummifi-
• Richard Shepherd; Simpson's Forensic Medicine. cation.
• David Dolink, Evan Matshes, Emma 0. Lew; Forensic Oral questions
Pathology Princ:ipal and Pracdce- 2005.
t Definition of death, molecular death, RM, post-mortem
• Pekka Sankko and Bernard Knight; Knight's Forensic lividity, decomposition, adepocere change, mummifi-
Pathology - 2004. cation.
• Stefan Timmenmanas- Postmortem: How Medical 2. What are-Importances of molecular death, con-
Examiners Explain Suspecious Deaths -.2007. tact pal or and: flattening, PM caloricity, cadaveri·c
• Brent E. Turvey· and Wayne Petharic; Forensic spasm, Tach!:1s noire change in eye, colliquative
Vicdmology: Examining Violent Crime_ Vic.dm~ in Inves- change, [Tla_r~lin.g : of skin, earliest decomposition
change; sudden ,and natural deaths, Mirror test,
tigative and Legal Contexts - 200.~ .
Feather test: 'Winslow' test, Magnus test, Diapha-
• ·Michael J. Shkrun and David A. Ri!Q;J~Ily;, f..qren$iC nous tes(1clclr;:h 'test; time of floatation of dead
Pathology of Trauma - 2006. • · ' ' ,. ·.' ' bodies, rate of fall of body temperature, evacuation ·
• . I ,. ~i ~
• W. Ooglous Hemming; Forensic Medicine.an.d Toxi- period for food from stomach, presumption of
cology - ,2qP8. . ,... survlvorsh~ ·pl:eS\l"inption of death, cutis anserina or
goo.se-sk~n;.Tai"di.eu(&spots, coma, syncope, asphyxia
• W.G. Aitchison Robertson; Aids to F?~~~f(~f'1~dicine antl -pthec ,qQ~S1ions -;as. in short notes, differentia-
and Toxicology ~ 2008. tions and factors influencing, etc.

Autopsy or post-mortem examination is per- Purpose of medicolegal post-mortem
fanned on dead bodies with the following examination
purposes:
1. Purely academic-Dead bodies are dis- 1. To know the exact cause of death.
sected by the students of Anatomy for aca- 2. To find out the circumstances of death.
demic purposes to know details about the 3. To find out the time passed after death.
different external and internal organs and 4. In case of unidentified dead body, to es-
structures of the human body, in their tablish identity of the deceased or to help
nonnal position, extent and morphologi- to do so.
cal relation between one another.
5. In case of death due to injury or poison-
2. Pathological or clinical autopsies are per-
.ing, the period for which the deceased
fanned by the pathologists or clinicians
survived after sustaining the injuries or
to diagnose the cause of death, where di-
exposure to poison.
agnosis could not be reached during treat-
ment; or to confirm diagnosis where the 6. To know the nature of death, whether it
same was doubtful. This also helps the is a case of natural death or a case of sui-
pathologists to know the pathology of cide, homicide or accident.
organs due to some diseases. It has aca- 7. To know the type of weapon or poison
demic and research value. used.
3. Medicolegal autopsies-In unnatural and 8. Whether one or more than one person
suspicious circumstances of deaths, dis- was/were involved, in case of homicide.
section of the dead bodies and their ex- 9. Whether any natural disease process con-
amination is compulsory by law. The pur-
tributed in any way to cause the death.
pose of medicolegal autopsies is to find
out the cause of deat4 .~d ~~lp dispensa- 10. Whether any other offence was related
tion of justice, if any criflle is. jnvolved in with the death or circumstance of death
the circumstance of the death. Though it e.g., rape.
is not devoid of academic interest, its pri- 11. Whether the injury which has caused
macy need lies in the delivery of social death is expected to cause death in ordi-
justice. nary course of nature ?
Parvej Dr. Md. Ahsan Uddin (Nayan)

'?A7
CoMC-24
12. Whether the dead body or its position was connection with the concerned case be-
disturbed sometime after death. fore the autopsy surgeon.
13. To know the place of disposal of the dead 5. Conduction of medicolegal PM examina-
body. Whether the body has been shifted tion does not require any consent from
from original place of disposal or death. the relatives or friends of the deceased.
14. To know whether more than one method 6. The dead body should preferably be dis-
or more than one weapon were used. sected with the help of natural sunlight.
15. Whether the deceased received any treat- But under special circumstances of ur-
ment before death. gency, it may be carried on at night, with
the help of artificial light. But the artifi-
16. Whether the treatment (if any) had any
cial light should not have any adverse
contribution in the process of death.
effect on examination in way of making
17. Whether there is anything on or with the difficult to observe minute findings , af-
dead body which may help identification fecting proper assessment of colour of an
of the assailant. injury etc. If feasible the body may once
18. In case of death due to assault, the possi- be examined (external), when it first
ble relative positions of the victim and reaches the mortuary, if it reaches at
the assailant/s. night. A detailed examination should be
undertaken in the next day when suffi-
Procedure to conduct medicolegal post- cient natural light is available.
mortem examination 7. The mortuary should have cooling cham-
bers for preservation of dead bodies. The
For conduction of medicolegal post-mortem
doors and windows of the mortuary
examination certain formalities have to be
should be fly proof There should be
observed.
plenty of water supply in the mortuary
1. It can be conducted only on the strength for proper cleaning and washing purposes.
of a requisition received from an author- The mortuary should have facilities for
ised person. (Ordinarily a police officer, arranging disposal of dead bodies and
a magistrate or a coroner as the case may other waste materials. It should have dis-
be is authorised to issue a requisition for section table, instruments and other
conduction of medicolegal post-mortem equipments and articles up to require-
examination). ment.
With the requisition, a copy of the inquest 8. When a dead body reaches the mortuary,
or the preliminary investigation report, the date and hour of its arrival and then
a dead -body challan and any other related the date and hour of conduction of the
paper of importance, should accompany. PM examination should be recorded.
2. . Medicolegal PM examination can be per- 9. It is reconunended that, the autopsy sur-
formed only in an authorised centre. geon should himself dissect the dead body
3. All registered medical practitioners in with the help of an assistant. His assist-
Govt. service can conduct the examina- ant will write down the findings dictated
tion. by him.
4. A police officer or any other authorised 10. Before starting the PM examination
person should identifY the dead body in proper, the doctor should go through the

chapter 7: MEDICOLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION I 289
inquest report and the requisition and (f) Vermilion or other mark on the fore-
must get the body identified by the ac- head.
companying police personnel or the au- (g) Any tattoo mark, moles or mention-
thorised person. able scars, deformities in the body.
(h) Condition of the eyes - closed or
PM Examination Proper
open, corneas- hazy or clear, con-
1. The description of the dead body should dition ofthe pupils '7 shapes and sizes
first be noted with the wearing apparels of both the sides. Any congenital or
in situ. Then the wearing apparels should acquired deformity or disease, pros-
be removed from the body disturbing the thetic eye, scar on cornea, petechial
body and the wearing apparels minimum or subconjunctival haemorrhages,
2. Detailed examination of the dress and cataract.
other wearing apparels should then be (i) Any discharge from mouth or nos-
made in respect of their number, make, trils - frothy, blood stained, drib-
design, stains on them,· old and recent bling of saliva, suspected poisonous
tears, cuts with their dimensions and lo- stain.
cations. These may have to be examined
(j) Protrusion or biting of the tongue.
once more after conduction of the PM ex-
amination, to compare the tears, cuts and (k) Congestion ,' petechial haemor-
blood stains on them with injuries on the rhages.
body. The tears and cut marks should be (l) Cyanosis - fingertips or elsewhere.
measured and their placements noted. (m) State and distribution of post-
After PM examination these should be mortem staining, its colour, contact
sun-dried, packed, labelled, sealed and pallor.
handed over to the police authority.
(n) Blood, mud or other stain on the
3. Examination of the dead body:
body.
A External examination: The following (o) State and distribution of rigor mor-
points should be recorded. tis.
(a) Body length. (p) Cadaveric spasm, content of the
(b) Body weight. hand.
(c) Built, complexion. (q) Cutis anserina.
(d) Scalp hair - length, colour, recent (r) Any foreign material anywhere in
hair cut, part shaved, use of any dye, the body including the nail beds. Mud
singeing, whether wet, presence of or sand or other stain on the soles.
dust, mud, stains, if partly fallen off,
(s) State of decomposition.
vermilion mark, baldness, sharp cut
on hair, crushing of hair bulb due to (t) Maggots.
injury. (u) Any adepocere ·or mummification
(e) Description of beards and mous- change.
taches in their length, colour, trim- (v) Condition of the prepuce-circum-
ming, shaving; absence of beards cised or not, condition of the scro-
and moustaches. tum and testicles.
-..._.
r ~:" ~~ _ 1 01
(w) Female breasts- parus , gravid Examination of External injuries

(signs of past or present pregnancy)
teeth bite marks, nail scratches. All external wounds should be recorded with
all their details, on the following headings:
(x) Discharge per vagina, any other find-
(a) Type of injury
ings.
(b) Size
(y) Any ante-mortem injury anywhere
• in tlie body including inside of nose, (c) Shape
inside of lips , inside of mouth, nape (d) Site, in relation to twc external anatomi-
of neck overf~male breasts, private callandmarks.
parts of females including inner as- (e) The weapon of infliction or the mode of
pect of thigh, hymen, vagina. causation (usually not mentioned in the
(z) Any suspected stain (poison, semi- PM report proforma).
nal fluid ) on lips, hands, mons (f) The direction of application of the force.
veneris, private parts, vaginal wall. (g) For the fatal wounds, the distance of the
(zz) Any ligature mark on the neck or wound from the same side heel may be
elsewhere, its position, dimension, . recorded. This may help to reconstruct
direction, nature, type, position and the incident.
placement of the knot. (h) The time and date of infliction of the in-
N. B. If the ligature material is present jury in relation to time and date of death
in situ, then it should be taken out should be studied. This can be done from
by tying the knot with a thread and inflammatory, healing changes and also
then cutting the ligature material from the colour changes.
at a point opposite to the knot. The (i) The vital reactions should be noted, pres-
ligature material should then be ence of which differentiates antemortem
examined in tem1S of type and na- injuries from the post-mortem ones.
ture of the material it is made of, G) Presence of defence cuts or injuries at
the design, length of the part encir- the expected sites proves the homicidal
cling the neck, length of the remain- nature of injury and death.
ing part, breadth of the ligature ma-
(k) Marks of resistance in the form of minor
terial, number of turns it is twisted
injuries on the non-vital parts of the body
round the neck, type of the knot,
has the same significance.
whether the ends of the ligature
material bear any recent cut mark, G) Concealed punctured wounds are homi-
the strength of the material, etc. cidal in nature and search should be made
for their presence.
The ligature material should then be
(m) Split laceration inflicted on the forehead,
packed, labelled, sealed and handed over to
scalp or so~. other areas, against a bony
the police of the concerned police station.
prominep.c~ looks like incised wound.
Any stains on any part of the body should Hence, su,~;h doV,btful injuries at these
be scrapped out, preserved without any pre- sites sh~"P.ici be .examined carefully with
)l_t • I
servative and handed over to :police. the help.af a h1:1,Ild lens.

The materials which ne.e d to be exam- (n) Burn inj~~~~ ;should be recorded in all
ined by FSL should be sent to FSL. details of their exte~t and other features.

(o) It should be kept in mind that, abrasions

can be caused on a dead body due to rough
and careless shifting of the body, from
the place of death to the mortuary.
(p) In dead bodies , removed from rivers or
ponds , PM injuries caused by fish or
aquatic animals , may be present. Simi-
larly, PM injuries due to gnawing by other
animals, starting from dog to rodents ,
may be present in body. Post-mortem in-
juries in the form of abrasion, may be
caused by ants or cockroaches also. B
(q) Injection marks and other signs of treat-
ment given, should be searched for and
Fig. 7.1: Autopsy incision for opening thoracic and
recorded. abdominal cavities (A-B) and neck structures
(A-C and A-D). A - sternal notch, B -
B. Internal Examination: For internal symphysis pubis, C - Rt. mastoid process,
examination, the different body cavities are D - Lt. mastoid process
to be opened in a planned way.
ter be taken considering whether the impor-
To start with, the mouth cavity should
tant findings are expected in the abdominal
be examined. If the face is in a state of rigor
or thoracic cavity. When no specific reason
mortis then opening the mouth may need
prevails, it is better to open up the abdominal
force. Inside the mouth cavity, any foreign
cavity first. After the incision is given the skin
body, froth, blood stain, desquamation, injury
is flapped out on both sides. The muscles are
ulceration, number of teeth-recent loss, dis-
dissected in the same line of incision. The ab-
located or broken teeth, biting of teeth, con-
dominal organs are then dissected out.
dition oflips and tongue should be noted. Any
peculiar smell on opening of mouth should 1. Stomach -The stomach is first taken out
be noted. by placing two ligatures at the cardiac end
of the oesophagus and two ligatures be-
A single incision is given for opening both low the pylorus end of the stomach. The
the thoracic and abdominal cavities. To open
stomach is removed by cutting between
the cranial cavity one more incision is needed. the double ligatures at both the ends. The
To expose the structures of the neck, three
stomach is opened along the lesser cur-
different types of incisions are recommended.
vature . The wall of the stomach is thor-
(a) To open the chest and abdominal cavi- oughly examined. Presence of any stain,
ties , one single incision, starting from the congestion, haemorrhagic points, desqua-
sternal notch above to the symphysis pubis mation, ulceration, sloughing or perfora-
below, through the right side of the umbilicus tion should be noted. The content of the
is applied. If there is any injury on the right stomach is noted in respect of quantity,
side, then left paramedian incision can be ap- nature of material/food, state of digestion,
plied. With this incision, some prefer to ex- colour, smell, any evidence of haemor-
pose the chest cavity first. Others prefer ex- rhage, etc. After examining and weigh-
posure of the abdominal cavity first. In the ing the stomach and its content sepa-
opinion of the author, the decision should bet- rately, the stomach should be stitched up

along the lesser curvature with the con- 5. Both the ureters should be opened along
tent inside, and kept for preservation. their long axes.
2. The liver should be removed and any in- 6. The spleen is then taken out and pathol-
jury or pathology in it should be noted. It ogy or injury noted.
should be weighed. A part of the liver 7. The intestine is dissected in its entire
· (minimum 500 g or the whole liver, length. It is particularly important to look
whichever is less) should be taken out for any injury or reaction due to the ef-
for preservation for chemical analysis. In fect of poison or presence of a foreign
case, any pathology is suspected in its body like a bullet. Curling ulcer is a phe-
gross appearance, then a small portion nomenon noticed in the duodenum after
from the suspected area is dissected out about 7 to 10 days of sustaining exten-
along with bordering healthy tissue and sive burn injury. illcerative colitis like
preserved in 10% formol saline for histo-
lesions are noticed in case of poisoning
logical examination. For macroscopic ex- with mercuric chloride.
amination of inside the liv~r, multiple
transverse incision at 1 em apart should 8. In penetrating wounds of the abdomen,
be given. The gall bladder is dissected the intra-abdominal vessels may be in-
open. Any pathology or stone format~on jured and there may be excessive intra-
inside is noted. abdominal haemorrhage. Excessive intra-
3. The kidneys are taken out along with the abdominal haemorrhage also occurs due
adrenal glands, after tying the ureters to gross injury to abdominal organs like
along with the vessels at least one inch liver, kidneys and spleen.
away from the hilum of each kidney. The 9. The pancreas and the adrenal glands are
surface of the kidneys along with the cov- to be examined. If necessary, tissue from
ering capsules should be examined for thes.e glands are to be preserved for his-
presence of congestion, haemorrhage and tological examination.
injury. The capsules and the adrenals are 10. The uterus and its appendages should first
separated. The kidneys are bisected be examined in situ and then removed
transversely along the longitudinal axes.
enmasse along with the vagina. The
Any pathology, congestion, haemorrhage
uterus should be examined in respect of
or injury should be noted with exact men-
its dimensions, weight, whether gravid,
tion of the sight and extent. In case of
parous or nulliparous or whether there
possible pathology, suspected part along
with marginal healthy tissue should be is any pathology in it. In case of gravid
preserved in 10% formol saline for histo- uterus, condition of the whole product of
logical examination. conception should be noted down. Any
evidence in support of abortion or at-
4. The urinary bladder may be examined
tempted abortion with remains of any part
in situ. Before opening the bladder, if it
contains urine, that should be syringed of the product of conception inside the
out, or can be taken out with the help of cavity should also be recorded. If there is
a clean spoon after incising the bladder, evidence of attempted abortion, then the
avoiding all chances of contamination with endometrial surface should be thoroughly
blood or any other material. The bladder examined in respect of colour, erosion or
should be examined for any pathology, any other damage including ulceration or
haemorrhage, congestion or injury. perforation of vaginal canal (particularly

chapter 7: MEDIC OLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION I 293
near the fornices) or of the uterine wall . 2. The heart is separated after applying dou-
Foreign body in the form of root, bark ble ligatures at the base of the heart over
(for that purpose any material which each large vessel and then dissecting
might have been used locally to cause them in between the two ligatures of each
abortion ) may be present inside the uter- vessel. The size and weight of the heart
ine cavity. Smell and nature of the fluid are noted. The walls of the heart may be
present inside the uterine cavity may be hypertrophied or dilated . The condition
further indicative in this regard. Death of the valves and presence and degree of
in occasions may occur due to other atheroma, in the valves and the intima
causes (pathological), preceded by hae- of the large vessels are noted. Aneurysm
morrhage locally, or systemic effect indi- or other pathology in the vessels should
rectly. Evidence of use of instruments be kept in mind in some cases of death.
may be present in the cervix or in os. Any ischaemic lesion , old or new infarc-
tion, should be searched for. The patency
11. Rupture of an ovarian cyst may be a very
rare cause of death, ·s ometimes associ- of the coronary vessels and intravascu-
ated with history of trauma. The ovaries lar clotting in the coronary vessels may
should be searched for presence of cor- be looked for. For the purpose- of exami-
pus luteum. Fallopian tubes and ovaries nation of the coronary vessels, probe of
have special medicolegal significance in suitable size can be used. Others prefer
cases of deaths due to their rupture in multiple transverse incisions on the ves-
ectopic pregnancies . sels, while some others prefer longitudi-
nal incisions along the length of the ves-
To open the chest cavity , after retraction
sels. Presence of subendocardial
of the skin sidewise, the cartilaginous parts
haemorrhagic spots should"be searched
_ of the ribs are cut on both sides and the
for in some poisoning cases or pathologi-
manubrium is separated from the clavicles
cal conditions. Patent foramen ovale may
at the sternoclavicular joints . The sternum
and the marginally attached cartilaginous ribs be noticed, though very rare. To exam-
are removed. The position of the intra-tho- ine the myocardium, transverse incisions
racic organs is observed. But, for detailed ex- are better. The cavities can be opened by
amination they should bP takfln OUt Of the longitudinal or transverse incisions . Any
chest cavity. Before that. the neck should be septal defect , haemorrhage at any site or
dissected and the structures there are exam- injury anywhere can thus be clearly seen.
ined (see below). The intra-thoracic organs For confirmation of any suspected patho-
should be taken out along with the neck struc- logy, tissue should be preserved for his-
tures namely larynx , trachea , oesophagus tological examination. Presence of clot-
and also the tongue . Before examining these ted or liquid blood or froth or air bubbles
organs, the chest cavity is examined for in the chambers of heart should be noted
haemorrhage or haematomas, injuries includ- with mention of the quantity, which can
ing fracture of ribs . Fractures of ribs are bet- be either due to ante-mortem or post-
ter examined ·by di-:;!-lecting the intercostal mortem causes. However, frothy blood
muscles. is more commonly of post-mortem ori-
1. After taking out the thoracic structures gin and mostly due to production of gas.
they are once inspected before separa- 3. The pericardium should be examined for
tion . presence of any pathology or injury. The

content of the pericardia! sac and its quan- upper end of the main incision at the sternal
tity should be noted. Pericardia! effusion, notch is extended up to the symphysis mentii.
cardiac tamponade, subpericardial haem- Skin, subcutaneous tissue, muscles and other
orrhage, constrictive pericarditis, etc. structures are examined layer by layer. But,
should be looked for. when a more detailed examination or expo-
4. Both the lungs are to be separated from sure of a wider area of the neck is necessary,
the mediastinal structures after tying the then a different type of incision is preferred
vessels and the bronchioles. The condi- to.
tion of pleura, ~Y sign of pleurisy or pleu- (a) A 'V shaped incision is given, the
ritis or pleural adhesion, subpleural pe- apex being at the sternal notch, with
techial haemorrhages, injury to pleura, the two wings extending upwards
condition of the pleural space (effusion, and laterally up to the mastoid proc-
haemothorax, pneumothorax, pyothorax, esses of both sides . The skin is
etc.) should be noted. flapped up to the margin of the man-
5. The lungs are examined for disease, in- dible.
jury and some other findings. In asphyxial (b) A third variety of incision exposes
deaths the surface of the lungs, particu- still wider area of the neck. Here,
larly, the interfaces of the lobes will show actually two incisions are required.
the presence of tardieu's spots, and there One incision extends from sternal
will be congestion ofboth the lungs with notch to the symphysis mentii. The
oedema sometimes. :rD. case of death due other extends from the acromion
to drowning, there won't be any tardieu's process of the clavicles of one side
spot on the surface of the lungs. But the to the same point of the other side.
lungs will be more oedematous. The cut The skin is flapped upward and out-
section exudes frothy blood-tinged fluid. wards in both sides.
The lungs of submerged body may show Irrespective of the type of the incision,
evidence of emphysema aquosum or most autopsy surgeons like to examine the
oedema aquosum change. Punctured or neck structures, before removal of the tho-
lacerated wounds cause collapse of the
particular lobe. In case ofblunt force in-
jury, wound of the lung corresponds with
the fractured end of a rib. In case of any
pathology in the lungs, tissue may be
preserved for histological test Thymus
should be examined and the tissue from
the gland is preserved, if necessary.
Examination of the structures of the
neck-The internal structures and tissues of
the neck should be examined thoroughly, in
case of death due to constriction of the neck
or injury or any pathology. For exposure of Fig. 7.2: Showing 'V' shaped incision for wider exposure
the structures of the neck, ordinarily, the and view of neck structure

chapter 7: M EDICOLEGAL A UTO PSY AND ARTE FACTS IN POST MORTEM EXAMINATION I 295
racic organs so that the tongue, larynx, tra-

chea and oesophagus can be taken out along
with the lungs. This helps examination of the
whole of the upper respiratory tract in its
continuity.
In case of death due to alleged constric-
tion of the neck, there may be fracture of
hyoid bone or thyroid cartilage with extrava-
sation ofblood in the tissue and injury to ca-
rotid arteries , stemomastoid muscles or
platysma. Compression of the neck with hard
materials may cause injury to the cervical
vertebrae and the corresponding part of the'
spinal cord. Level and ex~ent of other me- Fig. 7.3: (a) Incision for opening crani.a l Cilvlty A- A,;
Dotted line - line of incision. A & A1 - upper
chanical injuries on the neck should be cau- points of attachment of ears of both sides.
tiously examined to know the type of injury Anteriorly and posteriorly directed arrow marks
and organs or structures injured causing the indicate direction of flapping of scalp after
incision. (b) Incision followed by antero-post-
death. erior flapping of scalp (for opening of cranial
cavity).
Exposure of the Cranial Cavity
A circular incision though stitched up after
One of the two conventional incisions can be
PM Examination, in any case distorts the fa-
used-
cial appearance which should be avoided as
(a) A circular incision around the head at a it has no additional contribution in post
level 1" above the eyebrow, extending mortem examination.
sidewise up to the occipital protuberance.
Keeping the scalp over the protuberance The cranial cavity is finally exposed by
intact, the scalp is flapped out posteriorly. sawing and chiselling out the skull vault at a
Any haematoma or injury in the soft tis- levell" above the eyebrow in front and about
sue of the scalp is noted. The periosteum the level of the occipital protuberance at the
is removed and any fracture in the skull back. Some dissectors feel comfortable with
bone is recorded as to its type, position manual saw, while others use electric or bat-
and extent. tery operated saw. Any injury to the dura and
extradural haemorrhage is noted. With a
(b) The other type of the incision extends
criss-cross incision the dura is removed. Any
from just above the attachment of one
subdural or subarachnoid haemorrhage or
ear to the point just above the attach- injury to deeper meninges or surface of the
ment of the other ear. In this incision,
brain or any evidence of any disease is noted
the skin is flapped out both anteriorly and
at this stage. The meninges may be congested
posteriorly. Rest of the procedure is
due to asphyxia, apoplexy or other intracra-
same.
niallesions. The brain is dissected out at its
Many prefer the second variety of the stem, along with the roots of the cranial
incision for cosmetic reason,, as because this nerves. The whole brain is taken on a clean
incision does not distort the~fuc_ialappearance. enamel tray. Haemorrhage and fracture at

the base of the skull is searched out. Before Apart from these , to confirm a bruise, to
dissecting the substance of the brain the cir- confirm and examine a fracture, to trace the
cle of Willis is examined for any aneurysm track of a wound, to recover a foreign body,
and rupture of the aneurysm. All the ventri- e.g., pellet or bullet, to examine the site of
cles are opened and examined. The cerebral an injection mark and to examine any de-
hemisphere is dissected out along with base formity or pathology, incisions may have to
and the cerebellum. Both side cerebral and be given at any place on the body surface.
cerebellar hemispheres are sectioned, first, In relation to medicolegal post-mortem
longitudinally and then transversely. In this examinations, preservation of some organs,
way most of the parts of the brain substance some viscera or some other materials is nec-
will be exposed. Any haemorrhage, injury (in- essary or even essential in some cases . (See
cluding in the base of the skull), congestion also pages 730-733).
or pathology is noted. Haemorrhage in the
pons and base of the brain of any amount Viscera which are usually preserved from
is most important. In case of gunshC:Jt ~njury the dead bodies
the projectile may be present in the brain
1. Stomach with whole of its content and a
substance or inside the cranial cavity. The
loop (1') of smalljntestine from its upper
track of the projectile or the wound should
part are presred iit absolute alcohol ~r
be noted in case of gunshot and stab wounds.
saturated solution of common salt in one
The pituitary fossa should be examined container.
specifically and cautiously. 2. Half of liver or 500 g of it, (whichever is
more), whole of spleen, longitudinal half
Examination of the Spinal cord of each kidney are preserved in absolute
alcohol or saturated solution of common
When there is no indication, the spinal cord
salt in another container.
need not be exposed. When necessary, it
should be exposed from the back. A midline Other organs or materials may have to
incision is given on the back along the entire be preserved in some specific cases.
length of neck and trunk. The skin is flapped 1. Blood is preserved with suitable preserva-
out sidewise or laterally 1" on each side. The tive (see also pages 730-731) for chemical
vertebral column is cut along the medial examination, if there are reasons to be-
margins of the transverse processes of the lieve that there has been systemic absorp-
vertebrae. The whole length of the spinal tion of some poison. Preservatives used,
column can be taken out in this way without are oxalates , mercuric chloride , EDTA,
causing any PM trauma. etc. Blood should also be preserved sepa-
rately for DNA typing if it becomes nec-
Scrotal Sac- To open the scrotal sac and
essary in case of an unknown dead body.
examine the testicles and other organs, some
prefer two lateral incisions , though it can be 2. For the purpose of grouping, small
done by one midline incision also. Examina- amount of blood is well-preserved by be-
tion of the scrotal sac is a must when the sac ing soaked in blotter.
is enlarged, tense in look or deformed in ap- 3. Brain is preserved in case of cerebral
pearance. Injury, haemorrhage or pathology poisoning.
should be noted. 4. Lungs should be preserved in case of

chapter 7: MEDICO LEGAL A UTOPSY AND ARTEFACTS IN POST M O RTEM EXAMINATION I 297
poisoning with volatile agents which are Stomach and small intest ine are pre-
exhaled out through the lungs. served in one container and rest of the usual
5. Spinal cord is preserved in case of strych- viscera, e.g., liver, kidneys and spleen are pre-
nine or other spinal poisoning. served in a separate container. This will help
to know whether a poison has been absorbed
6. Bone marrow may be preserved for de-
tection of diatom, iffelt necessary. in the system after ingestion, or death has
taken place before the absorption of the poi-
7. Uterus-in case of abortion or attempted .6 son due to some other cause or whether the
abortion leading to death. poison was given to the victim just before death
8. Skin from the injection site along with to simulate death due to poisoning.
deeper tissue (suspected injection of poi-
For preservation of viscera, clean and
son or drug) or from around the site of
preferably sterile glass jar with glass lid should
entrance of bullet or splinters of a bomb
be used. The size of the jar should be such
should be preserved.
that at least l/3rd of the volume of the con-
9. Urine-should be preserved, if available, tainer remains empty to allow accommoda-
in all 3as ~. s of systemic :poisoning. tion of the gas which will evolve out of the
10. Scalp hai - a bunch is pulled out with organs preserved . The lid should be air-
root~ preserved. tighted by using molten wax.
11. Nail cutting and scraping are preserved. Absolute alcohol or rectified spirit is the
12. Vaginal swab and cervical smear-should best preservative in most of the cases. But
be preserved in cases of death following these cannot be used in case of death due to
suspected sex violence. ethyl or methyl alcohol poisoning.
13. Swab is taken from the glans penis when These also cannot be used in case of poi-
the deceased is allegedly killed after com- soning with white phosphorus, chloral hy-
mission of a sex offence by him. drate, formaldehyde, chloroform, pa r alde-
14. Pubic hair from such bodies as in no.12 hyde, etc. In these cases conclusive opinion
and 13 above should be preserved. becomes difficult, as the alcohol used as pre-
15. Swab or scrapping from suspected stained servative may mask the actual agent of poi-
areas of the body is also preserved. soning. In case of phosphorus, alcohol de-
stroys the luminous property of the poison.
16. Ligature material - in case of hanging,
On the other hand normal saline being the
strangulations.
normal constituent of the body, saturated
17. Wearing apparels and belongings of the solution of common salt has no limitation in
dead body including the pocket articles. this regard. It can be used as preservative in
Note: The materials should be preserved all cases. But as a preservative it is not as
in suitable container or packet with effective as absolute alcohol.
or without any preservative as is 10% formol saline is used to preserve tis-
necessary for each material. These sue for the purpose of histological examina-
are then properly labelled, sealed tion. For preservation of organs for the mu-
and sent for laboratory examination seum, formalin is used with traces of glycer-
with a requisition with mention of ine, pot-acetate and carbolic acid. Preserva-
special test, if any required. tion of blood and urine ordinarily does not

298 I PRINCIPLES OF- FORENSIC MEDICINE
need any preservative. When the cells of the 3. The magistrate and a doctor should be
blood need to retain their morphology, then present during the process of exhuma-
preservative as mentioned earlier should be tion . It is better if the doctor, who will
used. Swabs can be preserved without any conduct the PM examination subse-
preservative. Preservation of hair, bone or quently, remains present.
nails do not need any preservative. Wearing 4. Before opening, the particular grave in
apparels are first sun-dried and then packed. the graveyard should be located with full
Bullets or pellets are preserved in clean glass' satisfaction , so that wrong body is not
jar (without being washed), wrapped by cot- disinterned.
ton or soft mosleen cloth, after imprinting
5. Soil from above, below arid two sides of
identification marks on them at their breech
the body or the coffin should be preserved
end. Skin from near the entrance wound due
in clean containers separately.
to a splinter or projectile or an injection mark
should better be preserved without any pre- 6. · Before the body is lifted out , the medical
servative. officer should examine the body inside
the grave or- tlfe-.coffin regarding its posi-
When some preservative is used, some 1 '---
. and aypearance.
tion
amount of the same should be preserved in a
separate container for control test. 7. Before removal from the grave or the
coffin the body should be photographed.
EXHUMATION 8. After all these are done, the body is then
sent to a mortuary for post-mortem ex-
Exhumation means authorised digging out of amination as in all other cases, along
a buried dead body from the grave . This is with a requisition and a preliminary in-
done for performing medicolegal post-mortem vestigation report which contains the
examination. The indication for exhumation brief history of the case which acts as
are mostly same as for usual PM examina- guideline for the autopsy surgeon. In the
tion , e.g., suspected homicide , suicide cases , mortuary post-mortem examination on
or when any suspicion concerning nature of the body is performed as in all other
death arises after burial of the body. A dead
cases.
body may also be exhumed in relation to some
civil issues like identification of the deceased Post-mortem examination of mutilated
for settling of inheritance cases or succession and dismembered body parts
of property or some other claims.
It should be remembered that examination
PI'Ocedure and Precautions recommended of dismembered body parts does not mean
for Exhumation post-mortem examination of that part. In
1. To exhume a dead body, order from a many cases dealt by the author, human body
Govt. officer who enjoys the power of a parts were sent for examination, which were
first class judicial or executive magistrate not linked with death of the victims.
should be there. Medicolegal importances of different dis-
2. It should be done and completed in broad membered body segments-Depending on the
daylight, for which it should be started body part, the following informations can be
during the morning hours of the day. obtained from them.

chapter 7: MEDI COLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION/ 299
I. Identification: death was due to wound or injury. With

1. Race-from head (scalp hair, cephalic in- or without ante-mortem wound, death
dex, other bony features ), eye, skin, could be due to strangulation, throttling,
teeth, limbs (long bones, ratio of parts of suffocations, poisoning, etc. The victim
limbs). might have no~ died even.
2. Stature-from length of limbs and their Ill. Time of Death: Time of death (if death
parts, bones oflimbs. has occurred) or time of dismemberment
3. Sex-scalp hair, distribution ofhair in dif- -:! of the body parts can be estimated out by
ferent body parts; physical, _morphologi- observing the changes in the examined
cal feature of the part examined, histo- body parts, which are more or less simi-
logicai study of Barr bodies in epitheli~l lar to post-mortem changes, e.g., rigor
cells, presence of sex organs, study df mortis, decomposition, etc.
bones. Parts of wearing apparels, o~- IV. Weapon involved: In case of presence of
ments. c.. ante-mortem injury, the weapon used to
4. Age-greying of hair, wrinkling of skin; inflict the same and the type of weapon
archus senilis cataract, study ofteeth and used to dismember the part, can be said.
bones; pubertal changes in younger sub- V. The place of occurrence and disposal of
jects. In case of foetal body parts, devel·· the parts can be said in many cases from
opmental changes in different parts. trace materials adhered with the part
5. Blood group detection. from the place of disposal.
6. Tattoo marks, occupation marks, scars, VI. Cadaveric spasm ofthe hand may show
moles, teeth, vermilion marks, use of cos- foreign hair, etc. in the hand, nail beds
metics, use of dye, deformities, skin com- may show presence of foreign tissue.
plexion, fingerprint. VII. Defence cuts should be looked for, par-
7. Wearing apparels, e.g., wrist-watch, ban- ticularly while examining fore-linibs.
gles, ring in dismembered forearm and N.B. In examining a dismembered body
fingers. part, tissue or material should be pre-
8. With severed head, help of photography served, as and when felt necessary.
and superimposition technique may be
used, if the head is suspected to be that Examination of Charred (Burned)
of a known missing person. Body Parts
9. Use of DNA analysis technique may be
Sometimes charred remains of a bo_d y are
helpful.
sent for post-mortem examination. In these
II. Cause of death. cases detail opinion about different medico-
1. The cut ends of the segmented body parts legal aspects may not be possible. But the
should be closely examined to ascertain, autopsy surgeon should remember that,
if the wound margins of the severed body whatever information he will give to the I. 0.,
parts show ante-mortem reactions or not. may be of immense importance to him (the
Dismembered body parts showing ante- 1.0,1, Like dismembered body parts, by ex-
mortem wounds do no~; prove that, death amining.charred body remains, the autopsy
was due to those wq~s or even that, surgeon can say about any or many of the

300 I PRINCIPLES OF FORENSIC MEDICINE ·r
......,
points , discussed in the previous pages. In An~wers to the questions:
addition to these aspects, the autopsy sur-
1. Answer to question 1: From the knowl-
geon shall have also to opine, whether the
edge of human anatomy the autopsy sur-
burning was ante-mortem or post-mortem in geon can say, whether the bones belonged
nature. Sometimes charred bones or even to human being or not. If these do not
ash from the cremat~on ground may be sent. belong to human being, the autopsy sur-
From these charred bones it may be easily geon is not expected to say to which ani-
possible (may not be also) to know the sex mal did these belong. Precipitation test
and age of the victim. Sometimes type of ante- speaks confirmly, if the bones belonged
mortem mechanical injury , if any, and the to a human being or any other animal.
weapon used can be known. From the charred
2. Whether the bones belonged to one indi-
bones and the ash from the cremation vidual or more than one? If there is no
ground , poison like arsenic can be detected. duplication of one side bones, if the bones
Some ornaments and teeth may remain are of same race, sex, age, stature and if
unburnt or partly burnt . These may .help the corresponding bones fit snugly and
identification of the victim. nicely at their corresponding joints, then,
for all practical purposes, the bones be-
Examination of Skeletal remains longed to the same individual. For com-
paratively fresh bones, mixed agglutina-
Questions which arise in connection with ex- tion test may also be helpful. Time ofdeath,
amination of skeletal remains: estimated from all bones being same will
act as corroborating in support of their
1. Do the bones belong to human being?
being from one individual.
2. If so, then, are these of one individual or
3. Race of the subject can be determined
more ? from the skull bone, including study of
3. What was the race of the persons? cephalic index, the teeth as well as fea-
4. What was the sex? tures and indices of different long bones.
5. what ·was the age at the time of death? 4. Sex can be determined from the bones
quite satisfactorily. When all the bones
6. What was the stature ? are available, then sex can be accurately
7. Additional identification feature, if any? determined in 100% cases. With pelvis
8. What was the cause of death ? and skull, in 98% cases; with pelvis alone,
in 95% of cases; with skull alone, in 90%
9. If any ante-mortem fracture present then cases and with long bones alone, in 80%
what type ofweapon used? cases sex can be determined accurately.
10. If any sign of disease or pathology 5. Age can be estimated from the ossifica-
present? tion activities of the bones; eruption, fall-
11. What was the time of death ? ing and decaying changes of teeth; from
the osteoporetic changes of all bones;
12. What was the nature of death ?
from the special changes in the mandi-
13. What was the mode and place ofdisposal ble; changes at the symphyseal surface
ofthe body? of the pubis and at the margin of the gle-
14. Special information, if any available . noid cavity of the scapula.

6. Stature can be calculated out from the death might have occurred about one to
long bones by applying any of the avail- three months ba.c k If the bone is com-
able formulae chosen, depending on the pletely dry but has putrid smell in it, then
geographic origin of the deceased (See death has occurred within the last three
page 148-152). months. If the bone is dry, with no pu-
7. The special features in the teeth (tortion, trid s!Jlell, but has retained its normal
angulation, staining, cracks, caries, seal- col91JT, then the time passed after death
ing, etc. ) and bony deformities, healed is ~etween 3 months to 1 year. After this,
fractures, malunion, etc. may serve as unpres!J_rved bones get destroyed and
special identification features. In some gradually reduce to dust. But exact age-
cases DNA testing may be helpful. ing of skeletonisation is not possible.
Ageing ofbones by estimation ofC14 (half
8. Cause of death-In most of the cases it is
life being 5,600 years) is of anthropologi-
not possible to find out the cause of death
cal interest mainly.
of the subject. When some ante: mortem
fracture is found on some bone, covering 12. From the site and type of fracture or de-
some vital organs, then it can be assumed tection of any poison or pathology, na-
that, injury to the underneath vital or- ture of death may be said.
gan may be the cause of death, e.g., ante- 13. Mode and place of disposal A body buried
mortem fracture of skull, ribs or cervical in deep grave skeletonizes comparatively
vertebrae are suggestive of death due to later. A body disposed of in open air dries
injury to vital organs covered by these up early. Bones of the bodies disposed in
bones. Ante-mortem fractures of bones forest may be partly eaten offby animals.
of the non-vital parts of the body suggest Similarly, bodies disposed of in water may
that, death could have been due to seri- have their bones partly eaten offby aquatic
ous assault. Some poisons like arsenic animals. Stains on the surface of the bone
can be detected from bones if death oc- may also give some idea about the place
curs due to subacute or chronic arsenic of disposal. Place of disposal may disturb
or some other heavy metallic poisoning. the sequence of natural changes in the
9. From the fracture or nature of injury of bones to a great extent, due to the effects
the bones, it can be said, whether a hard of climate, environment, gnawing by ani-
blunt weapon, a light or heavy sharp cut- mals, etc.
ting weapon, a pointed weapon or a fire- 14. Sometime some additional information
arm has been used. may be obtained from bones.
10. Disease or pathology like tuberculosis or Obscure and negative Autopsy: In about
sarcoma may help to identify the subject 20% of all post-mortem examination cases,
and to assume the cause of death. the cause of death may not be clear at the
11. The time of death can only be roughly time of dissection of the body. These are cases
ascertained. If soft tissues, namely fas- of obscure autopsy. In many of these cases
cia, ligaments, etc. are still attached with the cause of death, etc. can be made out af-
the bone, then death might have occurred ter detailed laboratory examinations of dif-
within about two weeks to two months ferent materials preserved from the dead
back. If no soft tissue is attached, but the body. In about 5% of all post-mortem exami-
bone is still not completely dried, then nation cases the causes of death remain un-

known , even after all laboratory examina- in the forensic science laboratory during test-
tions and investigations are exhaustively per- ing of the materials.
formed (negative autopsy ). So far autopsy surgeon is concerned he
will check and cross check whenever a doubt
Post-mortem Artefacts
arises in his mind about something if neces-
P ost-mortem artefacts mean alteration , sary with the help of independent source till
modification , addition or absence of some satisfaction.
post-mortem features , due to certain causes Below , only a few exa given,
mostly originating after P.eath . though the chances and sou ces may be in-
numerable .
It is not necessary that such a change or
changes is/are the result of willful manipula- 1. It may originate just at the time of death,
tion. In many cases artefactual features' im- e.g. resuscitation attempt on the patient.
plantation occurs without knowledge after At the time of death external cardiac
death of the subject. But if the changes· or massage may cause fracture of ribs, ster-
presence of artefacts are overlooked, then it num and injuries to lung and heart, which
is very likely to lead to wrong observances may be taken as ante-mortem injuries
and wrong interpretations by autopsy or other causing death.
investigation agencies. Many a times arte- 2. After death, attempt to remove orna-
facts are implanted and may be overlooked, ments :~. nn body parts like nose, ear
leading to injustice. lobules, n18.y cause injuries to these parts,
All who are involved in the investigation which may be mistaken as to have crimi-
in mind of a suspicious death should keep the nal involvement. Impression of necklace
possibility of existence of artefacts which may or chain aronnd neck may be confused
interfere with the proper investigation of the and taken as ligature mark.
case. It is more important for the autopsy 3. During transportation of the body from
surgeon because many a things concerning the place of death to the mortuary, abra-
cause and nature of death along with many sion or some other mechanical injuries
other aspects depend on him which have much may be caused which may mislead in in-
evidential value . Artefacts altering observa- terpretation.
tions, their interpretation and evidential 4. During transportation again, the dead
value should be known well by the autopsy body may be contaminated with dirt, soil,
surgeon by his experience so that purpose of grease which may give wrong idea about
post-mortem examination will not be foiled the place o.f occurrence of death.
and the inference drawn from that may have 5. Tear of the wearing apparels during
full usefulness. transport may appear to be due to ante-
Artefacts may origin at the time of death, mortem struggle.
after death at the site of death, during trans- 6. Artefacts may originate during preserva-
portation ofthe body from the site of discov- tion of the body in the mortuary.
ery to the mortuary, in the mortuary-after 7. During the stage of rigor mortis, there
its arrival and before conduction 6f'PM ex- may be ejaculation of semen which may
a.rn.i.llation; during the--process of PM exami- wronglY be taken a~ death either due to
nation, while p're9e:rving the viseera:and other violent agphYx}a or from the involvement
materials for laboratory exainination and also in sexu:av activities .

chapter 7: MEDICO LEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION I 303
8. PM ant bite, cockroach bite and rodent EXAMINAnON OF THE DEAD SODV
bite injuries may be wrongly considered AT THE CENE OF CRIME
as ante-mortem injuries.
9. PM expul~ion ofblood-tinged decomposi- A practitioner doctor or a medicolegist may
tion fluid from nose may be wrongly sometimes be requested to visit the place of
taken as bleeding 9efore death. death of a person for various reasons like-
10. Artefacts may ofi~ate during PM ex- 1. To issue a death certificate
amination. Fractu~~y be caused from 2. If the subject is not yet dead, then for his
hammering of chisel during dissection of treatment
skull bone which may be mistaken as
3. To study the circumstance of death from
ante~mortem fracture.
various medicolegal angles.
11. During dissection of thorax and abdomen
some of the visce!a may be injured. For obtaining a death certificate or for
the purpose of treatment, a doctor is usually
12. During removal of larynx and trachea,
called by the relatives or friends of the de-
fracture may be cause'd to the cornu of
ceased/victim/patient. If, on arrival the doc-
hyoid. tor finds the person already dead, then he
13. The viscera preserved from the body may must not issue death certificate mentioning
not show poison after chemical analysis, the cause of death, if he did not treat the per-
though death might have occurred from son for some natural disease which could have
poisoning, due to faulty preservation caused the death. Ifhe finds the person still
technique or delay in examination or due alive, he should do whatever necessary to save
to many other causes (see page 732). his life and if situation demands, he should
14. In some cases, where death was not due also try to arrange for recording a dying dec-
to poisoning, some poison may be de- laration.
tected due to impurity of the preserva- In any case, if there is suspicion of a foul
tive or use of containers, not chemically play, he should closely examine the dead body/
free from any poison. patient and the surrounding, take history,
15. The wearing apparels and belongings of preserve materials which may help to know
the dead body may bear artefactual find- the cause and nature of death or offence, if
ings. There may be fresh tear or staining any. He should also inform the police when
of the clothes with blood, mud or soil dur- necessary.
ing carriage of the body, which were not
there originally nor is related with death. EXamination of fhe scene in medicolegGI
cases
16. Sometimes, while sending a naked dead
body to the mortuary, it may be wrapped To study the circumstance of death from vari-
with a cloth and the autopsy surgeon may ous medicolegal angles, a medicolegist may
take it as the wearing apparel during be requested by the police to visit the place
death which the police might have already where the dead body is lying or discovered.
seized. But, as this -may have no men- This may be of great help for proper investi-
tion in the inquest, the autopsy surgeon gation of the case . Here lies the additional
may find it very difficult to match the advantage and importance of medical exam-
bodily injuries with sucl]. clothes. iner's system of inquest.

I
I- - - - - - - - - - - -
Fig. 7.4: P.O. in a case of suicidal fall from the roof of
17 storied building. f\Jote the spurting of blood
--~
I
Fig. 7.5: Partial hanging inside a_r_o_o_m_ _ __ _ __.
L
ig. 7.6: Maid killed inside a kichen of a flat, a case of /
cut throat. Hands, feet are tied, mouth sealed.
-- - - - - - - - - ---
Fig. 7.7: Skull and other bones, recovered from a I I

L barren land __ - - -- - - - Fig . 7 .8: Dead body found on a rickshaw van

chapter 7: MEDICOLEG AL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION I 305
Fig. 7.9: Bones recovered from a rejected place
Fig . 7.11 : Skeleton recovered from a locked unused Fig . 7.13: Dead body hidden in a bushy
room area
rF . M. - 201
306 / PRINCIPLES OF FORENSIC MEDICINE;
Fig . 7.14: Adepocere change

(By courtesy-Prof. Dipankar Guharoy)
On arrival at the site, the doctpr should

take note ofthe followings:
1. The place where the dead body is lying.
2. The position and manner in which the
dead body is lying.
3. The condition of the dress and wearing
apparels. Fig. 7.15 : The skeletal remains of a dead human being
and two crutches used by the victim due to
4. Any apparent injury. body deformity were discovered from the
5. The extent of bleeding. safety tank of a latrine (both shown in the
background)
6. Any spurting of blood. If present then the
direction. 9. Cadaveric spasm with content in the grip
7. State of rigor mortis or decomposition. ofhand.
8. · Body temperature. 10. If a case of strangulation, then the na-
ture of ligature material, the position of
knot, etc.
11. Whether hands and limbs are tied.
12. In case of hanging, whether it is partial
or total; nature ofligature material; po-
sition ofknot; dribbling of saliva; point of
suspension and its approachability.
13. Whether there is any faecal, urinary or
seminal discharge.
14. If the deceased is a woman, then if there
is anything to suggest commission of
IFig 7 16: French National - found dead in hotel.
Stomach-smell of alcohol. Lungs- oedema
sexual assault before killing. If there is
any seminal stainr,f('}reign pubic hair, any
and oongested. injury near the_ piiY'~te parts.
---------------·------~

chapter 7: MEDIC O LEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXA MIN ATION I 307
15. If there is any sign of stmggle or distur-

bance in the surrounding.
16. Presence of any weapon or suspected
poison container; its placement.
17. Approach and exit to and from the room
or place.
18. Presence of different types of foot prints.
19. Presence of any article left by the assail-
ant.
20. In case o_f suspected fall from a height,
the length of fall, distance of shifting of
the body during fall, whether the body
struck at different points during the fall.
21. In case the body is lyiri.g in an open space,
say a grassy lawn, then an.y disturbance
on the lawn; foot prints, if present.
22. If there was any rain, then whether the
Fig. 7.18: Dead body discovered on 4th day in

summer-see maggots
body was lying there from befo::e the rain

or _after.
23. Whether there was anything to suggest
that the victim was killed elsewhere and
the body was brought and left there after
death.
IFig . 7.1 7: the

Site of homicidal death irrthe kitchen
spots of blood
Note I Fig : 7:19: Decomposed body discovered outdoor near
a area - after about 1Yz months

.308 I PRINCIPLES OF FORENSIC MEDICINE
J Fig . 7.2~: Decomposed body disintermed from a grave

Fig. 7.22: Bones recovered from a safety tank
24. Whether there is any evidence of drag-

ging of the body. graphs of dead body and other things from
different angles. He may also advise about
25. If the body is concealed, then the method
used for concealment. collection of evidences and their preservation.
However, the doctor, should in no way dis-
In addition to the above, the medicolegist turb the place, touch anything without inform-
may advise the police about taking of photo- ing the police officer and pass any hasty com-
ment.
Visit to the scene of crime definitely helps
investigation of the case including the subse-
quent post-mortem examination, as the doc-
tor by then has a first-hand knowledge about
the po.s ition and condition of the body before
its displacement and removal as well as about
the state of circumstance and surrounding.
Hence visit to the scene of crime should
always be encouraged.
Fig. 7.23: Same case as in Fig. 7.6. Adhesive plaster

Fig. 7.2 1: Body recovered from hydraif) used to fasten hands and I

)Fig . 7.24: Strangled woman inside a flat - - - - - - - '
I F~.___
:..__
7 .27' Orowood body
. a big pond
l~atod at lh• b"'hy b~k ot I
Fig. 7 .26: Scene of crime of a case of homicidal stab
______
..___
inury. See the position of the body and the
extent of haemorrhage
Fig. 7 .28: Missing of soft tissue from face , being eaten

up by animals. No marked signs of
decomposition elsewhere

310 f PRINCIPLES OF FORENSIC MEDICINE
Fig . 7.3 1: Pla·ce of disposal of a dead body-

decomposed remains of body parts with
wearing apparels; detected over 1 .5 months
after missing
Fig . 7.30 : Scene of crime- inside of a room- a female /

victim strangled (removed)
---
7.33: Scene of crime in a case of death due to

homicidal cut throat, inside the kitchen. Note
that, the hands are tied on the back. Note
also the bleeding. The house was locked from
outside . The body was discovered after a
d
Fig. 7.35:
Bullet
injury on
chest,
apart from
blood
stain,
mark the
bullet hole
with
blackening
of the area
on rt. front
of chest
and
Fig . 7.34 : Showing details of human remains and other
bleeding
articles recovered from a safety tan~ of a
from mouth
latrine

chapter 7: MEDICOLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION/ 317
Fig . 7.36: Scene of crime-Homicidal head injury. See

ttie offending slab of stone and extent of Fig. 7.37: Skeletanisation of bones recovered from
bleeding bushy area
Fig. 7.39: Vehicular accident. Victim crushed under

Fig . 7 .38 : Adepocere change. rear-tyres of lorry. (By courtesy Dr. C.D.
(By courtesy-Or. Dipankar Guharoy) Pande, M.D. LucknoWj
'--------- ·---·~-- -·- '--------- ----------~
Fig. 7.40 : Discomposed maggot infested body Fig . 7.41 : Scene of crime
outside a buildinQ (By courtesy-The Telegraph)

Fig. 7.42: Sustained abrasions from overtaking autorikshaw while moving

to a hospital after intake of poison for commission of suicide
Fig.' 7.43 : Bone recovered and cleaned from a highly

decomposed body in drum Fig. 7.44: Recovering a hidden dead body
Fig. 7.46: Hand grenade (inset) detected from the brief-

Fig. 7.45 : The exact picture of the body as removed case near a railway track.
from a drum (By Courtesy -Times of India)

• Britain's Gangland, by Norman Lucas. 1969. Long questions

• Criminal Investigation, by R. L. Jackson- 1962. 1. Describe the procedure of Autopsy examition.
• The Disposal of Dead bodies, by C. J. Polson and T. K. 2. What medicolegal informations we can have from
Marshal - 1975. examination at body fragments and bones?
• The Law of Burial, Cremation and exhumation, by Short notes
M.R.R. Davis-1982. Exhumation; Viscera preserved during PM examina-
• Murder in London, by R. Angus Downie- 1973 . tion; Post-mortem artefacts; Examination of scene of
en me.
• Practical Forensic Medicine - by F. E. Camps, J. M.
Cameron, David Lanham - 1971. Oral questions
Nagaire E. ~enge - The Science of Crime Scene 1. What are prerequisites of medicolegal PM exa-
•
Investigation\- 2002. mination?
• Mary H. Manh~l of Bones - 2005. 2. Is consent necessary tor ML post-mortem examina-

tion?
• Brent E. Turvey and Wayne Petherick - Forensic
Victimology: Examining violent crime victims in inves- 3. What incisions are given to open different body cavi-
ties?
tigative and legal contexts- 2008.
4. What information are available from body segments
• Sharon Cown and A.C. Hard - Mason's Forensic
and bones?
Medicine for Lawyers- 2008.
5. What are- exhumation, post-mortem artefacts?
6. What does a doctor note at the scene of crime?
7. What are obscure autopsy, negative autopsy?
,,
NOTES

Forensic Science includes those aspects of state. It is necessary that each district of a
scientific fields which are applicable and use- State be provided with a laboratory so that
ful for the purpose of enforcement and main-- there will not be undue delay in the process
tenance of law. A Forensic Science Labora- of investigation.
tory pertakes the relevant jobs.
Criminal investigation, in which a medi- Set up of a Forensic Science laboratory
cal man participates, is to a great extent de-
pendant on the services of a Forensic Science For providing wide range of service, a Fo-
Laboratory. Hence a medical man, particu- rensic Science Laboratory should have the
larly, he who is expected to give medicolegal following working sections:
service must have an idea about the scope 1. Toxicology and Chemical Section-This
and extent of the nature of services rendered section undertakes the examination of
by these laboratories. different materials including different
In our country, there are varieties of these body organs or viscera and fluid or other
laboratories, scattered all around. Some of exhibit for detection of various poisons
these laboratories are under the control of or drugs. Sometimes separate establish-
Union Government, some under the different ments are provided to share the load of
State Governments. Centrally controlled labo- this section of the laboratory.
ratories take up both specialized and specific 2. Serological Section-This section under-
type ofinvestigations or investigations gener- takes blood group and serological tests
ally required in most criminal cases. Almost for different suspicious stains, body fluid
each state has a State Forensic Science Labo- and blood-(see ''Identification from Trace
ratory. Depending on the workload, State substances and their other evidential
Forensic Science Laboratories may have values" chapter).
branches to cover distant corners of the states. 3. Biological Section-Identification of dif-
The State Forensic Science Laboratories ferent body fluids as to their nature, ex-
are overburdened with workload and cannot amination of hair of different origins,
do justice to the different parts of a state, plant materials etc. are done in this sec-
when only one la~_!:~~<?..~~~e..r.s ~-the w_hole ----tion.
------------- -- - - ---
Parvej 315
Dr. Md. Ahsan Uddin (Nayan) CoMC-24
.Jto 1 PRINCIPLES OF FORENSIC MEOIC1NE
4. Molecular Biology Section -With the use lar biology, Ballistic, Explosive and Polygraph
of DNA test in iforensic 'investigation, section. Hence, it is desirable that, he should
many FSL have tarted this compara- have some idea about the technique and
tively new unit. r detail , see Identifi- equipment used in these sections. The fol-
cation chapter ). lowing paragraphs are aimed at this end.
5. Physical Investigation Section - Various For detection of poisons, drugs and differ-
physical evidences collected from a scene ent chemicals, apart from usual chemical and
of crime or elsewhere, are tested in this biochemical methods, the following analytical
section to know the nature of the physi- techniques are applied, which are of course
cal evidence. much more dependable and satisfactory :
6. Ballistic md Explosive Section -All about 1. Chromatography
the firearms, missiles, gunpowder and 2. Electrophoresis
other explosive materials are examined 3. Spectrophotometry.
in this section.
7. Finger Print Section -Development and Chromatography
study of latent and chance finger prints
Chemical substances, may it be gas, liquid or
are the job of this unit. At many places
solid, spread around a media or in a suitable
this section is independent ofFSL Serv- environment. This spreading character is dif-
ices. ferent for different materials in different
8. Polygraphy Section -In many countries, media. This property of chemicals is suitably
service of polygraph or lie detector is in- used by different chromatographic tests, for
corporated in Forensic Science Labora- qualitative and quantitative assessment of
tory. different poisonous drugs and chemicals.
9. Document Analysis Section -Handwrit-
Different Chromatographic Techniques
~ng, typewriting and examination of al-
leged forged documents, currencies are 1. Column Chromatography : In this, a glass
undertaken in this section of the labora- cylindrical apparatus is packed with dif-
tory. ferent absorbents, at different levels. The
10. Photography Section -Many of the evi- material to be tested is placed at the top
dences detected from different exhibits of the absorbents inside the glass cylin-
or materials require to be photographed. der. Then a suitable solvent is allowed to
Hence a photography section is impera- pass very slowly from the top. The mate-
tive for such a comprehensive laboratory. rials to be used as absorbents are silica
gel, aluminium, charcoal, etc. The sol-
11. Lastly, each Forensic Science Laboratory vent chosen, depends on the suspected
should have a mobile evidence collection nature of the material to be tested. On
unit with provision of vehicle, preserva- being dissolved in the solvent, the test
tive and other required materials. material will pass down and depending
Of the services rendered by different secon its nature, will be absorbed at some
tions of Forensic Science Laboratory, a level of the abs01.·bents. This process may
medicolegist is concerned mostly with serv- directly help to detect the tested mate-
ices ofToxicology, Serology, Biology, Molecu- rial or may help to collect the material

chapter 8: FORENSIC SCIENCE LABORATORY I 317
in pure fonn after evaporation of the solvent. Then the plate (the chromatogram)
vent, from the level of the column which is taken out and dried and exposed to UV
has ~rbed the material. In the later rays which identifies some materials.
event, m(»-e specific tests can be taken After that, the absorbent is separated out,
up to kno~tlie material. and the material is also separated by us-
2. Paper Chromatography Special strips of ing some suitable solvent material, which
absorbent paper (porus, filter paper) is is subjected to further tests like
used for the purpose. The testing mate- spectroscopic tests for proper identifica-
rial is spotted at one end of the strip of tion of the material. Simple spraying of
the paper. By its side, a pure sample of colour-producing reagent may help by
the suspected testing material is used as making visible the areas of extension of
control. This end of the paper is dipped the test material, with their control for
in a solvent in a glass tank. The solvent comparative study.
is soaked by the paper and rises in its There are certain advantages of TLC
height. On way, it dissolves the testing (Thin layer chromatography) over paper
material and its pure co:n:trol and carries chromatography. TLC can identifY very
a part of them, up in the strip along with small quantity of the material in a very
it. The ratio of the length of the rise of short period. The material from the chro-
the testing material to the length of the matograph can be easily separated and
rise of the solvent in percentage is taken subjected to other tests. Most of the
into consideration and the value is ex- chemicals or poisons can be identified by
pressed in Rf, which is compared with the this method.
control as well as with a standard chart. 4. Gas Chromatography In gas chromatog-
To identifY the material, for the invisible raphy the material to be tested is mixed
stains of the test material on the paper, in its gaseous or vapour fonn, with some
suitable colouring spray is used. inert gas like nitrogen or helium and then
3. Thin Layer Chromatography The prin- passed through layers of different absorb-
ciple is to a great extent similar to paper ing particles arranged in a column (vir-
chromatography. Instead of specific pa- tually an appliance used in column chro-
per strips, thin layer of absorbent mate- matography) which absorb different
rials like silica gel or aluminium gel chemicals present in the testing mate-
preparation is used on glass plate. The rial and then allow the different compo-
sample to be tested and a control sample nents of the gas or vapour to come in
of pure fonn of the suspected material in phases out of the column, which are then
the sample, both are placed side by side passed through a detector, e.g., an elec-
at one end of the chromatographic slide tron captor detector or a flame ionization
on the absorbent surface and this end is detector. The electrical signal is fed into
dipped into a suitable solvent in a glass a recorder, after amplification of the sig-
container. But the solvent should not nal in flame ionization detector. Flame
touch the testing material and the con- is used to ionize the components of the
trol. The solvent is allowed to rise up to gas for generating electric signal. The
10-15 em which occurs between some signal is recorded on a strip of chart re-
minutes to 2 hours depending on the sol- corder. The vertical ordinate of the

318 I PRlNCIPLES OF FORENSIC MEDICINE <
,
graphic chart records the power or elec- characteristic bands, each of which is indi- ·
tric strength or electric response from the vidualistic for a protein. The stationary phase
ionized component and' the horiz.o_ntal is made of starch or agar gel on a glass slide.
axis records the time of each such ye- The testing material is placed at one end of
sponse and thus, that gives the retentm~____tll~ stationary phase (gel layer on the slide).
time of the components inside the col- Electrodes are attached at both ends of the
urrm. The time required for rejection of gel slide. Electrically charged protein com-
the components helps to identify the rna- ponent moves on the phase plate and at the
terial. end, the gel plate is treated with the colour-
Gas chromatography is most suitable for ing agent for the protein which causes ap-
testing gaseous substances. If in liquid pearance of visible characteristic bands de-
or solid form, the substance is to be con- pending on the characters of the protein.
verted to its gaseous form first and then L Starch or agar gel electrophoresis is used
subjected to the test. This test also gives for serological tests for identification of
quantitative assessment of the material, human serum or for specific blood group
which is most accurate . The peak of antibody, by placing antigen and anti-
height (vertical ordinate) recorded, rep- body on separate holes at short distance
resents quantity. and causing electrophoresis movement
In pyrolysis gas chromatography, solid of the an' ibody across the gel phase to
substances are subjected to a very high reach the antigen side and vice versa.
temperature, so that the material is con- The precipitation and agglutination re-
verted to complex gas which is.then fed action can clearly be studied in the gel
into the gas chromatography column media.
along with an inert gas. This type of 2. In paper electrophoresis , Whatman no.
chromatogram is termed pyrogram . The 3 paper is used instead of gel plate. The
graphic record of a chromatogram or a sample to be tested is applied at one end
pyrogram acts as a "finger print" for the of the paper strip in the midline . Buffer
· substance, indicating that in this method solution is applied so as to make the
there cannot be any wrong assessment whole pape.r, l'ltrip wet, except 1 em
.;• 1,:. J
of the nature and quantity of the .<

mat- breadth are~ : on each side of the spot,
ter. made ready ·~it~ the testing material.
The end 9f.-....t.h~ :.s.trip nearing the spot is
h t >.' t-;1. ~.'
now dipped in the same buffer solution,

in a vertical eleCtrophoresis tank. Elec-
trophoresis is continued for about 15
By this method different pxoteiiJ: components hours. The spot made with testing rna-
of different :bo.dy .Jluids arejd~ntified. The terial and its surrounding which was
proteinous componentf'l:ofthe.t€~t_ip.g~-in1\t.e- ~. kept dried, soon gets wet by the buffer
rial pass th~ugh a stationary phase on ap- solutioii~- ~q\ially from all sides. As the
plication of electri6 charge. The charged com- elect~phoresis is c~ntinued, there is dis-
ponents moy~,;~ 1 ~~~?i~Air?-t#.~·c,e.-.. ~~- ~~~P.;~F; , 1 j • • Pl~~-Y.Th\~~t1 ~{\lJ1:R,_Wtein making specific
rated protein-s,• jn- '~the. i si<ati~al:J( •.p,ba&Eli ~r -· zv;' baml.:at~ili<iidmtance, which is char-
,
stained with .culouring _age.nt.s_whkh _s.how _ __. _ acteristic'lt'6t:t'b.~..iiilo.te.in .

chapter B; FORENSIC SCIENCE LABORATORY I 319
SPECTROSCOPY OR
for photo.electric detector to detect the range
SPECTROPHOTOMETRY ofwavelengths ofrays absorbed. The source
oflight radiation in simple spectroscope and
Every substance have the capacity to absorb ()rdinary colorimeter is tungsten bulb.
light rays of various wavelengths, both in the
visible as well as in the invisible range. In Ultraviolet and Infrared spectroscopy
the visible wavelength range, absorption of
some components of rays and reflection of As in case of visible light rays, the invisible
others gives the specific colour to a sub- light rays, e.g., those with more frequency
stance. On being examined by a spectroscope, and less wavelength like UV rays, X-rays,
dark absorption bands are seen, represent- gamma rays and those with lesser frequency
ing the absorbed splitted rays of specific wave- and more wavelength like infrared rays, mi-
lengths. Light rays are splitted according to crowave rays and radiowaves are also ab-
a
their wavelengths by prism and .passed sorbed by different substances which cannot
_through the substance to be -examined. The be visualized by naked eye or by ordinary
absorption of specific wavelength by the sub- spectroscopic examination They can be ap-
stance causing appearance of dark bands in pf1i!ciated and in their case range of absorp-
specific zones of the visible light rays' range; tion can be measured by more sophisticated
helps identificatio!l- Qfthe InAtterwit.hout any spectrophotometers. Such sophisticated
chance of mistake. In the practice of Foren- spectrophqto-meters have components like
sic Medicine, use of ordinary spectro-scope is monochromators, sensitive electronic detec-
helpful to identify haemoglobin in its differ- tors with amplifier and a recorder, to meas-
ent forms of chemical state and combina- ure the amount of electric energy liberated
tion (and amplified) from photons which are emit-
Colorimeter is a type of ~pectroscope , in ted by the testing substance, when placed in
which by using filters, some of the light rays a suitable media, through which the mono-
of specific wavelength range are allowed to chromatic rays pass (Fig. 8.1).
pass through the testing matter and others For ultra violet spectrophotometer, the
are restricted When the :rays ofi!J)ecific wave- light source is either a hydrogen or deute-
length pass through the testing substance, ril,llll discharge lamp, and for infrared spec-
absorption of some of these rays of specific trophotometer a heated moulded rod of spe-
wavelengths by the s-ubatan® makes lt easy cis.l type is more suitable.
~; 6 ....·~~- -+ ~~~V~
y-,'\' x
- 0 Reoo~er
1 _......,. _
1 3 4 5 6
Fig. ·g-:1: PartS 1'1 a Spfllqtropliotometer: (1) Bulb; (2) Priam, (S) Monochromator (Slit)
which allows only $elective ray15U1ro4gh the slit, (4) Sample cell, (5) Detector,
{6) Reqorder

In the monochromator, a prism splits the M~ss Spectrometry

light rays according to their wavelengths and , /
slit allows to pass rays of suitable wavelength ( Mass Spectrometry is more sophisticated a
range. \ test which detects a substance in minute
The testing matter is dissolved in a sol- .quantity. The testing material in trace
vent, and glass cells or quartz cells are used amount is placed inside a high vacuum cham-
in the solution for absorption of visible and her and is then collided by high energy elec-
UV rays respectively. For infrared rays, cells trons. This causes loss of electron from the
made of sodium chloride and potassium bro- molecules of the testing material which gets
mide are suitable. Photons liberated from the positively cllarged. These molecules break
surface of the cells in the solution strike the down instantaneously into numerous frag-
photoelectric detector, get converted to elec- ments, which are then separated according
trical signal and then are amplified. The sig- to their mass, by passing them through an
nal is represented graphically and thus the electromagnetic field. The graphic presenta-
electric signal is then recorded graphically by tion of the minute particles of the mass as
the recorder. This graph when compared with obtained subsequently by the same process
a graph oflN or IR rays, gives the nature of as applied in case of UV or IR spectrometry
absorption of the wavelength energy by the gives a complex pattern with qualitative and
test material which coated the cells. Thus, the quantitative assessment of the material
matter is identified from the graph obtained. tested. The lines in the graph represent the
The graph obtained in lN spectrophotom- mass, and the height of the lines represent
etry is easy to study but not conclusive about the quantity of each fragmented mass. Thus,
the nature of the material tested because the whole graph acts as an unique picture
many substances may exhibit similar energy for a material. Mass spectroscopy is applica-
and thus the recorded graph from them also ble only in case of testing some pure mate-
may be similar. Confirmation about the ma- rial. In case of possible admixture or impu-
terials may, after this test be done by TLC rity, the components of the material may first
which becomes easier, once some idea about be subjected to fractional separation by gas
the testing material is available by UV spec- chromatography and then tested by mass
trophotometry. spectrometry for identification and estima-
In case of infrared spectrophotometry, tion of each type of matter present in the
the matter is a bit different. Here the absorp ~ complex. Chemical ionisation mass
tion bands are numerous, which gives a very spectrometry is an easier process to identify
complex pattern of the graph for each mate- components of a mixture without application
rial tested. Hence the spectrum represented of gas chromatography beforehand.
in the graph, gives so many characteristic
complex patterns that, the graphic prints can Emission Spectrograph
be safely accepted as confirmatory for some
substance which, in pure form, is also sub- Every element, on being excited appropri-
jected t~ the same test as a control. ately, emits light spectrum. The spectrum
. .
Drugs and other trace evidences can be can be separated and recorded by photogra-
detected by spectrophotometry. phy.

chapter 8: FO RENSIC SCIENCE LABORATORY I 321
'
The element to be tested is placed in be- NEUTRON ACTIVATION ANALYSIS
tween two carbon electrodes to vaporise and
excite the particles of vapour which then
emits light which is then passed through a When an atom is bombarded with a neutron,
lens and then thro'ugh a prism to spread the isotope of the atom with increased number
spectrum which is}t'gain passed through an- of neutron develops. However, most of such
other lens to ·focus it on a screen to be photo- newly formed isotopes ate decomposed and
graphed for further study and preserving as there is radioactive decay of the isotopes.
record. None of the elements give similar There is radioactivity in the process with lib-
line of spectrum and from the bands of spec- eration of alpha, beta and gamma rays. Al-
trum and dark bands the element can be iden- pha rays are positively charged particles, beta
tified. rays are electrons and gamma rays are elec-
In case of a compound, many lines of tromagnetic radiation. In a neutron reactor,
spectra are recorded having a specific type neutron is bombarded to an atom which en-
for each element. From the combination of ters the nucleus of the atom and during dis-
different lines of spectra, the ·elementary com- integration the gamma ray radioactivity is
bination of the component can be assessed liberated. This has characteristic energy
and then the compound can be identified and value which is assessed to know the atom or
compared with another by similar test. A the element
modification of the process may be adapted Many elements can be studied at a tim.e
by use of laser be~m at the initial phase to inside a reactor. The characteristic energy
vaporise the compound. Rest of the test, i.e., value of gamma rays tells about the type of
exciting of the elements of the compound by the element and the intensity of gamma ray
carbon electrodes and the subsequent proc- radiation tells about the concentration of the
ess is same as in the other variety of emis- element in a substance. The measurement
sion spectroscope. of the gamma rays energy involves a sophis-
ticated testing technique which needs a
Atomic Absorption Spedrophotometry (1) detector for the rays, (2) a multichannel
analyser to khow the type of energy of the
Here, an element or compound is subjected radioactivity and also (3) a recorder.
to the contact of Acetylene air flame or a
Many elements (or many complex or-
graphite furnace or a heated strip of metal
ganic substances can thus be studied at a
for vaporisation of atoms of the specimen.
time. It identifies an element or compound
Radiation from a light source of similar type
in 1/lOOOOOOOOOth (one billionth) of a gram.
is directed towards the vaporised atoms which
But the apparatus is a too costly one and the
absorbs the radiation energy with displace-
ment of electrons from the outer circle of the analyser has to be very efficient and experi-
enced.
atom. This movement of the electrons emit
energy which is passed through a manom- Neutron activation analysis is useful to
eter and. then the selective radiation is proc- detect trace elements in hair, gun powder
essed through the detector and recorded deposited around a firearm wound, primer
graphicaliy, which speaks for the element's contaminating the hand of the user of a gun,
presence in the component. etc.

STUDY OF X-RAY DEFRACTION PATIERN with fluorescent agent, after absorption of

invisible short wavelength, high frequency
:r:ays (e.g., UV rays) cause emission of rays of
X-ray defraction from atoms of a substance
longer wavelength and lesser frequency, so
is photographed in X-ray plates, which gives
as to make the emitted rays visible due to
specific patterns for each individual material.
presence of fluorescent agent.
The material should be available in crystal-
line form to be detected by X-ray defraction. Polarising Microscope : In polarising mi-
croscope, polariser and analyser are used, the
fanner in between the source oflight and the
MlCROSCOPES IN FORENSIC USE object of study, and the latter (the analyzer)
in between the object and the eyepiece.
Stereoscopic Microscope : In stereoscopic mi-
Though light passes in straight lines in
croscope two eyepieces give pictures of two
all directions, some materials allow the light
planes of the material examined, giving a 3-
(passed through it) to travel in one plane only
dimensional image. It is a reflecti_on mic:o-
and not in all directions. This is the function
scope which gives surface view of trace ele-
of both polariser and analyser. A polarising
ments present on the surface of some 9ther
lens turns the path of light rays passed
object. The field of view being wider, a wider
through it, to pass in one direction only. The
surface can be examined. The magnification
analyser (which is actually anotherpolariser),
is 15 to 125.
is used to ascertain, whether the polariser
Comparative Microscope : (See page 417). limited the path oflight passed through it in
Fluorescent Microscope : By this type of one plane or not. When the analyser is placed
microscope, only certain specific items can in a perpendicular plane, in comparison to
be studied. To have a more general use, the the placement of the polariser, then it can be
specimen to be examined is to be treated with understood if light from the matter tested,
substances which fluoresce, so as to be vis- was polarised by the polariser or not, as in
ible by this microscope. The specimen treated such a case the analyser being placed in the
a • I D
" ''
/ ..... .E
Ol
:.:J
0
,, .
<' __.
z
'I'\ -+ -+
1 2 ·3 4
·-~
/
.--~ @ ~
b
-
..
' -
,·i ·\<'__.. __..
2 3 4
Fig . 8.2: Polarising microsco.pe: (a) 1. Bulb, 2. Polariser, 3. An~dyser (turned
through 90°) does not transmit polarised light being placed in
perpendicular plane in relation to · polariser, 4. Screen·.- {b) 1 .'Bulb,
2.- Polariser, 3. Analv.ser ·transmits polarised light bGth being if) the
same pl~ne, 4. screen

stated manner, will change the pathway of than other surface microscopes, and the mag-
the light rays coming in one plane, after pass- nified image of surface of the testing mate-
ing through the polariser and will not be vis- rial has a 3 dimensional stereoscopic appear-
ible. Placement of the analyser then, in the ance.
same plane of the polariser, will cause the This helps identification· of minute trace
light rays to pass in the same direction and elements present on the surface of a matter,
the matter will now be visible, if looked or in other words, gives an enormously mag-
through ~ the microscope. Thus, by this nified surface of some minute invisible trace
method, nature of dispersion oflight rays by element, the exact nature of which is required
the tested specimen will be · known. In this to be known in Forensic practice.
way a polarising microscope tells about the Electrons, striking surface of the testing
nature of the sp~cimens tested (mostly min- material, also produce X-ray which is de- .
erals), from their nature of dispersion. An fleeted from the surface. With the help of an
ordinary microscope cannot be used for this f
X-ray analyser and recorder, the amount o
purpose. . X-ray emitted and its character can be known
ElectronMicroscopeorScanningElectron which will tell about the elements present
Microscope : This is an example of great adon the surfac~ of the examined sample. This
vance in the study of surface of some o?je;!cts, f \vay, the metallic trace from the primer or
so as to identify it, or any trace matenal, up gun powder contaminating the hands of a
to the level of elements. The use of S shooter can be detected, as to whether the
(Scanning Electron Microscope) gives highly material contained lead, antimony, etc.
magnified detailed picture of the surface of
In fact electron microscope can be uti-
the material tested for trace element as well
lized for detection of extensive range of trace
as a graphic presentation of electrons emit-
eleme~ts available in the dress and other
ted by the element present in the testing sub-
articles of the accused, victim and at the scene
stance which gives clear identification ofthe
of crime.
trace elements.
Beam of electrons is emitted from a hot
tungsten filament. These electron beams are POLYGRAPHOR MECHANICAL LIE
focussed on the surface of the testing mate- DETECTOR
rial by means of electromagnets. The
focussed primary electrons cause emission of Polygraphy is the process which is used in
electrons from the surface of the testing medical practice for comprehensive study of
material. These emitted electrons are functioning of different body systems with
scanned, amplified and fed into a cathode ray particular reference to circulation, respira-
tube to be converted and focussed on a screen tion and peripheral nervous response. This
to produce magnified pictures, as it happens technology has been attempted in forensic
during picture formation on a TV screen. investigation process. The basis of its appli-
The magnification of the image may be cation is the fact that with mental excitation
up to 100000 times than the real dimension or stimulation there is altera,tion of these
of the testing particles. The·depth ofthe pic- body functions due to autonomic, particularly
ture is also quite high, about 300 times more sympathetic excitation.

Basing on this principle, polygraph, which Preparation of the subject (who is suit-
indicates the functioning levels of the above able for ready examination): The person is
noted systems, has been used to know subjected to pre-examination interview dur-
whether a suspect or an accused of a case is ing which its purpose, aim, the process of
deceptive while facing interrogations during polygraph examination to be followed, should
the investigation, so that subsequent inves- be explained to him to his optimum under-
tigation process can be channelled through standing. For satisfactory result of the test,
right way. For this purpose, the persons to the tester should have the knowledge of the
be so examined with the help of a polygraph incident. The subject should be informed that,
should be so done in his complete physical he would be asked certain questions, and he
and mental relaiation stage, without any fac- is to answer the questions as 'yes' or 'no'.
tor acting on him to influence the responses, For this the questions will be of suggestive
except which should naturally occur while in nature. The subje~t has nothing to be ap-
giving a deceiving or false reply. prehensive about an3 · rong study and inter-
pretation of the poly aphic test. But if he
The person is made to sit on a chair and deceives then, tha 1ll be reflected in the
the accessories of the instrument are prop- test. In the second stage he should be made
erly attached on different parts of the body. acquainted with the questions and he has to
An arm cuff is placed around the arm for re- understand the questions well so as to give
cording blood pressure and pulse rate and 'yes' or 'no' answers. Ideally, not more than
pulse features. An elastic belt is placed around 10 questions should be asked to him in the
the chest to measure the rate and amplitude same sitting. Initially three categories of ques-
of respiration with deviations and an elections are asked.
trode connection is placed, one on the tip of 1. Irrelevant questions· These are the ques-
one side index finger for recording galvanic tions which have no bearing with the in-
skin reaction (Galvanic current is used for cidence of offence in any way. For exam-
the purpose). The response is recorded graphi- ple - Is your name Mr. 'X'? Are you 25
cally on a single paper from where different yrs. in age? Are you an usual inhabitant
adverse responses, the intensity of responses, of 'Y' area? Do you work in 'Z' firm?
and the time and extent of exciting reaction, 2. Relevant questions· Relevant questions
can be studied. are mostly directly implicating him with
The subject to be examined is to be pre- commission of the offence or suggestive
pared without any premedication. The prepa- of having knowledge about some aspects
ration is more a mental preparation than oth- of the offence. For example, 'on 15-8-93 at
erwise. Certain subjects are naturally unsuit- 4-30 p.m, you stabbed Mr 'A' at his resi-
able for this test, for example, subjects with dence or saw Mr 'B' stabbing Mr 'N, on
psychotic personality, overreactive personal- 15-8-93 at'4-30p.m'. 'You have robbed N.D.
ity, drug addicts; persons suffering from gross bank of Rs. 4 lac'. The answers for the
abnormality of any of these three conditions relevant questions should be ''yes" or ''no".
and persons who are by nature deceptive, 3. Control questions: For proper under-
restless and noncooperative. These subjects standing and interpretation of the graphic
require special preparation and need time to curves imprinted with answers and men-
be fit for the test. They are not suitable for tal reaction of the subject to different
ready examination. relevant questions, control question are

chapter 8: FO RENSIC SCIENCE LA BORA TORY I 325
asked, which are mostly generalised in in such a way that he faces the instrument
nature, related to some minor bad acts and the operator faces him so that during
which the person might have committ.ed questions and answers he can observe the
some time in his early life and should facial reactions of the subject.
have not forgotten. e.g., 'Have you at any
The different settings of test Constitutes:
time during your childhood, stolen some
(i) first test (ii) card test (iii) 3rd test (iv) mixed
money from your mother's purse for pur-
question test (v) yes test (vi) guilt complex
chasing some playing materials'? 'Did
test (vii) repeat test (re-examination test)
you ever think to make money by way of
(viii) peak of tension test.
bank robbery or some such way'? '~
1. The first test is carried on after the sub-
In case of deceptive answers, adv rse
ject settles and the appliances and instru-
reactions are reflected in different way in
ments are attached to his different body
the graphic presentation of the bodt func-
parts. Next he is explained about the type
tions. Irrelevant questions are asked to fa-
of questions and the type of reactions
cilitate comparison between th~ reaction to
which will be obtained, ifhe lies.
a correct answer and that to a deceptive an-
swer. Interpretation of reaction to answers 2. Card test : In case interpretation be-
to controlled questions helps further to as- comes difficult on the findings of the first
sess whether the person is generally reac- test, the card test may be performed to
tive to any of the questions which he feels know whether he has lied during the
may indirectly implicate him to the present first test.
offence in question, that has not been com- The person is subjected to this test when
mitted by him. Thus, a negative answer for the findings of the first remains ambigu-
both relevant as well as control questions ous or if no conclusion can be drawn from
with similarity in abnormal response will the findings . Seven playing cards of dif-
rather be taken as the person's adverse nerv- ferent numbers are used for this test. The
ous and other systemic reaction to any in- person is asked to pick up one out of them
criminating question or affair. without looking at the number. Then he
The questions should be so arranged that will see the number of the card he has
the graphic response can be easily compared picked up. The card is taken back from
and becomes conspicuous. Thus, an irrelevant him and mixed with the other six cards.
question should be followed by a relevant Then all the seven cards are handed over
question, to be followed by an irrelevant ques- to him with instruction that, he should
tion again and then should be followed by a take up each one individually when asked
control question. All these should be so done the question. "Is that the card you picked
to allow the person to come back to normal up earlier?" lie should answer "No" in all
receptive stage, after giving a deceptive an- cases, including the question relating to
swer to a relevant question, so as to make the card he actually picked up earlier.
him ready for another relevant question. The Thus, one of the "No" answers must be
purpose of the control questions have been wrong, and graphic change due to such
narrated above. wrong answer becomes helpful to make
Examination proper . The person to be a comparative study with graphic pattern
examined is made to sit on a polygraph chair related to his answers for relevant ques-

- - - -- ------~---
~26 I PRINCIPLES OF FORENSIC MI!:D1CINE
tions asked during the first test. If the jected to another test with just some re-
responses are similar, then it becomes arrangement of the same questions. If the
strongly suggestive that, he lied during responses to the individual questions are
the relevant question during the first test. same as during the first test, then it indi-
3. A "Third Test": is often necessary, when cates that, the answers given are genuine.
no conclusion can be drawn after the card 5. "Yes" Test: In some persons, another test
test, i.e., when no change in the response in a changed form may be necessary.
is noticed during answering "No" in con- Here, among the irrelevant questions
nection 'Yith questions related to the card some false incriminating questions are
test. During the third test, the same also asked. Before setting him for the test,
questions are repeated after informing he is narrated the questions and asked
the ·person that, the polygraph showed to replay in "Yes" in all questions. It is
that, he was not always truthful while expected that there will be change in the
answering the questions. response when he says "Yes" for a false
4. Mixed Question Test : To· know whether incriminating question. If there is no
the answers given for relevant questions change in response for the incriminating
during the first test, which have shown question, then absence of change in re-
some changes in recorded response, are sponse against relevant questions in the
correct or not, the person may be sub- previous test becomes meaningless.
Fig. 8.3: Shows polygraph records with respiration circulation (BP & Pulse) and GSA curves related to examination
of a suspect of one criminal case. The curves from baseline-upwarcj represents, (a) starting points of
questions, (b) pulse reaction, (c) respiration , (d) GSA and (e) BP ·

6. "Guilt Complex Test ": In the guilt com- ous reasons like over consciousness, contrac-
plex test, offence for which a person is in- tion of muscles, body movements, etc·.
terrogated is not the matter of questions An illustration of Polygraph record is
directly. But questions which will create given in the Fig. 8.3.
a guilt complex in him are asked. For ex-
ample, if.he had hit a person, then he may
be asked question like, ''You can-ied dag-
ger with you when you met him that day" • A. S. Curry- Advances in Forensic and Clinical Toxi-
or ''You have know ledge that the person cology, 1972.
was stabbed on that day at that tlme". • A. S. Curry- Poison detection in human organ, 3rd
7. ''Re-examination Test ": Re-examination is Edition, 1976.
carried in case of erratic response or with • H. J. Walls- Forensic Science, 2nd Edition, 1974.
unresponsive persons or in persons with
• R. L. Williams- Forensic Science, The present and
inconsistent behaviour. The examination
the future in analytical chemistry, Vol. 45, No. 13,
is done by specific stimulation by general
1973.
suggestive questions which.does not bear
• Richard Saferstien-Criminalistics-An introduction
an element to unnecessary excite the
to Forensic Science -1981.
person. The question should be like, ''You
know that such and such person has been • Dawson M, Morrice C, Zurzulo V, Hodda A - The
stabb~'You also can say who might Determination of Beta-Hydroxybutyrate in Urine, Pro-
ceedings of the 15th Meeting of the International As-
have st~~e~ him".
sociation of Forensic Sciences, IAFS, Los Angeles,
8. Peak of Tension Test : These questions
(E5) .
contain the 'fact of offence without di-
rectly linking the person with the offence • Dawson M, Williamson K, Maynard P, Hydriodic Acid-
in a specific manner. For example, when Red Phosphorous Reduction of N, N-Dimethyl-3-phe-
it is a case of theft of some ornament, nyl-3-hydroxypropylamine, Proceedings of the 15th
the interrogator may name several or- Meeung of the International Association of Forensic
naments out of which one has been al- Sciences, IAFS, Los Angeles, (E5) .
legedly stolen by the person. The peak • Dawson M. BissetT, Mikah S, Hodda A, The Analysis
excitement period will be at the time of of Cyanide in Blood Using Gas Chromoatography,Pro-
naming the exact ornament, which was ceedings of the 15th Meeung of the lnternauonal As-
stolen and that peak of excitement will sociation of Forensic Sciences, IAFS, Los Angels, (E5).
be represented in the graphic records. It • Raux C, Saywell S, Greenwood P, Royds D, The Analysis
is ~uitable for persons ~ho remain to of Toner Samples from a Document using Laser Micro
some extent excited and alert all along Pyrolysis GC-MS, Proceedings of the 15th Meeung of
the period of interrogation. the lnternauonal Association of Forensic Sciences,
_IAFS, Los Angeles, (E5) .
Of all the responses, the response in the
change of respiratory function and in the GSR • Raux C, Maynard P, Dawson M. FTIR Spectroscopy
(Galvanic Skin Reaction) are more depend- Applications in Forensic Science, Chemistry in Aus-
able. The circulatory response represented tralia, RACI, val. 66 (2). 11-15.
by pulse rate and blood pressure may be help- • Raux C, Kwok B, Dawson M, Maynard P, Keegan J,
ful but often are less so. Further, variation Royds D. The Analysis and Persistence of Capsicum
in circulatory response may occur due to vari- Spray Using Gas Chromatography - Mass

Spectrometry, Forensic Science International, Elsevier (a) Chromatography, (b) Electrophoresis, (c) Spec-
(C5) -1999. troscopy or spectrometry, (d) Stereoscopic Micro-
scope, (e) Comparative Microscope, (f) Ruorescent
• Remand G, Phillips MR, Stevens-Kalceff MA,
Cathodoluminescence Des lsolants En Microscopie Microscope, (i) Neutron Activation Analysis.
Electronique Analytique, Phenomenes Luminescents 2. What are the different types of chromatograph
des Materiaux /so/ants, Jardin C (ed.), Division tests? What is the principle of (a) Thin layer Chroma-
Dielectrique de Ia Societe hancaise du Vide, Lyon, tography, Gas Chromatography 7
France 9-10 Sept 1999.
Oral questions
• Kipps AE and PH white head - The significance of
1. What are the principles of :
analysis in Forensic investigation of body fluid- 1975.
(a) Electrophoresis.
• Fred Smith arid Jay A Siegal- Handbook of Forensic
(b) Neutron activation analysis.
Drug Analysis- 2004.
(c) Polygraph.
2. What are recorded and studied in polygraph test in
Possible Questions
criminal investigation?
Short notes 3. What are the modern scientific techniques of detec-
1. How the followings come to the help of criminal in- tion and analysis of poisons and different trace ele-
vestigations? ments?
NOTES

Further, the legal use of the term has
also some psychological aspects. But medi-
cally, it deals with only the physio-pathologi-
Medical and legal definitions of Injury cal aspect of the body of an individual.
The conception of a legal man about the term The differences between law and medi-
'injury' is quite different from what a medicine regarding the use of the term injury, is
cal man understands by the term. To a medi- only but proper, when viewed from the an-
cal man, injury means ''breach of continuity gles of the two applied fields of social or com-
of any tissue of the body", which means all munity servi.ce . For the two professions the
wounds or all bodily injuries only. To a legal term means, just what they should mean.
man, injury has a much broader meaning
which includes "any harm caused illegally to Offences against the human body
a person, i.e., to his body, mind, reputation
Offences against the human body are de-
or property". Sec. 44 I.P.C.
scribed, with punishment for such offences,
Thus, for a medical man, injury means under sections 299 to 377 I.P.C. and also un-
any dissolution of continuity of any tissue of der sections 394, 396, 397, 459, 497 and 498A
the body and nothing but dissolution or breach and provisions of Indian penal code related
of continuity of tissue of the body. to bodily injury or harm caused by way of
For a legal man, injury means not only adulteration offood,'drink, by poisoning and
breach of continuity of body tissue, but also abuse of drugs vide pages 272-278, 284 and
mental injury, loss of property and damage some other sections of I.P.C. (which deals
to the reputation of a person, when caused with offences which may cause harm to hu-
illegally. The inclusion ofthe word "illegally" man body). Offences against human body be-
has legal implications in that, all breach of ing the theme of these sections, services of a
continuity of tissue which in consideration medical man are essential in connection with
to a medical man is an injury, may not be so many of these issues under these sections.
considered by a man oflaw. A surgical inci- The offences, dealt under these sections con-
sion or wound, legally may not amount to cern death of human beings, confinement, as-
injury as it is not an illegal breach of conti- sault, hurt, sex offences , abortion, cruelty,
nuity of tissue. etc. Apart from brief consideration about the
329
legal definitions of different types of unnatu- his death, then the first person shall be
ral deaths, this volume deals with different deemed to have caused his death. If a person
injuries or hurts, in detail, just as detail as is after injuring another person arranges treat-
necessary for a medical man to work in con- ment for the person and if the person still
jugation with the law enforcing people. Thus, dies, then also the first person will be deemed
Sections 299 to 311 (offen~es affecting life), to have caused his death. Killing of a living
Sections 312 to 316 (abOrtion and child birth), foetus who is partly born out of the mother's
Section 317 (abandonment of child), Section womb, though might have not breathed, will
318 (concealment of birth), Sections 319 to come under the purview of this section.
338 (offences related to causing hurt), Sec- Sec. 300 I.P.C. Murder -Except some
tions 349 to 358 (assault), Sections 394, 396, exceptions, culpable homicide is murder un-
397 (causing hurt and death during robbery der the following circumstances:
or dacoity), Section 459 (causing grievous
hurt during lurking house), Section 497 (adul- Firstly, if the act by which the death is
tery) and 498A (cruelty aga1nst married caused is done with the intention of causing
women) of the Indian Penal Code, c~me un- death, or
der the purview of this chapter and a few Secondly, if it is done with the intention
other chapters of this book. Section 375, 376, of causing such bodily injury as the offender
377 (natural and unnatural sexual assaults knows to be likely to cause death of the per-
have been discussed in chapter 27). son to whom the harm is caused, or
It is not at all necessary that, · the stu- Thirdly, if it is done with the inten tion of
dents should memorize the provisions of all causing bodily injury to any person and the
these sections oflndian Penal Code. But it is bodily injury intended to be inflicted is suffi-
expected that the students should be conver- cient in the ordinary course of nature to cause
sant with some of these sections. The next death, or
paragraphs deal with the provisions of some
Fourthly, if the person committing the
sections ofi.P.C., in relation to death, hurt,
act knows that it is so imminently danger-
assault and cruelty against human body.
ous that it must, in all probability, cause
HOMICIDE -It means death of a person death, or such bodily injury as is likely to
due to the act of another. cause death, and commits such act without
Sec. 299 I.P.C. Culpable homicide - Who- any excuse for incurring the risk of causing
ever causes death by doing an act with the death or such injury as aforesaid.
intention of causing death, or with the in ten- -~ Exceptions:
tion of causing such bodily injury as is likely
1. Culpable homicide is not murder if the
to cause death, or with the knowledge that
offender lost self-control in the face of
he is likely by such act to cause death, com-
sudden and grave provocation and causes
mits the offence of culpable homicide.
death of the provocating person or any
Whereas "homicide" may or may not be other person by mistake or accident.
an offence and thus may or may not be pun- Note : The provocation must have not been
ishable, "culpable homicide is an offence and sought for by the offender as an ex-
is punishable". cuse to kill. If anything done in obe-
If a person by injuring an ill, infirm or dience-to the law or lawful discharge
disordered person accelerates the process of of duty by a public servant, that will

chapter S': INJURIEs-LEGAL CONSIDERATION I 331
not amount to provocation for the V'ihoever commits murder shall be punished
purpose of exception of this section. with death or iviprisonment for life and may
Anything done to exercise the right also be fined.
of self defence will not amount to Sec. 3031.P.C. - Punishment for murder
provocation. by a life convict- A person under life impris-
2. Culpable homicide is not murder, when onment if commits a murder he will be pun-
the act resulting in death of a person is ished by death sentence.
done in good faith of the right of private
Sec. 3041.P.C. - Punishment for culpa-
defence of person or property, without
ble homicide not a~ounting to murder may
premeditation, and without any intention
be imprisonment for life or imprisonment of
of doing more than what is necessary for
any description which may extend up to 10
the defence, if he has actually exceeded
years, with or without fine if the act was in-
the power given to him.
tended to cause death or such bodily injury
3. Culpable homicide is not murder if the as is likely to cause death. When the act is
offend~r is a public servant or while aid- done without the intention to cause death,
ing a public servant exceeds the power then the pu:qishment may be imprisonment
given by law for advancement of public of either description for a period up to 10
justice, causes death of a person by his years and/or fine.
such act, done in good faith believed by
him to be lawful and necessary, having
Sec. 304A I.P.C.- Causing death of a per-
son by doing rash or negligent act not
no ill will towards the person so killed.
amounting to culpable homicide shall be pun-
4. Culpable homicide is not murder if it is ishable with imprisonment of either descrip-
committed without premeditation in a tion for a tenn which may extend to two years
sudden fight in the heat of passion upon and/or fine.
a sudden quarrel and without the offend-
ers taking any undue advantage or act- Sec. 304B I.P.C. - Dowry death - When
ing in a cruel or unusual manner. In such death of a woman occurs due to burn or other
a case it is immaterial who offered the bodily injury or in circumstances other than
provocation or the first assault. A recent normal, within 7 years of marriage, and if it
Supreme Court ruling. says that, killing is seen that she was subjected to cruelty or
a person out of rage does not amount to harrassment by her husband or any relative
murder. of the husband for or in connection with any
demand for dowry, such death shall be called
5. Culpable homicide is not murder- When
"dowry death" and the husband or his rela-
:the person whose death has been caused,
tive shall be deemed to have caused her .
being above the age of 18 years, suffers·
death. Punishment for the offence shall not
death or takes the risk of death with his
be less than seven years imprisonment but
own consent.
may extend to life imprisonment.
Sec. 3011.P.C. - Qulpa:ble homicide by
Sec. 305 I .P .C. - Punishment for abet-
causing death of a person other than whose
ment ofsuicide of a child under 18 years of
death was intended will be considered in the
line as if death o.f the intended person has
age or of an insane, idiot, de~.i~ous or in-
toxicated person may be death or imprison-
been caused.
·merit ·fm- life or imprisonment fol: a p'eriod
Sec. 3021.P.C. ,_.Punishment of murder..:.. · :not exceeding 10 yeats with or without fine.

Sec. 306 J.P. C. - Punishment for.i-bet- ·· Sec. 319 I.P.C. - It defines hurt. Who-
ment of suicide in any other case may ex- ever causes bodily pain, disease or infirmity,
tend up to 10 years which may be of either he/she is said to cause hurt.
description (simple or rigorous), with or with-
Sec. 320 I.P.C. -This section designates
out fine.
grievous hurt . The following is the list of
Sec. 307 I.P.C. -An act attempted to com- grievous hurts-
mit murder, if causes hurt to the person, may 1. Emasculation.
lead to life imprisonment of either descrip-
2. Permanent privation (loss) of sight of ei-
tion, or imprisonment of either description
ther eye.
which may extend up to 10 years with or with-
out fine. Ifthe attempt does not cause any 3. Permanent privation of hearing of either
hurt then the offender is liable to. be pun- ear.
ished with imprisonment of either descrip- 4. Privation of any member or any joint.
tion up to a period of 10 years with or with- 5. Destruction or permanent impairing of
out fine. When a life conviCt makes attempt power of any member or joint.
of murder and if the act hillts the person then
6. Pennanent disfiguration of head or face .
the offender is liable to be punished with
death. 7. Fracture or dislocation of a bone or tooth.
8. Any hurt which endangers life or which
Sec. 3081.P.C . .-Attempt to commit an
causes the sufferer severe bodily pain or
act, the commission of which would amount
makes him unable to follow his ordinary
to culpable homicide not amounting to mur-
pursuits for a period of20 days.
der, will make the offender liable to be pun-
ished with imprisonment of either descrip- Explanations and examples of grievous
tion for a term which may extend up to hurts
three years and or fine, if no hurt is actu-
ally caused by the act. If the attempt causes Emasculation - This means loss of mascu-
· hurt to the person, then he becomes .pun- line power of a male. This may include exci-
is_hable with imprisonment of either term sion of penis (the male organ for intercourse),
for a period which may extend up to 7 years injury to the vertebral column leading to fail-
and or fine. ure of erection, castration involving both side
testicles before puberty, leading to impotence.
Sec. 3091.P.C. -Attempt to commit sui-
cide makes the person so attempted, liable Permanent privation of sight of either eye
to· be punished with simple imprisonment or hearing of either ear - To be counted as
which may extend for a period of 1 year and grievous hurt, the loss or privation of sight
or fine. or hearing may be partial and ~eed not be
complete but has to be perm~ent . Again,
Sec. 310 I .P .C. defines a 'thug ", who
permanent does not mean that, it should be
is a person who habitually associates with
incurable. For example, when the loss of sight
others for committing robbery or child-lift-
is due to corneal opacity due to some injury
ing by means of or accompanied 'with mur-
· over cornea; it is curable by corneoplasty. But,
der.
as because corneal opacity due to scarring
Sec. 311l.P.C. -A thug shall be punished resulting from an injury is permanent by it-
for life with or without fine . self, it will be considered grievous hurt and
. ... .
chapter 9: INJURIES-LEGAL CONSIDERATION I 333
chance of cure by comeoplasty does not mini- to grievous hurt in way of causing severe
mise its gravity for this purpose. bodily pain or even endangering the life. By
Privation of a member or a joint - Loss the phrase "unable to follow his ordinary pur-
of a joint is obviously a grievous hurt. Priva- suit" for 20 days, it indicates that, the person
tion or loss of a member means, loss of any must be unable for 20 days to go to the toilet
part of the body which has separate morpho- by himself, taking bath by himself, or taking
logical and functional identity. Example -:- food by himself, apart from being unable to
loss of one testicle alone may not amount to do his other routine works.
grievous hurt in any other consideration ex- Sec. 321 I.P.C. - This section defines the
cept that a testicle is morphologically and term "voluntarily causing hurt". If an act is
functiomilly member of the body. done with the intention to cause hurt or with
No. 5 does not require any explanation. the knowledge that, the act is likely to cause
hurt to a person, then the act amounts to
Pennanent disfiguration of head or face. "voluntarily causing hurt".
This provision has elasticity in it. The amount
of disfiguration offace which may be consid- Sec. 322 I.P .C.- This section defines the
ered grievous in case of one person, may not term "Voluntarily causing grievous hurt". If
be considered so in case of another. An iran act done with intention to cause grievous
regular, small, permanent scar on the face hurt or done with the knowledge that, the
of a young unmarried girl or a stage orcin- act is likely to cause grievous hurt and if ac-
ema actress, may be considered as grievous tually grievous hurt is caused, then it
hurt, because, this may affect her life or live- amounts to voluntary causation of grievous
lihood, most adversely. But such a scar may hurt.
not be considered for the purpose of this sec- Sec. 323 I.P.C. - It describes the pun-
tion to have disfigured the face of an old ishment for voluntarily causing hurt, which
woman, already having multiple creases and may be imprisonment of either description
other scars on her face. which may extend up to one year and/or fine
Fracture or dislocation of a bone or tooth which may extend up to one thousand ru-
of any extent or dimension will amount to pees. Exception - as provided under section
grievous hurt. However, dislocation of bone 334.
may not be a feature to persist for long but Sec. 324 I.P.C.- As per this section, pun-
dislocation of a tooth may retain the feature ishment for voluntarily causing hurt by dan-
for a considerably long period or may even gerous weapons or means shall be imprison-
be a pem1.anent feature when a dislocated ment of either description for a term which
tooth falls off. may extend up to a period of three years and
Hurt which endangers life means injury or fine .. Exception - as provided under sec-
which may or is likely to cause death in ordi- tion 334 I.P.C.
nary course of nature, irrespective of treat- Sec. 325 I .P .C. - Punishment for volun-
ment given or not. As regards severe bodily tarily causing grievous hurt shall be impris-
pain, it is correct that, one or two bruises or onment of either description for a term which
abrasions may not be considered grievous may extend up to seven years and also with
hurt. But multiple bruises and abrasions in- liability to be fined. Exception- as provided
volving extensive body surface may amount under section 335 I.P.C.

334 I PRINCIPLES OF FORENSIC MEDICINE.
Sec. 326 I.P. C. - Punishment for causing servant from his duty, shall be imprisonment
grievous hurt by dangerous weapons or of either description for a term which may
means shall be imprisonment·for life or im- extend to ten years with or without fine.
prisonment of either description for a term Sec. 334 I.P.C. -Punishment for volun-
which may extend up to ten years with also tarily causing hurt on grave and sudden
liability to be fined. Exception -: as provided provocation without knowledge or intent to
under·section 335 I.P.C. c~use hurt to any .p erson other than the per-
Sec. 327 I.P.C. - Punishment for causing son giving the provocation, shall be impris-
hurt to extort property or to constrain to an onment of either description for a term which
illegal act shall be imprisonment of either may extend to one month and/or fine up to
description for a term which may extend to five hundred rupees.
ten years with or without fine.
I
Sec. 335 I.P.C. - Punishment for causing
Sec. 328 I.P.C. -Punishment for causing grievous hurt on grave and sudden provoca-
hurt by means of poison, etc. with intent to tion shall be imprisonment of either descrip-
cotmnit an offence shall be impnsonment of tion for a term which may extend to four
either description for a term which may ex- years and or fine up to two thousand rupees.
tend to ten years with or without fine. Sec. 336 I.P.C. -An act endangering life
Sec. 329 I.P.C. - Punishment for volun- or personal safety of others if done rashly or
tarily causing grievous hurt to ·extort prop- negligently sll tl be punished with imprison-
erty, etc. or to constrain to an illegal act shall ment of either description for a term which
be imprisonment for life or imprisonment of may extend to three months and/or fine which
either term which may extend up to 10 years, may extend to two hundred and fifty rupees.
with liability to be fined also. Sec. 337 I.P.C. -Causing hurt by act en-
Sec. 330 I.P.C. -Punishment for volun- dangering life or personal safety of others if
tarily causing hurt to extort or to compel res- done rashly or negligently, shall be punished
toration of property shall be imprisonment with imprisonment of either description for
"o f either description for a term which may a term which may extend to six months and!
or fine which may extend to five hundred ru-
extend up to seven years with or without fine.
pees.
Sec. 331 I.P.C. -Punishment for volun-
Sec. 338I.P.C. -Punishment for causing
tarily causing grievous hurt to extort confes-
grievous hurt by rash and negligent act en-
sion or to compel restoration of property,
dangering life or personal safety of others
shall be imprisonment of either description
shall be imprisonment of either description
for a term which may extend to ten years
for a term which may-extend to 2 years and!
with or without fine .
or fine which may extend to one thousand
~c.. 332 I.P.C. -Punishment for volun- rupees.
tarily causing hurt to deter public servant
Sec. 349 I.P.C. - This section defines
from his duty, shall be imprisonment of ei-
''Force ". A person ·is;said to use force to an-
ther -description for a term :which may ex-.
other person if he causes motion or change
tend to three years an,d or fine.
of'motion or cessati'oh of·motion to the other
Sec, 333 l:P.C. - Punishment . for. vollln~, petson-or to any eubstance bringing it in con-
tarily causing grievous hur.t to deter public tact with the bOdy f!l'f the other person or ere-

ates sense of feeling in the other person with Sec. 356 I.P.C.- Punishment for causing
anything which the other person is wearing assault or using criminal force in attempt to
or carrying or being so situated. Causation, commit theft of property carried by a person
change or cessation of motion, for the pur- is imprisonment of either description up to 2
pose of this section may be caused by - a) years and/or fine .
own bodily power, b) by disposing any sub-
stance in a manner that motion or change or Sec. 357 I.P.C.- Punishment for causing
cessation of motion takes place without any assault or using criminal force in attempt to
act on his part or on the part of any other wrongfully confine a person is imprisonment
person, c) by inducing any animal to move, of either description up to 1 year and/or fine
to change its motion or to cease to move. upto one thousand rupees.
Sec. 350 I.P.C. defines "Criminal force". Sec. 358 I.P.C.- Punishment for causing
Criminal force means force used intention- as~ault or .using criminal force on grave
ally without consen~ of the person on whom provocation is simple imprisonment up to 1
. the force has been used, to commit an .offence month and/or fine up to 200 rupees.
or with intention or knowiedge that such use
of force .is likely to cause injury, fear or an- Sec. 394 I.P.C. - Punishment for volun-
noyance to the person. tarily causing hurt in committing robbery
shall be imprisonment for life or with rigor-
Sec, 351 I.P.C. - This section defines as-
ous imprisonment for a term which may ex-
sault Whoever makes any gesture, or prepa-
tend to 10 years with or without fine.
ration intending or knowing it to be likely
that such gesture or preparation will cause Sec. 396 I.P. C.- Punishment for causing
any person present to apprehend that he who dacoity with murder shall be death or impris-
makes that gesture or preparation is about onment for life or rigorous imprisonment for
to use criminal force to that person, is said a term which may extend to 10 years with or
to commit an assault. without fine .
Sec. 353 I .P .C. - Punishment for caus- Sec. 397 I.P.C. - Punishment for com-
ing assault or using c·riminal force to deter mitting robbery or dacoity with attempt to
public servant from discharge of his duty cause death or grievous hurt shall be mini-
shall be imprisonment of either description mum 7 years imprisonment.
for a term which may extend to 2 years and/
or fine . Sec. 459 I.P.C. - Punishment for causing
grievous h~rt whilst committing lurking
Sec. 354 I.P.C. - Punishment for causing
house, trespass or house-breaking shall be
assault or using criminal force to a woman
with intent to outrage her modesty shall be imprisonment for life or imprisonment of ei
imprisonment of either description for a term ther description for a term which may ex-
which may extend to 2 years and/or fine. tend to ten years with or without fine.
.Sec. 355 I.P.C. - Punishment for causing Sec. 498A I.P.C. - Punishment for the
assault or using criminal force with intent to husband or relative of husband of a woman
dishonour a person otherwise than on grave subjecting her to cruelty, shall be imprison
provocation is imprisonment of either de- ment for a term which may extend to 3 years
scription up to 2 years and/or fine . . with or without fine.

336 ! PRIN.Gif'r.ES OF FORENSIC MEDICINE
5. The phrase "in being" means any subject

F ll H
who is leading a separate existance. Thus,
according to English law, a foetus , if killed
inside the uterus of the mother or before
In English law, all cases of criminal trauma fully born, it will not amount to murder.
are covered by the "Offences against the Per- By 'fully born alive' or by 'separate
son Act of 1861". existance' in English law, it means all
parts of the foetus must come out of the
Murder as defined in English law -
body of the mother with the child being
''Where a person of sound memory and alive or still alive (excepting a part of the
discretion unlawfully killeth any reasonable umbilicus which may remain inside the
creature in being and under the King's Peace body of the mother) with circulation and
with malice aforethought, either express or respiration of the new born functioning
implied, the death following within a year and independently.
a day." 6. "Under the King's peace" means, killing
The definition of murder in English law within the legal jurisdiction ofEngland,
provides as follows : anywhere, any time, except during war-
1. To amount to the offence of murder, the time in the battlefield. Hence, during
killer must be of sound memory and peace, killing of an enemy nationale in-
mental discretion. A mentally retarded side England will amount to murder if
or unsound person (killer), may not be other conditions are fulfilled .
held guilty of murder, though he may be 7. To establish commission of murder, it
guilty of manslaughter. must be shown that, the act leading to
2. In a few circumstances killing of a man the killing was done 'with malice afore-
may be considered justifiable and lawful, thought', which means that there was an
e.g., killing of a person while executing intention to kill the person who has ac-
his lawful arrest, killing while preventing tually been killed. Or, a person has been
crime of atrocious nature, killing in course killed by an act which was done with in-
of self defence or defence of property. tention to kill another person. Or, with
inten tion to cause serious bodily injury
3. Killing (killeth) need not be essentially
to the person who ultimately died as a
due to direct physical violence. If a person
result of that.
acts with the intea tion to kill another per-
son or to cause such bodily harm which is Defence to a charge of murder (English
likely to cause death and if as a result of Law) -
the act the person is killed, then it will 1. If the act was the result of provocation
amount to murder. Thus, confining a per- which has caused sudden and temporary
son at a place or not providing a child or a loss of self con trol resulting in the com-
disabled person necessary protection and mission of the crime, then it will not
food which the person is required to do, amount to the offence of murder.
leading to death of the child or that disa- 2. An act of self defence is another defence
bled person, will amount to murder. to the ch arge of murder. But the defen-
4. By the phrase "any reasonable creature", sive act should be reasonable and match-
the subject of killing indicated is, any ing to the offensive act of the other per-
human being. son. A person cannot kill another person

if he was only slapped on the face by the According to English law, the following
other. The act of the other person must offences amount to misdemeanour -
have endangered the life of the accused 1. Unlawfully and maliciously wounding or
person and he can kill that other person, inflicting grievous bodily harm to a per-
if there was no other way to protect him- son amounts to misdemeanour.
self but to kill the other person. To pro-
2. Maliciously administering poison witl;l
tect his own life the person should first
try to retreat from the place, which, if intent to injure, aggrieve or annoy any
person.
not possible, then he should apply mini-
mum force to restrain the other person, In British law the term manslaughter
which if necessary, may be up to the ex- means killing of a person by an act which
tent ofkillirig the attacker. But when it does not amount to murder. Manslaughter
is related with protection of property or may be voluntary manslaughter, e.g., kill-
life of another person, then retreat is not ing under provocation or killing with legally
the remedy. But here also the action by diminished responsibility. In involuntary
the person must not be unn~cessarily manslaughter, one of the two ingredients ,
disproportionate (force used to prevent actus reus (actual physical act causing the
felony). death) and mens rea (state of mind respon-
3. Application of reasonable force is allowed sible) is absent. In a case of voluntary man-
to effect a lawful arrest of a person. If slaughter, both actus reus and mens rea are
such application of reasonable force kills present.
the person arrested or to be arrested , it Causing injury or bodily harm with valid
will not be taken as murder. consent as in case of surgical operation or
4. Death _due to misadventure resulting reasonable chastisement for lawful correction
_ f:r:<?m an accident, without any intent to of a child by his parents, teacher or guard-
kill, will not find the accused guilty of com- ians, does not amount to any offence.
mission of murder. The term 'maim' in English law is used
According to English law the following to mean an injury rendering a person less
offences amount to felony - able to defend himself.
1. Unlawfully and maliciously causing Grievous bodily harm means really seri-
wound or grievous bodily hann or using ous bodily injury .
firearm with intention to maim, disfig-
Assault means application of force unlaw-
ure or disable any person (Section 18 of
fully or an act intended to unlawfully cause,
the offences against the person Act).
or unlawfully causing apprehension to an-
2. Attempting to commit murder (Sec. 11 other person that the first man is about to
of the Act). apply force on him.
3. Attempting to choke, in order to commit In this text book different injuries have
any indictable offence (Sec. 21). been described and discussed primarily ac-
4. Using chloroform to commit any indict- cording to the classification based on the
' (Sec. 22).
able offence causative factors . The other aspects of these
5. Maliciously administering poison so as to wounds on which the other classifications are
endanger life or inflict grievous bodily based, have been discussed while describing
harm (Sec. 23). those injuries individually.
rF. M. - 221
f:lj K NC rQ RENSIC 338
• Major Criminal Acts (Euthal Law Agency, Allahabad, Theoretical

1989).
1. Define injuries medically and legally.
• Indian Penal Code (Act No. XIV of 1860, as amended,
1988). Short notes, differences
• Gradwahl's Legal Med- FE Camps, 1968.
Grievous hurt, assault.
• Criminal mannual containing -Code of Criminal Pro-
cedure 1973! Indian Penal Code 1860, Indian Evi- Oral questions
dence Act 1872, as amended by Code of Criminal
Procedure (Amendment) Act 2005 and Criminal Law What are Homicide, Murder, Culpable homicide not
(Amendment) Act 2005 (2 of 2006) - Published by amounting to murder, Assault, Hurt, Dangerous
Universal Law Publishing Co. ; 2007. weapon?
NOTES
( '
•• .. j •• ( ... •

OFWOU 5 (i) Heat hyperpyrexia (heat stroke
june} or sun stroke)
(ii) Heat exhaustion or heat col-
Injuries can be classified in many ways. lapse
A Classification of Injuries according to (iii) Heat cramps or miner's cramps
causative factors: (b) Effects oflocal application ofheat -
I. Mechanical or Physical injuries -These (i) Bum (due to application of dry
are the injuries produced by application
heat)
of mechanical force. These are:
(ii) Scald (due to app lication of
1. Abrasion
') moist heat)
2. Bruise or contusion
2. Due to application of cold
3. Laceration
(a) General effect of exposure to cold -
4. Incised wound
Hypothermia
5: Punctured wound
(b) Local effects of exposure to cold
6. Fracture or dislocation of a bone,
tooth or joint (i) Frost bite (due to dry cold)
7. Firearm wound - a type of punc- (ii) Trench foot (due to moist cold).
tured wound, caused by a high ve- Ill. Chemical injuries -
locity projectile.
1. Corrosion (due to application of
Nos. 1, 2, 3, 6 and 7 are the result of ap-
strong acids or alkalies)
plication ofblunt force ; No. 4 is caused by
sharp edge of a weapon and no. 5 is caused 2. Irritation (due to application of weak
usually by the pointed end of a weapon. acids , alk alies and some other
ll. Thermal injuries - chemicals or plant or animal ex-
tracts).
1. Due to application of heat -
(a) General effects of exposure to heat, IV. Miscellaneous injuries -
hot atmosphere (may not cause any 1. Electrical injury (due to electrocu-
visible injury). . · · tion)

2. Radiation injuries (due to X-ray, U.V. Mode of Production

ray, radio-active substances) . Abrasions are produced by the impact with
3. Lightning injuries (a combination of the above materials, when friction is caused
electrical injury, mechanical injury between the object and the epidermis due to
and thermal bum/injury) the impact. The direction of force causing the
4. Blast injuries (a combination of me- friction may be horizontal or tangential (as
chanical and thermal injuries). in scratches or grazes) or it may be more or
B. Classification according to severity of the less perpendicular (as in pressure or imprint
Injury : abrasion).
I. Simple Features of Abrasions
ll. Grievous which may or may not be
Abrasions are superficial injuries. But often
dangerous to life.
there is accompanying injury to the subcuta-
C. Medicolegal classification oflnjuries : neous or still deeper tissues. At the site of
I. Self-inflicted or Suicidal abrasion, there may be oozing oflymph and
IT. Injuries inflicted by others or Homi- sometime very slight oozing of blood. The
cidal lymph or blood which oozes out, and the de-
ill. Accidental injuries nuded epithelial debris, dry up within a few
IV. Defence wounds hours to form a scab. Abrasions heal without
formation of permanent scars.
V. Fabricated wounds.
D. Classification in relation to moment of Types of Abrasions
Death:
On the basis oftheirfeatures and manner of
I. Ante-mortem wounds
causation, four types of abrasions are recog-
ll. Post-mortem wounds. nised.
1. SCRATCHES or LINEAR brash Abra-
sions- These are caused either due to,
(a) horizontal or tangential friction by the
pointed end of some substance like thorn
In an abrasion there is damage or destruc- or needle or tip of any pointed weapon
tion of the superficial epithelial covering of or, (b) by the perpendicular friction with
skin (epidermis) or mucus membrane, due
(pressure of) some linear object like nail
to impact (mostly frictions) with hard, blunt
or linear projection of a vehicle. A scratch
and rough object or weapon.
or linear abrasion caused by horizontal
There may be loss of continuity of the or tangential movement of the pointed
epidermis (denudation of cuticle) or the mu- end of an object will be wider at the start-
cus membrane. ing point than at the ending point. In this
type, the denuded cuticle heaps up at the
Causative agent or Weapon terminal point. Thus, from a scratch, the
Hard blunt or hard blunt and rough, or pointed type of weapon and the direction of appli-.
erid of an object or weapon. Example : stone, cation of force or the relative position of ·
stick, nails, pointed end of a thorn, needle or the victim and the assailant can be
anY, other weapon, or rough surface of any known. The direction of the force is from
other material . the wide.r side to the narrower side of the
• 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

chapter 10: MECHAN ICAL INJURIES I 341
scratch. The position of the assailant is the ligature marks around the neck in
at the wider side ofthe scratch, i.e. ; op- case of hanging or strangulations, nail
posite to the side of heaping up of the abrasions on the neck in case of throt-
denuded cuticle. The size and shape of tling and teeth bite abrasions are the
the abrasion do not always depend on the examples of pressure abrasions.
size and shape of the part of the weapon 4. IMPRINT or PATrERNED Abrasions-
or object causing the frictional impact. In case of pressure abrasion, the design
Grazes are sliding abrasions produced by of the weapon with its shape may be left
wide rough surface on a comparatively imprinted on the abrasion. These are
wider area of the body surface and they imprint abrasions. From the design im-
have no sub-category. But when grazes printed on the abraded area, the weapon
are caused due to sliding friction of body of offence can be guessed. Example -
surface on road, some prefer to term abrasions caused by cycle chain, automo-
them as 'brush' abrasion. bile grill or tyre of a wheel. Imprint abra-
sions are varieties of pressure abrasions.
2. GRAZES or SLIDING Abrasions-These
occur due to horizontal or tangential fric- It should be remembered that all abra-
tion between the epidermis and wider sions are the result of direct impact of an
part of the rough surface of an object, object or weapon. As such there cannot
weapon or ground. These abrasions are be a separate variety of impact abrasion.
more commonly seen in road traffic acci- Similarly "gravel rash" is a misnomer for
dent cases, where the victim after being abrasion in general.
knocked down by a vehicle, falls on the
ground with motion, resulting in horizon- NAIL SCRATCH or ABRASION
tal friction ofthe skin against the ground. Nail scratches can be caused by horizontal
In this type of abrasion also, the starting friction or by pressure. When caused by hori-
part is wider and deeper with narrowing zontal friction, these are triangular in shape
and thinning at the terminal part. There with denuded epithelium being tagged at the
is also heaping up of denuded epidermis terminal narrow end. Example- scratches
at the terminal part. Thus, from grazes produced during scuffle. When nail scratches
also, the direction of application of force are produced by pressure, then these are cres-
can be ascertained. Here also the size and cent in shape, representing the shape and
shape of the abrasion do not depend on size of the nail.
the extent of the part of the weapon or
object coming in co:p.tact with the body. Medicolegal impo~ances of abrasions
Friction bum, brush bum or gravel rash, 1. Abrasions are simple injuries and are su-
all are occasionally used other terms for perficial in nature. Though abrasions are
graze abrasion. known to involve or remove epidermis
3. PRESSURE Abrasions- These are the only, it is not unlikely that in an abrasion
result of more or less perpendicular ap- small areas may involve deeper dermis.
plication afforce on the body surface. The Hence, though scab falls, but even after
extent of friction is less and is directed that the white temporary scar may not
towards the depth of the body. The size regain its original epidermal colour uni-
and shape of the abrasion depend on the formly. And at some spots the scar may
part of the weapon or the object coming continue as permanent scar. This may
in contact with the body. Abrasions on also occur if the abrasion gets infected.

2. Though simple by themselves, there may scratches around the mouth and nose of
be dangerous wounds involving vital or- a dead body may be indicative of killing
gans, deeper to the site of the abraded by smothering.
area. 9. Abrasions over front of knees, elbow
3. 'llliese are more commonly accidental, prominence palmar aspects of hands and
next in sequence homicidal, and com- front offace indicates fall on front on the
parativelyless commonly suicidal. In sui- ground.
cidal fall from a height or suicidal hang-
10. Abrasion over the cornea may cause cor-
ing, abrasions may be present.
neal opacity and may restrict the vision
4. Abrasions may be self-inflicted, the pur- permanently, amounting to grievous
pose being, to bring a false charge of as- hurt.
sault on some person.
11. Abrasions may be produced on the vul-
5. From abrasion, the type of the weapon nerable sites of the dead body during
used, can be said. From imprint or pat- shifting of the body to the mortuary.
terned abrasion the exact ~esign on the -These post-mortem abrasions may be
body of the weapon can be known.
mistaken as ante-mortem abrasions.
6: From lin.e ar or graze abra_sion, the direc- These abrasions are present mostly
tion of application of force and the rela- against the vulnerable bony
tive position of the victim and the assail- prominences. These are yellowish ,
ant can be known (see scratches and parchmentised and slightly translucent
grazes above). when dried, do not have oozing, scab for-
7. From abrasions, time of assault can be mation or colour change, as are seen in
roughly assessed. ante-mortem abrasions.
When fresh , an abrasion is red with evi- 12. Multiple depressed small excoriations
dence of oozing of serum and a little blood. may be produced by ants or cockroaches
There ·is no scab. on the dead body. These are multiple,
By 8 - 24 hours, there is a reddish scab small, depressed, dry, yellowish lesions,
fonnation. grouped together and do not show any
By 2nd and 3rd days, the scab is brown- ante-mortem feature in them. Excoria-
ish. tion during life near the anus or inguinal
By 4th and 5th days, it is dark brown. folds m~y look like abrasion after death.
They also lack in the features of ante-
By 6th day, it is blackish and it starts fall-
mortem abrasions like oozing, scab for-
ing off from the margins.
mation or colour changes.
A big scab may take a few days more to
fall off. Note : As told above, abrasions caused by
8. Abrasions sometime give indication about ligature material around the neck
the specific type of offences committed. can suggest about the pattern of
Thus, abrasions near the private parts causative material. Similarly,
or over the breasts of a woman may be there are abrasions due to kicks,
indicative of sex offence, attempted or fist blows bite marks, defence in-
committed on her. Nail scratches in the juries as also brush abrasion (sus-
neck of a dead body may be indicative of tain~d on roads ) which tell about
or
manual strangulation thr-ottling, and the cause.

chapter 10: MECHANI CAL INJURIES I 343
Table 10.1: Differences between an\e-mortem and

post-mortem abrasions·-
Points Ante.mortem Post-mortem

abrasions -_;Ibrasiofl~-
1-::' Site Anywhere Over exposed
onthebody bonypromi-
nences
2. Oozing of lymph Present flbsent
3. Scab formation Present .Absent
4.- Colour changes Present Absen~ mostly
yellowish with-
out any change
5. Parchmentisation Absent Present
1
-Fig: 10.1 : Ahta.slon -6-7th da y

FIQ. 10.3: Impact abrasion
Fig. 10.4: Abrasion of unconscious inmate of a three

Fig . 102(a): Linear abrasions and contusions- wheeler autorickshaw while in motion due to
homicidal friction with a sided cycle-van
Fig. 10.2(b): Linear abrasion- back of chest, J;or~>r;ll,on-1 Fig. 10.5: Postmortem artefact- postmortem ant-bite
scalp na•em1on·na1aic spots

chapfer 10: MECHAN ICAL INJURIES I 345
Fig. 10.5(a): Abrasion (homicidal case) Fig . 10.5(b): Abrasion
-
Fig. 10.5(c): Abrasion, 7th day Fig. 10.5(d): Contusion (on dissection)
FIQ. 10.5(e): Abrasion

By courtesy Prof Dipankar Guharay

a b c d e f
Fig. 10.6: Different types of abrasions- (a) Linear abrasion, (b) Crescentic nail scratch , (c) Heap of epithelium at the
end point, (d) Grazed abrasion , (e) Patterned (pressure) abrasion due to ligature around the neck,
• (f) Imprint abrasion on forehead
Scab due to burn appearing as scab due to

Fig . 10.7: Scarred abrasion, 3rd day abrasion
B UISEORCONTUS 10N weeks . It is usually roundish or takes the

shape of the striking part of the weapon .
Thus, a bruise may have a definite shape.
In bruise or contusion there is ecchymoses But the margin of a bruise is diffused and not
or effusion of blood in the subcutaneous or sharp due to diffusion of the extravasated
submucus tissue for extravasation of blood blood in the surrounding tissue. Along with
due to rupture of capillaries , caused by appli- rupture of the capillaries, there is damage in
cation ofhard blunt force. In bruise, there is the soft tissue. But the skin is usually spared
no solution or breach of continuity of the cov- because skin tissue is quite tough.
ering skin but the epidermis may occasion-
ally be abraded. Type of weapon
Impact with hard blunt weapon produces

Features of bruise
bruise. Example- stone, stick, fist blow. Blow
When fresh , a bruise is reddish in colour, with hard blunt weapon, after covering the
slightly raised above the surrounding area, part of the body with soft object , may not
painful and tender and may or may not have cause production ofbruise at the subcutane-
denudation of the covering cuticle. Gradually, ous level, but there may be gross extravasa-
it changes in colour and subsides by two tion near the bone underneath .

chapter 10: MECHANICAL INJURIES I 347
Fig. 10.8(b): Bleeding from

ear indicates
haemorrhage
due to fracture
of bone of skull.
By courtesy:
Dr A Kumar
Fig. 1O.B(a): Scab abrasion removed
. '
. /..._,
-., ...
Fig. 10.8(c): Laceration in a case of homicidal assault

and strangulation after sex offence.
By courtesy: Dr Aman Kumar
Fig. 10.8(e): Haematoma with fracture of leg bone.

By courtesy: Prof Nayan Kumar Mohanty
Fig. 10.8(g): Haematoma (on dissection)

348 I PRINCIPLES OF FORENSI C MEDICI NE
Impact by a stick or rod will cause two apparent externally, because the impact
parallel linear bruises along the two margins being soft, there may not be any rupture
of the impact, with a pale gap intervening, of capillaries underneath the skin. But it
the breadth of which corresponds with the may cause deep bruise or haematoma
diameter of the stick. adjacent to the bone, because the applied
When a malleable instrument strikes a force causes the soft tissue to strike the
body curvature, then a linear curved bruise hard bone, resulting in the rupture of the
appears along the curvature of the body. capillaries and venules there.
3. Site ofapplication offorce - Development
Factors which influence the formation and of a bruise depends much on the type of
appearance of a bruise the tissue hit. Tissue, which is tough or
which can absorb force will not be bruised
A blunt force of moderate intensity applied easily. Hence, it needs great force to pro-
on the ann or against the malar prominence duce a bruise on the back of the trunk
of a fair complexioned female or a child will due to toughness of tissue there . A
produce a prominent bruise, whereas twice greater force may even not produce any
the same force applied on the abdomen or bruise on the anterior wall of the abdo-
back of an adult male may not produce any men due to toughness and yielding and
bruise . Thus, certain factors influence the
force absorption capacity of the tissue
causation and appearance of bruise. These
there. But bruises are easily produced
factors are as follows -
against a bony prominence , say malar
1. Quantity of force used - A greater force prominence because the capillaries in the
is more likely to cause a bruise. With still subcutaneous tissue rupture easily in be-
greater force a haematoma may be pro- tween the bone underneath and the hard
duced with accumulation ofliquid or clot- blunt force applied on the surface.
ted blood in the tissue of the affected part.
When the size of the bruise is small, say 4. Sex - Females bruise easily due to deli-
less than 1 em in diameter, in some parts cacy of tissue in them including the ves-
they are termed ecchymoses. In this part sels, and also due to more subcutaneous
ecchymoses is synonymous with bruise fat in them. Vessels present in the fatty
(i.e., diffusion ofblood in the subcutane- tissue are more likely to be ruptured on
ous or submucus level due to the effect applicat ion of force than the vessels
of application of force). present in the tough fibromuscular tis-
sue.
2. Quality of force - A hard blunt force will
cause a bruise, but a soft blunt force may 5. Age - Infants, young children and very
not. Thus, striking with a stone, stick, old perso~s bruise easily than young
fist or shoe will produce a bruise, but adults. In infants and young children, it
striking with a bag of sand or covering is due to delicacy of tissue including ves-
the part of the body with a rug before sels and more amount of subcutaneous
hitting with a stick may not produce a fat. In old P.ersons, it is due to looseness
visible bruise. If a limb is first wrapped of tissue and d!ri'te.rk>sclerotic changes in
with a rug and then hit with a ·s tick with the vessels which make the vessels brit-
sufficient force, then no bruise may be tle .

Fig. 10.8(i): Haematoma (on dissection)
Fig. 10.8(1): Haematoma (on dissection)

6. Certain pathological conditions -Persons tissue over the tough cu~ muscle of
suffering from purpura, haemophilia, the leg causes ultimate settling of the
scurvy, leukaemia, prothrombin and vi- blood in the subcutaneous tissue around
tamin 'K' deficiency and phosphorus tox- the ankle due to pull of the gravity.
icity, bruise easily without application of PATI'ERNED bruise - The design on the
much force. These persons may even surface of the weapon may be imprinted
develop haemorrhagic spots without apon the bruise. Such a bruise is called a
plication of any force. In children suffer- patterned bruise. Example - bruises
ing from whooping cough, repeated force- caused by a cycle chain or motor vehicle
ful coughing may cause subconjuctival grill. A bruise caused by the roundish end
haemorrhage. of a weapon is circular in shape. When
7. Complexion of the person - A bruise ap- caused by the margin of the circular end
pears more prominent in a fair complex- of the weapon, it is crescent shaped. If
ioned person. In dark-·s kinned persons, caused by the body of a rod or stick, then
it may not be well appreciat~d. two parallel lines of bruises appear with
8. Delayed appearance of bruises - Deep a gap in between, which is roughly equal
extravasations may take some time to dif- to the breadth of the weapon, which were
fuse in the subcutaneous tissue and in earlier more conunonly termed as "rail-
such a case appearance of the bruise may way track" like bruise and are still tenned
be delayed by a day or two . Deep bruises as "tramline" bruise in some countries.
over internal org13-ns due to external ap-
plication offorce, are not expected to ap- Medicolegal Importances of Bruise
pear on the body surface. Due to their 1. Bruises are generally considered as sim-
delayed appearance for coming to the ple injuries . But multiple extensive
surface from their deep site, they are also bruises, distributed all over the body can
termed as 'coming out bruise'. be the cause of death and as such may be
9. Shifting ofbruise or appearance ofa bruise considered grievous on the ground of be-
at a site away from the site of impact - ing dangerous to life .
When extravasation occurs at a site 2. Bruises are result ofhard blunt impact.
where the tissue is so tough and tissue A surface bruise may be the external
space is so less that, the extravasated phenomenon of such an impact with pres-
blood cannot be accommodated there, the ence of serious internal injuries , includ-
blood settles down to a lower level where ing those of the vital organs which may
tissue is loose. Gravity helps such shift- be dangerous to the life.
ing of the extravasated blood. Example - ·
When ecchymosis occurs in the subcuta- 3· Generally speaking, bruises are either ac-
neous tissue on the forehead due to im- cidental or hbmicidal in nature except in
pact over there, the blood cannot accu- circumstances of suicidal fall from a
mulate there due to lack of loose tissue height or suie.idal jumping in front of a
at the subcutaneous level there. Gravity vehicle. Suicides do not prefer to suffer
shifts the extravasated blood from the bruises, because these are painful inju-
I
forehead to the loose tissue of the ey~lid, ries.
l 'I :
giving rise to bruise on the eyelid or "black 4. Bruises are P:b_t~IJll110nly fabricated due
eye ", as this is othe·rwis~ known. ·Simi- to the same 'reas.on that, their produc-
larly, extravasation in the subcutaneous tion is painful.

5. False bruise or bruise like lesion may be 6. From bruise, time of assault can be as-
produced by application of some chemi- certained.
cal or plant juice like that of semicarpus A fresh bruise is slightly above the sur-
anacardium or calotropis gigantea, to face of the surrounding area; it is slightly
bring false charge of assault against some- warm When fresh, a bruise is reddish in col-
body. However they can be differentiated our. Within a few hours it becomes bluish
easily (see table 10.2). and remains bluish for about up to three days.
Table ·10.2: Difference$ between bruises'and lesions produced by chemicals or plantjuices
- .: {.
SI. No.· Features Bruise False bruise or bruise /Ike lesions

'
t Shape Regular ~
Irregular
2. Margin Diffused Clear and sharply defined
3. Swelling Slight No swelling
4. Abrasion over the area* May be present Not present
5. Small blisters Not present May be present on the margin
6. Itching Not present Present
7. Colour changes Occur as the age of the bruise progresses No colour change
>e. Similar lesions May be present elsewhere in the body May only be present around the nail beds
due to itching
9. Cause Mechanical force Chemicals or plant juice
10. Extravasation of blood Present in the subcutaneous tissue Not present
11. Chemical test of skin Detects nothing Detects the chemical or the plant juice used
scrapping
. . . . -- ' .
Table 10..
3· Differences between bruise and congestion <. ~'·
Sf. No. Points Bruise Congestion

1. Cause Mechanical force Pathological concfition like inflammation,
capillary stasis due to hypoxia, etc.
2. level of the tissue Diffusion of blood at the subcutaneous or Intravascular phenomenon with engorge-
involved submucous level with rupture of capillaries ment of capillaries {stasis of blood in them)
.3. Colour ·Changes from red to blue, brown, It is all along dusky red without any change
green and yellow
4. Margin Diffused Rather well defined
5. Dissection Cut surface appears stained due to Bleeding which occurs from the engorged
extravasation which is not washable vessels during dissection is washable
For differences between Bruise and post-mortem staining see Table 6.2, Page 254 in "Death and Post-mortem changes"
chapter.

able due to the diffusion ofatmospheric oxy-

gen through the conjunctival tissue for which
the pigments liberated after the breakdown
of the extravasated R.B.C.s change to bi-
lirubin without having noticeable stages of
haemosiderin and haematoidin . More or less
similar effect is noticed in case of meningeal
haemorrhages where C.S.F . , supplies some
oxygen .
Fig. 10.9: Lesion due to juice of semicarpus anacardium

on the dorsum of Lt. hand of the author- 3rd
day. Produced to notice the actual
appearance of the lesion . Note the swelling
and brownish abrasion ·and blister (small)
Fig. 10.12: Haematom a demonstrated in a decomposed

body by incision
Fig . 10.10: Contusion due to beating
By 4th/5th day, it appears brownish due to

presenceofhaemosiderin pigments at the site
of extravasation. By 5th/6th day, the bruise
appears greenish due to presence ofhaema-
toidin pigments.Afterthis period, it becomes
yellowish due to the presence ofbilirubin and
it continues to be yellowish which gradually
fades away and clears out by the end of the
second week . In subconjunctival haemor-
Fig. 10.13: Bruise on 3rd day
rhage , all the colour changes are not notice-

Rg. 10.13(b): Haematoma on dissection
Rg. 10.13(e): Haematoma (on dissection)
Fig . 10.13(f): Four of the 11 street dwellers of Kolkata

(mostly beggar type people), who were
killed during night hours, their head being
crushed by stone by the so-called "stone
man"
rF M- ::>~1

JS4 I PRINCIPLES OF FORENSIC MEDICINE
A B
'--.._/
(a) ~ttt .
(b)
'
'
..
(a) (b)
Fig. 10.17: A - (a) Crescent shaped bruise caused by

margin of cylindrical weapon. B- (b) Y shaped
bruise caused by end part of a cylindrical
weapon
·.
.
Fig. 10.18: Contusion on dissection rH~ar,'the groin
indicat,es relation .with sex offence
Fig. 10.16: Bruise on breast- dissec;:ted Fig. 10.19: Ecchymosis demonstrated.on disse.~tion
-----...J

Mukherjee, J. B. in his textbook of Fo- in'ner aspects of lips in a dead body with
rensic Medicine and Toxicology, creates in- other signs of asphyxia may be indicative
terest by his own findings, that the extrava- of smothering.
sated R.B.C.s in very old subjects may remain 11. Certain categories like women, infants,
intact for even a period of 120 days. Bile pig- young children and very old persons
ments also may be detected at the site as early bruise disproportionately in consideration
as the third day and may continue for a pe- to the force applied.
riod of 120 days. Neutrophils appear within 12. In certain pathological conditions of the
one hour and their count increases gradu- body like blood dyscrasias , bruises or
ally and steadily. Lymphocytes make their bruise like lesions may be produced with
presence after about 24- 30 hours. Accord- application of slight force or it may occur
ing to hi~, macrophages may not appear be- without application of any force.
fore three days. Fibroblastic. proliferation, 13. Patchy post-mortem stainings at the early
reticular and elastic fibres , neo-vascularisa- phase of their appearance, congestion of
tion, fibrinous network and collagen fi~re an organ or some part of the body, stain-
appear at the site of the lesion. ing due to some other causes may be mis-
Raekallio (1966) observed enzymatic taken for bruise .
changes at the site ofbruise. Adenosene tri- 14. Formation of a bruise is an ante-mortem
. phosphatase and cholinesterase show in- phenomenon. It cannot be easily caused
creased activity by about 1 hour after extrava- in a dead body. However, if great force is
sation. There is increase of aminopeptidase applied within a few minutes after death,
after 2 hours, acid phosphatase after 4 hours particularly over a bony prominence,
and alkaline
. phosphatase
. . after 8 hours
. of then some amount of extravasation may
sustai:Jfing the injury. .. be caused. But the bruise produced will
7. Patterned bruises tell abmit"the. tjpe of ·be m"significanfin cons1'deration to ~he
weapon .used. great 'force applied. Such post:mortem
8: Shifting of the extravasated blood and bruises. do not show any change i.n: the
apear!ffice ofbruise at a different site may colour, except which occurs due to · de-
· cause confusion about the site of applica- composition:
tion of force.
9. Deep extravasations may not appear ·on lACERATIONS
the surface before lapse of some hours.
Thus when examined early, they may es- In 'laceration there is breach of continuity of
cape detection. tissue involving depth more than the cover-
10. Like abrasions, bruises at some particu- ing epithelium of skin or that of an organ:
lar parts of the body may be indicative of Lacerations are caused due to impact by hard
some particular type of offences, e.g., blunt and rough weapons or objects.
bruises near the private parts of a woman
may be indicative of sexual offence hav- Features
ing been committed on her forcefully ; 1. Shape -:- Usually irregular. Only in a few
bruises over the neck on a dead body may occasions lacerations may take the shape
point towards throttling or bruises on the of the weapon.

Rg. 10.19(a): Haematoma and bruise- · • :· Fg. 10.;"9(b) : Haeniatoma (disseclf?d).

· Hard blul")t injury (dissected) · · · By c()urtesy Dr A Kumar
.; .
Rg. 10.19(c): Haemorrhage in the periosteum of skull

chapter 10: MECHANICAL INJU RIES I 357
2. Size - May or may not correspond with 13. Bed sores devitalized lesions caused due
the effective part of the weapon (part of to lack of blood supply formed in areas
the weapon which actually comes in con- under continuous pressure and they are
tact with the body). not lacerations .
3. Dimensions - Length, or length and
breadth both are more than the depth of Types of laceration
the injury. ·
According to the mode of production, lacera-
4. Margin -Irregular. tions may be classified into 5 types -
5. Floor - Tags of tissue may be seen pass- 1. SPLIT laceration ..., This type is produced
ing across the floor. The bridging nerves due to crushing of the skin and subcuta-
and vessles are seen across the deep ex- neous tissue by a hard blunt weapon
posed tissue. against a bony surface. When such split
6. Damage to the tissue - Gross. The dam- lacerations are caused by a linear weapon
age is always more than what it appears. like a stick, then the split lacerations look
7. Lacerations have some a.ccompanying like incised wounds . This variety may be
bruise or abrasion at their margins . of spindle shape and under naked eye
examination the margins may appear
8. Haemorrhage -Less in comparison with
rather smooth. But when examined
the size and extent of the wound. This is
closely or examined with the help of a
because of irregular damage to the mar-
hand lens, the irregular, uneven and rag-
gins of the splitted vessels which collapse
very rapidly and there is early clotting of ged characters of the margin will be ob-
vious. The floor of the wound also will
blood at the site due to gross damage of
the tissue. But in gross lacerations where show tags of tissue running across the
wound. In case of incised looking split
big vessels or tom, there may be exten-
laceration, if on the scalp, the hair bulbs
sive bleeding.
will be crushed, instead of being cut as in
9. Foreign substances at the site of lacera- the case of incised wound. Though a lac-
tion -Many of these injuries being sus- erated wound, it bleeds more freely than
tained on roads or due to fall, etc., often the other varieties. This is because the
the lacerations have dust or such mate- margins of the split-ends of the vessels
rials adhered to their floors . These for- do not collapse easily.
eign materials may sometime help to find
2. TEARS - This type is produced due to
out the place of occurrence of the injury
frictional stretch by the irregular or
or assault.
pointed end of a weapon or an object on
10. Infection is very common in lacerations, the surface of the body. A tear is thus
more so when sustained in vulnerable deeper at the starting point than at the
places like roads. terminal. Tears are produced while slip-
11. Healing - The process of healing is de- ping over a pointed object or when such
layed due to (1) gross damage to the tis- a material passes over the surface of the
sue and (2) infection, which occurs in most body. In one variety, force applied on one
lacerations. part of the body, say a forceful pull on
12. Lacerations leave pe'rtriabent scars due the upper limb, may cause multiple tears
to damage to, at least, part of the true at a different site, in this case at axilla,
skin. where the skin is comparatively thin,

35B I PRINCIPLES OF. FORENSIC MEDICfN(:
'
delicate ·and less resistant. .Such tears · 2. ·From a laceration some idea about the
may' ·look like · multiple incised injuries; · . · causative agent may be formed. Some- ..
but on close ex~minatio~ all the features · times the. shape ·and the design of the.
of lacerated wound will be evident. Ex- weapon may be kno:Wn fromthe wound.
tended and-divergent ends oflaceration . If the circular or spherical surface of a
niay have "~w.allow tail" like appearance. :weapon.strikes the body perpendicularly; .
3. STRETCH:· iaceration - Due to heavy then a circ~lar wound will be produced. If
forceful frictionRI impact by a hard blunt the margiri of a circular surface strikes, a
and rough substance, overstretching of crescentic laceration will be there. If the
the skin and subcutaneous tissue may length of a cylindrical weapon strikes the
cause laceration with flapping of the skin, body, then a linear laceration will be pro-
etc. From the flapping of the tissue, the duced. If the end part of such a cylindrical
direction of application of force can be weapon is used then a 'Y shaped wound
guessed, which is from the opposite side will be caused. The design of a tyre may
of the flapping. Internal tissue bridging get imprinted on the avulsion laceration
is more conspicuous in stretch laceration · when a person i-s run over by a vehicle.
and to an extent in aVulsion laceration. 3. Foreign substances like dust, sand,
4. AVULSION - Grinding compression of a gravel, etc. present on the wound ·will
·part of the body with heavy weight may speak about the site or place where the
cause separation or flaying of the skin injury was sustained.
from the underlying tissue making a 4. Lacerations leave permanent scar which
pocket at the site, which contains blood, may link the person with an old injury of
fat and crushed soft tissue. In avulsion, a long time back.
there is gross damage or crushing of the 5. Extensive scar resulting from a lacera-
muscle or other soft tissue. Such laceration on the mouth or around a joint, re-
tions are caused in run over cases by ve- strictmg its function, will amotmt to griev-
hiCles in road traffic accidents. Tissue ous hurt.
bridging is a feature at the depth of 6. Gross post-mortem lacerations may be
wound. caused by placing the dead body in front
5. CUT laceration - This type oflaceration of a running vehicle or a train to obliter-
is produced when "not-so-sharp" edge of ate ante-mortem homicidal injuries.
a heavy or moderately heavy cutting 7. Post-mortem lacerations may also be
weapon is used. They are often seen in caused by land or aquatic animals like
chop wounds, inflicted by rusted uneven dog, jackal and fish, etc.
edge of a heavy weapon. The margins are 8. As lacerations do not have uniform heal-
not smooth and there may be abrasions ing pattern and timing, time of infliction
or contusions on the margins. of the wound cannot be satisfactorily es-
timated from the healing process of lac-
Medicolegal importances of the
erations.
lacerated wounds
9. Lacerations produced by the broken mar-
1. Lacerations are usually accidental or gins ofglass may be mistaken for incisions.
homicidal and only rarely suicidal, as in But their irregular margins can be appre-
case of suicidal fall from a height or sui- ciated if closely examined. In fact, sqme
cidaljumping in front of a running train. authors like to term wounds caused by

chapter 70:-MECHANICAL INJtJ.RIES I 359
Fig. 10.20: Fall from height- roof of 17 storied building. Fig. 10.21 : Incision like tear laceration over neck region
. Note - gross laceration on left for~ head an d -due to overstretching ; look the tags of tissue
expulsion of intestine on left side. across the floor at the angles. Look also
multiple tears medial to the main wound
FIQ. 1022: Crush laceration of_Head

_ _ __ J
Fig . 10.23: Gross lacerations and mutilation in a vehicular

accident case
Fig. 10.24: Laceration - note the slash like stre tch

laceration over right temporo-parietal area;
must have been casued by tahgenital impact.
Also note multiple .tear9 at the base of neck i Fig. 1'0.25': Post-mortem artefact, gnawing of both
near left side. I_ aRd 9rbits by rats

sharp edge of broken glass causing sharp tions are easily produced on body surfaces
margins of the wound as 'incised wound' covering bones immediately underneath,
instead of the term lacerated wound: like scalp , forehead , malar prominence
10. Split laceration also may be confused with elbow, front of knee. The same force, in
incised wound, both of which can of soft areas like buttock might not have
course be differentiated easily. Lacera- caused laceration but caused bruise only.
Fig. 10.27 : Polymorph infiltration in the lacerated wound Rg. 10.30: Homicidal blunt force injuries
- 6 hours x 450
F.g 10.28: Polymorphs in lacerated wound- 6 hours x

450 Fig. 10.31 : Homicidal blunt force injuries

:....:. 10: MECHANICAL INJURIES I 361
_ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ c_h---;;:11fer
FIQ 10.31 b Suicidal cut throat mark hesitation cuts

FIQ. 10.31 (a): Haematoma on dorsum of hand by
blunt force (dissected)
Ftg. 10.31 (c): Suicidal cut throat
Fig. 10.31 (d): Homicidal cut throat · Homicidal incised cut throat

incif:>ed wound. During the stage of de-

INCISED WOUNDS {Slc:lahM,
wCMmek) CO:nlposition the gap or breadth of an in-
ci~·ed wound increases in any case ..
3. Depth - Depth of an incised wound is less

Incised wounds are cuts or slashes produced than the length, and may be less,_equal
by the sharp edge of a weapon like knife, or more than the breadth. The depth of
sword, dagger, razor, tangi, katari, etc.
the wound corresponds with the extent
Mode of infliction -by drawing or saw- of the breadth of the blade entered in-
like movement of the weapon on the body side the wound.
surface when the weapon is rather light, like 4. Shape. - The shape of an incised wound
a knife or razor; by striking the sharp edge is elliptical or it is spindle shaped. It may
on the body when the weapon is heavy or be oval if the wound gaps much. The
moderately heavy like tangi, axe, sword, shape of the incised wound IllflY change
katari, etc. in its curvature due to elasticity, creases
and cleavages of the skin and the direc-
Features of incised wounds tion of the underlying muscle . The shape
of the incised wound will further depend
1. Length of the wound - Length of an in- on the shape of the blade of the weapon.
cised wound is greater than breadth and The angles at both ends of the incised
depth. Length of the wound does not cor- wound is sharply defined.
respond with the length of the blade of 5. Margin - Margins of an incised wound
the weapon when the incised wound is
are well defined, cleanly cut and sharp.
caused by drawing or sawing. It may cor-
6. Floor - Floor of the wound is also sharply
respond when the wound is caused by
striking. cut and di-vided.
7. Haemorrhage _:_ As the vessels are also
2. Breadth -:- Breadth of an incised wound .
primarily depends on the thickness ofthe sharply cut,. there is excessive external
haemorrhage. If the haemorrhage is from
effective part of the blade , i.e., the thick-
a vein then: bl~eding occurs in drops,
ness of the blade at that level up to which
which is stellate in appearance. If it is
the edge of the weapon has gone in the
from the arterial source , then there is
tissue. But the breadth depends much on
spurting .effect and the bleeding occurs
the ~lasticity of the skin of the area and
in jets (see Fig. 5.1 in Ch. 5, page 192).
direction of the fibres of the muscle un-
derneath the skin in relation .with the 8 . Direction of the wound - Direction of the
length of the wound. If the underlying incised wound or the relative position of
muscle fibres are cut across their length, the victim and the assailant can be known
then contraction or shortening of the cut from the tailing or bevelling of the wound
muscle fibres on both sides of the incised (see below).
wound will cause widening of the gap 9. Tailing of the wound- When the incised
(breadth) of the wound during the stage wound is caused by way of drawing the
of rigor mortis. This does not happen so edge of the weapon, the wound is thick-
if the muscle fibres are not cut across or est and deepest at the midpart, thinner
if the fibres run along the length of the and comparatively le's s deep at the two

chapter 10: M.ECHANICAL INJURI~S I 363
. .
ends, of which it is thinnest and least deep 11. Hesitatio'n. .cuts - .These are also termed
·at the terminal part. This is due til dif- "tentative ~ts". These are multiple su-
ference in th~ degree of pressure or force perficial cuts placed around the beginning
exerted. The pressure or the force is :n:Uni- part of the main wound, in cases of sui-
:rhum at the terminal part, when the cide. These superficial tentative or hesi-
weapon is withdrawn. This tenninal end tation cuts indicate hesitation or indeci-
indicates the position of the assailant, if sive state of min~ of the suicide, before
the wound is a homicidal one. But g~ner he finally inflicts the deep fatal wound
ally speaking, as because suicides use on his own body. Hesitation cuts indicate
light sharp cutting weapon which is con- the followings - (i) use of sharp cutting
venient to draw on the body of oneself, light weapon; (ii) if there is a large wound,
tailing of the wound is mostly seen in case then starting point and the direction of
of suicides. Hence if tailing is present. in the wound (hesitation cuts occur at the
an incised wound, then the following starting point of the main wound) ;
opinions can be !iiven : (i) A sharp cut- (iii) suicidal nature of the wound.
ting light weapon has been used; (ii) it is
most probably a suicidal wound (other
points in favour must be there);
Medicolegal aspects of incised wounds
(iii) direction of the wound (starting point
1. Incised wounds are usually suicidal, then
and the tenninal point); (iv) the mo.de of
homicidal and only occasionally acciden-
production can be said as, it has been
tal.
caused by way of drawing, (v) ifhomicidal,
then from the direction of the wound the
relative position of the victim and the as-
Features of self inflicted or suicidal incised
wounds
sailant can be said.
10. Bevelling - When a sharp cutting heavy Self-inflicted incised wounds are superficial,
or moderately heavy weapon is used multiple, grouped together, parallel to each
(striking) tangentially or at an angle to other, placed over the approachable partS of
the body, then there is flapping at one the body, more conunonly on the anterior
margin of the wound at the cost of the aspects of the forearms, inner aspects of the
other margin. This is bevelling. If bevel- thigh and front oflower abdomen, and ante-
ling is present, then the following opin- rior and lateral aspects of upper arms These
ions can be formed - (i) A sharp cutting wounds are directed towards the centre of
heavy or moderately heavy weapon has the body. Thus, self-inflicted incised wounds
been used, (ii) The wound has most likely on the thighs are directed upward and medi-
been caused by striking and not by draw- ally; those in the upper arms are directed
ing or sawing, (iii) The flappingwill speak downward and medially and those on the
about the side or direction of application lower abdomen are transverse.
of the weapon, (iv) Bevelled wounds are Suicidal incised wounds are usually placed
very much suggestive ofbeing homicidal in front and sides of the neck or sometimes
in nature, (v) Direction of application of in front of the wrists, to cut the radial artery
the weapon tells about the relative posi- to bleed to die. In case of sui<:ide, the wound
tion of the victim and the assailant. or wounds. will have tailing, hesitation cuts

364 I PRINCI PLES O F FO RENSIC MEDICINE
and are directed from left to right in case of a of heavy or moderately heavy sharp cut-
right handed person. Usually, suicide is com- ting weapon .
mitted at a secluded place, often inside a 3. Manner of use of the weapon can be said
room, closed from inside. The weapon may from the wound. Deep chop wounds and
be held by the suicide in a state of cadaveric bevelling suggest striking by the weapon.
spasm or is available nearby. Clothes are Tailing and hesitation cuts indicate draw-
usually spared. There may be a suicidal note ing of the weapon on the body. Multiple
left by the suicide. When a double edged open superimposed or overlapping injuries are
blade is used, there may be cuts in the pal- caused by sawlike movementofthe blade
mar surface of the finger(s) used to cause sui- of the weapon on the body.
cidal cut. These cuts in the palmar surface
4. Direction of application of force - From
must not be confused with defence cuts . These
the tailing and bevelling, the direction of
are unintentional cuts.
application of force can be known.
Homicidal incised wouhds may be on any 5. When direction of application of force is
part of the body, including the \Ulapproach- known, the relative position of the vic-
able parts . More than one severe wound at tim and the assailant can also be known.
more than one site are common. Bevelling
may be there , hesitation cuts are absent and 6. Age of the wound or time of assault -
tailing is present only occasionally. The place From the incised wound, time of assault
of occurrence remains approachable to oth- or infliction of injury can be assessed. In
ers. The place of occurrence is disturbed . case of dead bodies, histological exami-
There will be presence ofmarks of resistance nation of the tissue from the margin of
on the body of the victim. The clothes will the wound can help to know, for what
not be spared . The weapon is usually absent. period the person survived after sustain-
Chop wounds are mostly homicidal. ing the injury. This time can be estimated
by studying the state of healing of the
Accidental incised wounds may be caused
wound. By adding the time passed after
when somebody falls upon the sharp edge of
death to the period the victim survived
a cutting weapon; when in course of work a
after being injured, the time of assault
peasant or a butcher draws a sickle or a knife
can be calculated out. The chronology of
towards himself, injuring himself acciden-
the healing process given below is appli-
tally. Occasionally chop wounds may be acci-
cable only when the incised wound is not
dental, which may be caused by the sharp
infected. If infected, then the healing
part of a machine, e.g., the blade of a fan in a
schedule is not maintained.
machine or chopping one's own foot with an
axe while cutting wood to pieces. Accidental When fresh - Bleeding is still present or
wounds may be present anywhere on the body fresh soft clot is adhered to
and may be of any severity. The weapon or margins which are red ,
object is present at the place of occurrence. slightly swollen and ten-
There is no mark of resistance on the body der.
or no sign of struggle at the place. By 12 hours - The margins are swollen
2. Weapon - Presence of incised wound and red ; blood clot dry up ;
means use of sharp cutting weapon. Bev- histologically, there is
elled cuts and chop wounds suggest use leucocytic infiltration.

. chapter 10: MECHANICAL INJURIES I 365
By 24 hours - There is proliferation of 10. Incised wound produced by saw-like move-

connective tissue cells ment of the weapon over those parts of
and vascular endothe- the body covered with loose tissue may
lium for neovasculari- appear irregular and ragged and give the
sation impression oflacerated wound
By 36 hours - There is capillary net- 11. Post-mortem incised wound - Post-
work formation and mortem incised wounds may be produced
fibroblastic infiltration on the dead body, which though rare, may
By 48 hours - Capillary network is com- be related with sexual perversion, when
plete and the fibroblasts after forceful intercourse and killing the
run across the new ves- victim by any means like injury or stran-
sels. gulation, the body is mutilated. particu-
larly, the private parts and sex organs
By 3- 5 days '""' Vessels are thickenedand Sometimes after killing a person, the body
·· many vessels obliterate. ·
is cut i~to pieces before disposal Some-
Healing of the wound by
. times the face of the victim of a murder
scar~onnatioii starts and
. case is mutilated by multiple ineif:!ed
adv~ces .
. wounds to obliterate identification
By 6th day·. ~ Sea~ .formati~I). is com~ ·.
plete. The scab over the
Defence wounds
· · : . woU.nd falls off or can be
taken out easily, leaving
These are in most occasions, incised wounds
a soft, tender, reddish
though abrasions; bruiseS; lace·r.~t~on:s or
scar which in course of
punctured wounds also may be sustained in
weeks and months be-
defence for selfprotection Defence cuts may
comes tenderless, whit-
be present on the palmar aspects of the hand.
ish and firm.
When attacked with a sharp cutting weapon,
7. Cause of death - In case of incised wound the victim holds the blade of the weapon to
there is excessive external bleeding. avoid the assault. In such a case there may
Death, therefore, in many cases occurs be incised wounds on the palmar aspects of
due to haemorrhage and shock In case of more than one finger, but all of them are
cut-throat injury, death, in addition, may expected to be in one line, if the blade of the
occur due to asphyxia because of choking weapon is single edged. If the blade of the
of the respiratory passage by blood.
weapon is double-edged. then two parallel
8. Defence cuts may be present on the pal- lines of incised wounds will be caused. When
mar and dorsal aspects of hands or on the victim tries to ward of attempt of assault
the postero-medial aspect of the forearm. by raising one arm, defence wounds may be
(see page 365). produced on the dorsal aspect of the hand or
9. Fabricated incised wounds may be pro- posterio-medial aspect of the forearm Pres-
duced on the approachable parts of the ence of wounds at these places, when identi~
body to bring false charge of assault fled as defence wounds, is very m~ch helpful
against another person or for some other to ascertain the homicidal nature ofth~ inju-: . ·
illegal purposes. (see page 367). ries or death (see Fig. 10.40).

366 ! PRINCIPLES OF FORENSIC MEDICINE
.,
. t ""' . , ··; Table 10.4: Differenc~s between suicidal and homicidal cutt~t
·,"7;t1[,; ' ..·
' .. ,,i; ..,.
l;aflltej~ P?ftrts .f ,.. ·Sui ·-Homicidal Cut thmat
·:i'' ~
·~,
, .. et.'da·l.ciltfliiPat
,, . . . .•.• k
t Site (a) Mostly on the lt. side and front and partly (a) Mastly in front and partly on either a both
on rt side of neck, in case of right handed sides of the neck
person
(b) High up on the neck (b) At a lower level
2. Stope of the cut in depth Upward No slope or downward sloping
3. Direc1ion From left to right and above downward in a Transverse and from right to leftvmen the assaJ.
right handed person lanrs position is below the level of the neck d b!
victim. Transverse and left to right IM1en assai-
anrs position is at the head end of the lying vic-
tim. If the assilant was on the right side-oft.!
victim, then direction of the v.oond v.ooldbe 11m
left to right
•
4, Tailing Present at the rlQht end of the wound in a right May be present on either side depending on lie
handed person position of the assailant
·5.: Hesitation cuts Present Absent
6~- Severity of the wound One or two are severe, others are superficial o" ;:re of equal severity
hesitation cuts
7. Defence cuts Absent Present
8. Marks of resistance Absent Present
,9: Secondary wounds Self-inflicted incised wounds may be present Other homicidal wounds, defence cuts,I'TB1<s a
on other approachable parts of the body resistance present on ()!her parts of the~
fO. Weapon Held in cadaveric spasm.of the hand or Usually absent. Sometimes after killing, the
present nearl:>y weapon is placed in the hand of ihe victim
n. Vessels Carotid arteries are usually spared, because The vessels remain vulnerable due to lack of
before injuring himself, the suicide stretches his this manoetMe
neck upward, when these arteries shift behind
the sternomastoid muscles
12. Bleeding As because a suicide cuts his neck in standing As becasue in most cases the allsailant cuts
or sitting position, a good amount of blood trick- the neck of the victim, being in lying position,
ies dov.m in front of the chest and the abdomen blood trickles down by the sides of the neck
1~.; Foreign materials like Substances like foreign hair, shirt button, etc. May be present in the hand of the victim,
hair, etc. will not be present in the hand of the victim gripped in a state of cadaVeric spasm
14, Corresponding cuts on Absent as the person cautiously removes the Cuts may be present on ctothes as the assailant
clothes Clothes to get a clear field to cut the neck being in h$te is unmindful about the clothes
15. Circumstance Closed room bolted from inside u secluded Place~f occurrence remains approachable to
place. which appears undisturbed; the body other which appears disturbed due to struggle
may be found in front of a mirror with tl)e assailant latent fingerprint, belongings
of assailant may be available from the spot
_1(). Sl!icidal note ~iiY be present _. -~nt

Fabricated wounds wounds to show that he had resisted the

commission of the offence.
Fabricated wounds are wounds inflicted with 9. By policemen, soldiers or factory work-
some motive. These are superficial injuries, ers to avoid duty.
mostly self-inflicted or occasionally inflicted
with the help of another person. When self-
inflicted, these are on the approachable parts CHOP WOUNDS
of the body. When inflicted with the help of
another person these may be placed else- Chop wounds are·incised wounds produced
where. When incised wounds are produced by by striking with sharp cutting;.heary c{r mod-·
oneself, then the injuries bear all the features erately· heavy weapons, like · axe, chopper,
of self-inflicted incised wounds. Apart from tangi, katari, kukri, sword, etC. These wounds
incised wounds, abrasions may also.be caused a.- t:; ...;omparatively .deeper and broa4er than
with the same pUIJ.loses. But it is unlikely that, .the incised wounds produced by drawing or
bruises, lacerations or deep stab wounds will saw-like movement of light sharp cutting
be fabricated in nature. The usual :motive for weapons. Abrasions or contusions may be
producing fabricated wounds is to bring a false produced at the II)iJ.rgiDS due :to friction with
cllarge of assault against an enemy. The other the: surface of the thick and heavy biade .
reasons to produ(lE) fabricated wounds are to These ~ounds· usx:rany have :bevellizyg Al~o.
alter the appearance .of an injurj to at~ach When ·inflicte~i- ori a liinb of over the ~e:ck; · ....... ·
more importance_to the same or in case ofthe · th~n there. ~Y be . amp~t~tion;:or ~ot~l ... : ··:
assailant to alter the appearance of a wound sev~retice at the p~rt: ,Wb.e~:~ .~ei6h.t¢ii: ·. ··.
. •. l .• •
sustained by him during a criminal act, so that.

• • ·.
,,~
~ ~:
~ ~.
~
-~. ~ -_.-.. . .. . : :. . ·.
·~ ~x.: .~· ·~ ~ ~
'.,~
:~ ~ ~ . ...: ·- .... .
ne cannot be linked with the act: ·. • .• • . • :.·· ·: ' I ; o • •• • • ., \ • • ' o •
·~ : : -~ .: ·~ ~
·.. :.
' • •. • • • c •• :
The motives in 4etail ~: .-· -:· · · : ·. · · · ~·}}< ..·...,. ' · ·;:~· .': .<·~
· · · ·. . · · · · · ·~ ·t -~ ~ ~~· 1o:3i:.~apeS ~Ot. iAds.e·d~~o~d
a
·To bring fw_se.ch.arge of.assauit;:agains~ :~ · .... · : ·m'ay ·varY' ctepending on
an enemy. ',. :. •' . , .. . .. , . dir!lc~iQn : o(vRdarfining
• . . . . . .;• .• ' ' : • • •• ~ ••. inusG>Ie· nbie' ..; . :: .. : .
To alter tM 'app_e arance of a ·simple in~ •·. · · ·.:·· : . ~: : >: . : f·.:·· · .. · ,.. ·;~:; : ·:·.: .·.
·
jury to attract more attention • · · · ·. -''. ·- ·b.~"·
· ·a :, • · ·..... · ,. · .,,;·
· ·. ···;·· ··.... ·· ' . .. , ·· ·' .·.:. ·.:· ·:·.
· · ·•··
• -~ u •: ,· " :. • ~ '' ." · : ' ; ' II ' , o ~-: .. : · , : . • '•• / ' •. -. ·~ : · • • • ,p '• _. : : ,
In case ofth,e assailant, the appearan~ pf. · .. ;;:; ·_.; . .··: :.·.,:-; , ... <:t.:;..\ . ;.:.:;.:··::~·:· :.-~'.: :..,_~·.:_::->. '· .~ ·. ·
an injurY he "s!fstained·W.l_i~l~ ~~aui~g.a ~:: ·:. . . . . .-. . .. -
~on,
•' . :.
may
be altered by fabn:cati~..· . ~· : · · ·.. :· . , ··~ ·~~
'-, ',:f.~ • ' . ~ .... ~ ... ;·.:.,·." ,.. ,~ . :~: - ... ~ ' \ .. :.<-·~;~ · ·-:.·.. ·
,::.: : ... : ·. . .. .. :, . ·.... : -.' ·, ....
.~ ~~.!~ · .- l ...... .
To claim compensation 'or damages·'.:.;. · • · ·. · · ·. . "' ..~ -..·;!"·· •... /.. :•.; .;. .- . <· ·· . .
. . ~~ .. .· .... ·. :.~ .. ~ . _. ...... ~· . . -: . :~ _ --~::. ··~.:~. ·-· · '.: ·:.:-~·;:"_~~t ·~·R.-: ·~ ·~ "' .. . .
::: By an assailant, to establish ·a grob.nd of ' ·: · · ' . '· • • ~.
;. r· ·.·~ .:· ."• :·. .·: · :
• • to • ' « ~· · ~
! , · ,
self defence. ·. :. . · " ~- ·· • ··• •..

By prisoners, to bring a charge of atroc-
ity against a jail or police officer.
By a woman, to bring a charge of sex of-
_., .
fence against an innocent.
In house breaking, theft or q~coity cases, •' ·· ·· ·
E: guard who acts ·in .conni¥ance with .. F.id.·)b:~; l~cleed ~~~nd·:·~e~ ·d~ftried.~h~rp arid clean
criminals, ·~ay p~odu~e f~bricated · :.· ·· · -~ . marg· ·. . :. . · .. . . . .. ' ' · ' ·
.. · .
Fabricated wounds wounds to show that he had resisted the

commission of the offence.
Fabricated wounds are wounds inflicted with 9. By policemen, soldiers or factory work-
some motive. These are superficial injuries, ers to avoid duty.
mostly self-inflicted or occasionally inflicted
with the help of another person. When self-
inflicted, these are on the approachable parts CHOP WOUNDS
of the body. When inflicted with the help of
another person these may be placed else- Chop wounds are incised wounds produced .
where. When incised wounds are produced by ·b y striking with sharp cutting;.heavi a~ mod-.
oneself, then the injuries bear all the features erately· heavy weapons, like.·axe, chopper,
of self-inflicted incised wounds. Apart from tangi, katari, kukri, sword, ek. These wounds
incised wounds, abrasions may also.be caused. a.-t ..;omparatively .deeper and broa~er than
with the same purposes. But it is unlikely that, the incised wounds produced by drawing or
bruises, lacerations or deep stab wounds will saw-like movement of light sharp cutting
be fabricated in nature. The :usual motive for weapons. Abrasions or contusions may be ·
producing fabricated wounds is to bring a false produced at the II)iJ.rgins due to friction with
charge of assault against an enemy. The other the. surface of the thick and ·heavy ·biade. .
reasons to produce fabricated wounds are to These ~ounds· usualJy ha~e· bevelliiJ.g .$o..
alter the appearance of an injury to at~ach When inflicted a lirllb .or over on
neck, .•. ... the·'
more importance to t}le same or in case ofthe . them there. may be . ampu;tation\o~ f.ot~l ·. ; .: :::
a~sailant to. . .alte. ~ the appearance of a. . wound
: . . . ,·_. . . .: ·, ·. ...
::. .... ' / ~ '
• • . · t .. . . . . ·. sev~rence at th~ pwt;: Whe-q.a;tl J!.Xe;oH_ a;ngi.: · .

sustained by him during a Criminal act, so that'. • • ' ' ' .~. ' • •':L ~. · ', . .. ,: ,' '4.: ~:: :· :,~::· ... ·•• '
. .. ..
o ;• •
. ~ . . ·.. ..~ ~ :
he cannot be lirtk~d wi·th tl~e act: . · ·. •• •• • : •• : . • j : ··· . ':i..: .• -:~ . \ . .
. ~ :.. ~ ~~..... .. .
The motives in ~etail ary: . .. -. · ·
. •. . ·.: : ·• '· ..
. ":::·:·· . ·'·. : '- · -._-;;·. . ·~
..4
>·': ·.:.
• \ .. • .:
• · • · •. ~~'~ ch
. ·• ·· · . • •• : .. , • •.: ~ ~g . 1o:3i:'·Shaperot ·i~cis.e·d ~wo~d
L ·To brin.g a 1w.se . arge of assault,: against \ . - ..· ·. , • : :· ~:. .. · : ·may ·vary depel'l~ng on
·_} an enemy. ·. :: . ·.. _ .. . ·. . .. · .• : .. . dir~ctiQn·:ot \mda,tining
~ • _ _ _ . - ·. . • • . ." : o ~ -. ··\muscle tibie· ·: : ':~ .: ;
2 . . To alter thi') 'a ppearance of a ·simple in~ . · . ·· · ;:··. · ·~- ::~. ·: : ..· ·., ·. · .. ·; J;:.· : · . .
-jury to attract more attention_·.·.·.··:: ·. ·.· .~ ~: :: ·~- ~~-~: _.... ·.:ti·:;· ~. '}:-·~:.~·:::··--.~::_:,:: :<'·:;',
3. In case of th,e assailant, the a~p;ara4~·-
pf: . ·.
an. injury·h~ 'Ei!tstained· ~J;tj}~ a~~auiimga : ~ . ·:. .
- .~: _.' : ..::,: ~...·.;_<_·: <::r\_·~ '~{ :.;._·;;~:-_,~· :· _:?._.-~ ·_,_ ..:_>-.
.
. ': ·.~ ·... .'
.p~on, maybe.altered by· fal:rn~ti.ob. ·.:· : ·. . . ~.~ : ·;.:.;. ~: .... . · . ...:.. ·.
! ;; :::;:~::::::~~::if·: . :<· '· ,yr_:~~?::.k:?;~;"~::.:·.·;' .

self defence. · ·· · · · '· ·· ·· ' ··: -~·.;·
6. By prisoners, to bring a charge of atroc-
ity against a jail or police officer.
7. By a woman, to bring a charge of sex of-
fence against an innocent.
8. fu house breaking, theft or Q.acoity cases, ,.. · . · . . --. "
the: guard who a~ts ·in ,oonp.i~ance with . . F~\O:Sa~ l~~~~~d ~~~nd\v~li ·d~.firied,~harp arid clean
·:tb.e criminals, mayproduce ...f~bricated -:.: . .• ..· . . margin ·. · -~.. .• .. : : ., .... ' ' ....

'·
FIQ. Suicidal cut throat by it. hand ;

mark the tailing on it. side. By
L courtesy-Prof. G.B. Tripathy,

BHU
10.38: Multiple superficial parallel incision of neck,

self inflicted
10.35 Suicidal cut throat; mark hesitation cuts at the

start and cut on the medial aspect above wrist
Direction of strike
Flapping or
bevelling - _, \+- ,
\
F ; Incised wound due to striking Rg 10.39: Multiple superficial transverse parallel

showing bevelling incisions on abdomen (self-inflicted)

Ftg. 10.39(a): Homicidal cuts over scalp of head, face _ 10.39(b): Homicidal incised wound and bruise on
and ear face with incised wound on ear
10.39(c): Homicidal cut throat

FIQ. 10.39(d): Laceration and incised wound with
disfigurement of face (Homicidal)
- ---'
10.39(e): In a suicidal cut throat case cut over rt.

index finger due to use of a double edged
razor blade
fF M -241
310 I PRINCIPLES OF FORENSIC MEQJONE I
I
Fig. 10.40: Ciose view of presenting Fig. No. 10.39(f)

page 369 (bottom) Fig. 1.0.41 : Suicidal cut throat. No hesitation cuts
FIQ. 10.42: Homicidal cut throat inj. with defence cut on Fig. 10.43: Homicidal incised wound.
it. wrist By courtesy- Prof. VCS Verma, Darb hang a
Fig. 10.44: Murder by cut throat; it. arm - acquired

abnormality

FIQ . 10.45 & 46: Both mutually and concurrently inflicted fatal incised wounds on the other with the help of shaving
blades
10.47: Homicidal death by cut throat, injury on neck

(not visible). Note the adhesive plaster used 10.48: Chop wounds. By courtesy - Dr Nayan K
,_______ to close mouth and tie hands - - - - - - - - - ' Mohanty SCB Med College, Cuttack
~---------- ------~
,.
Fig. 10.49: Multiple chop wounds on face Fig. 10.50: Decapitated dead body- At. lat. position

Fig. 10.51 (b): Neck in case of beheaded body.

By Courtesy- Dr Nayan K Mohanty
SCB Med College , Cuttack
Fig . 10.51(d): Herniation of intestine in a case of stab

Fig. 10.51 (c): Beheaded dead body in supine position on abdomen
L__________ -----------------

chapter 10: MECHANICAL INJURIES / 373
Position of the
assailant ---.
Toe end of
weapon
striking the
body last Heel end of weapon
striking the body first
Superficial
toe end of the~
wound ~Deeperheelend
of the wound
Fig . 10.52:"Determining the relative position of the Fig. 10.53: Cellular infiltration in incised
assailant from a chop wound wound ( x 100)
~, 10.54: Macro phages and histiocytes - incised Fig. 10.55: Fibroblast in the healing process of incised
wound ( x 450) wound 48 hours ( x 450)
. 10.56: Incised wound -new capillary formation -

... I
10.57: Complete epithelisation of incised wound -

96 hours ( x 450) 120 hours ( x 450)

374 I PRINCIPLES OF fO RENSlC MBDICINE
I
Fig. 10.57(a): A case of crush injury after ski. ·.:~r::fllng
...__ _ _ _ By_c.
_o_u_rte_sy
_ - _o r_ A_tfd s
_h_a_ke_b_A_hamed I j Fig. 10.57(b): Blunt force injury with haemorrhage
.___ - - - - -- -- - - - - - - _I
Fig. 10.57(c): Bullet injury over chest
Fig. 10.57(d): Closer view of Fig. 10.20.

Fig. 10.57(e): Crush injury of head fall from 16th floor of I
~ -- -- - - -- --- ----~----'
1_ _ _ _abuilding_ _ _ -------

chapter 10: MECHANICAL INJURIES / 375
like weapon is in use, the part of the wound Thus, punctured wounds may be caused by
nearer to the assailant (otherwise known as the tip of a knife, dagger, sword (sharp cut-
heel end of the wound) is deeper than the ting pointed weapon); arrow, spear (have
end distal from the assailant (otherwise pointed end but may or may not have sharp
known as the toe end of the wound). Thus, edge) ; needles (have pointed end but no sharp
identification of the heel end of the wound is edge), end of an iron rod (not pointed or sharp
important to know the relative position of the edged). Bullet or pellet injuries are punctured
assailant and the victim. wounds caused by high velocity projectiles
(considered under "fire-arm injuries").
Medicolegal importance of the chop
wounds Varieties of punctured wounds
Punctured wound may be of the following

1. Chop wounds are mostly homicidal in na- varieties:
ture. Accidental chop wounds may be
1. Penetrated wound: Here the wound ter-
caused by sharp part of an instrument
minates inside a body cavity or viscus,
like the blade of a fan, and mostly hap-
e. g., penetrating wound ending inside the
pens in factories.
abdominal or chest or cranial cavity.
2. From the heel end of chop wound the rela-
2. Perforated wound: Here part of the
tive position of the assailant and the vic-
weapon passes through and through the
tim can be known.
whole thickness of any part of the body,
3. The type of the weapon used can be said. e.g., when the tip of a weapon enters the
4. When amputes a limb or when injures a body through anterior surface of the
bone or when poses danger to life, a chop chest and exits out through the posterior
wound will amount to grievous hurt. surface of the chest. In a perforated
5. Though, being deeper and wider than wound there will be two outer or exter-
othervarieties ofincised wounds, a chop nal wounds with a single strike, (a) wound
wound heals slowly, yet a more or less of entrance, the wound through which
fixed schedule is maintained. Hence some the weapon enters the body and (b) wound
idea about the time of infliction of the of exit , through which the tip of the
wound can be formed. weapon comes out of the body.
3. Punctured or stab wound without caus-
ing penetration to a body cavity or with-
out perforating the whole thickness of the
body. Here the tip of the weapon termi-
Punctured or stab wounds are deep wounds nates inside the body except in a body
produced by the pointed end of a weapon or cavity.
an object entering the body. Depth is the
greatest dimension of punctured wound. Features of punctured wounds
The pointed weapon may or may not have 1. Length of the external wound - The
sharp edge. Punctured wounds may also be length of the external wound (wound of
caused by an object or weapon having no entrance) should correspond with the
pointed end, e.g., blunt end of an iron rod. breadth of the blade of the weapon at that

376 I PRINC IPLES OF FORENSIC MEDICINE
point up to which the blade of the weapon when the whole length of the weapon
enters in the body. But the length of the enters the body but has not produced any
external wound is usually shorter in wound of exit. Ifthe whole length ofthe
measurement than the said breadth of blade of the weapon enters the body, then
the blade~ or body of the weapon. Simi- surrounding the wound of entrance there
larly, the length of the wound of exit is will be a contusion or abrasion due to fric-
also slightly shorter than the breadth of tion or pressure by the hilt or blade-guard
the blade near the tip which comes out of the weapon. (see Fig. 10.62). If the
through the exit wound. This shortening whole length of the weapon does not en-
in length is due partly to elasticity of the ter the body, then there will not be any
skin and partly to the contraction or post- hilt mark in the form of abrasion or
mortem shortening of the underlining bruise. In such cases, the depth of the
muscles during the phase of rigor mor- wound will llOt correspond with the
tis, particularly when the muscle fibres length ofthe blade of the weapon. Simi-
are cut across. larly, in case of a perforated wound, when
a part of the weapon comes out through
2. Breadth of the external wound - Breadth
the wound of exit, the depth of the wound
ofthe wound of entrance or the wound of
will not give the length of the blade of
exit should correspond with the thickness
the weapon even though hilt mark may
of the corresponding part of the blade of
be present around the wound of entrance
the weapon, up to which it has passed
indicating that, the whole length of the
through the wounds of entrance and exit
blade passes through the tissue. Further,
respectively. But in some cases the
the · measurement of the depth of the
breadth of the wounds may be more or
punctured wound over the chest and the
less than the thickness of the correspond-
abdomen may not correspond with the
ing parts of the weapon, depending on the
length of the blade even though, the
elasticity of the skin, the direction of the
whole length of the blade might have
underlining muscle fibres and whether entered and there is no wound of exit
the muscle fibres have been cut across. indicating that, no part of the blade of
If the underlining muscle fibres run the weapon remained outside the body
across the length of the external wound when the victim was stabbed. This may
and if they are not cut then shortening be due to various reasons. When a per-
of muscle fibres due to rigor mortis will son is stabbed in front of the chest, the
reduce the breadth of the wotmd and if lung, if punctured, will collapse and will
the fibres are cut then their shortening be drawn backward and upward at the
will cause increase in the breadth of the point of its attachment. Hence, measure-
external wounds. ment of the depth of the wound from the
3. Depth is the greatest dimension of a punc- anterior chest wall to the point of its ter-
tured wound. The depth of the wound mination will increase during post-
usually depends on the length of the mortem examination of the dead body.
weapon or the blade of the weapon up to Conversely, if the stabbing is on the back
which it enters in the body. Depth of the of the chest and if there is puncture and
punctured wound should correspond with collapse of the lung, then due to the shift
the length of the blade of the weapon, of the lung posteriorly to the point of its

Fig. 10.58: Death due to penetrating wound injuring II. Rg. 10.59:A- Arrow injury. Arrow in position . Victim
common iliac artery. Note the site of injury survived after operation
which ended intra-abdominally. Note a few
drops of blood
FIQ. 10.59(a):
Same as
Fig. 10.59
Rg. 10.59 : B-Arrow heads removed, vide 10.59A
~
Fig . 10.60: B-Arrow which went inside chest cavity.
Courtesy- Prof. VCS Verma, Darbhanga,
Fig. 10.61 : A - Arrow head recovered from a dead body.
Courtesy - Prof. VCS Verma, Darbhanga,
i
Medical College . Medical College _
'------ - ~~~~~------~

1 2 3 4 5 6 7 8 9 10 11 12 13 14
Fig. 10.62: Varieties of weapons:
1 and 2 - Spear head - sharp pointed
3 - Ramda - heavy sharp cutting also pointed
4- Da- heavy sharp cutting, also pointed
5- Sickle- sharp cutting curved, pointed
6 and 7 - Kukri - heavy, sharp cutting pointed
8 - Dagger - sharp cutting pointed
9- Sharp cutting, flat ended
10- Rampuria - sharp cutting pointed
11 - Dagger - sharp cutting pointed
12 - Bread knife - sharp cutting
13 - Kitchen knife - sharp cutting pointed
14- Pocket knife - sharp cutting pointed
2 3 4 5 6
Fig. 10.63: Sharp cutting heavy and sharp cutting pointed 2 3 4
heavy weapon: (1} Da, (2) Ram Da, (3) Tangi,
(4) Single edged sword, (5) Double edged Fig. 10.64: Pointed weapons: (1 & 4) Gupti, (2) Bow and
sword, (6) Axe arrow, {3) Spear

~g. 10.67: Sharp cutting heavy and pointed weapons

or for that purpose the pressure, the
measurement of the depth will increase
which will obviously not correspond with
the length of the blade of the weapon
IFig 10.65 : Sharp cutting , sharp cutting
I The depth will measure more. Measure-
pointed and blunt weapons ment of depth of a punctured wound
------
should better be done on dissection table
in case of a dead body or on operation
table in case of a living subject.
4. Shape - The shape of the wound of en-
trance in case of stab wound depends
mostly on the shape of the weapon or
shape of the edge of a weapon When a
double edged pointed weapon is used, the
external wound is elliptical, spindle
shaped or slit-like in appearance. When
a single-edged pointed weapon is used,
Rg. 10.66: Diff. types of weapons- sharp cutting heavy, the external wound will be triangular or
sharp cutting light, sharp cutting pointed wedge-shaped In spindle shaped or ellip-
[ _.,IB.pvl:,
tical wounds produced by double edged
attachment, the measurement of the weapon, both the margins and angles will
depth from the wound of entrance on the be sharp, clean and well-~efined . In
posterior wall of the chest to the lung will wedge-shaped wounds produced by sin-
be less than the length of the blade of gle-edged pointed weapons two margins
the weapon, though whole of the blade and one angle will be sharply defined. But
might have entered the chest. If the stab when a single-edged sharp cutting pointed
is on the anterior wall of the abdomen, a weapon strikes the body at an angle with
weapon with a 3" long blade may reach a the sharp edge touching the body first,
much deeper point inside the abdomen and then an elliptical external wound
due to yielding of the anterior abdominal with sharply defined margin and angles
wall, due to application of excess pres- may be produced, as the sharp edge will
sure. Hence, on withdrawal of the weapon cut the tissue and make way for the rest

of the weapon. However, due to the elas- skin of the affected part. When a single
ticity of the skin and course of the under- edged weapon is used, the blunt margin
lining muscle which may be cut across, may produce a "fish tailing" angular ex-
the shape of the external wound caused by tension of the wound at that end.
double edged weapon may be oval instead 6. Direction -Direction of the track of a stab
of being elliptical with increased gap be- wound should be studied in course of dis-
tween the two margins. Due to the same section of a dead body and on the opera-
reason, the margins may not be uniformly tion table in case of examining a living
curved but may sometimes be partly subject. The direction should be described
twisted. With a pointed conical weapon the in three terms , e.g., when a weapon has
external wound will be circular with irregu- been used from above, back and left side,
lar abraded :margin. A pointed weapon with the direction of the track of the wound
a cylindrical body will produce more or less will be downward, forward and from left
same type of external wound but the mar- to right. Of the three terms of descrip-
gins here will be more irregular and un- tion, the one which is most conspicuous
even. With cylindrical weapon without a should be described first and the one
pointed end, the margin of the ·external which is least conspicuous should be de-
wound will be irregular and a part of the scribed last. Thus, when the direction is
skin from the area of the wound of entrance described as downward, forward and from
may be pushed inside the depth of the left to right, it should mean that, the
wound. When the cross section of the body downward direction is most conspicuous
of the weapon is a square or a rectangle, than the other two and the forward di-
then a criss-cross external wound may be rection is more conspicuous than left to
produced. right direction. Direction of the track of
5. Margin - When stabbed with double- a stab wound along with the site of the
edged sharp cutting pointed weapon , both entrance wound , tells about the relative
the margins of the elliptical external wound position. of the victim and the assailant.
will be clean cut, regular, sharp and well 7. Hilt mark -Most of the sharp cutting
defined. When caused by a single-edged pointed weapons have a hilt or hand
sharp cutting pointed weapon, the wedge guard in between the butt and the blade,
shaped external wound will have two long, so that during use the hand will not slip
clean cut, regular, well defined margins down over the blade of the weapon and
with one short irregular margin. When get injured. In a stab wound, the whole
caused by pointed or blunt ended weapon length of the blade is pushed inside the
without any sharp edge , then the margin body; then the hilt strikes against the
will be irregular, uneven with abrasion, skin around the wound of entrance and
contusion and even tears . Hence exami- keeps its mark over there in the form of
nation of alleged weapon of offence if avail- abrasion or occasionally in the form of
able should be examined to match the ef- bruise . Thus , hilt mark has two
fective part of the weapon with the shape importances . Ifthere is abrasion due to
of the external wound and sometimes the hilt around the wound, we can say that,
depth of the wound, say tapering curva- that wound is the wound of entrance and
ture length of the blade, the hilt , allow- that the whole length of the blade of the
ing maximum depth of extrance and mi- weapon was pushed inside the body and
nor injury and/or impression over the the weapon has a hilt.

8. Haemorrhage - In case of stab wound Medicolegal importances of stab wounds

internal haemorrhage is more than the
external haemorrhage due to injury to The following informations may be obtained
internal vessels. The extent of internal from a punctured wound:
haemorrhage may not be guessed untill 1. About the nature of the injury - Whether
the body is dissected open. it is suicidal, homicidal or accidental.
9. Injury to the internal organs - In stab Generally speaking, stab wounds are
wounds, injury to the vital internal or- most commonly homicidal, next in occur-
gans is more common and is the real dan- rence suicidal and lastly accidental.
ger. Stab wounds over the head, neck, Homicidal stab wounds are usually more
chest or abdomen are obviously more than one in number, all are quite deep, may
dangerous due to possible injury to the be located anywhere on the body, including
vital organs. self unapproachable parts. In homicidal cases,
the covering clothes usually bear correspond-
Examination of punctured wounds -Ex-
ing cutmarks or tears. If the victim was as-
amination of punctured wounds require extra
saulted in standing or sitting position, then
vigil, because these wo-ilnds have greater
the direction of the wound will be downward,
depth which cannot be examined from outside
if it is located at the upper part of the trunk.
and such, punctured wounds are expected to
Defence wounds and marks of resistance may
cause injury to the vital organs of the body
be present on the body. Foreign materials like
and extensive internal haemorrhage.
foreign scalp hair or shirt-button, etc. may be
Like other injury cases, here also exami- found in the tight grip of the hand of the vic-
nation of the clothings is an important part tim in a state of cadaveric spasm The weapon
of the total examination. The clothes should of offence may not be available on the spot.
be examined for any corresponding cut marks The place of occurrence will remain approach-
or recent tears, blood or other stains. These able to others and will show signs of distur-
findings should be properly located and re- bance. Concealed punctured wounds (see be-
corded. The external examination of the low) are almost always homicidal in nature.
wound should take note oftheir number, ex- Suicidal stab wounds are located on the
ternal dimensions_.and exact location in rela- approachable parts of the body, more com-
tion to two fixed anatomical landmarks. The monly over the left side front of chest, neck
depth and direction of the track of the wound and lower abdomen. In many cases, the main
should not be attempted from outside with deep wound is surrounded by multiple super-
the help of a probe. Such an attempt may ficial punctured wounds which are-'the prod-
cause further extension of the depth or ex- ucts of hesitating mind. The direction of the
tension in a new direction during probing. If track of the wound will be backward and up-
the victim is living, then the depth and direc- ward. The main wound may be only one, but
tion of the wound should be examined on the sometimes the weapon may be pushed in more
operation table, so that, danger of further than one direction through the same wound
damage or additional haemorrhage will not of entrance without withdrawing the weapon
be there. If the person is dead, then depth totally out of the body. The covering clothes
and direction of the track should be exam- may not bear corresponding cut marks as that
ined during dissection of the body. Examina- may be partly removed from the area while
tion for medicolegal purposes should not cause doing the act. The weapon may be held in the
delay in the treatment of the injured. hand in a state of cadaveric spasm, or it may

be present near the dead body. The butt or 4. From the depth and the tissue injured,
the handle of the weapon may bear the fin- the amount offorce used can be guessed.
gerprint of the deceased which may of course 5. Like incised wound, time of assault can
be so made , by the assailant in a homicidal be assessed from the state of healing of a
case, by pressing the fingers of the victim on stab wound.
the handle of the weapon. No defence wounds
6. Power of volitional act after sustaining a
or marks of resistance will be present on the
stab wound on a vital organ - After sus-
body, but some self-inflicted incised wounds
taining a stab wound, involving vital or-
may be present on the other approachable
gan, a person can perform some volun-
parts ofthe body. The place of occurrence will
not be disturbed and it may be a secluded place, tary acts like walking a distance or writ-
not approachable to others. Sometimes a sui- ing a letter, e.g., after sustaining stab
cidal note may be left behind by the suicide. wound on the heart. This is possible if
In some cases the suicide might have tried the weapon did not enter the chambers
some other method before stabbing himself of the heart or if it enters obliquely, then
to death. Evidence in support of. this may be during each contraction, the track of the
present on the body. wound closes and that prevents excessive
rapid loss ofblood.
Harakiri is a process of committing sui-
cide by causing extensive stab wound on ones 7. Post-mortem punctured wound may be
own abdomen. caused in '1 body, floating on water which,
if strikeu ·" projected part of a ship or a
Accidental stab wounds -Accidental stab- jetty, rHay sustain post-mortem puncture.
bing may occur when a person falls on a
pointed weapon or object. It may occur when 8. Therapeutic punctures - Parenteral in-
an arrow strikes an innocent person, instead jection of drugs is the example of thera-
of a hunter's prey which was actually aimed peutic puncture .
at. Accidental punctured wounds may also be Concealed punctured wound - These are
caused when a man is gored by a homed ani- punctured wounds produced by needles , nails
mal . Accidental punctures may be caused on or pins , over the concealed parts of the body ,
anypartofthe body. There will be correspond- in order to cause undetectable injury to a vi-
ing cut or tear over the covering clothings. tal organ of the body. These are always homi-
The weapon or the object is always present at cidal in nature. Usual sites are the fontanelle
. the place of occurrence, often in situ in the of a new born infant to kill it by injuring the
body. The body may or may not bear second- brain; nape of the neck to kill by injuring the
ary injuries, also caused accidentally, when base of the brain; axilla andunder the fold of
present. But there will not be any defence the female breast to cause death by injuring
wound or marks ohesistance on the body. the lungs; under the fold of the left side breast
2. In homicidal cases of death due to stab of a female to cause her death by injuring the
wounds, from the direction of the track heart. Other sites being the medial canthus
ofthe wound and the site of the external of the eye , nasal apertures and soft palate.
wound, the relative position of the assail-
ant and the victim may be guessed. Causes of Deqth due to Punctured Wounds
3. From the shape and size of the extenlral . '-1
wound and the depth , the type of the blade 1. Injury to the vital organs like brain,
of the weapon used can be said. heart, liver, 'kicl.ney, lungs.

2. Intracranial haemorrhage causing cer- vessels and larynx or trachea.

ebral compression. 7. Vagal shock due to injury to larynx, uri-
3. Cardiac tamponade due to accumulation nary bladder, diaphragm.
ofblood in the pericardia! sac. 8. Air embolism, fat embolism
4. Haemothorax, pneumothorax, pyothorax. 9. Infection, abscess, septicaemia, peritoni-
5. Haemorrhage leading to shock. tis.
6. Choking due to occupation oflarynx and 10. Diaphragmatic hernia, duodenal fistula
trachea by blood, in case of injury to neck- leading to pancreatitis.
Table 10 5: D" erences between Incised Punctured and Lacerated wounds
,SINo Points lnC'fsed wounds ,- Punctured wound Lacerated ·mmds

1 sr.e I ~oa::h!lblaarea,but i Any\lilere ,bu tataJ ones n fJorryll;nere. but fatal ones ~&o
fatal~sateonll nt!Ck, on dlest and ab<b:nen cl'lest. abdomenand head
heaoand frontohMist COI'M10111y
4
s.
2 Weapon a agent
~le
Margin
~
S !liP edge o a cutting
Elhp1ical, spindleshaped cr
C'llal
Clea11 wt, smoo!h, sharp I
Pomled or elon~ed weapon Hard, bl\Jnt and rough ~po
C(cbjecl
Elliptica , oval. spindlef>hetped Irregular
or circt~larc
Usually clean out ami Mll lrregurar, uooven rapd
and well defined defined ool may bE!Irreg ar
5 Different dinmsiOOS length IS the !Jealest Oeplh IS the !JSlliest Leng1tl and breadltt are !JE!!ller
drnension dmensloo lhandapth
6 Mooa olprot11coon By draWirl!J sav. ·ng or By pusling !he po~nted end By frtction, s etching or
mklng 1he shaip edge compression
7. floor or deptn of tile ~MJurKl Clea11lycul Tapenng, cleafW ctJI or ragged R.apdv~lh loose ta£JS of tissue
B. Margir~al abrasion or tbsfl Atlrasloo we to ~Ill milY be Nlrasions ana bnlises ate
lnlise ~esenll:lut usually absent ust~ally jl'eoont lr1 the argin
g
Haemoof1age .t® and is external Internal haemootlage Is more Haemorrllage is less
-- :-
10 Bolle uooernea I Mey be eanly cu May C( may not be puoollsed Maybe actured
1 . Hair Cleanly cut Usuany cleen~ cut Ta-nw1th cri.J!Shlng ofhli bulb
12. Nati.Je Us1..ally suicidal. may be Usually h<lmicidal, somenmes u-ually aa:ldental, less
liomicidal, rarely accidental suicidal. very rareiy com!l'Kinly homicidal, very
acclcmtal rarely suicidal
3. Heali~ Quick follows a regular As in case of incised wound Delayed ciJe min ection
pattern a1 d schedute
14: Fore~gnbodj in the 'IIOIIlld .obsel t Usually absent, sometimes Dus anddeaismay be
fcbics of oovering doth are present
- 15. ;covering clothes Is,-!,._.. pushed inside

Cleanly cut or spared TcmustJaDy

Table 10.6: Differences between Suicidal, Homicidal and Accidental wounds

S/. No. Points Suicidal Homicidal Accidental
1. Type Mostly incised, sometimes Mostly stabs and lacerations, Mostly lacerated, sometimes
stab, very occasionally sometimes incised stab and incised
laceration
2. Site Accessible parts of the body Anywhere on the body Anywhere on the body
including vital parts including vital parts
3. Number Usually only a few Multiple May be of any number
4. Grouping Usually grouped Scattered Nothing specific
5. Hesitation wound Present Absent Absent
6. Tailing I tapering Presenl if incised Occasionally present Absent
7. Bevelling Absent Present May be present
8. Severity One or two severe All may be severe Nothing specific
9. Direction From II. to rt. in rt. handed Not specific Not specific
person. Towards the centre
of the body in general
10. Defence wound Absent Present Absent
11. Secondary wound Absent May be present due to struggle May be present
12. Clothes Usually spared Bears corresponding tear or Will have corresponding tears
cut
13. w~ Present in death clutch Usually absent May be left in Present, except in case of
(cadaveric spasm) or nearby the hand of victim to simulate vehicular accident
suicide
14. Motive or cause Present Present Absent

-
15. Scene of crime Secluded unapproachable May be secluded but remains Any place, may or may not pe
place app-oachable to others approachable to others
16. Sign of struggle Absent. No disturbance of May be present Absent

the place of occurrence
17. Suicidal note May be present ' Absent Absent
18. Foreign body in the hand Absent Foreign articles may be Absent
and place of occurrence present at the scene.
Foreign hair or shirt-button
may be present in the hand
of the victim in a state of
cadaveric spasm

The projectile, thus expelled out through

the muzzle end, can pass a long distance to
strike the target. Actually, the cartridge con-
(The use offirearm weapons is increasing rap-
tains gun po~der which when ignited with
idly. There may be various reasons. But cer-
the cartridge inside the chamber of the fire-
tainly it indicates deterioration of law and
arm weapon (gun), produces enormous
order. Possibly we are trying to reach closer
amount of gas which pushes the projectiles
to USA, the country where use of firearm is
through the lumen of the barrel in front of
so preponderant that it is said, the Ameri-
the chamber of the gun and then out of the
cans live in a "gun culture" state of society.
muzzle end of the barrel.
Further, possession of firearms in USA is
Every firearm weapon has the following
more common in females than in males, in
parts -
comparison to other parts of the world, ap-
parently due to feeling of insecurity by the 1. Stock or butt - This is the rear part of
females there. In UK use· of firearm in gen- the gun which is held in hand (in case of
eral is comparatively much less for strict vigi- short barrelled or hand rest gun) or is
lance of the state machinery. In USA number supported against the shoulder (in case
of fatal and non-fatal gunshot injury are of long barrelled or shoulder rest gun),
around 30000 and 200000 respectively per while firing one round of shot.
year. For our country the present author does 2. The barrel - It is the hollow cylindrical
not have a dependable statistic with him, but length of the gun which has the follow-
as said at the starting, the number of fire- ing functioning parts-
arm injury and death for this, both are on a (a) Chamber - It is the posterior part
constant rise.) of the barrel which accommodates
These are injuries caused by high veloc- the cartridge to be fired. The poste-
ity projectiles, called bullets or pellets. They rior wall of the chamber has a me-
produce punctured wounds. The capacity of tallic plate (breach plate), which has
a central hole for the pereussion pin
the projectiles to penetrate the tissue de-
of the hammer (see below), to strike
pends on various factors including the type
the percussion cap at the centre of
of firearm weapon and the ammunition
the back of the cartridge, which ini-
used.
tiates the process of firing of a round.
(b) The taper or leed - The inner diam-
Strudure of firearm weapons and their eter of the chamber-part of the bar-
components rel is wider than the rest part. The
part of the barrel, anterior to the
The cartridge (ammunition) contains the pro- chamber, tapers anteriorly. This
jectile (bullet or pellets). The cartridge in it- part of the barrel is known as taper
self has the device to push the bullet or pel- or leed. In a smooth-bored gun this
lets forward in high velocity, which when part of the barrel is termed as the
made to work with the help of the firearm, chamber cone.
causes the bullet or the pellets to leave the (c) The bore of the barrel - The vast
muzzle end of the firearm. length of the hollow barrel anterior
fF. M. - 251
386 I PRINCIPLES OF FOR-ENSIC MEDJGINE
Fig. 10.66: Rifle
a
(A)
Fig . 10.69: A- Cartridge and its contents
(shot gun) (a) Percussion cap, (b) Priming
mixture, (c) Post. metallic part of cartridge
\3Z:7 8
case, (d) Ant. card board part of cartridge
case, (e) Gunpowder or propellant charge,
(f) Thin card board disc, (g) Wad, (h) Thin
card board disc, (i) Pellets, (j) Thin card
Fig. 10.70: 1(a)- Land on inner surface of barrel, 1(b)- Grooves, board disc.
2- Taper of the chamber, 3- Chamber, 4- Percussion cap, 5- Rim 8 - Breach surface of cartridge case
of the cartridge, 6 - Percussion pin, 7 -Trigger, 8 - Trigger guard (a) Percussion cap.
groove
Fig. 10.71 : Cross section of barrel of a rifle
Fig. 10.72: Pistols with magazines of diff. models
2 ·, '3 4 5
Fig. 10.74: Cartridges of Rifled weapons. Note the size and
Fig. 10.73: Revolver with revolving cylindrical shape of bulleJs/cartrk:jges of rifles: (1) Pencil
magazine, each chamber of which acts pointed bullet, '(?)'Poirited.nose, (3) Round nose,
as the chamber of the revolver (4 & 5) Cartridges of Pistol

chapter 10: MECHANICAL INJURIES/ 387
Fig . 10.74(a): Different parts of Revolver

Fig. 10.74(b) : Types and parts of rifles

chapter 10: MECHA NI CAL INJURIES I 389
to the chamber cone or the taper is variety has rifling or is grooved- In addition
called the bore- to the commonly available varieties of smooth
(d) The muzzle -The anterior end of the bored and rifled guns (see below), some spe-
bore is the muzzle end of the barreL cific types of guns are also available to serve
some specific purposes. These also are usu-
3. The breach mechanism -
ally smooth bored, e.g., air gun, gyrojet and
(a) Hammer - Behind the chamber improvised guns-
there is a hammer with a pointed
pin (percussion pin) at the centre of Smooth bored guns or shotguns- Features:
the anterior surface of the hammer.
1. In smooth bored guns or shotguns the
(b) Trigger - Below the chamber there inner surface of the barrel is uniformly
is the trigger, which when pulled, smooth. In shotguns, either a single ball
causes the hanrmer to advance and or a charge of shots (pellets) act as pro-
the percussion pin of the hammer to jectile or projectiles. Smooth bored guns
pass through the central hole of the may be, (a) long-barrelled or shoulder
breach plate of the chamber to strike
rest type like ordinary shotguns or
the centre of the posterior surface of
maskets (used to be used by military).
the cartridge (percussion cap).
With maskets, bayonets are used to be
(c) Trigger guard - The trigger is sur- attached. (b) short barrelled or hand rest
rounded by a metallic trigger guard, type, e.g., some varieties of carbines-
so that the trigger will not be acci-
2. Loading - Shotguns may be muzzle load-
dentally pulled.
ing or breach loading. In muzzle loading
(d) Aiming of the gun is done with the type, instead of whole cartridge, the pro-
help of fore-sight (front sight) and pellant charge, i.e., the gunpowder, the
rear sight- To aim some target, the wad (see breach mechanism above), the
rear sight, the fore sight and the ball or the pellets, all are loaded and
target should be in a straight line. p acked in the chamber, one by one
(e) Safety catch - This is a safety de- through the muzzle end of the barrel with
vice which prevents firing even if the the help of a rod. The percussion cap with
trigger is accidentally pulled. the primer or priming mixture (see page
(f) The loading and emptying of cham- 391) is placed at the breach end sepa-
bers -The mechanism ofloading the rately. In breach loading, the cartridge,
chamber with the cartridge and complete in its make containing the
emptying the chamber of the used primer, the propellant charge, wad and
cartridge case, depends on the type the projectiles, is placed inside the cham-
of firearm weapon. (see below and ber through the breach end of the cham-
next page). ber, breaking open the breach end each
t ime, or by a bolt mechanism.
Types of firearm weapons (guns}
3. Number of barrel in each gun - A shot-
The primacy classification of the guns depends gun may be single barrelled, double-bar-
on the bore or the inner surface of the barrelled (placed side by side or one below
reL The inner surface of some of the barrels the other) or multi barrelled (more than
is smooth, while the inner surface of the other two barrels).

4. Choking - In some smooth-bored guns Paradox guns - In some smooth-bored

the terminal few centimeters of the bore guns the inner surface of the barrel near the
near the muzzle end is slightly con- muzzle is grooved like rifles . Such partly
stricted. This is called choking of the bar- smooth and partly rifled guns are called para-
rel. The degree of constriction may vary doxguns.
from 40/1000th of an inch to 3/1000th of
Muskets are smooth-bored long-barelled
an inch. The degree of choking is ex-
old type military guns with bayonet at the
pressed as follows:
muzzle end.
Table 10.7: ShoWing the different grade~ of choking of Rifled guns are comparatively more pow-
muzzle~nd of shotgun bare! erful guns. Rifled gun cartridge contains one
Degree of choking Degree of constriction
bullet as the projectile. The term "rifle" comes
from the riflings or groovings made on the
Full choke 40/1000 th of an inch inner surface of the barrel. On the inner sur-
Three quarter choke 30/1000 th of an il'jch face of the barrels of these guns, parallel
grooves (usually 4- 7 in number) are made
Half choke 20M 000 th of an inch
which run spirally all along the bore. The
Quarter choke 10/1000 th of an inch raised areas in between the grooves are
termed lands (Fig. 10.71). When a bullet is
Improved cylinders 3-5/1000 th of an inch.
forced forward after firing, for the first few
inches of its journey inside the barrel, it yields
Choking of the muzzle end of the barrel to the pressure exerted by the raised lands
has certain advantages. (1) It keeps the pel- of the inner surface of the barrel resulting in
lets compact and prevents their dispersion
the production of grooves on the surface of
up to a longer distance. (2) As a result of this,
the bullet. Similarly, due to the grooves on
the pellets act like a single ball and exerts
the ·inner surface of the barrel, parallel lines
greater impact at the site of the body struck
of ridges (or lands as these are known) will
and thus, there is a larger wound of entrance
with more penetrating power. (3) T'he chok- be produced on the surface of the bullet.
ing exerts momentary obstruction to the ex- Hence after travelling for a few em the bul-
pulsion of the pellets resulting in increased let will move forward with spiral twists along
pressure of the gas behind the pellets which the spirally arranged grooves on the barrel
ultimately causes expulsion of the pellets Thus, when the bullet comes out of the muz-
with greater force. Thus the muzzle velocity zle end, the following effects are available due
of the pellets is much increased. These all in to grooving or rifling of the inner surface of
their turn, increase the effective range and the barrel. (1) Spiral grooving in the barrel
penetration capacity of the pellets. gives spinning effect to the bullet and it spins
A single barrelled shot-gun may be cylin- around its long axis. (2) The spinning gives a
drical all along the bore or it may be choked straight trajectory to the bullet. (3) It pre-
at the rrruzzle end. In a double-barrelled shot- vents wobling of the bullet. (4) It gives per-
gun, one of the bore may be choked near the fection to the motion of the bullet to hit the
muzzle and the other is cylindrical all along. target. (5) It also helps to reduce the prob-
In guns with more than two barrels, one may lemoffoulingthe inner part of muzzle end of
be cylindrical all along and the others may the barrel from the unburnt gunpowder par-
have varying degree of choking. ticles.

Mechanism of loading and emptying the magazine with the empty cartridge case shifts
chambers of rifled guns its position, bringing the next chamber of the
magazine with another live cartridge , in the
The mechanism of loading and emptying of
line of the barrel , which then acts as the
rifled guns depends on whether it is a single
chamber of the revolver. In single action re-
shot, repeating, semi-automatic or automatic
volver, to revolve the magazine to bring the
weapon, or it is a revolver. However, all ri-
next chamber of the magazine with a new
fled guns are breach loading guns ·
cartridge in the line of the barrel, the ham-
In single shot guns , to load the chamber mer has to be manually pulled back after fir-
the breach action is opened and the cartridge ing of a round. In double action revolver, a
is placed inside the chamber. To extract the sustained pull on the trigger will cause auto-
used cartridge case, the breach action is to matic revolving of the magazine and shifting
be opened again. of the chamber after firing of one round.
A repeating gun has the provision for at- In semi-automatic variety of rifled guns,
tachment of a magazine which can accomo- for each round of loading, firing and ·empty-
date more than one cartridge . In this vari- ing of the chamber, the trigger has to be pulled
ety, there is a bolt action in the breach mecha- once. With a loaded magazine attached with
nism which opens the chamber on being . the chamber, each pull on the trigger will do
pulled back to eject the used cartridge case these three works during each round of fir-
from the chamber automatically with the pull ing. PISTOLS are examples of short-barrel-
on the bolt. With the emptying of the cham- led semi-automatic gun.
ber, a fresh cartridge from the magazine en-
In automatic guns , a sustained pull on
ters the chamber automatically . To fire this
the trigger will cause repeated firing , empty-
round of cartridge, the chamber has to be
ing of the chamber and reloading of the cham-
closed by pushing the bolt. Hence in this va-
ber with cartridges from the magazine till the
riety, for loading the chamber with cartridge,
. magazine contains a single cartridge. The
firing the cartridge and emptying the cham-
pressure by the gas generated during each
ber of the used cartridge case, the chamber
round of fire and the power of recoil of the
has to be opened and closed with the help of cartridges cause ejection of the empty car-
the bolt action and the trigger has to be tridge case from the chamber whose position
pressed Eeparately foreach round of shot. The is taken by a fresh cartridge from the maga-
magazine may be attached below the cham- zine. Henry Maxim and Richard Galting used
ber, as in case of ordinary long-barelled ri- the more expensive gas producing gunpow-
fles; it may be placed above or on one side of der mentioned above (smokeless ones) to
the chamber as in stengun or brengun or it generate force for cycling the mechanism of
may be included in the breach mechanism multiple rounds. (up to 600 rounds per minute)
itself, as in case of a REVOLVER in which as is used in varieties of automatic guns (ma-
the cartridges are placed in the peripherally chine guns).
located chambers of a cylindrical magazine ,
one chamber of which lies in the line of the
The cartridges (the ammunitions)
barrel of the revolver and that chamber of
the magazine acts as the chamberofthe gun . The cartridge of a shotgun and the cartridge
With firing of one round; the magazine re- of a rifled weapon are essentially different in
volves slightly so that the chamber of the their makes.

The cartridge of a shotgun- (Fig. 10 .69) nitrate or tetracene, gets ignited due to
the pressure and friction, and fire comes
The cartridge of a shotgun has the following out through the vents or openings on the
parts and contents- wall of the percussion cap.
1. The cartridge case - The longer anterior 3. Contents inside the cartridge case - Sur-
part of the cartridge case is n' ·:1de of card- rounding the percussion cap is the gun
board. The posterior part and the poste- powder or the propellant charge which
rior surface is made of brass. The mar- cannot ignite by pressure or friction and
gin of the breach end of the cartridge case which on being ignited does not produce
is rinuned, so that the cartridge can be flame but produces huge amount of gas.
properly placed inside the chamber and Usually the gunpowder of the shotguns
with pressure on the rim the empty car- contains charcoal, pot. nitrite (salt peter)
tridge case can be easily ejected out of and sulphur. This combination of the gun-
the chamber. The anterior margin ofthe powder is known as black powder, as it
cartridge case is twisted inward to keep produces much smoke . Nowadays
the pellets and other materials inside the semismokeless gun powder is in use in
case compact. The anterior part of the shot guns, which is a combination of80%
cartridge case is made of cardboard, for of black powder and 20% of smokeless
'
which, with production of gas inside the powder. Smokeless powder is ordinarily
cartridge case it can slightly expand, so used in the cartridges of rifles (nitrocel-
that the twisted grip by the anterior mar- lulose or a combination of nitrocellulose
gin will be released and the pellets can and nitroglycerine). The black powder
come out of the case. The posterior me- produces 200- 300 ml of gas per grain. In
tallic part keeps the shape of the breach front of the gunpowder, inside the car-
end of the cartridge intact. It helps to tridge case, there is a thin cardboard disc
maintain the right position of the car- In front of the cardboard disc is placed
tridge in the chamber, so that the per- the wad. The wad is made of soft sub-
cussion pin of the hanuner strikes the stance like felt, cork, straw or rug. In
percussion cap rightly at the breach sur- front of the wad there is another card
face of the cartridge. In the central part board disc. In front of this disc, the pel-
at the breach end inside the cartridge case lets are placed. The pellets are spherical
is the percussion cap. projectiles used in shot guns. Their size
2. The percussion cap - It contains primer may be variable, according to the need
or priming mixture and there are some and make. One ounce of pellets may con-
vents or openings on the wall of the persist of6 to 2,600 of them. Accordingly on
cussion cap. When the posterior surface the basis of the size, they are called dust
of the percussion cap is struck by the per- size (very small), bird shot (medium) or
cussion pin, the priming mixture which buck shot (larger) when single shot is used
consists of a mixture either of mercury that may be Rifled slug which certain ad-
fulminate, pot. chlorate and antimony vantage like that can have greater mo-
sulphide or of antimony sulphide with mentum and may travel a longer dis-
lead styphnate, lead peroxide, barium tance. In front of the pellets there is an-

other cardboard disc on the anterior mar- Explosive bullets have gun powder inside
gin of which the anterior margin of the them which ignites and explodes due to vi-
cartridge case is twisted. The functions bration when they strike the body and cause
of the wad are to give compactness to the fragmentation of the bullet (shot) causing
gunpowder, to prevent admixture of pro- extensive wound as a result.
pellant charge and the pellets, and pre-
vent leakage of the gas produced after Cartridge of a rifle- (Figs. 10.74 and 10.75)
the firing. Wad also cleans the inner sur-
face of the barrel after the pellets pass In a rifle cartridge, the whole of the cartridge
out through the barrel. To facilitate this case is made of metaL usually brass The
cleaning, some greasy material is soaked posterior margin of the cartridge case is ei-
in the wad. In between the propellant ther rimmed or grooved to facilitate its per-
charge and the wad there is a cardboard fect placement and good catch on it inside
disc so that the greasy substance in the the chamber and easy extraction of the used
wad will not be soaked by the propellant cartridge case. At the central place of the
charge and become useless. In between posterior part inside the cartridge case, the
the wad and the pellets there is a disc percussion cap is placed. The percussion cap
which in one hand prevents impregna- and the priming mixture inside it are same
tion of the pellets in the soft wad and on as in the cartridge of a shotgun. Surround~
the other, prevents leakage of the greasy ing the percussion cap is the propellant
substance from the wad in the pellets charge which is either nitrocellulose alone
which would otherwise become adhesive or a combination of nitrocellulose and nitro-
to each other, loosing their dispersion glycerine. These gunpowders are known as
capacity. The anterior-most disc, placed smokeless powders as they do not produce
in front of the pellets, give compactness smoke and rather burns more completely to
to the pellets and the whole content of produce more gas. One grain of the smoke-
the cartridge case. less powder produces about 800 - 900 ml of
gas. (See automatic guns in page 391) In front
Shots of different sizes are suitable for
of the propellant charge is placed the projec-
different purposes. Accordingly "Buck shots"
tile, the bullet Here, as because a single pro-
or "Bird shots" have different sized shots or
jectile is used, there is no need of wad and
pellets for hunting wild birds or other
hence, no need of cardboard disc in between
prey.
propellant cha.g-e and bullet and in front of
In some cases instead of multiple pellets bullet. The anterior part of the bullet remains
a ·single shot or metallic ball, usually made exposed outside the cartridge case. The bul-
up of lead, is used. "Rifled slugs" are single let is kept tight inside the cartridge case ei-
shot projectiles for shot guns with prominent ther by grooving called cannelure or by in-
parallel grooves on the surface. dentations, over that part of the cartridge case
which covers the bullet.
Rubber bullets or plastic bullets are used
to control riots and are fired from smooth In some types of rifle cartridges, there is
bored guns. These bullets have no penetrat- no percussion cap. Instead, the marginal rim
ing capacity. on the posterior end of the cartridge case

contains the primingmixture which is hit by striking the hard part of the target. it will
the percussion pin when the trigger is pulled. not get distorted . The jacket is made of alloy
The rifle cartridge can be of various sizes, of cupro-nick.el or copper and zinc or steel .
depending on the type of the firearm and the '
calibre of the barrel of the rifle in which it is Calibre or gauze of a gun
to be used. Calibre or gauze of a gun is the inner diam-
eter of the barrel . In case of rifled barrel, it is
Bullets of the rifled weapons the diameter measured between the lands and
The mass of the bullet is made oflead to give
not the grooves (see Fig. 10.71). The meas-
urement of the diameter can be expressed in
it weight and softness.. The weight gives
greater momentum to the bullet. Its softness tenns of centimetre or inch or in an indirect
way of expression. In indirect expression, a
helps to yield according to the riflings
(groovings) and lands on tpe inner surface of number is used which is actually the number
the barrel so that depressions and elevations of spherical lead balls that can be made of one
are created on the surface of the bullet which pound of lead, each of which will exactly fit
helps to get the bullet a spirally twisted move- the inner diameter of the barrel. Thus by a 12
ment which ultimately gives it the spinning bore gun it means that, if 12 spherical balls
motion. To avoid the problem of extra- soft- are made out of one pound of lead, then the.
ness of lead, antimony is added to make the diameter of one such ball will be equal to the
bullet a moderately soft alloy. inner diameter of the barrel. Helixo meter is
used to measure the inner diameter or the
The soft lead alloy bullet is given a cov-
gauze of the barrel of a gun.
ering with a jacket of hard metallic alloy so
that while passing through the barrel or while
Types of bullets used in the rifled guns
The type of the bullet, apart from the metal

used to give the mass and make the jacket,
depends on the size, shape of the nose, i.e.,
the anterior end and shape of the base, i.e.,
the posterior part.
According to the length, a bullet may be,
short, medium or large.
According to the shape of the anterior
end, a bullet may be flat-nosed ,round-nosed,
hollow- nosed, sharp pointed or pencil pointed
(very sharp pointed like the sharp point of a
pencil). According to the base of the bullet it
Fig. 10.75: Structure of a bullet of a rifle may be flat based , boat tailed , or streamlined
(1) Cartridge case, (2) Bullet,
(3) Groove at the base, with sabot . (see Fig. 10. 74, for some varie-
(4) Gun powder, (5) Percus- ties). In case of .some bullets the posterior
sion cap
part or the base ·pru:t is jacketed, which gets

expanded after corning out of the barrel and Fire - causes burning around the wound
while entering the body causing extensive of entrance and singing.
injuries. This type ofbullets are called Mush- Hot gas - scorching around the wound of
room bullets. entrance.
Unburnt and partly burnt gunpowder-
Firing of a round tattooing aro~d the wound of entrance.
When the trigger of the gun is pulled by Cardboard discs can pass for a short dis-
spring action by a shear movement, the ham- tance but do not possess the force in them to
mer proceeds anteriorly and the percussion cause any injury.
pin of the hammer strikes the percussion cap The wad can pass a considerable distance
with force. This causes a depression on the and when made of firm material and when
cap and thus exerts a pressure and creates the firing is from a short distance, can pro-
friction in the priming mixture inside the duce minor injury like abrasion or bruise
percussion cap which gets ignited and bums near the main wound of entrance.
with production offlaJ?e which ventilates out
The pressure created inside the cham-
through the vents on the wall of the cap and
ber of different guns, the muzzle velocity, the
ignites the propellant charge or the gunpow-
spinning revolution of the bullets and the ef-
der, when enormous amount of gas is pro-
fective range of different projectiles are shown
duced which creates high pressure that causes
in table no. 10.10.
widening of the cartridge case and relaxation
of the grip of the cartridge case on the bullet A bullet "YAWN" in its course (change of
or the contents of the case and pushes for- axis of bullet in its course), or it may even
ward everything in front of the burning gun- "tumble" with its nose or tip being at the back
powder. Thus, in case of a shotgun cartridge in course of its trajectory or progress. If the
cardboard discs, wad and pellets and in case · margin of the bullet passes tangentially over
of a rifle cartridge, the bullets, come out of the skin without entering the body a grazed
the muzzle end of the barrel forcefully and abrasion is produced which is called "Bullet
run forward with great motion to hit the tar- slap" or "Bullet graze". If similar thing oc-
get or to drop down due to the pull of the curs under the skin and over the skull bone
gravity after running the optimum distance. on head then gutter fracture of skull bone
occurs (See page 484).
When the gas comes out of the muzzle end,
it expands which gives the sound to the fir- The force of trajection of the ejected bul-
ing, usually termed as reporting of fire. With let can be better understood in terms of ki-
the escape of bullet or pellets, some amount netic energy imported in the bullet, from the
of fire, smoke, burnt and unburnt gunpow- formula,
der and in case of shotgun cartridge, the wad . MV'
Kinetic energy = -
and the discs also come out. They travel for
a shorter distance and if the gun has been '
(M = mass, V =velocity)
fired from a short distance, then they keep
their marks around the·'w ound of entrance. The firearm wounds
(see table 10.10). The effects of these ingre- Ev~ry firearm wound is a: punctured wound
dients are as follows. c.see·.also table 10.1;1), - with a wound of entrance, progressing deep

396 I PRINCIPLES OF mRENSIC MEDICINE
inside, presenting the track of the bullet and track created by the compact pellets.
sometimes, making a wound of exit. The cardboard discs do not inherit much
force and momentum in them. Though in
In case of shotgun injuries
case of firing from a short distance they may
For some distance (a yard or so) the pellets strike the surface of the body, they are un-
run enmasse. Up to this distance the pellets able to travel a long distance and produce
make a single wound of entrance. Then, due even any surface injury. Sometimes, when
to dispersion of the peripheral pellets, multi- the gun is fired from a very short distance
ple small wounds of entrance are produced (say a foot), they may produce mild abrasions .
around the main wound of entrance. With The depth and track pft12e wound (in case
increase in the distance of firing, the area of of shotgun) - After entering the body, within
dispersion of the pellets increases and ulti- a short distance the pellets separate and take
mately all the pellets enter the body by mak- different courses injuring structures and or-
ing separate holes. The rate of dispersion (dis- gans over a wide area. But only some of the
persion diameter) of the pellets ha~e a rela- pellets run for a longer distance inside the
tion with the distance of firing. For the 1st body and only fewer among them come out
yard, the diameter of dispersion in inches is of the body by making small wounds of exit,
equal to the distance of firing in yards . After one each for individual pellet. The margin
this distance, the diameter of the dispersion of such an exit wound is irregular and
in inches is equal to the distance of firing in everted. When fired from a short distance ,
yards x 1.5.
The margin of the main wound is very
irregular, ragged and inverted .
In case of shotgun injury, some of the
peripheral pellets may just strike the skin
without entering the depth of the tissue.
Some of the pellets may just remain lodged
underneath the skin , while others may en-
ter the depth of the body and cause fatal in-
ternal injury. Beside this, effects of fire , hot
gas , smoke , unburnt and semi-burnt gunpow-
der may be found around the wound of en-
trance. (see tables 10.12 to 10.15). The effects
of these materials will be present, only when
the gun has been fired from a reasonably
short distance and the injured part of the body
is bare without any covering cloth.
The wad can travel a distance of 30 - 40
ft . But it can produce surface injury in the
Ftg. Multiple pellet wounds; see some visible
form of bruise or abrasion only up to a dis- pellets, one near rt. eye
tance of 10- 12ft. Sometimes , the wad may Courtesy-Or Y Nath, Dr Hariprasad of MGM
enter inside the main wound, following the Medical College, Jamshedpur

Fig. 10.77. Shotgun wound of entrance with dispersion Fig. 10.78: Ciose shotgun firing on face; see the wad
of pellets around the main wound placed on the rt. side of chest. See also the
Courtesy-Prof CB Tripathy, Benaras Hindu stab wound
University · Courtesy - Prof VCS Verma, Darbhanga
Medical College
Fig . 10.78(b): Wound of entrance in a case of shotgun

Fig. 10.78(a): Distant shotgun injury distance about 4 yrd

Table 10.6: T)'P8sofG ns
TYPES OF GUNS
t
~
Smooth-bored Rifled Air gun Gyroject Paradox guns
t t •
(rifling near
muzzle end only)
~ ~
Short-barrelled Short-barrelled
Long-barrelled Long-barrelled
or shoulxnd resl or hand rest or shoulder rest
l
t
Single
action
Double
action R·r·, pr ~:~:::.:~ Semi- Automatic
automatic
;+
Single
+ h
Double Single Double
aciion action action action
'
S. B.
(single-barrelled)
D. B.
(double-barrelled)
M.B.
(multi-barrelled)
~ t
+ t +
'
Pure
y '
Muzzle Pure One cylindrical, Muzzle '
Some Some
cylin~ked cylindrical one choked · choked choked cylindrical
Muzz~e Breach
loading loading
Table 10.9: Mechanism of breach loading
Mechani~rn
.••
ofbreach
l·
loading
t . ,• , ·
8 l t 'Erom a magazine;
t by_
t.'
.. : . ~8¥ Breaking .By bolf mechanism;_apeniilg . AsJo case of revolver,
olJen the rear
:of chamber with ejectioncof · b'olt mechanism or as.irr •.ctJ!'om rotating cylindrical
~rc£.6fchamber -~tnJ>tY. ~rt-rfd~e case, tt)~[l ~ses o(semi-au_t9r7J~~--:~.:))l~9!=itirie (Page 387)
-- fe~ing,the chamber witn guns (Page 388) - - ·
:.:'·· ahew cartridge

.Tt'Bbl'e 10.fQ:PrE!SSU\~i~ chambeJ'l JJ1uzZievelocity, sf:linnil;tgrevolutiO)lof projee~!e.{ ·

t.- >
F.
',;
._, ·, stlikibg range af!d·effective range of proje¢tjles ·.

?ir~ :: . .
,_~
·~· -"-'
Types of Pressure in - Muzz/&· Revolution of ,striking Effaclive
r:. -,
cli~mber velocity pfiNectife .' '-·~.<

..
range r;tng& -
;.; gullS- ~ . •.: ... . s ..
1. Shotijuns 1 ton/sq. inch 1000ft/sec - 50 yd 30-40 yd

2. Long-barrelled 20 tons/sq. inch 800yd/sec 3000 per sec 1000 - 3000 yd 1000 - 3000 yd
rifles
3. Pistd 4-6 tons 400yd/sec Variable, depends 400 yd 200yd
on make
4: Revolvers 4- 5tons 200yd/sec Variable, depends 200yd 150 yd
on make
.,,
~,~
Taore 10,1 t Features offireann inju~ ;'
,, . .
Projectile Hote,. Margin . Size Shape Collars. Haemorrhage DispersionotPrQ[egn~_
·' " '
. " '
Bullet Deep Irregular Small Circular I Abraded or Less at Nil

or oval contused entrance, more
collars present at exit
Pellets Less Irregular 81'11!11 Circular M:lsent Less Presenf
Deep
1. Shot-guns 50cm 30cm 25cm 12-15cm

2. Long-barrelled rifles 50cm 25-30cm 30m 25-30cm
3. Short-barrelled rifles 40cm 25cm 20-25cm 20cm
-Table
. ,
at
10J 3:iJVound-of Entrance differentparts of the t:x)qy.at different distances in case ofshot-:Quns....iC: =·· .,,,.
•' .
Di~tance from Head '
.• Chest Abdomen ,. ' ,' Umbs·~<,~~ . ~..-""
ml¢zle' -· .. ·- •:."
Contact shot Bursting effect Impression of muzzle, Bursting effects Bursting effect
size = size of muzzle Muzzle impression
61:: Singeing, blackening, Blackening, tattooing As in chest As in chest
tattooing scorching, singeing
12" Blackening, tattooing Blackening, tattooing As in chest As in chest
2' Tattooing., wound -1" dia. As in head As in head As in head
3' . 1" 'diameter As in head As in head As in head
2 yards Dia.'ct dispeisrori :- 3" As in head As in head Asin.l'lead
> 2 yards Dia. of dispersion > 3" As in head ·, As in head As in head

Table 10.14: Wound of Entrance at different parts of the body at different distances
in case of lon~rrelled rifledi1uns
Distance from Head Chest Abdomen Umbs
muzzle
Contact shot Burs~ng effect, burning, Muzzle impression Burs~ng effects, Bursting effect,
blackening, tattooing, = size of muzzle other effects as other effects as
inside other effects as in head in head in head
6" Singeing, burning, As in head As in head As in head
blackening, tattooing scorching, singeing
abraded collar
12" Blackening, tattooing As in head As in head As in head
abraded collar
2' Tattooing abraded collar As in head As in head As in head
3' Abraded collar As in head As in head As in head
smaller wound
3 yards Abraded collar As in head As in head As in head
smaller wound
50 yards Abraded collar As in head As in head As in head
smaller wound
>50 yards Abraded collar As in head As in head As in head
larger wound
Table 10.15: Wound of Entrance at different parts of the body, fired from different distances
in'case of short-barrelled rifled..guns
Distance from Head Chest Abdomen •• Umbs
~
muzzle
Contact shot Bursting effect, Wound equal to muzzle Asincaseof Bursting effect,
blackening, end. Muzzle impression chest blackening etc.
etc. inside present. Blackening inside
etc. inside
6" Singeing, burning, As in head As in head As in head
blackening, tattooing, small
wound, abraded collar
12" Tattooing, abraded As in head As in head As in head
collar, small wound
2' Tattooing abraded As in head As in head As in head
collar, small wound
3' Abraded collar, As in head As in head As in head
smaller wound
3 yards Abraded collar, As in head As in head As in head
smaller wound
50 yards Abraded collar, As in head As in head As in head
larger wound
>50 yards Abraded collar As in head As in head As in head
larger wound

chapter 10: MECHANICAL INJURIES! 401
the pellets may cause fracture of a bone and tusion of the frictioned area, around the
can pass across the bone. When fired from a wound of entrance, termed abraded or con-
greater distance, the pellets may cause frac- tused collar. Around the abraded or contused
ture to only thin bones. When fired from a collar, there is a dirt or grease collar, made
still greater distance, they may not break any by the metallic dust and grease on the sur-
bone. face of the bullet, which the bullet inherits
when it passes through the length of the bore
Contad wound by shotgun of the barrel (grease is used in the inner sur-
In case of contact wound, the gas coming out face of the barrel to prevent rusting, and
of the muzzle end enters the body and ex- metallic dust is produced due to the friction
pands in the depth of the wound causing ex- between the bullet and the inner surface of
tensive damage at the site of entrance. If the the barrel when the bullet travels inside the
contact wound is over the abdomen, the gas barrel). Grease collar should not be confused
expands inside the abdominal cavity with with "CORONA" which is a blackish circular
bursting effect on the. abdqminal wall. zone around the wound caused by smoke in
case of close shot. The abraded or contused
In contact wounds, a part of the depth of
collar and the grease collar tell about the di-
the wound shows burning, blackening and tat- rection of firing (page 402 of this print). The
tooing due to the effects of fire, smoke and wound of entrance is inverted and there is
gunpowder. When the contact wound is on
no protrusion of fat through this wound. In
the head, then bursting of the cranium may
its course due to friction with air~ surface
occur. of the bullet becomes red hot and soft. When
the bullet strikes the body, minute particles
Injuries in case of rifled weapon (bullet
of metal from the soft surface may spread
injury) ·
around which on X-ray examination "bird
There is a single punctured wound of en- shot" patterned picture is available.
trance. It travels deep inside the body, injur-
ing organs in its track and sometimes makes The depth and track of the wound
an exit wound.
After entering the body the bullet may run a
straight course or it may get deflected and
The wound of entrance
take a different course due to obstruction by
The wound of entrance is circular when the the tissue, mostly a bone. Sometimes the
bullet strikes the body surface perpendicu- splinter from a fractured bone may take a
larly. It is oval, when the bullet strikes the course different from the track maintained
body at an angle. This wound (wound of en- by the bullet, often producing a separate
trance) is smaller when the firing is from a wound of exit.. In other cases the bullet may
close range (except contact wound). It is remain lodged against a bone or inside an
slightly larger when the firing is from a long organ, e.g., inside the ventricular wall of the
distance. While the bullet enters the body heart, or the bullet may even be expelled out
through the hole made by the nose of the by any natural orifice of the body. Occasion-
bullet, the surface of the bullet faces a fric- ally after striking some bone of the body the
tion with the skin surrounding the hole bullet may reflect back and come out through
(wound of entrance), causing abrasion or con- the same wound of entrance. If the affected
rF M - ?61
402 J PRINCIPLES OF FORENSIC MEDICINE
Fig. 10.79: Bullet injury on chest. Apart from blood stain ,

mark bleeding from mouth
Fig. 10.81 : Wound of entrance (bullet). Note the abraded

J collar
I Fia. 10.82: Wound of entrance (bullet). Note the abraded

~ collar
I
Fig . 10.83: Wound of entrance above lt. eye (a case of
homicide) ~ig. 10.~4~~~te ·of.flnal impact of bullet (vide Fig. 10.83)

Fig . 1O.B4(a): Bullet injury. Breach part of bullet FIQ. 10.84(b): Bullet injury with abraded collars .
visible (By courtesy Prof T. Bose)
Fig . 10.84(c): Bullet injury with abraded collar. Fig. 10.84(d): Wound of entrance bullet injury with
(By cowtesy Prof T. Bose) abraded collar. Bullet struck side wise
Fig. 10.84(e): Bullet injury Rg. 10.84(f): Ricocheting bullet injury

- - - - -- - - - - - -
Fig. 10.84(h): Bullet hole on frontal bone -wound of

entrance
Rg. 10.84(i): Wound of entrance (bullet) ____

.____Fig. 10.840): Grazed abrasion by surface of bullet
I Fig. 10.84(k): Wound of entrance with abraded collar j

Fig. 10.85: A ricochet bullet wound of entrance causing

extended superficial wound before entrance.
----- FIQ. 10.86: Wound of exit (bullet injury)
The relative situation and 'extent of abrasion

and the entrance hole alqo indicates
momentary change of position of the body
when the bullet struck the body
L--------- ----------~
a b
0
abraded collar abraded collar
around main around main
wound of entrance wound of entrance
when the bullet when the bullet
strikes perpendicularly strikes at an angle
Fig. 10.88: Homicidal bullet wound of entrance, see the
Fig. 10.87 I abraded collar 1
~-
Fig . 10.89 : Wound of exit in a case of firearm (bullet) . 10.90: Wound of exit in case of a suicidal bulletj
injury injury. At. temple ; same case as in 10.91
-------

The wound of exit

The wound through which the bullet comes
out of the body is usually slightly larger than
the wound of entrance, when the gun is fired
from a short distance. But when fired from a
long distance, the exit wound is slightly
smaller than the wound of entrance. The
wound of entrance is smaller when the bul-
let is fired from a short distance, because in
that case the bullet possesses high velocity.
But the wound of entrance is larger when
Fig. 10.91 : Wound of entrance of bullet injury over lt. the bullet is fired from a great distance as
temple - a case of suicide
then the bullet possesses a low velocity. The
wound of exit is everted, with protrusion of
part of the body is covered with clothes, then fatty tissue through the wound. Here also the
the depth of the wound near the wound of margin is irregular. Haemorrhage is more
entrance will show presence of fabrics torn near the wound of exit. When the site of exit
out from the clothes and pushed inside the wound is in contact with some hard surface
wound by the bullet. In bullet injury, usually like wall, then the margins of the exit wound
there is less haemorrhage near the wound of may be abraded, giving appearance similar
entrance. to entrance wound (shored exit wound).
Tab~e. 10.16: Differences between wound of entrahce and wound otexit

J .-~.
Points of difference Wound ofEntrance Wound of Exit
1. Size Smallerwhen near, larger when Larger when near, smallerwhen

dstant dstant
2. Margin Inverted Everted
·''
3. Singeing, blackening, burning, tattooing Present .Absent
4. Abraded or contused and grease collars Present Absent
5. Haemorrhage Less More
6: Foreign fabrics of cloth, etc. Enters in the wound Nothing such .
7: Dispersion of pellets in shotgun cases Present
. /lbsent
'·-
.. ·'
: 1 .
,8.; Protrusion of fat Absent Present
9, Bright redness due to formation of COHb Present (near shot) ' .Absent
•'
10. Metallic ring shadow on X"ray Present Absent

'
11. Impression of muzzle Present in contact shot Absent
12. Bursting effect In contact shot may be present ;Absent

chapter 10: MECHANICAL INJURIES /4.01
Fig. 10.91(a): Used bullet with primary marks _j
FIQ. 10.91 (b): Two sectioned 45 caliber pistol

barrels
FIQ. 10.91 (c): Used rifle cartridge
,___ _ _Fig. 10.91 (d) : Ust;d rifle _c_a_rtt_i.Q_g_e_ _ _ __.l L FIQ. 10.91 (e): Used rifle cartridge

In case of bullet injury over the head, or fragmented tissue from the wound (back
when the bullet enters the cranial cavity, it spatter). This helps linking the weapon with
produces a PUNCHED IN hole on the skull the offence, if the weapon can be examined
bone at the site of entrance of the bullet with early.
sharp margin of the outer table of the bone
and bevelling of the margin at the inner ta- Some special features of buliet w~unds
ble. When the bullet produces an wound of
1. Ricochet bullet wound - A ricochet bul-
exit on the head a PUNCHED OUT hole is
let is a bullet, which before striking the
caused on the skull bone at the site ofthe exit
body, strikes some hard surface like a
of the bullet. Here the margin of the bone at
wall, where it gets bounced or deflected
the inner table is sharp and the margin at the
to take a different track and then strikes
outer table of the bone is bevelled (see Figs.
the body of a person. When the bullet
10.95- 10.98). In some cases of bullet injury
strikes the hard wall-like surface, it gets
of the head, the bullet may not enter the cra-
deformed. Such a deformed ricochet bul-
nial cavity. The bullet in such a case may pass
let causes more extensive wound of en-
along the outer surface of the skull bone un-
trance. But its power of penetration in-
der the skin and may be found present in the
side the body gets reduced. (See page 403).
subcutaneous tissue at an unexpected place.
2. Tandem bullet (Piggy tail bullet) - Some-
Contad wound in case of rifled weapon times it so happens with a rifled-gun that,
when one round is fired the bullet comes
In case of contact wound, there will be muz- out of the cartridge but remains lodged
zle impression around the main wound in inside the barrel without getting out
the form of abrasion or depression. The' ef-
through the muzzle end. If after extract-
fect of fire, hot gas, smoke and unbumt and
ing the empty cartridge case, the gun is
semibumt gunpowder will be present in the
used for firing another round, without
depth of the wound near the wound of en-
cleaning the inside of the barrel, then
trance, instead of their effects being present
the second bullet may take out the first
around the wound. Due to expansion of the
enlodged bullet in front of it and both
gas coming out of the muzzle end and enter-
may enter the body of the victim through
ing inside the depth of the body tissue, there
a single wound of entrance, during the
will be greater destruction of the tissue with
second firing. In such a case, with one
a large wound. If the contact wound is on the
wound of entrance two bullets may be
abdomen, then the ejected gas enters and
expands inside the abdominal cavity, caus- found inside the body, during post-
mortem examination. In these cases the
ing bursting effect on the abdominal wall or
as in other cases of punctured wound over back of the front bullet is depressed by
the abdomen there may be "herniation of in- the nose of the 2nd bullet after success-
testinal coil" through abdominal wall if there ful second firing. In TANDEM or Duplex.
is no bursting effect as a result of muzzle con- CARTRIDGE, two bullets are lodged in
tact. If the contact wound is on the head, then a single cartridge.
bursting of the cranial cavity may occur with 3. Dumdum bullet - Dumdum bullets are
exposure and expulsion of the brain matter. hollow at their nose. These bullets split
In case of contact wound, the vacuum cre- when they strike the body, causing dis-
ated inside the barrel of the gun after the proportionately greater damage to the
bullet is eJ..-pelled out, causes suction of blood affected part. The effects of dumdum bul-

cflapter 10: MECHANICAL INJURIES I 409
let is similar to frangible bullet where the ing extensive wound which is termed as
bullet is so made that it breaks in pieces the "billjard board ricochet bullet" phe-
when it strikes the body so as to make nomenon.
extensive wound locally. 7. With more than one wound of entrance,
4. Wound caused by a single shot (ball) fro!D there may be one bullet present in the
a smooth bored gun- The entrance wound body, if one of the bullets has exited out
is comparatively larger with irregular and by making a wound of exit or has passed
uneven margin. But the penetration out through the natural orifices of the
power of these projectiles is less than body or after striking the body it has de-
bullets because their velocity is low and flected back after striking a bone, to get
the soft lead ball gets distorted in its shape out of the body through the same wound
when encounters a bone and are not so of entrance. This also may occur when
efficiently effective against the body re- some specific parts of the body is hit, like
sistance. This, however, does not reduce when a bullet enters through the lateral
chance of fatality with them. aspect of the upper arm, gets out through
5. Presence of more than one bullet in the the medial aspect of the same arm to
body with only one wound of entrance enter the chest cavity by making another
may occur in case of tandem bullet en- wound of entrance.
tering the body or when two bullets of 8. With only a wound of entrance and with-
two rapidly successive firings enter the out any wound of exit, no bullet may be
body without any change in the position found in the body duringpost-mortemex-
of the body or the gun, i.e., both enter- amination of the body, if the bullet comes
ing the body, striking the same spot. With out of the body through the same wound
a single shot making one wound of en- of entrance after striking a bone or if the
try, two splinters of one bullet may be bullet entering the body exits out through
detected in the body, if the bullet splits some natural orifices, e.g., bullet enter-
after striking a bone. ing the mouth cavity may be splitted out
6. Single wound of entrance may be there or that entering the larynx or trachea may
with more than one wound of exit, when be coughed out, and one entering the in-
tandem bullet or two bullets enter the testinal canal may pass out with stool
_body through the same wound of en- 9. Multiple wounds of entrance and multi-
trance and then get separated inside the ple wounds of exit are possible with a sin-
body and take two tracks to exit out gle bullet shot. When a bullet enters
through two different wounds of exit. through tht lateral surface of one side of
This may also occur when two or more the upper arm, exits through the medial
.splitted parts of a single bullet exit out surface of the arm enters in the chest
through different wounds of exit or when cavity through that side, exits through
a piece of a fractured bone acts as a splin- the opposite side of the chest and then
ter and exits out of the body by making a enters the other arm through the me-
separate wound, other than the exit dial surface artd lastly exits through the
wound made by the bullet. In case oftwo lateral surface of that arm, it produces
bullets striking the same spot of the, 2nd three wounds of entrance and three
one striking the back of the first may wounds of exit. Similarly, if the body is
change its direction inside the body caus- in stooped position or is bent, both at hip

and knee joip.ts, bringing the abdomen, Examination of the injured

thigh and leg of one side in the same line,
1. General condition of the injured.
and a bullet strikes the back of abdomen
on that side, then it may pass out 2. The part involved , extent and severity of
anteriorly through the anterior abdomi- the injury.
nal wall, then enters in and exits out of For these, radiological examination may
the thigh and the leg of the same side • be necessary. X-ray examination is also
making multiple wounds of entrance and necessary for therapeutic purposes. A
wounds of exit. gunshot injury case is better examined
on the operation table . In case of shot-
Examination of gunshot Injury cases gun injury, many a times the superficially
lodged pellets are left as such without
A. In case of living
disturbing, particularly when many of
In pellet (shotgun ) injury, the problem is oc- them are lodged sporadically at distant
casionally more than bullet injury. This is places. If such pellets are compatible with
because of dispersion of the pellet~ in the continuance oflife and normal function-
body. The pellets may be distributed in wide- ing, then their removal by surgery may
spread area. But fortunately, often the depth be considered as a unnecessary step, just
of the wounds are less with less involvement to cause further trauma. It is on record
of the internal vital organs due to less pen- that person sustaining bullet injury in
etrating capacity of the pellets. heart, survived for a period of over five
years with the bullet in the thickness of
The part of the body apparently injured
myocardium.
with possible extent of the pellets to deeper
tissue, should be subjected to X-ray exami- 3. Examination of the clothing - It is im-
nation . This will help to know the exact loca- portant to examine the clothings to ~ote
tion of the pellets, which is necessary for both the presence of recent tear or bullet hole
legal and medical purposes. The examination and blood and other stains.
of the person should be carried out on the 4. Examination of the place of occurrence
following points : of the bullet injury may at times be
Fig . 10.92A: Subcutaneous lodging of pellet; mark the

raised surface and non-existance of scar, Fig. 10.928: The pellet seen in situ after
about 1t month after shotgun · dissection

necessary, which Illay be helpful to know urement of diameter ofdispersion of pellets .

the direction of firing, etc. The term point-blank firing means contact,
near contact or very close range firing.
B. Post-mortem examination of a case of The size and shape of the entrance and
doath due to firearm injury exit wounds should be noted. Mark of con-
The post-mortem examination in a case of tact with the muzzle is also an important find-
death due to firearm injury should follow the ing. The track of the wound should be thor-
general line of medicolegal post-mortem ex- oughly traced and examined for presence or
amination with certain additional points absence of findings as discussed in page 393.
which should not be forgotten. Once the bullet or a pellet is traced (which
becomes very easy ifthe body is X-rayed prior
1. The dress should be examined for pres- to the starting of the post-mortem examina-
ence and distribution of recent tear or tion), it has to be removed from the body cau-
bullet hole and blood stain , etc. tiously. It is recommended that bullets or
2. The line of flow ofblood from the wound pellets should be removed with the help of
should be observed. rubber-tipped forceps and not with the bare
3. Secondary injuries , if present, should be met allic tips of the forceps so that no
noted. artefactual scratches or markings will be
4. The wound of entrance and the wound of caused on the surface of the bullet due to fric-
exit should be identified (see Figs. 10.81, tion with the metallic tips of the forceps. Al-
10.82 and Figs. 10.84(b), 10.84(c)). ternatively, the bullet can be safely removed
by tips of the fingers . After removal, some
5. From the margin of the wound ofentrance,
identification marks should be engraved by
the direction of firing on the victim should
the autopsy surgeon, on the back of the bul-
be assessed from the abraded collar (see
let with the help of a pin or needle so that he
page 40 1) in case ofbullet injury and from can identifY the bullet inside the courtroom
the measurement of dispersion of pellets or elsewhere, when necessary. The identifi-
on the body surface in case of shotgun in- cation marks should not be engraved on the
jury. side wall of the bullet, because that may ob-
The distance of firing should also be as- literate or disturb the primary or secondary
sessed from the presence or absence of burn- marks on the wall of the bullet which help to
ing , singeing , scorching, t attooing, etc. and identifY the weapon of offence by compara-
in case of shotgun injury, also from the me as- tive study with the markings on the body of
Fig. 10.99: A- Appearance of "punched in hole" caused by bullet on the skull bone at the wound of entrance; sharp
margin at the outer table and bevelled margin at the inner table
8 - Appearance of ''punched out hole" caused by bullet on the skull bone at the wound of exit, bevelled
margin at the outer table and sharp margin at the inner table

a bullet test-fired fro_m a suspected gun. In grease collected from these two sources
case of pellets, no identification marks are tallies.
required to be engraved on their surface. The 3. Clothings - Apart from bullet or pellet
bullet or the pellets so recovered; need not holes and tears, the margin of the bullet
be washed and should instead be preserved hole on the dress may bear the effects of
along with the blood stain over them, being
fire , smoke, gunpowder and grease and
wrapped with cot ton, in a clean glass jar. The
dirt from the surface of the bullet
jar should be properly labelled and sealed and
sent to the Forensic Science Laboratory. If Medicolegal informations available from
fragments of a bullet have been recovered, a firearm injury
then all the available fragments of the bullet
should be preserved. The number of bullets, 1. Nature of death due to firearm injury -
fragments or pellets recovered and preserved Death due to firearm injury may be sui-
should be mentioned on the label of the glass cida~ homicidal or accidental
container. In case of contact wound by shot- Suicidal firearm injuries are commonly
gun, along with pellets, th!'l wad and the discs located on the easily approachable parts of
should be searched out from the track of the the body. The elective sites for suicidal fire-
wound and preserved arm entry wounds are palate, area below the
In case of bullet injury on the head, the chin, right temple in case of a right handed
punched in and punched out holes of the skull person and left temple in case of a left handed
bone help to know the sites of entrance and person, forehead, medial canthus of right eye
exit .ofthe bullet, respectively (see page 411 in a right handed person and precordial area
and412). over the left side front of chest. Suicides usu-
ally use short, hand-rest weapons. But long-
Materials to be preserved during post- barrelled weapons may also be used with the
mortem examination in cases of death due muzzle end being fixed below the chin, and
to firearm injuries - the trigger in such a case is usually pressed
Along with other materials which are or pushed by the greater toe of one foot. Of-
usually preserved during post-mortem exten the entrance wounds are contact wounds
amination , the following materials also must with presence of the impression of the muz-
be preserved zle around the wound of entrance. Often the
suicide fires more than one round, and some-
1. Bullet, fragments ofbullet or pellets.
times successive rounds are fired without
2. Skin from around the wound for chemi- changing the position of the gun, so that with
cal identification of the unbumt gunpow- one entrance wound there may be more than
der and the type of grease (available from one wound of exit or more than one bullet
the grease or dirt collar), which help to may be present in the body. The gun may be
identify the firearm weapon used. If the held in the tight grip, in a state of cadaveric
unburnt gunpowder detected from the spasm of the hand used. Sometimes in homi-
skin around the wound tallies with that cidal cases, the gun may be placed by the as-
present in the inner surface of the barrel sailant in the hand of the dead to simulate
of a gun which is suspected to have been suicide, but that can be easily understood due
used to injure the victim, then that be- to absence of cadaveric spasm and often from
comes a strong corroborative finding the peculiar placement of the gun in the hand
Similar conclusion can be drawn, if the of the victim which is not compatible with

414 I PRINCIPLES GF FORENSIC MEDICINE
conunitting suicide . Apart from this, the cir- cidal firearm injury death may occur
cumstance or place of occurrence will be sug- the victim alone being inside a closed rov~
gestive if the incidence is suicidal in nature; In such a case the assailant shoots the ·- -
in that, the place maybe a secludedone , i.e., tim from outside the room, through an op--
a room closed from inside , with the weapon window or a ventilator. The dead body may
being present inside the room with the trig- be detected in a room, closed from inside. 1be
ger bearing the latent fingerprint of the de- place of occurrence is not disturbed and the
ceased. The place will not show any sign of weapon is not traceable at the place of occur-
disturbance. The suicide may leave a suicidal rence. Sometimes after killing the victim by
note and there should be a recognizable rea- shooting from outside, the weapon may be
son for committing suicide . The scope of avail- thrown inside the room , occasionally after
ability of the gun to the suicide must also be rubbing out the finger prints of the assailant
kept in mind. In case of suicide, dermal ni- from the trigger and other parts of the
trate test of the paraffin cast from the hand weapon. The distance of firing guessed from
of the deceased will be positive. the wound of entrance may be ofhelp in such
cases. Other circumstantial evidences like,
Homicidal gunshot injuries may be more
presence of the assailant with the victim at
than one in number; may be placed anywhere
the time of his death , somebody seeing him
on the body and may be contact, near shot or
entering or coming out of the victim's room
distant shot wound . More than one wound of
at around thP time of his death or hearing
entrance , which are either contact or close
the sound oJ· ring or cry of the victim at a
shot wound and placed on the back , are cer-
time wher.. the assailant was expected or
tain to be homicidal in nature. Homicidal fire-
known to be present with the victim and
arm wounds may be from both long-barrel-
known enemity between the assailant and the
led and short-barrelled guns. In death due to
victim, all may be helpful to make clear the
homicidal firearm injury, the place of occur-
homicidal nature of an incident.
rence of death may furnish many important
informations. The weapon of offence is usu- Accidental firearm injury may be sus-
ally absent at the place of occurrence, but tained due to wrong aiming or missing of the
may occasionally be present when there is aim, or due to wrong firing during hunting
an attempt to simulate suicide . The weapon at night baseo. on.-the assumed movement of
in such a case may be placed in the right hand an animal. It may occur with the muzzle be-
ofthe dead body . But the manner of its place- ing in contact _w itp the body or from a close
ment may be indicative of the artificial na- range while playing with a loaded gun or while
ture of the arrangement. The trigger and part cleaning a loade,d ·gun . Accidental firearm
of the stalk may or may not bear the finger- injury, if ~.auf:le.s instantaneous death, is
print of ~he assailant . The finger print im- bound to c~.~~·-~<?~fusion, if the place of oc-
pression of the assailant may be wiped out currence,, t?~.-~ and the dead body is not
'before placing the weapon in the hand of the properly exartuh€id.
-•' . 1' .
victim and in some ·cases th~ finger of the 2. The d;ir;~s_~~~ ,pf, the firing - The direc-
victim may be pressed on the 'trigger to fur- tion , [rqry;
~~!-~~ the · fire ann has been
ther confuse the issue.- The place of occur- be
used caii teasily understood from the -
rence may be disturbed , ifth~re was a strug- (i) Findin~'~t the margin of the wound
gle between the assa.ihtnt arufthe victim. The ·or e&ra:ru:e-.
place of btcurrence -·in. ·s\ieh-·a case remains (iiJ From the direction of the track of
apPn>aChable· to outsiders . >However, homi- · ·tP1~· W<>\in<i-inside the body .

Assessment of the direction of firing from Hence, giving due consideration to all
the margin of the wound of entrance: these factors, it is better to try to assess the
(a) In case of shotgun injury, the pat- direction of the firing from the dispersion of
tern of dispersion of the pellets gives the pellets in cases of shotgun injuries and
the direction of the firing. The pel- from abraded I contused and grease collars,
in cases of bullet injuries by rifled weapons.
lets disperse over wider .area as it
travels more. Hence firing is sus- 3. Distance of firing
pected to have been from the side (a) In case of shotgun firing - The dis-
opposite to the side of wider disper- tance of firing in case of shotgun can
sion of the pellets (see Fig. 10.77). be assessed from-
(b) In case of rifled weapon, when a sin- (i) Presence of the effects of fire,
gle bullet enters the body of the vic~ smoke, partly burnt and
tim, the abraded, contused or grease unbumt gunpowder, when the
collar around the wound tells about firing is from a short distance
(see page 399, 400).
the direction.ofthe firing. Ifthe bul-
let enters the body perpendicularly, (ii) The effects of discs and wad
then there will be circular collars. (iii) The diameter of the area of dis-
If the bullet enters the body at an persion of pellets over the body,
angle , then the collar will be in all cases.
broader on that side of the wound (iv) In case of contact wound, im-
from which side the bullet has come, pression of the muzzle should
i.e., the side from which gun was be there.
fired (see Figs. 10.81, 82, 89). (b) In case of bullet injury ( rifled gun),
Direction of firing from the track of the the distance of firing can be assessed
bullet inside the body - The track of the bul- . from-
let inside the body may be accepted as the (i) Effects of fire, smoke, burnt
direction of the firing only occasionally, be- and unbumt gunpowder, when
cause, in many cases it is seen that the bul- firing is from a short or near
let changes the track inside the body. Often, distance.
the bullet, after striking against a bone, splits (ii) Beyond the distance covered by
up and the pieces of the bullet may take sepa- the influence of these, it is very
rate tracks. Sometime the fragment of a frac- difficult to assess the precise
tured bone acts as a separate splinter and distance of the firing. Only a
takes a different course and when in such a vague idea can be formed from
case both the bony piece and the bullet are the diameters of the wound of
out of the body through separate wounds of entrance and the wound of exit
Usually, when the firing is not
exit, then it may not be possible to say which
from a great distance, the
one is the actual track ofthe bullet, and which
wound of entrance should be
one is of the bony fragment.
smaller than the wound of exit.
In case of shotgun injury, the individual But if the firing is from a long
pellets take divergent routes which may not distance, the wound of entrance
help to know the direction of the firing. may be equal or even larger

than the wound of exit. This terial, used to keep the inner sur-
theory is not applicable in case face of the barrel of the suspect gun
of ricocheting of a bullet or in clean, then this finding also serves
contact wound, where there is as a linking line between the use of
greater distortion or bursting that particular gun in causing the
effect at the wound of entrance. particular wound.
In these cases, though firing is (c) Comparative study of the bullet re-
not from a distance, the wounds covered from the dead body and the
of entrance are large or exten- test bullet fired from the suspect
sive. gun- Such a comparative study may
(iii) As in case of shotgun injury, be confirmatory to conclude
impression of the muzzle will whether a particular gun was actu-
indicate contact firing. ally used or not. The comparative
4. Identification of the firearm weapon used: study is made on two basis. Two
This can be done from the followings: kinds of markings are usually avail-
(a) The gunpowder used in the ammu- able on the surface of a used bullet
nition (cartridge), can help identifi- and both the types are related with
cation of the weapon used. After fir- the gun used to fire the round.
ing of a round, trace of the gunpow- These are -
der used in the make of the car- (i) Primary markings -These are
tridge, remains in the inner surface the marks engraved on the sur-
of the ban-el until it is cleaned. The face of the bullet due to lands
skin surrounding the wound of en- and grooves present on the in-
trance or the covering clothing of ner surface of the barrel of a
corresponding part , if subjected to rifled gun, which are sinlilar in
chemical examination , will show the barrels of all the guns of
presence ofunburnt or partly burnt the same make. Hence, these
gunpowder, if the firing was from marks on the surface of the bul-
within a distance of their propaga- let, which are parallel and spi-
tion. Ifby chemical examination, the ral according to the line of the
nature of the gunpowder present at grooves and lands on the inner
the inner surface of the barrel and surface of the barrel, will be
those around the wound of entrance sinlilar on all bullets fired from
or the corresponding part of the any rifled gun of the same
clothing of the victim are found to make.
be same, then it is an indication that (ii) Secondary markings - These
the suspected gun nlight have been marks on the surface of the
used in that particular occasion. bullet are caused due to certain
(b) As in case of gunpowder, if the individual features of the inner
grease material from over the surface of the barrel like mi-
grease collar around the wound of nor projections or elevations or
entrance or the corresponding part depressions which are specific
of the clothing (in case of bullet of a particular gun and not com-
wound), tallies with the grease rna- mon to all guns even of the

chapter 10: MECHA NICAL INJURI ES I 417
Fig. 10.100: The bullet in question grossly abraded on

the surface due to rough inner surface of
a country made pipe gun
Frg. 10.102: Blackening of base of index finger due to

leakage of smoke through country made
pistol (pipe gun). Rt. hand of the suicide
two bullets are searched for. If ap-

Fig . 10.101 : Primary mark on the bullet surface parently similar secondary marks
are available on the two bullets, then
same make. These secondary reflected light from these on the
marking are also called metal-
surfaces of the two bullets are
lic fouling on the bullet surface
brought closer on the same line to
by inner surface ofbarrel of the
match them in all respects.
gun. They act as fingerprint of
the gun on the bullet for iden- If these marks on the body of the
tification of the gun used. test bullet and those on the body of
The test fire is aimed towards a the recovered bullet tally in their di-
caracass of a pig. The bullet is col- mensions and curvature, then it can
be more or less conclusively opined
lected with all precautions not to add
any artefact to its surface and then that, the bullet causing the death of
the victim was fired from the gun
it is subjected to comparative study
with the bullet recovered from the examined.
body of the victim. The two bullets (d) Examination of the suspect gun - If
are examined with the help of a the offensive gun is examined after
COMPARATIVE :MICROSCOPE, a use and before cleaning, then evi-
reflection microscope . Light rays dence of recent use of the gun can be
from the surface ofboth the bullets established by physical and chemical
are reflected and observed through examination of the swab from the
the common eye-piece of the micro- chamber and bore of the gun.
scope. By adjustment of the posi- 5. Identification of the assailant - Apart
tions of the two bullets , the reflected from the circumstantial or some other
light rays from the primary marks evidences , a laboratory test is recom-
of the two bullets a~ brought in the mended for the identification of the as-
same line and observed, ifthey tally. sailant. Dermal nitrate or paraffin test is
Similarly secondary marks on the one such laboratory test. Paraffin impres-
rF M. - 271
418 j PRINCI PLES OF FO RENSIC MEDICINE
sian from the medial surface and the base false positive reaction even if a gun has
of the thumb, and lateral surface and the not been used by the accused person, if
base ofthe-index finger of the right hand his hand gets contaminated with his own
of a right handed accused is taken and is body fluid like urine, which contains ni-
subjected to the test for the presence of trogenous compounds. In place of paraf-
nitrite, peiformed with the reagent diphe- fin impression, saline wash of the ~and
nylamine. In case of recent use of a gun, can be collected inside a plastic bag to
if the hand is contaminated with nitrog- perform the test. Nowadays, for the fal-
enous compound of the gunpowder or lacies of the nitrous test, "Harrison and
priming iniXture, then bluish discoloura~ Gilroy" test for metal present in the prim-
tion of the relevant parts of the paraffin ing mixture like, lead, antimony or
cast will be there due to leakage of the barium which also contaminates the
gas from the chamber through the defec- hand, is recommended. Trace of the
tive breach mechanism, during a fire. primer metals may be detected by SPEC-
However, before givl.ng much importance TROPHOTOMETRY- ATOl\IIIC ABSORP-~
to this test, it must be remembered that, TION SPECTROSCOPY or NEUTRON
·the test may be negative even though one ACTIVATION ANALYSIS (See page 319,
round was fired by the accused, if there 321).
is no chance ofleakage of the gas through Identification of the assailant is possible
the breach mechanism or if the assailant while firing the gun during the night
has thoroughly washed his hand after hours, from the flash of the fire , if the
using the gun or used gloves while using assailant is viewed from a distance of not
the gun. Conversely, the test may give a more than 8 yards.
6. Fatality from the firing of an empty car-
tridge - This chance cannot be ruled out
if the wad nr the unburnt gunpowder hits
some vulnerable points of the body from
a very close distance, e.g., when those
materials enter the cranial cavity
through the orbital cavity.
Fig. 10.103: X-ray of thigh showing fracture b"f ' Fig. 10.104: X-ray showing · presence of pellets in the
fe·mur due to shotgun pellet impact soft tiss u~

chapter 10: MECHANICAL NJU RIES I 419
Rg. 10.104(b): Effects of cell phone battery explosion
Rg. 10.104(a): X-ray showing presence of pellets in

the soft tissue of the knee joint.
Fig. 10.1 04(c) : Injury due to cell phone battery explosion
Fig. 10.1 04(d): Intact grenade'. Rg. 10.104(e): Grenade after Fig. 10.1 04(f): Different parts of
By Courtesy: removal of some grenade shown
Dr Aman kumar parts separately

Examination of the place of occurrence cannot cause any serious injury unless they
hit the eye , in which case even death may
In a case of death due to firearm injury, it is
occur.
important to inspect the place of occurrence
as early as possible. Stud guns are used in factories or indus-
tries often to lodge something inside a
In addition to the informations like ap-
wooden or metalic piece.
proachability of the place by others or scope
of targetting the victim inside a room from
Rubber Bullet or Plastic Bullet
outside , presence or absence of evidences of
disturbance at the place , there are other These bullets being yielding, do not cause
things to ob~?erve or search for in the place of puncture wounds. But they cause, bruise and
occurrence. In thorough searching of the place abrasion. They can damage the eye. These
of occurrence, empty cartridge case, extra are used by police to disperse mob.
bullet, bullet mark on the wall or some other
article and the offensive weapon may be avail- Zip guns, pen guns etc. are modified guns
able . Latent fingerprints and footprints may of suitable sizes for carrying and use.
be available at the place of occurrence. The
· place of shedding of the blood in relation to Gyro jet
the body may be noted. Evidence of ricochet-
Gyrojets are missiles which contain the pro-
ing of a bullet may be left on a wall. The cir-
pellant charge at their back. When ignited,
cumstance may also tell about the time of
the burning propellant charge continues to
death and the last position of the victim be-
push the missile from the back. Thus, a gyrojet
fore he was fired or before he died.
achieves maximum velocity, some distance
Airgun after coming out of the muzzle end of the gun.
This is in contrast with projectiles from other
In airgun, compressed air is used to eject a guns, ·which achieve maximum velocity when
projectile which may be a lead ball or even a it comes out of the muzzle end. In case of a
piece of stone. The velocity of such projec- gyrojet, as the propellant charge behind the
tiles from an airgun is very low and thus their missile continues to burn for some distance
penetrating capacity is also very less. They (about 500 yards), the effects ofburning, singe-
Fig. 10.105: Explosion (bomb) injury of face and rt. FJQ . 10.106: Effects of explosion on he-ad and other
shoulder. parts of the body of a child
CourtBsy - Prof CB BHU Courtesy- Prof CB Tripathy, BHU

chapter 10: MtCHANICAL INJURIES I 421
ing, etc. will be there around the site of the

wound of entrance , if the missile strikes the
body within this distance. As a gyrojet missile
gets maximum velocity only after it travels
for some distance, in case of contact shot and
very close shot the missile may not even en-
ter.the depth ofthe body.
Cause of death in case of firearm in jury

As in other cases of injuries, death of the vic- Fig. 10.107: Blast injury. Courtesy- Prof CB Tripathy,
BHU
tim may occur due to haemorrhage , shock,
injury to the vital organs , embolism, asphyxia 1. When the explosive material contains
resulting in the choking of the air passage by solid splinters .
blood or bullet in the early phase , and infec- 2. When the explosive material is liquid.
tion , complications like stricture of the 3. When the explosive material is a gas
oesophagus or lead poisoning from an impreg- producing substance.
nated bullet in an organ at a later period . A
1. When the explosive matter primarily con-
bullet may be rarely compatible with life if
lodged in a part of a vital organ like the myo- tains solid splinters as in case of bomb
explosion, the following injurious effects
cardium without causing penetration to the
heart cavity. But there remains another dan- may be there on the body of the victim -
ger that in the long run such a bullet may (a) Effects of missiles (splinters) - Mis-
cause chronic lead poisoning due to gradual siles from the bomb may strike the
release oflead in circulation over a prolonged body of a person and cause deep pen-
period. A bullet accommodated in the body etrating injury, leading to injury to
with healing of the injured tissue around it the vital organ, shock, haemorrhage
and in the track of the bullet is called a "sou- and death (flying splinter effect).
venir bullet". (b) Effects of the expanded gas due to
bursting of the bomb may cause
Explosion Injury
gross mutilation and extensive in-
Fatal injuries may be sustained from 3 types jury of the body of the victim (air or
of explosions . gas blast effects).
Jable 10.17: PTqlefties of different explosives

Vel. ofdetonation Temperature Volume on explosion
(mtsec) (= oc) (mllg}
Nilroglyoerine 7,800 4,510 730
40% nitroglycerine (dynamite) 4,500 3,030 610
PETN (P~nta erythrotd tettanitrate) 7,920 4,270 765
TNT {2 : 4 : 6 Tri nitro toluene) 6,900 3,150 085
RDX (Cyclonlte) 8,180 4,230 84.5

422 I .PRINCIPLES OF FORENSIC MEDICINE
Rg. 10.107(a): Blast injury. Courtesy-Prof CB Tripathy, Rg. 10.1 O?(b) : Blast injury. Courtesy-Prof CB Trfpathy,
SHU ~HU
Rg. 10.107(c): Blast injur}-. ·Fig. 10.107(d): Blast injury. Courtesy-Prof CB Tripathy,
Courtesy ~ Dr NK Mahanty SHU
Rg. 10.107(e): Blast injury. Courtesy-ProtCB Tripathy, Fig. 10.1 07(1): Blast injury. Courtesy-Prof CB Tripathy,
SHU SHU

(c) The victim may be tossed on the (f) A powerful bomb explosion may
ground due to the force of the ex- cause collapse of a house wall or simi-
panded air and may sustain exten- lar structure and may cause serious
sive external and internal injuries , injury to the nearby victim or vic-
in the form oflaceration , bruise and tims.
abrasion . The splinters used in a bomb ~y be any-
(d) The fire caused due to the explosion thing which can act as missile, e.g. , me-
may set ablaze the clothings of a . tallic pieces or stone chips.
nearby victim and may cause exten- 2. When the explosive matter is liquid -
sive burn injury. (a) If explosion is due to excessive heat ,
(e) Explosion inside a closed apartment causing increase in the pressure in-
may cause the entrapped victims, side the close container as in case
poisoning with CO,· present in the of bursting of a boiler, then exten-
smoke. sive scalding of the affected part of
Fig . 10.108: Effects of blast on clothes and body, lat.

aspect of chest and below ft. nipple Fig . 10.109: Close distance explosion death
Courtesy- Prof CB Tripathy, BHU
Fig. 10.110: Injury and death due to chewing of a

cracker,
Courtesy-Prof VCS Verma, Darbhanga Fig. 10.111 : Close distance explosion effect

Fig. 10.112(a): Effects of explosion on head and other Fig. 10.112(b): Death due to house collapse in an
parts of the body of a child. accidental explosion.
Courtesy- Prof CB Tripathy, SHU Courtesy- Prof CB Tripathy, BHU
Fig. 10.112(c): Blast injury. Fig. 10.112(d): Blast injury.

Fig . 10.112(e): Blast injury. Fig. 10.112(f): Blast injury.


the body will be the main feature in Hurt - for details, see Ch. 9, page
the victim or victims. 332.
(b) Simultaneous production of the ex- Force - for details, see Ch. 9, page
panding gas may cause extensive 332.
mutilating injuries. Skull bone fractures - see Ch. 9,
(c) If the expl~ded liquid is a chemical pages 484-486.
which burns then death may occur Murder, culpable homicide, homi-
as a result of asphyxia due to chok- cide due to rash and negligent act
ing for the inhalation of the gas lib- etc. -see Ch. 9, pages 330, 331.
erated or due to systemic poisoning Murder, Manslaughter, Felony,
effect of the gas or chemical injury. misdeminour - according to English
(d) There may be secondary injuries law, see Ch. 9, pages 336, 337.
due to tossing of the body on the
ground.
3. When the explosive matter is a gas pro-
ducing substance, then the following ef-
fects may be encountered- • Gonzales, T. A.; Vance, M.; Help ern, M.; Umberger G.
(a) Gross mutilating injury due to the J. - Legal Medicine and Toxy. 2nd Edn.
expanded gas. • Gordon, 1.; Turnen, R. and Price, T.W.(1953)- Medi-
(b) Chemical lesions, ifthe gas is chemical Jurisprudence, 3rd Edn.
cally so active. • Smith Sydney and Fiddes- 1959, Forensic Medicine
(c) Inhalation of the gas may lead to -1Oth Edn.
death due to choking. • Firearm- Rao, Bhooshana; Jouhari, W.; Supanekar,
(d) The gas may cause systemic poison- N. M. (1965).
ing, after inhalation of the same. • Firearm and Firearm injuries- Gonzales.
(e) Secondary injuries ·may be caused • Wound healing- Charles Illingworth (1966) .
due to tossing of the body on the
• Self Mutilation- Robert Robertson Ross, Hugh Bryan
gro~d because of the thrush cre-
Mekay, Lexington Books- 1979.
ated by the expanding gas.
• Pistols and revolvers. Vol. 1- W.A.B. Smith (1946).
(f) Rockets, grenades, mines, etc. are
used to cause blast at a desirable • The book of Riflss- 3rd Edn. White, H. P. &Smith, J.
place, either to hit a target or to G. 1965.
cause explosion under earth to kill • Druid H, Ward ME. Incomplete shored exit wounds: a
and combat enemies. report of three cases. Am J Forensic Med Pathol.
(g) Incendiarf or Molotov cocktail 2000; 21 (3) : 220-4.
1 bomb. • Druid H. Site of entrance wound and direction of bul-
(h) Grievm - for details see Ch. let path in firearm fatalities as indicators of homicide
9, pages 332-334. versus suicide. Forensic Sci Int. 1997; 88(2): 1.47-62.
Assault - for details, see Ch. 9, page • Mukhe~ee, J. B.; Forensic Med. and Tax. 1st Vol.
335. 1981 .

• Bull S, Raux C. Dawson M, Lennard C, Organic Pro- 5. Differentiate betwen a wound of entrance and a
pellant and Explosives Analysis by LC/MS/MS- Pre- wound of exit in case of punctured wounds.
liminary Results, Proceedings of the 15th Meeting of 6. How do you ascertain the distance and direction of
the International Association of Forensic Sc;iences, firing from the wound of entrance of a bullet or pellet
IAFS, Los Angeles (E5) /• · injuries?
• WB Woodman and Charles M Tidy- Forensic Medi- 7. How do you differentiate between the wound of
cine and Toxicology- 2007. entrance and exit in case of bullet injury?
• WG Aitchison Robertson -Aids to Forensic Medicine
-2008. Short notes, differences
• Richard Shephard.- Simpson's Forensic Medicine- Medicolegal importance of bruise, delayed bruise, post-
2003. mortem bruise and artificial bruise and its difference
• David Dolinak, Evan Matshep, Emma 0 Lew- Foren- with true bruise, difference between bruise and post,
sic Pathology: Principle and Practice - 2005. mortem staining, bruise and congestion, types of abra-
• Michael J Skrun and Davidson A Ramsay - Pathol- sions, medicolegal importance of abrasions, difference
ogy of Trauma - 2006. between ante-mortem and post-mortem abrasions;
• WarnElr U, Spitz David J, Spitz Ramsay Clark, Russel definition, types and medicolegal importances of abra-
S Rsher - Spitz and Fishe/s Medico/ega/Investiga- sions, bruise, lacerations, chop wounds, fabricated
tion of Death - 2006. wounds, hesitation or tentative cuts, bevelled cuts,
• Pekka Saukko and Bernard Knight - Knight's Foren- tailing of an incised wound, difference between
sic Pathology- 2004. wounds of entrance and exit in case of stab wound
and difference between entrance and exit in case of
• Stiffen Timmenmanas- Post-mortem: How Medi-
bullet wounds, ricochet bullet, tandem bullet, dum-
cal Examiners Explains Suspicious Death- 2007.
dum bullet, rubber bullet, gyr~et, improvised gun, chok-
· • W Ooglas Hemming- Forensic Medicine and Toxicol-
ing ·of a barrel, dermal nitrate test.
ogy- 2008.
Oral questions
Patterned abrasion, scratches, grazes, avulsion lac-
eFation, split laceration, gunpowder, primer, effects of
Theoretical rifling of the barrel, why a revolver is called a revolver,
· 1. How do you classify injuries? balling of pellets, muzzle velocity and range of differ-
2. How do you assess time of assault or infliction of ent guns, bore or calibre of a gun, single wound of
entrance, multiple bullet in the body, single wound of
different injury?
entrance and multiple wounds of exit, multiple wounds
3. What are the features of incised arid stab wounds ? of entrance and exit with a single firing, primary and
4. Differentiate between suicidal and homicidal cut throat secondary markigs on a bulle( test bullet, effects of
injuries blast, effects of explpsion, dermal nitrate test.

Damage may be caused to the body, if ex-
EXPOSU TO COLD
posed to extreme heat or cold. Hence , ther-
mal injuries may be due to exposure to heat
General effects of exposure to cold
or cold which may have generalised effects
(Hypothermia)
or local effects according to the nature of ex-
posure. Thus thermal injuries may be classi- Much of the general effects of exposure to
fied as in Table 11.1. cold is known to us as a result of most cruel
Table 11 1: Thermat injur.es
Th~rmal injuries
!
+
Due to exposure
t
Due to exposure
to extreme cold to extreme heat
. i
.---t-~
General effects :.Local General Local
(Hypothermia, _ effects effects effects
immersion syndr9me} '.
-~ +
1
t
-Prostblte
t
Trench foot or Bums Scald
Immersion foot (dry heat lnj.) (moist heat inj.)
Heat stroke Heat cramps Heat exhaustion Heat rash Sunburn

(Sun stroke, (Miner's cramps, (H~at syncope)
Heat hyperpyrexia) Stoker's cramps)
427
428 I PRINCI PLES OF FO RENSIC fv1EDICINE
and brutal human experiments, conducted on fall of the temperature . Meanwhile patchy red-
the prisoners of the second world war in war dish area may develop at places, due to local
camps, during 1942 and 1943. The victims of action of the exposure.
the experiments were exposed naked to an Clinical death , i.e., stoppage ofrespira-
atmospheric temperature of - 6°C and im- tion and circulation and failure to respond to
mersed with dress, in water at 4°C - 9°C, for stimulii occurs. But in reality brain death in
varying periods. From these study and study these cases occurs late (in comparison to
of others in different circumstances, the gen- other circumstances of death).
eral effects of exposure to cold are known to
be as follows : Fadors influencing the rate of fall of the
body temperature
Signs symptoms-with gradual fall of
body temperature the following signs and 1. Body built and physique-Persons with
symptoms appear: good physique can resist exposure for a
At first the skin appears pale and then longer period.
cyanosed. In the early phase , .the respiration 2. Obesity also preserves body temperature
and the pulse rate are increased. But as the well due to heat insulating capacity of
exposure is continued and as the rectal tem- subcutaneous fatty tissue.
perature falls below 34°C , both respiration and 3. Age-Persons in the extremes of ages are
pulse rate decreases . Gradually, the pulse more vulnerable to exposure .
becomes weak and imperceptible, but the veins 4. Cold water (as in case of immersion syn-
remain prominent. At this stage the rate of drome) is more penetrating than cold air
pulse may be as low as 50 per minute. Pain and hence may cause early fatality.
sensation is diminished. With further fall of
5, Alcohol or other intoxication or ill health
body temperature consciousness becomes makes a person more vulnerable to ex-
cloudy . When the body temperature comes posure to cold. (see page 84 7).
down to 29°C - 30°C, the person is totally in-
6. Malnutrition is another condition which
active, in way to death with cardiac irregu-
reduces the .tolerance or resistance of a
larities and auricular fibrillation . At the early person to cold.
period , there is severe shivering which is a
mechanical physiological process to raise the 7. In addition to these factors, other factors
like clothing and medium of the expo-
body temperature. But as the body metabo-
sure (atmosphere or water) are also im-
·lism comes down, there is no more shivering,
portant.
stumbling. The blood sugar level increases and
may even be doubled without any glycosuria .
Once the temperature of the body comes down Medicolegal importances of death due to
to less than 30°C, coordinated movement and exposure to cold
walking is not possible ; incoherent behaviour, 1. Deaths due to exposure in most cases,
at one time is due to increased circulation in are accidental in nature. The victims may
limbs with feeling ofheat and hence there may be expeditionists , poor people having no
be paradoxical undressing. The subject gradu- satisfactory means to protect themselves
ally becomes stuporous and it may not be pos- from cold waves, victims of shipwreck in
sible to revive the person. Even after removal polar and cold arctic , antarctic and tem-
to a safe environment, there may be further perate zones.

chapter 11: THERMAL INJURIES I 429
2. Suicidal exposures are not common. much and does not move the limbs.· There .
3. Homicidal exposure is also not common, may be reddish patches which may be spo-
though it occasionally occurs, as in cases radically placed but are most remarkable on
of killing of unwanted newborn infants the face. The limbs are swollen and pits on
and also by abandoning a child. Cruelty pressure. The respiration and pulse rates fall.
to old and disabled persons may precipi- Fall of temperature below 30°C may lead to
tate fatal exposure. Criminality of the an irreversible state.
experimental exposure does not require
much elaboration. Often a person, made Post-mortem findings in death due to
unconscious due to assault or due to the exposure to cold
action of certain intoxicating agent or
External findings
poison, may be left in an atmosphere of
very low temperature, causing death ul- Rigor mortis starts late and stays for a long
timately, due to exposure. time. Even before the onset of rigor, the body
4. The paradoxical undressing due to sense may appear stiff, which passes off if the body
ofheat in limbs in case of woman victim is left for some time in normal atmospheric
may give a preJiminary wrong idea or temperature. The post-mortemstaining may
doubt of sex offence. be bright-red in colour, though bluish or red-
dish-blue patches may be present at places.
Exposure to cold in case of newborn
infants Internal findings
Infants are specially vulnerable to the expo- The organs are congested and bright red in
sure. Premature infants are susceptible to colour. Haemorrhagic spots are common in
even moderate degree of exposure. many organs with evidence of blocking of
capillaries with clumped blood cells. The find-
In infants specifically, danger arises due
ings are more common under the mucus
to exposure to lower degree atmospheric tem-
membrane of stomach and intestine, in the
perature, from the following factors:
lungs and in the layers of the meninges.
1. Children, like old subjects, have greater Necrosis of the fatty tissue in the pancreas is
body surface area in comparison with the said to be common but was not found by the
body volume which causes quick lower- author in any case where death occurred due
ing of the body temperature. to exposure to cold. The blood in the vessels
2. The heat regulating centre of a child or (both artery and vein) is bright red in colour
an infant does not function as effectively due to presence of oxy-haemoglobin in both
as in an adult. arteries and veins because of non-utilisation
3. The capacity of generating heat by me- of oxygen at the tissue level.
chanical way, e.g., by shivering is mini-
mum. Local effects of exposure to cold
Features This happens when there is some protective

clothings on the body, so that only the ~istal
A child who is seriously exposed to cold is segments of the body like fingers, toes, tip of
drowsy, lie still, refuse food but does not cry nose, ear lobules which remain exp.o sed are

affected. The maximum local tissue reaction sion in cold water. The feet appear red-
to exposure may be total necrosis . Two such dish or bluish, are swollen and numb with
conditions are met with~ blisters and sores. Fungal infection may
1. Frost bite -It occurs due to exposure to occur subsequently, when it is termed
dry cold, as in cases of mountaineers or "Jungle rot ".
polar expeditionists . Atmospheric tem- Prevention-By avoiding precipitating
perature has to be below ooc which causes condition.
damage to skin and underlying tissue Treatment-If gangrene occurs then am-
when the exposure continues for a pro- putation of the affected part. Pathogenesis
longed period. This occur in fingers , nose , -see below.
ears , i.e., parts furthest from heart and
having comparatively more covering sur-
face. '¥rost nip " is the term us~d for the Pathology and Pathogenesis
affected area before damage, occurs when
as a result of exposure, there .are burn- Frost bite and immersion feet and hands oc-
ing or tingling sensation, discolouration, cur in the distal segments of the body. The
numbness or intense pain. If death of the fingers , toes , hands and limbs are more com-
tissue occurs, the affected part ultimately monly affected than the tip of nose and ear
becomes black and needs amputation. A lobule.
cold wind is more penetrating and often
precipitates the conditiqn. Treatment At first, there is vasoconstriction and the
consists ofgradual warming of the part- affected parts appear pale. Then, there is
vaso-paralysis and vaso-dilatation . There is
dipping in warm water at around 42°C,
damage to the intima of the vessels . There is
till the temperature of the part rises to
37°C. Exposure to higher temperature to clumping .o f the blood cells and that causes
bring 37°C is harmful. Further the area occlusion of the vessels. This, along with
should not be rubbed. Sterile dressing is vasoparalysis and vasodilatation causes tran-
sudation ofblood fluid in the tissue space caus-
recommended to avoid further exposure.
ing local oedema. Lack of circulation to the
Pathogenesis- see below.
affected part ultimately leads to necrosis of
2. Trench foot or immersion foot or hand - the part. Occasionally, there may be blister
Necrosis of the fingers , toes or hands and formation and throbbing pain at the affected
feet may occur at a low temperature say, part. The pain increases on application of
below 5°C- 6°C, if the limbs are wet due warm fomentation .and if the limb is lowered
to immersion': When wet , cold is more down.
penetrating 'and thus a temperature
higher than ·that required to cause frost
bite may cause necrosis to these··distal
segments of the bodJ. Such necrosis oc-
curred -f requently on thEdeet~fth& sol- ( .r r • ' • .
GENERAL o'R S~Stf.\.{lt EFFECTS OF

diers inside the trench during Crime@
EXPOSUREiO'ff(!)T<ATMOSPHERE
war and when the !'Q~die~ ofNapoleon
' ''
attacked Russia in 1812. Immersion foot Qur· boQ.y, tq.. a.p~r.t.G\-i:n extent, can tolerate
~- .iili.d hand -.syndrome oceurs due to immer- ~xposure to some degree rise of atmospheric

temperature. The threshold of tolerance de- 42°C (104°F- 108°F). The skin isdry, face
pends on various heat regulating factors in- is flushed, generalised hot red flushy skin,
cluding those which are endogenous. The the pupils are constricted. There is no
endogenous heat regulating centre and sys- heat loss from the body by way of radia-
tem fails with increase .in the atmospheric tion as the atmospheric temperature is
temperature and humidity. Increase in the high. There is also no loss of heat from
atmospheric temperature can to a great ex- the body by way of evaporation as there
tent be tolerated, if the humidity of the at- is no sweating due to dehydration. There
mosphere is low. With increased humidity, may be vertigo, staggering gait, vomit-
the increase in the atmospheric temperature ing. There may be mental confusion, hal-
becomes more and more intolerable and dam- iucination, agitation, disorientation. The
aging. It has been noticed that with 100% pulse and respiration may be irregular
humidity, an atmospheric temperature above and before death there may be delirium,
90°F becomes intolerable; at above 90% hu- convulsion and coma. Death occurs due
midity, temperature above 100°F may be dan- to failure of the vital centres.
gerous; at above 40o/o humidity, temperature Infants, elderly people, people with heart, ·
above 120°F may be dangerous; and when the lungs, kidney or other diseases, athletes
temperature is around 140°F, humidity above and those who work outdoor are more
20% is intolerable and dangerous. Thus it is
prone .to heat stroke.
seen that among the exogenous factors, hu-
midity plays a definite role by way of acting Heat stroke may be preceded by heat ex-
on the process of evaporation of the body fluid haustion (see below).
which is very much important to maintain Treatmenir-Rest, cooling of the body by
the temperature of the body to prevent the bathing, ~old sponging and fanning, fluid
failure or upset of the different systems of. therapy, avoiding exercise, alcohol and
the body. Among the other factors which also hot drinks.
act, are the clothings and the quality of the Post-mortem appearance-Post-mortem
clothings, air movement, mental and physi- caloricity (raised body temperature after
cal state of the person. Personal tolerance, death) is a finding, appreciable for some
on the basis of regional climate, occupational time after death. Rigor mortis appears
habit, etc. can influence the effects to a great in the dead body at an early period and
extent. also passes off early. Similarly, decom-
The systemic effects of exposure to hot position also starts early in the body. In-
atmosphere may be manifested in three dif- ternally, the organs are generally con-
ferent ways. gested The blood is dark and liquid. The
1. Heat stroke (sunstroke, heat hyper- lungs may be congested with haemorrha-
pyrexia, thermal or thennic fever)- This .gic spots on the surface. There may not
occurs usually in the tropics due to long be any other specific finding available
exposure under the scorching sun. during post-mortem examination.
There are headache, mental confusion, 2. Heat exhaustion (heat collapse, heat syn-
thirst, stoppage of urination though there cope)-This occurs due to exposure to a
is a strong desire to ·:riiieturate. The body • dosed environment of moderately high
temperature may ~e -to 40°C or even ·- temperature; insufficient intake of fluid,

432 / PRINCIPLES OF FO RENSIC MEDICINE
sometimes after exposure for a long pe- 5. Sun burn-Occurs in "white" youngers
riod (may be even for days continuously). of cold or temperate areas when exposed
Due to the effect of heat on the nervous to the scorching sun of tropical zones, for
system, in such circumstances, there may a reasonably long time. There may be fe-
be failure of heart and circulatory sys- ver with dry, red, swollen areas on skin,
tem. There are fall ofblood pressure, fall which itches, and the epidermis peels off
of body temperature, excessive sweating after a few days. UV radiation is the dan-
with cold moist skin, paleness, nausea, ger.
vomiting, occasional cramping of muscle, Treatment- To avoid exposure to the
headache, giddiness, thready, weak pulse sun, use of dusting powder and use of sun-
rapid respiration, tiredness, dizziness, screen to avoid UV radiation danger.
fainting. Relief is easy , if the person is
removed from the place early and resus-
Local effects of heat
citation measures are adapted.
Treatment-Cooling by cold bath, remov- Local effects of application of heat depend on
ing to airconditioned room,·cold sponging, the nature of heat, degree of heat, period of
rest, non-alcoholic cold beverage with or contaCt and the material used to transmit
without mineral supplementation. heat.
3. Heat cramps (miners' cramps )-This oc- Sun bum described above has not been
curs due to exposure to high atmospheric included in bum injuries.
temperature with loss of body fluid and
salts (electrolytes ). There are muscular
pain and cramps with fall of blood pres- BURNING AND BURN INJURIES
sure. There may be accompanying head-
ache, dizziness and vomiting. This condi-
Bums are injuries or lesions caused due to
tion arises due to excessive sweating. application ofheat , which may be dry heat
Treatment with fluid and electrolyte re- (free flame , hot metals or similar hot mate-
vives the patient.
rials ), heat generation due to electrical con-
Post-mortem findings in cases of heat tact or may be caused by radiation. Moist heat
cramps and heat exhaustion are nonspe- (hot liquid or vapour) causes scalding. Some
cific. Signs of dehydration with congested chemical injuries are also termed "chemical
organs are the main post-mortem features. bums ". All these agents damage tissue and
4. Heat rash -More commonly seen in cause lesions which have some similarities
young persons , in hot, humid weather, in them to attribute them the common term
causing excessive sweating and rashes in "Bum", though all of them have some spe-
clusters, occasionally with fom1ation of cific features also. Here we shall discuss in-
small painless blisters. Such rash fom1a- juries produced by dry heat and moist heat,
tion are more corrrmonly noticed around simply termed as "bums" and "scalds" and
the neck, upper part of chest, under the in short, lesions produced by corrosive chemi-
breasts of women in the groins. cals which have been described in details with
Treatment-Cold sponging and applica- individual injurious agents in toxicology chap-
tion of dusting powder over the affected ters. Lesions due to electricity and radiation
areas. have been described in t~e next chapter.

Clauificotion of Bum injuries due to dry These lesions ulcerate, may get infected, heal
heat with deep scarring and may cause contrac-
ture and when near a joint may limit the func-
Classification of dry burn injuries are prima-
tion of the joint.
rily done on the basis of depth of involvement
and to some extent the surface area involved. 6th degree - Here the lesion extends
deeper than the subcutaneous tissue , involv-
1. Dupuytren's classification of burn infit-
ing the muscles and bones. These lesions are
nes:
also less painful. They also heal with contrac-
1st degree - When contact occurs with ture limiting the function , when nearer to a
comparatively low degree heat for a very joint. These lesions obviously heal with great
short .period, there is erythema over the area difficulty.
of contact. It is painful for sometime. The ery-
Dupuytren's classification of burn inju-
thema passes off in a few hours or a day.
ries was later modified by Wilson.
Occasionally, the covering epidermis may get
devitalised and may be shedded off after a 2. Wilson's modified classification of bum
few days. injuries
2nd degree - Here also the effect is lim- 1st degree - First degree ofWilson's clas-
ited within the superficial layer of the skin, sification of burn injury includes the 1st and
the epidermis. There is blister formation 2nd degrees ofDupuytren, having involvement
which is surrounded by a red line (hyperae- of the epidermis alone. There is erythema or
mia). The blister contains serum, rich in pro- erythema and blister formation. The injuries
tein and chloride .· This is also painful . The are painful and heals without formation of scar.
blisters may rupture and may get infected. Death may occur when the involvement of the
Extensive blisters, in addition to shock due surface area of the body is extensive. Death
to pam, may also cause hypovolumic shock. may occur due to primary shock within a few
hours, within about 2 days due to hypovolumic
3rd degree - Here part of the thickness or secondary shock, and due to infection and
of the true skin is involved. There is singe- other systemic causes subsequently. Rupture
ing of hair and blackening due to deposition of blister may cause infection followed by ul-
of soot. The tissue involved is also charred to cer and healing by scar formation.
some extent. This variety is extremely pain-
2nd degree - These are dermo-epidermal
ful. There will be a red lining and there may
burn injuries which are painful and heals with
be blister formation around the wound. These
permanent scar formation. These include 3rd
wounds ulcerate and may get infected. They
and 4th degrees of Dupuytren's classification.
heal by scar formation .
3rd degree - When the lesion extends
4th degree -Here the depth of the lesion beyond the depth of the true skin, it is 3rd
involves the whole thickness of the skin. Rest degree of Wilson's classification which in-
of the features are similar with the 3rd de- cludes 5th and 6th degrees of Dupuytren's
gree variety. classification. These are less p~inful; they
5th degree - In this degree, the depth of heal with scar and contracture formation ,
the lesion extends up to the subcutaneous causing disfigurement and loss of function of
tissue . These wormds are less painful due to the part of the body involved, particularly
total damage of the sensitive nerve endings . when near a joint.
n:: M - ? Al

3. Modem classification on the basis of in- Factors which influence the outcome or
volvement of depth: prognosis of burn injuries
(a) Superficial - Here the depth of the 1. The extent of the surface area of the body
lesion does not extend beyond part
involved. This is the single important
of the thickness of the true skin.
criterion which influences the outcome
(b) Deep - Here the lesion involves the (prognosis) maximum. The percentage of
whole depth of the true skin to its the body surface area involved is calcu-
minimum All burn injuries involv-
lated out by the rule of' g . According to
ing the whole thickness of the true
this rule the percentage of area attri-
skin or deeper tissue are grouped
in this type. buted to the different parts of the body
are as follows :
4. Classification on the basis of involvement
of depth and BSA (body surface area): Head and neck = 9% of the whole body area.
(a) Minor- 1st and/or 2nd liegree burn
Front of chest = 9%
ofWilson's modified type inyolving
less than 10% of body surface of a Back of chest = 9%
.child or involving less than 15% body Front of abdomen = 9%
surlace of an adult. Back of abdomen = 9%
(b) Moderate-1st and 2nd degree burn
Right upper limb = 9%
(of Wilson's type) covering more
than 15% of body surface in an adult Left upper limb = 9%
or 3rd degree (Wilson) covering less Front of left lower limb = 9%
than 10% ofBSA (body surface area) Back of left lower limb = 9%
of a child or adult.
Front of right lower limb = 9%
(c) Severe-3rd degree (Wilson type)
covering more than 10% ofbody sur- Back of right lower limb = 9%
face area in a child or adult. Pudendal area = 1%
5. Recent classification: To!DJ = 100%
(a) Superficial bum-involving epider-
mis (1st degree Wilson). Generally speaking, involvement of more
(b) Deep than 30% of the body surface may be dan-
gerous. But more than 50% involvement
(i) dermal (partial or full thickness
of the body surface is expected to be fa-
of dermis (2nd degree Wilson)].
tal.
(ii) dermal and subcutaneous (in-
volving up to subcutaneous 2. Age - Infants, very young children and
fatty tissue-3rd degree ofWil- old subjects are more likely to succumb
son's type). to extensive burn injuries. Elderly chil-
(iii) thickness involvingdeepertis- dren and Y,Oung adults can withstand burn
sue like bones, muscles, etc. (It injury ~W~r. Subjects above 40 years of
is also -Wilson's. type of 3rd age are lik~l~ to su,ccumb with over 40%
degree) surface b~- ~r,tj~.
In burn injuries usually the central part R Sex -:.Male.s.witbstand burn injury bet-
is.deepest '(~ . te·r than females .

4. General physical condition and health - culatory failure . Metabolic disorder is a com-
Persons with good physical condition and mon feature. There is rise in the body tem-
without any systemic disease, stand bum perature and there may be muscular cramps.
injuries better than those with ill health On second and third days, signs of renal fail-
and disease. ure may appear. There is serosanguinous dis-
5. Degree of heat applied - High degree of charge from the raw surface of ruptured blis-
heat causes deeper bum injuries. ters. If there is infection, then pus appears
by third day. There may be ulceration and
6. Time of contact -Application of dry heat
slough fonnation. Depending on the surface
for a prolonged period will cause deep
area involved, the depth and infection, a bum
injuries. In addition to that, prolonged
injury may take one to a few weeks to heal
contact may lead to neurogenic shock and
completely. In bums which are deeper and
death.
which heal by ulceration, there is permanent
7. Depth of the bum injury -Depth of the scar formation and there may be contracture.
bum injury makes the healing difficult
and leads to complications. But so far fa- Treatment- To keep the patient in a ster-
tality is concerned, area of involvement ile , tranquil and comfortable condition. Pain
of the body surface is more important. A and excitement be minimised. Coverage to
deep wound over a small area of the body prevent or combat infection should be given
priority. If the patient has extensive scar or
is less dangerous than a superficial in-
contracture then skin grafting may be nec-
jury spreaded over an extensive area of
essary for cosmetic purpose and to avoid con-
the body surface.
tracture to pi;event limitation of mobility of
8. On the basis of the modem classification, a joint. Loss of body fluid, shock metabolic
permanent scar may be formed with any disorder and failure ofkidney function should
variety of the two . In deep variety, heal- be given proper attention.
ing with permanent scar fonnation is a
Prognosis-Minor, uncomplicated, super-
must, but in some cases of the superfi-
ficial bums heal without permanent scar for-
cial bums, there will be scar fonnation
mation within 7-10 days. Moderate bum or
(where part of the true skin is involved),
bum involving dennis or deeper tiss~e takes
whereas in others there will not be any
longer time to heal-the period varies on the
permanent scar formation, if there is no
size and depth ofbum and also on whether
infection or ulcer fom1ation and is lim-
infection has complicated the condition, scar-
ited to epidennis only.
ring and also contracture will be the outcome
of deep bum. In major or moderate bum
Signs, symptoms of burn injuries cases depending on surface area, part of the
Bum injuries are extremely painful which body involved, infection, shock, renal failure ,
may give rise to primary or neurogenic shock. effects of metabolic disorders, death may oc-
If not unconscious, the person will have vom- cur, sooner or later.
iting. There is headache , ' cy~os1s, tachycar- Age of.a bum injury - In case of superfi-
dia. There may be loss of consciousness. In cial bu.ms there is immediate erythema. If
deep bum, instead of pain there will be numb- there is fonnation of blister, then that oc-
ness of the area due to·damage of nerve end- curs within 2- 3 hours. The erythema around
ings. There is hypotensiori·with signs of cir- a blister or deep injury passes offby 2nd day.

Pus formation occurs by 3rd day. Within the A When death occurs immediately or
next one or two days there is slough forma- within some hours after sust aining the
tion which is shedded off once by the end of injuries -
the first week. Burn injuries involving the
skin and deeper tissue takes a minimum of2 External findings
weeks to heal.
Externally, the dead body may still bear burnt
Causes of death in case of burn injury remains of dress , particularly the portions
and the connecting circumstances of burn-
which were tightly in contact with the body
ing- and which during the process of burning got
1. Death may occur within a few hours due pressed on the skin. Smell of kerosene or any
to primary or neurogenic shock. such fuel which might have been used to set
2. Secondary or hypovolumic shock may fire on the body, may be detectable, The scalp
cause death within the first 2 days: hair and other body hair may be singed. There
After this period, death may occur due to may be blackening of extensive area of the
any of the following reasons. · body. Due to coagulation of the muscle pro-
3. Renalfailure . tein resulting in contraction of the muscle
fibres, in which flexor muscles take upper
4. Systemic absorption and action of the
hand, the whole body may assume a flexion
toxins from the ulcerated burn injuries.
attitude. The flexion attitude of the body is
5. Infection and sepsis. popularly termed as pugilistic or boxer's or
Apart from all these direct effects of burn fencer's attitude which is nearly similar to
injuries, death of a person may occur for an attitude taken by a boxer to defend him-
reasons, bearing with the circumstances self during boxing or fist-fighting. However,
of burning. These are - singeing, blackening and pugilistic attitude
6. Due to inhalation of asphyxiant gases like do not indicate anything in specific about the
CO and C02 , during conflagration. nature of burning, whether ante-mortem or
7. Death may also occur due to mechanical post-mortem. These are the results of expo-
asphyxiation, e.g., traumatic asphyxia in sure of the body to fire, soot and heat, either
case of collapse of a house resulting from occurring before death or after death. Hence,
out-break of fire in a house. as in a case of ante-mortem burning, they
8. Due to sustaining fatal mechanical inju- will also be present in a case of post-mortem
ries as a result of sudden collapse of wall burning.
or house. Presence of blisters containing serum,
rich in protein and chloride, surrounded by
Post-mortem findings in a case of death red (hyperaemic) line, and presence of rup-
due to burn injuries tured blisters with evidence of serosanguin-
Post-mortem findings vary according to the ous discharge from the reddish raw floor are
time gap between sustaining of burn injuries constant findings in a case of death during
and death. In some cases death occurs after sustaining burn injuries or death occurring
a week or so, when the apparent picture is within a few hours. The post-mortem stain-
totally different from those found in a case of ing is bright red in colour due to formation
immediate death, after sustaining burn inju- and presence of carboxyhaemoglobin which
ries. forms due to inhalation of CO, a p~oduct of

incomplete combustion of carbonaceous sub- In some cases, there may be discharge of

stances. This can be taken as an ante-mortem blood mixed fluid through the nose. This is
feature of burning death, though there is an due to excessive secretion in the lung for in-
argument that, if a dead body is subjected to halation of smoke and rupture of capillaries,
similar situation, then absorption of CO as a result of contraction of muscles.
through the skin and some absorption of CO
by the haemoglobin of red cells which has Internal findings
great affinity for the gas may also cause post-
mortem carboxy-haemoglobin formation. The nasal and the mouth cavities may show
presence of carbon soot. Soot may also be
Heat rupture may be present at places
present, mixed with mucus, adhered to the
which may occur due to severe contraction
wall of the lumen of the respiratory tract, as
of the coagulated muscle fibres but occurs
below as the lumen of the bronchioles. The
mostly during movement of the body when
mucus membrane of the respiratory tract is
the coagulated and contracted muscles tear
congested. The lungs are congested and may
easily. These heat ruptnres may be confused
also be oedematous. The blood in the vessels
with ante-mortem lacerations, or they may
is fluid, bright red and thick. Muscles and the
even be confused with incised wounds. But,
organs are congested and bright red in col-
if carefully examined, then there is no-scope
our. The chambers of the heart may be full.
of confusion of a heat rupture with any other
ante-mortem injury. Due to the effect ofheat The skull bone may show heat fracture
there is no haemorrhage from a heat rup- which may occur either due to (1) drying and
ture. As in case of laceration, here there is desiccation (cracking and outward curving of
no marginal abrasion and swelling. Instead, the outer table) or may be due to (2) bursting
there may be marginal blister formation with involving whole thickness of skull or sutural
·fracture (separation), due to increased intra-
· zone of red line surrounding the rupture, if
cranial pressure, from production of gas due
the process of burning at that part started
to the effect of heat.
before the moment of death. The floor of a
heat rupture will show intact vessels and Heat haematoma in the form of firm, fri-
nerves running across the floor. able, cherry red or chocolate red clot ofblood
present in the extradural level, which on sec-
Charring of the tissue may occur due to
tioning has honeycomb appearance because
sustained burning, which is common with
of vaporisation ofliquid part ofblood, due to
deep burns. Charring may involve even the
direct effect of heat. This haemorrhage ap-
bone. Like singeing, blackening and heat
pears to be due to heat rupture of vessels at
rupture, charring also does not say anything
the extradural level.
specific of whether the burning was ante-
B. When death occurs after some days of
mortem or post-mortem. It should be remem-
sustaining burn injuries-
bered that extensive charring at times may
obliterate the antemortem features ofburn-
ing, when burning of the body continues even External findings
after death causing charring and destruction Smell of the fuel and blackening will not be
of the parts which were burnt before the oc- there. Singeing may or may not be appreci-
currence of death. ated which depends on how many days after

burning, death has occurred. Pugilistic atti- matous and the meninges may show signs of
tude and heat rupture are also not expected inflammation. Some degenerative changes in
in such cases which with time may be re- the liver may not be unlikely.
placed by necrosis and ulceration. Post-
mortem staining also need not be bright red Medicolegal aspeds of death due to burn
when death occurs after some days. Blisters injuries
or ruptured blisters may still be present but
the red lining around them will not be there. The following questions may arise in deaths
The floors of the ruptured blisters show evi- with history of burn injuries-
dence of serosanguinous discharge or if in- 1. What is the actual cause of death? Was it
fected , then pus formation. There may be due to burning?
ulceration and slough formation and in some These questions can be solved on the
cases there may be marginal scabbing or scar- basis of the following observations:
ring. Application of antiseptic lotion, paint or
(a) Whether the burn injuries were
ointment and evidence of venesection are the
ante-mortem in nature.
common findings in these cases . In obese
bodies, surface liquefaction of exposed sub- (b) If so, whether those ante-mortem
cutaneous fat is a common finding. burns were sufficient to cause death
bfa person.
(c) If so, whether signs of precise cause
Internal findings
or causes of death were present on
Carbonaceous soot will be absent in the lu- the body.
men of the mucus membrane of the respira- (d) If there were any other finding or
tory tract. Blood and organs will not be red- findings in the body to suggest any
dish as is in the case when death occurs in a other cause of death.
day. A specific finding is the "Curling Ulcer" (e) If there were any sign in the body,
which is seen in the inner wall of the first which in addition to burn injuries,
part of the duodenum, if the victim survives could have contributed to the cause
for 7- 10 days after sustaining the burn inju- of death.
ries. This ulcer is about 2 em in diameter (a) Whether the burn injuries were
and is different from the usual duodenal ul- ante-mortem in nature - If the burn
cer. A few similar ulcers of smaller sizes may injuries were antemortem in nature,
be present over the pyloric part of the stom- then the findings which should be
ach or at other places of the intestine. The present are : red hyperaemic
lungs are congested and oedematous and of- patches, ante-mortem blisters which
ten show the signs of pneumonitis. There may have red marginal linings and which
be signs of endocarditis with small areas of contain serum, rich in protein and
haemorrhage. The kidneys may show evi- chloride and in case of ruptured blis-
dence of toxic or infective nephritis. The uri- ters, the floor will appear reddish
nary bladder may show signs of cystitis and slippe.ry due to sero-sanguinous dis-
may .contain turbid urine which on micro- charge. There may be bright red or
scopic examination will show presence of pus cheryy red post-mortem staining. In
cell; RBC and casts. The brain may be o~jle- some cases there will be charring

with marginal red lining. In cases (e) If there were any sign other than
where death occurs after some days, burning in the body which also
there will be presence of ulcers might have contributed to the cause
which may have tags of epidermis of death in addition to burn injuries
of the ruptured blisters on the mar- - Sometimes in addition to the burn
gins. Internally, the most important injuries some other findings like me-
findings of ante-mortem burning are, chanical injury or effects of some poi-
presence of soot in the larynx, tra- soning, may be present which may
chea and bronchus , and bright red partly be responsible and along with
colouration ofblood, organs and the burn injuries, may be the cause of
tissues. Rest of the findings are not death.
specific of ante-mortem burn injury. 2. Once the cause of death is established as
(b) Whether the ante-mortem burn in- to be partly or wholly due to burn inju-
juries were sufficient to cause death ries, the next question that arises is,
- As has already been mentioned, whether burning was accidental, suicidal
the surface area ofburning is more or homicidal.
important in the question of fatal- From general statistics it can be said that,
ity. Burn of more than 30% body burning incidents are mostly accidental; next
surface may cause death and when to accident, these are suicidal and least com-
the burning involves more than 50% monly these are homicidal in nature.
of the surface area, death is likely
Accidental burning - Accidental burning
to occur. While considering this
deaths may occur inside the domestic
point, the factors which influence the
kitchen, at the place of work in factories, ac-
prognosis or the outcome ofburn in-
cidental house conflagration incidents and in
juries (see page 434-435) may be
totally unforeseen happenings like fire inside
given due consideration.
the train compartments, bus (due to carry-
(c) Whether signs of the precise cause ing of highly inflammable substance), or
or causes of death are present on bursting and flaming of highly inflammable
the body - The precise causes of fuel during transport through carrier tank-
death due to burning have been enu- ers. In 1983, over 70 people died due to burn
merated on page 436. The post- injury at "Dhulabari" railway station in Bihar
mortem findings should be consist- near the West Bengal border. While they were
ent with any one or more of them. stealing highly inflammable petroleum prod-
(d) If there is any finding in the body uct, by making out leaking point in a fuel
which suggests any other cause of carrier tanker of a halting goods train, the
death - In the body there may be area contaminated with the inflammable liq-
evidence of poisoning, fatal mechani- uid suddenly caught fire which in a moment
cal injuries or violent asphyxia like spread up to the tanker, which readily burst
strangulation or throttling. These causing spilling of the the liquid and spread-
findings may partly be obliterated by ing of the fire all around. On another occa-
burning and ·the burn injuries, if sion a distant running express passenger bus
closely examined~ mJt~rreveal their got S'uddenly blazed when a full acetylene(?)
post-mortem nature. cylinder started leaking and caught fire from

a burning cigarette (?). In this occasion also, Self-immolation in protest against some so-
there was heavy casualty. In another occa- cial injustice is committed at open places. In
sion, a liquid gas tanker collided with a bus India, suicide by immolation in domestic en-
causing bursting of the tanker and outbreak vironment is much more common in females.
of fire in the heart of city ofKolkata (the then Suicidal bride burning death~ have presently
Calcutta). Many passengers of the colliding taken a new magnitude. Suicidal burning is
bus sustained burn injuries though death toll more common in females , because this kill-
was comparatively less (three), with only two ing agent is very much within their easy
spot deaths. reach. With more and more number of fe-
In domestic kitchen, free-flame ovens are males committing suicide by this method, it
specially dangerous. Another danger is the seems to be becoming more and more popu-
popularity of the inflammable syn,thetic saree. lar day by day, though the method is a very
Electrical short circuit is sometimes the cause painful one. Suicide by self-immolation has
of serious outbreak of fire. Accidental burn also become a practice against alleged social
injury may be sustained at the :place of work injustice.
by them, who work near a furnace or with In case of suicidal burning, usually some
liquid hot metals. The circumstance in these inflammable fuel like kerosene or petrol is
cases will tell about the accidental nature of used. The fuel is usually poured on the head
the incidents. The victim is either busy in so that, the whole body will catch fire all at a
work or the fire breaks out accidentally in- time. Hence in all suicidal burn death cases,
juring a good number of people. Problem evidences of pouring fuel on the head may be
arises when burn injuries are sustained in- appreciated from the smell of the fuel in this
side the kitchen. Claims and counterclaims part of the body. Obviously in these cases,
may arise that the incident was accidental, the head and other parts of the body are usu-
suicidal or even homicidal. In these cases ally affected but the soles may be spared. At
absence of suicidal and homicidal features, the place of occurrence, the common things
both in the body as well as in the circum- in sight are, an empty kerosene tin or bottle,
.stance, will count much to prove it as a case or an empty kerosene stove and a match box.
of accident. It should be remembered that, a suicidal
burning scene may be created in case of a
Other circumstances af accidental burning homicidal burning or in a case of post-
mortem burning of an otherwise homicidal
The leakage of cooking gas, at times satu- death. Suicide is usually committed by bolt-
rates the inside of the kitchen. Accidental con- ing the door of the kitchen or bathroom from
flagration has occurred when in such a con- inside. A suicidal note may be occasionally
dition attempt was made to lit the oven. The left. Often the reason is clear. It may be due
kitchen room saturated with cooking gas gets to frustration in love, failure in examination
ablazed. Accidental death due to burn injury or torture and cruelty in case of a housewife.
is also a common occurrence during "Diwali" Marks of physical torture may be present in
(from use of or playing with fireworks). the body in the form of contusion, etc.
Suicidal bum injuries - Suicide by burn In some cases, suicides are seen to have
occurs mostly in the domestic situation, like adapted this method after failing to achieve
inside the kitchen, bathroom or bedroom the goal by some other means. In them, self-

chapter 11: THERMAL INJURIES I 441 .
inflicted incised wounds or effects and evi- evidence will be in support of pouring of fuel
dences of poisoning may be present in the on the head. But, expectedly, burn injury will
body. In one case of post-mortem examina- be absent on the soles and in the line of the
tion performed at Kolkata (the then Calcutta) body in contact with the pillar. In all cases,
Police Morgue, the mouth of the deceased to unfold the true nature of homicidal burn-
was seen to be gagged by a piece of napkin. ing case, the autopsy should be thorough and
Apparently, the suicide herself did this to pre- examination of place of occurrence, which
vent herself from crying or raising alarm remains approachable to all, should be me-
during the process of immolation. ticulously done. Sometime the victim is con-
Homicidal burning-Homicidal burning fined in a room by locking the door from out-
is not a common occurrence. Despite suspi- side, then fuel is spilt from outside the room
cion at the preliminary stage, many incidents through a window and the inside of the room
at a subsequent period are found not to be is set on fire from outside.
homicidal. It is very difficult to kill an active Deaths in arson cases (deliberate and
conscious person by burning. Either the vic- criminal burning of houses), are also exam-
tim is first made unconscious or semicon- ples ofhomicidal burn deaths. "Molotov cock-
scious by way of intoxicating or assault and taif' bombs are petrol bombs which kill per-
then burned after pouring fuel on the body ; sons by burning.
or at first the hands and feet of the victim 3. Post-mortem burning-Sometimes a per-
are tied and mouth gagged or tied and then son murdered by some other means is
burned. In the first case, evidence of assault ablazed to give a cover and to simulate
in the form of mechanical injury including suicidal or accidental burning. In such a
head injury, or evidence of use of intoxicat- case, the body should be thoroughly ex-
ing agent will be available. In the second case, amined during post-mortem examination,
evidence of fastening by rope or some other to detect the actual cause of death which
ligature will be there around the wrists and inay be due to strangulation, mechanical
ankles. The rope or the tying material may injury or poisoning. Problem arises when
be fully or partly burnt but the impression of the dead body is extensively burnt and is
the tie remains in the form of abrasion, con- charred. Not only the actual cause ofdeath
tusion, groove, showing absence or minimum may be obliterated, but the extensive char-
burn injury on the skin over the tied areas. ring may even make the autopsy surgeon
In these cases, as the victims are in lying helpless to say whether the victim sus-
position from before the starting of the proc- tained burn injury during life, because
ess of immolation, parts of the body which extensive cl-:1rring is suggestive, that the
are in contact with the ground do not show body continued to burn even after the
any sign of burning, whereas ante-mortem death, so that the initial ante-mortem
burn injuries may be present on both soles. burned lesions may in course of further
Evidence of pouring of kerosene oil on the burning get charred and obliterated.
head including the vertex may not be a con-
4. Time of sustaining burn injury can be
stant feature which may be more conspicu-
assessed from the different changes that
ous on other parts of the body.
occur after contact with fire and the dif-
In some cases, the victim is tied first with ferent changes which occur thereafter
a pillar or a tree-trunk and then lighted after ~ue to the process of healing. (see page
pouring inflammable fuel. In such a case, 435-436).

5. Identification -Identification of the vic- burnt out to a great extent, without ex-
tim becomes a problem and is a matter traneous aid or addition of fuel or agent.
of expertised study, when deep burn in- 8. Flash burn of electrical origin - When a
juries obliterate the facial contour and high voltage electric current gets resist-
when different body parts get charred. ance, a considerable amount of the elec-
This is a common problem in aviation trical energy gets converted to heat en-
accidents where not only physical disfig- ergy which may produce flash burn if a
urement but also charring of the body person is standing nearby and contacts
obliterates the identity of many victims. the flash.
In these cases, determination of race, sex,
age, complexion, appearance of the hair
should be studied as far as practicable.
SCALDS
Dress , pocket articles including passport
and identity card may solve the problem ,
if at all available intact with the dead Scalds are thermal lesions produced due to
body. In other cases, teeth and artificial contact with moist heat . The moist heat may
denture which resist the effect of fire to be either of a hot liquid (water, milk, etc.) or
a great extent , can be very much help- its hot vapour.
ful. Apart from the different identifica- Because of limited temperature (the
tion data available in teeth, artificial den- maximum possible temperature for a liquid
ture with inscription of the particulars of ordinarily is its boiling point) and early cool-
the manufacturing firm and some other ing of liquids due to evaporation, the lesion
informations may help to trace the den- due to scald is not very deep. The insulating
tal care centre from where the victim layer of the skin prevents inward conduction
procured it . From the registerofthe den- of the heat during the short period for which
tist's clinic, the exact identification of the the hot liquid remains hot. The latent heat
victim is then easily established. Apart (heat retention capacity) of sticky viscid liq-
from these, articles like wrist watch , ring uids is high and hence the penetration ca-
or ornaments may also be helpful. pacity of heat from those liquids is also more .
6. Preternatural combustion of the dead Thus injury caused by hot tar, syrup , oil is
body-After death during the process of comparatively deeper than that caused by hot
decomposition there is production of cer- water.
tain inflanunable gas, namely, hydrogen , Features ofscald-Scalds produced by wa-
methane , carbon monoxide , etc. If a free ter at the boiling point have the following
flame is brought in contact with these features-
gases , then due to combustion of these With splashing or pouring of boiling wa-
gases there may be post-mortem burn ter there is inunediate reddening of the area
injury on the body. But such occurrences of contact. Within 2 - 3 minutes, there is blis-
are very very rare. ter formation . Surrounding the blister, there
7. Spontaneous combustion ofthe body-It is red lining. There is intense burning pain
is an impractical proposition that, a body which may lead to primary shock . After the
can be burnt out with intrinsic fuel (fatty primary shock is overcome, there may be a
tissue) of the body. A body cannot be secondary shock due to hypovolumia, because

1st and 2nd degree burn injuries except on

pressure parts
Courtesy- Prof CB Tripathy, BHU
'
i1 F'tg. 11.3: lntected and ulcerated burns Fig. 11 .4: Ulcers, slough and scar following burns
j_ _____ Court~- Prof ~~- !ri~thy, !H~- -- _ Courtssy- Prof CB Tripathy, BHU
' Fig ._11.6: {Place of ·aetection)in a death due to burning.

P:ug.ilistic;~ttitud E!
Fig. 11 .5: A case of death at19>1o burh injuty-:-'-

I ' 1 I
• CCiJ~sy:... Prof'JN BS
Dey, MedicalGo !lege,
infected I a11kur

444 I PRINCIPLES O F FO RENSIC MEDICfNE
FIQ. 11 .7: Extensive burn injuries with blackening ,

blister formation rupture of blisters and
singeing of pubic hair
Courtesy- Prof CB Tripat'ly, BHU
Fig . 11.10: Suicidal burn: victim collapsed on a chair;

surfaces impacted with chair and parts below
.___ __ are spared 1
Fig. 11.11: Burn-death. Note absence of burn on the

line _of abdomen where petticoat lace was FIQ. 11.12: Self immolation
tightly tied Courtesy - India Today

Fig. 11.15: Close view of the case as in Fig. 11.14

Courtesy- Dr Nayan K Mohanty, SCB
Medical College, Cuttack
Fig. 11 .1 6:
Fig. 11 13: A case of self-immolation
Irregular
Courtesy- Encyclopaedia Britannica
permanent
scar resulting
from burn
injury
Courtesy-
Dr Nayan K
Mohanty, SCB
Medical
College,
Cuttack
Fig. 1114: Body at the place of post-mortem

burning in a case of homicide
Courtesy- Dr Nayan K Mohanty,
SCB Medical College, Cuttack Fig. 11.17: Postmortem burning

Fig . 11.18: Almost about 80% burn. Parts of back and Fig. 11.19: Burn death
one side limbs were spared created
suspicion of foul play. (upper part of front of
body seen)
l;'ig. 11,21: Same. case as, ir.t. Fig. 11 .20. Left side and
Fig. 11.20: Burn death inside. Ji'fing room (suicidal) back Vif;!~ , availllbl!il

Fig. 11.22: Suicidal burning
Fig. 11.23: Homicidal burning just outside an apartment

Courtesy - Prof Nayan Kr Mohanty, SCB
Medical College, Cuttack
Fig. 11.24: Burn injury on the soles, one of the findings

which according to some goes in favour of
post-mortem burh or burning at laying
position in unconscious state Fig. 11.25: Ante-mortem burn death

448 I PRI NCI PLES OF FO RENSIC MEDICINE
of the loss ofbody fluid through the blisters. The blister may its~lf get ruptured or may
If the scald heals without infection then, be ruptured for therapeutic reasons. Before
there should not be any deep scar formation blister formation, the affected area appears
and contracture. However , in case of an ex- sodden and bleached . After blister formation
tensive scald or in case ofscalds produced by the epidermis over the blister appears gre-
a very hot viscid liquid chances remain that yish white . When the blister is ruptured , the
there may be a permanent scar , particularly floor appears reddish with serosanguinous dis-
at the central zone , because in case of a very charge . Healing of small scalds is complete
big area being affected, the progress of neo- by 7-10 days with formation of temporary
epithelisation from the periphery to the cen- scar.
tral zone may take much time during which
a portion of the true skin devoid of epithe- Medicolegal aspects
lium may get devitalized. In case of infection ,
the picture may be totally different , and ex- 1. Scalds are mostly accidental in nature.
tensive scar may be formed . Scalds may be formed due to accidental
f .. D"ffe
Table. 112 I rences between Bums and Scalds
..:.::. ~
f .
Points Bums Scalds '~ .1~
....L d
1. Causative factor Dry heat, flame, hot metal Moist heat, boiling water, milk, oil, hot
vapour
2. Appearance Reddening, blister formation, blackening, Reddening, blister formation, sodden
charring and bleached
3. Depth Often deep up to skin or even more deep Usually depth is less
4. Sin9eing of hair Present Absent
5. Site At and above the site of application of heat At and below the site of application of heat
6. Blister formation Takes sometime Occurs within a few minutes
7. · Splashing or spilling or Absent Present
dribbling mark
8. Sloughing May occur in deep bums Usually, does not occur except infection or
contact with very hot viscid liquids
-
9. Scar Permanent when true skin or deeper Usually no permanent scar without infection
tissue is involved or application of very hot viscid liquids
1{). Contracture Common Not common
1t Clothes Burnt Not burnt
12. Medicolegal aspects Suicidal or accidental, rarely Usually accidental, occasionally homicidal
homicidal
13. Healing Delayed Comparatively early
14. Fatality More fatal Less fatal

spilling or splashing ofhot liquid like hot Causes of death in cases of injuries by
water, milk or oil. It may occur due to moist heat
careless swallowing of very hot water 1. Primary shock - at the very initial phase.
from a kettle. Often a young child in pres-
2. Secondary shock - at the middle phase, due
ence of a careless mother or in her ab-
to loss ofbody fluid through the blisters.
sence may dip a hand in very hot water
in a bow 1. Accidental scalding may occur 3. In case of swallowing of hot liquid - as-
in bleaching and dyeing factories . phyxia, due to swelling and blistering of
the area near the upper part of larynx
Homicidal scalding is very very uncom-
causing choking and later, due to com-
mon. But cases are on record where dur-
plication like stricture of oesophagus.
ing an altercation one party poured or
4. In case of inhalation of very hot vapour
splashed very hot water on the body of
the other. In a few occasions the intoler- of some liquid, death may occur from as-
ant mother or the father may 'punish' the phyxia due to laryngeal spasm and chok-
child by dipping th~ child's hand or leg in ing.
hot water (battered child syndrome). 5. Infection of extensive scald is a cause of
Suicidal scalding does not occur, because death at the late phase.
it is very painful and there is no guaran-
tee of death. Post-mortem findings in case of death due
to scald
2. From scalds, time of its occurrence can
also be made out (see features of scalds). In cases of death due to scalding, the body
3. Blisters may be formed post-mortem both will show externally the presence of exten-
in fresh and decomposed dead bodies. The sive blisters or ruptured blisters with ante-
blisters formed post-mortem in a fresh . mortem reaction (see this page). In long
dead body, contains mostly gas or may con- standing cases, there may be ulcer formation
tain only very little fluid which is not much due to infection. If death occurs due to swal-
rich in protein and chloride. Blisters lowing of hot liquid or inhalation of hot va-
fonned during decomposition contain both pour, signs of gross irritation, oedema and
gas and fluid which are often reddish with- blister formation will be present inside the
out any ante-mortem reaction in and mouth and near the larynx. In case of death
around it. Blisters may also be produced due to shock, there will be minimum other
due to application of some irritant plant changes. In case of death due to asphyxia,
jpice, like that of calotropis or semicarpus signs in support of the same will be present
plants (see pages 500 and 550). They can inside !Uld outside the body.
easily be recognised frQm their features, . C~mical bur:rzs: Le_sions having similar-
iricluding their sizes and distributions. .:.i(y..w~th _b um injuries are _caused by cori'o-
. So.me syste~cdrugs orpois~ns, e.g.:, bar- · sive acids .a nd·. alkal.ies:· and some ·irritants;
• bi~te may produce blisters. These ca8es . 'i;g,~ ·sulphuric.a~id, nitri~ ~~id, ~ydrochlorlc· . .: ' .
.. .:- . . ·.. · ~ -~e properly diagnosed from ·acC<;lm-· · aGid; ·ph~nol, .o~~Hc ~cid; :Qaloge~s, . so~e· al-..:. : ·.
':.. ·'·· .....·.·. panying' sigD.s' :~a symptoms. <. :· ·. :.
-~~lies ;~f9mialji{ and.:~-few:~t~eci, '•: ' ':' .. -~ .. ·.
~ .. ·. _4.· · sc~i4s are 1e.s·s .·fatal :~··l~f?s ~_nj:uho~~·: .' · ·.. .Ag~nU whi·~~ -~re ~ost ~6rro~iv~ ~o~·:-~~;-: : :. :..·: :·'
:. /::: ih~bums. · · .: ...':.: .:· • .: -;: _ief.n~1~:Us~ . can ·ca~se. dani~~~::);oJhe·:·w~-~1~:.; .'-. ·... :
I ' . ·.' ·. . . ... " -
n:: f\ .1 _ .,01

• 0 ! • ... • : • • .. •• • : .... . ,. • • : • • ; •·• ~ • ~. .• ; ' • .. ...
. .• _.;'::t:±:rt::~~~:~~:; ;~· ·~·;~.,d ·~.L~~.f]],i,:~~~~::~,:'~:i"

. : ._.. . ·bummg :Pru.ii ..:riumbriess·
. . . .. . . .. .. . ' . . . .. . .
dued.o:aarn.a'
ge ·ot·· ~-- ·. .·:zoo3. . <:··:. :·;.-··.:.. ~ ·.. :_.----~---·_:.
. . . . . . . .. .. . . . . . .. .' . .
:..-:: ... :_._, _.
. ~ . . . . ·. '.
•, •.' : '
·.. -:·..-. . ·.
'
. . _. ·.. rierv.e.. _endings; .Ei4ock, _col~ur : c~an~ -~f the; ; :. .... WG;Aitohisdri RobertSon ~ Aid~ io..fomnslcMedicfne .. . . .
~:-': . ~ffe~t~da.~a-~~!:dir,lg:'t(f~he age~t.~ andthe .. . ;. ·:.~. ~~zoo{:-. ·:·:·: ..- .-:· : __ ,.:_ --~::·:···
... 'cherirical reaction it cai.Ises arid'. o.th!3~ ·accom- ... · .... : . . ·. : . <_.' :, . - . <:: .:. : .·. ·.· . ', ' ., . :. -: .
·< . : ·_., .' ::., ·:·:, . ·. ._,:·: -.·
·· ·_·. · · · •·· · · · :.-.· · · '.· ·d · .'~ . ·t· o .. · · ·d·· ·. · ::· ·: · . •·· .:·_Michael J.Skrurr and DaV.rdsotr.A R~msay.'-:' :Pathol" -·
· · · panym,g slgns .an_ symp. ms ·.ap ·.·c.a n 1eave · .. _..· ..... _:,·· .. ·. · ,· ·.: ·..· · .~--~· ...
· ·: .. temporacy.orpe~en~sc;:ri-ring_.Sloughmg .. _:'::: _- o~yoflfay.r:'~:. ·?-906 . , :- ·. , :. ·.. ..-, '. -~: ··. -·.,. :._
· . :-· cau~e~ pei:manent f{~rrin.g . Daina~~·olQ.e~ep'- . : ~-·_: -.itv_8 Woorlrnan_imd Chaf:t~s ~~~t~f-:fbrenslc'_Med;~ ,.-_ ;. · .
~ :· . tissue iis 'such 'causes :scarrilig. B.itd:-oo~trac-· .../··:- cirie #nd.-r~~ology_·::.. 20iJ1: -...: . ··-<-: .• _.: . ; . . : .. :·
.- .- :_: ture:__Tli~~ Jii~Y. -~ ·hif~~iori:. ~~ility ·o( : :•.-:_-:· war~~i-u:·s·~~t.6~vi_d ·Lspi~. ~~~~~·Y.c·, ·aik;:Ru·~~ef':. · ·
~:; ..' jo~~-rna~ - ~~~ iq?e;:~ritra~t~~.' i~Volves.; .:. . - ~- ·. s:f-i~her_ ~~_Spf~·~n~: Fl~rs':fv?.~(fJ~ot~~?l ~f!stiga·, ... ·.
. ·. an : area .<rver JOIDt~.: ' :. :· .. .-.' ..' -"·~·-.:·. :. \;::.::.:.: ._. -~· .. _:
···:' ··,.,- :·:· fion ..of0e~th;_2000 :· _,·.~:.·.-:<
_ . >rrea~-~n~- .-~~a~h~~ ·.of'.the·_ ~~~~ d~~~·-:::_·:;. :: :w D~~~lai~~~~~·~_:r~reh~id~M~d;d~e:a~~; Taxi;. ::
·.: wit~ w~ter orwe~ _ solu~io'n ~f -~~do~ of:. ·._. eology:...2ho8: .~- -.- · . :--. · . .·. :. .. _:_. · : ;:_·._-..
the agent. To .pr.evept.·shock, contracture , _· · . . ·-:· : ·. . · . . ·.· . . · :-. . .
infection:steps shoUld be. taken. Yitriolegejs. • . Stiffen TuT)menmanas-.:_ ~o~t -qlOrtem: -How Medi-
cal Examiners Expi~ins Susplcio_us Death - 2007.
throwing of strong corrosive agents on the . .
face or body to take revenge or punish the • David Dolinak, Evan Matshep, Emma 0 Lew -,Foren-
'victim. Suicidal use is mostly by swallowing. sic Pathology: Principle and Practice- 2005.
Use with pure homicidal intention is not un- • Pekka Saukko and Bernard Knight- Knight's Foren-
common with some agents whose taste, col- sic Pathology- 2004.
our and odour may be masked by some food
or drink.
FOR DETAIL SEE INDIVIDUAL Questions
AGENTS IN TOXICOLOGY CHAPTERS.
The.oretical . ;
:
1. What are the_different therm-al injuries? : _· ..
2. How do you classify burn injuries?
• Polson C.J., GEE, D.J, Knight Bernerd- Essentials of
3. What are the features, causes of deat~. pi:Jst ~moriem
Forensic Medicine {1985) .
findings and medicolegal aspects of burn-injuries?
• Gradwohl's Legal M'ed,- F. E. Camp. 3rd Edn. {1984) .
4. Difference between burns and scalds.
• Spencer, H- Lightning, Lightning strokes with treat-
5. Rule of:'9'·.
m~nt {1932) .
. ..;'! .·.'Sums· .., Pathology afl.d ~Eltap-eutlp applicatipn~ .-:- 0ra1_1lues~~n~ ·: . . . _ , ._. _.: '.' _
::. :_ :- -:~Dion -snihtt·B.~~i~~h~-~~~11. -)~57.-::~: · ~- · · .·.::· .Ass~sSWreh~ :ot.tlm.e· ~t'-tiu~ -i~~~;ie; Am~: ~t'1i': -·. ·.:.. ..
..·:.:_<;~ .-; iliims:.::- a~Y!nP~i~m.-:-:- ~).e.d-l;ly:re_Dt:l tti(~~~·ti~d .·-·._ .. :·: ~ :fi~~t h'~ern~t~m~~- Heat.nipt~i~. -P,ugi.tiitib' aitii&a~... :· ...·.
. . ~- ..·. · ~ ... :r ti(~t-ia·cd .E:: Baidtier i(;.harles c.;.Th9ffia~ ...1965.· ·: ·. : ·-
:: :·::~.. ·He a£. tr~ct~~ :--p-;et~chat~f~1'io'm!iu·stia~· :s·pbhta~ ·:: ·., (: ·:
,.
Parvej Dr. Md. Ahsan Uddin (Nayan) ....... · :
CoMC-24
-~ w!'i : ... ~,.:. ·..
•• • ... -:
"
· ~
.
... .... ~ .
... .
: .: ..../
··.·:.
_._ ~ ..
·.. ;
.• ..
. ·:- .
: .· ...
,.
. :
•.• ....... . :.··~: .......__ .:· .-··~·.;< .••... ,..- •.~ ... •· ..•• ·~... .;.~;.··:..,· .. •• ~:; -~ ·~ .. _·,; .. ·," ..
.. ' :
o •• :.- o .... '~ o .. ~.•,._ •o ,o', ~~.:? I ~:·.•:,•: :, '.'• o ', o ,,···~: • ·~~·~=··· ~.:;:•
·.: ... ·:~,::~~·:••, '••,..:..,, -:~·. ,• ;,
'.
•• ·.~1 ~~-::·
,_;,-·\... .. •••• •• ~-~·· ·~. ··.·: •• : •• ~.. • ·• • • •• ·~ ·.·~···.
• , •••• •• ·:- ·.
.. : ,·: ·f·=·· .~ . ·.··:·· . .'-::·=·~-~~.'.": ;· ... ·=::~.!-. ,.·; -::·· .·.· ....:.:· ...
_:.: -_~;:_.:._.~./.: .·.~':/.: :.: ....: .... :.i~:·:.=..·~......· ·:··.'· :~:
:. ·.·./:.- .· .. , . ·... ·...:. :......
0
••• :
. .·:.):··?·.-. ·>.·.·; ~-: ;-.:-:_.~··..;:·T::·· .. ·. :.: . -·.· ..... ...... .-~:··. ··.. :·:; :.- ·:· :~~<
. :: :·::; ~iDEATH DUE b f:LEC OCUTION ·.:: · :site';ofim~rarice, t.o.the bodY. and .at .the site'of
,.. .. . . . •. . .. . . .. . · .e xit .froirt ~h~ b~'dy to' p~~~ .to:tll,iie~th. In-
..~:· ..-·· · · ·· · '. .·. · · · · · · : ..... · · · side the'l:i.ody ifj:>asses ·_through'·the content
·.··Tniipc~arge. o.f'ev~ry mo,tuary must agree
··· 't h' a·t· ,· d eat.h d ue t o ' e ec t racu
1 . · t'wn 1s. . no t. t oo of the . blood vessels. (i.e. blood) as· liquid
. is a
. . ·- ~ncdmm~n. But an':the wliile;it ~lso h~s to ... gP.o.a COnd!J.ctOr lof elec"t:r:icity, . However, ex-
. ternalinjurious effect , w:h~n: a pe~son is elec-
be admitted that, in comparison with the
trocuted, is almost totally due to electrical
widespread use of electricity for commercial,
energy with some minor effects due to the
industrial, public and domestic purposes and
converted heat energy and only to a very
the lethality of the ordinarily used electric-
small extent , in very rare occasions due to
ity, the number of cases of deaths due to elec-
the converted mechanical energy , depending
trocution is rather less. This is so because,
on resistance at the site.
deaths due to electrocution being mostly ac-
cidental in nature , its known lethality has Sources of fatal electrocution :
imposed compulsory precautionary measures 1. Domestic source,
which are voluntarily adapted by the consum-
2. Industry , commercial centres and trans-
ers of electricity. There are exceptions also.
port system,
Electricity is an energy which moves in
a path with a tendency to pass to the earth , 3. Electricity distribution system ,
where it gets neutralised . In household use 4. Lightning .

.... . , ......
2. Amperage - It is the measurement of Passage of electric current through the

strength of the electric current through body
a path or medium. Amperage is more im-
The course of the electric current in the body
portant in electrocution cases, because
depends on the fluid content of the tissue. Thus
it indicates the actual intensity or amount
maximum amoun.t of the current passes
of electricity which passes through the
through the blood vessels. The path of flow
body. Even in case of a high voltage con-
through different organs depends also on the
tact, the actual amount of the electric
structural morphology of the tissue, and the
current, i.e., the intensity of the current
chemiCal composition. However, the general
passing through the body may be low due
rule is that, to be neutralized in the earth,
to high resistance offered by the skin at
the flow of current in the body adapts the short-
the point of entrance of the electric cur-
est route to the earth. For the purpose of flow
rent.
of current through the body, 'earth' is any-
3. Resistance - Certain materials are good thing which is a good conductor and is in di-
conductors of electricity as these offer rect contact with the earth, without being in-
least resistance to the flow of the elec- tervened by any insulator, i.e., any substance
tric current. Others which offer high re- which is a bad conductor of electricity.
sistance to the flow are bad conductors.
Features of electrocution-Features
Skin, as a protective layer of the body,
offers some degree of resistance to the should be considered as follows :
electric current. Dry and thick skin of- 1. Lesion at the site of entrance of electric
fers more resistance being a bad conduc- current in the body.
tor of electricity. Wet skin allows com- 2. Lesion at the site of exit of the electric
paratively free flow of the current. current from the body.
4. Nature of the current - In DIRECT CUR- 3. General features.
RENT the electricity flows constantly in Lesion at the site of entrance of the cur-
1.
the same direction. It is less dangerous. rent-At the entrance of the electric cur-
In ALTERNATING CURRENT the flow rent, due to the resistance offered by the
occurs alternately in the opposite direc- skin, there will be a crater formation,
tions. which is tough on palpation and the mar-
5. Number of cycles per second - In alter- gin of which is raised and the floor is de-
nating current the frequency of alteration pressed according to the shape of the con-
of the direction of the current per second ductor causing the contact. The r1dges or
is known as the cycle persecond. This cycle the creases of the s~ are ~blikt~ted ~d
i~ import.m t.·Ordinary household supply .the skin in the crat~r appea~ flatten.e d.
:. ' of~~erit IS of_k olind5.0 cy~les, and that If the -skin is dey ~ top:gh; as.in case of
. .of ~Om~erdiilsupply lS between 25 to 5q the Skin of the palm then, due to greater
cyCles: ·This ~ta:nge of frequency is very . resistance offered.by the skirr, tll;er~ 'may. .·
· · · ·d.&.ngei-ouS ·~d· the. body ·c annot ·tolerate · be solne etaeking of the skin ·a t .t he:tria.t-
:'' ·. this.· V~rY lo~ ~r very high freq~ency of. . . ·., . gill :of the crater.-.!f,hk.' b-~fthus g~ner- ..
c~cle~,' e.'g., less than 10 ~yd~s PElt second· .;, · .: ·...ated.,:;m~y als~ ~f\\i$~~~'0ciisa~OOi _or:t~~:. · .. .
and ruo:re :tb.~ iOOO cycles pei; sec¢ld ~s ·· ~ .': ··:meta.liJ'<{~l~ctri~- w!~e:_·;~~~~::'t;p.~ ~!tth)(·- -~.
h~essforthe body. · · ·· · · ·. >·>
• • - f
- ~b:t:r·~~6~ ·ina.y-~av~ ·aitf~t~illfcJusire.. :_ :::·:.
•
.• .
•• , ' . -
..
~ ~
..
• • •. .....
...-
..
r ,- • ~

chapter 12: INJURIES DUE TO ELECTRICITY, LIGHTNING AND RADIATION I 453
Rtg. 12.2 : Electrical inJ·ury and burn at the site of

entrance and wire responsible.
Courtesy: Prof T Bose
tear out giving the appearance of an abra-

sion or even a laceration. With low volt-
age electrocution, the crater should look
Rg. 12.1: Electrical injury and bum at the site of pale with a line of hyperaemia surround-
entrance. Courtesy: Prof T Bose
ingthe crater. But with high voltage elec-
trocution, these two features may get
totally obliterated due to gross damage
of the tissue locally, due to the effect of
heat and fire or flash · Occasionally, in-
stead of clear crater formation or char-
ring the lesion increases in depth. Micro-
.scopicaUy, the effects of heat on the tis- .
sue protein is noticeable in the form of
coagulation necrosis and flattening of the ·
cells - Wakely, as quoted by Glaister's
Medical Jurisprudence used the term
electrical burns as 'electrical necrosis '.
The production of heat, in case of high
Rg. 12.3: Another lesion of site of entrance of electricity. voltage and high resistance, may be so
Courtesy: Prof T Bose
high (according to Wakely may be up to
When the voltage is very high and the the extent of 7000°C ) that, there may
skin offers considerable resistance, then even be deep burn (4th and 5th degree of
sufficient heat may be produced to cause Dupuytren), at the site of contact.
burning of the tissue. In such cases, de- 2. Lesion at the site of exit of the current-
pending on the voltage and the resist- The site of exit of the electric current from
ance, there may be scorching , blacken- the body may be anywhere depending on,
ing and even charring . Due to heat, the which part of the body is nearest to the
superficial tissue may shrivel and also site of entrance , and in the line of the

.· .· . r • ...• • • •. ~ . . • •• ••~. • • • •.• ·:: ~ -~·•. •
•
.... ~' PRIN~I~~·~-~~~~SJCMEDI CIN~ .
• D - • •. • '• &
_:.~ •
..' ..:--. :. ·. ~- ·.•... ' --··. ·:\~·~<· ·· :~:-.:·:~ ·. '.· -~ ·:.·:_.~· :;.· · .· .·
.· •.. C~u;.~~ ~i -~~-~~e~t ~ ·.~e b~;.~·~ ;~ ' ·.: :.~;;~.~~"~~ ;i;;.d.;~~· .
' .. .. ·.- confac(~ith :the ~· e'arth'~Jt'i's~ canl'rlionl:f.. ; . ~::· nesS;" daf~tive':vision;:iiicoritmenc!i:is, ;ye_tJ' . . :
. . .: : .. .o~e '6{ the' h~~e}ible~ : B~fif.th~ :s'or~~- nf :- ...:'. \ig~· et6>sqni'e .of 'il\es~· .Pr.9b1eiris."iria.Y _...: .
. · · . . ·-'. .f~et ~~ ~sUlated.·w.iti;·sh«:>~ \Vi:th.qjyn;b:.-<·:- .. \-~ · P~~~ist ·f'~r. daY:s -~~ fl.fe~ .rilay .be 'eye~·: ·...
·• ' . <· •, ·-J?er sole 'u~det it -~d .if. s~~e ~ther' p~~{, , :.<<
J)eroiarte~t.Ifthe·~~t pa~s_e,s t~ro~~h. ··::..-
.• ;· . ·. ·. of the body, like_anarmi~ in.contaet _With.·,:.: .:_the .bas~· o~.the _b rafu; then uncori:sciour~ .
. .' .. :· a walhvhicli can:-act as t;h~ 'earth',.'then: . . ·: n:essisv~iyquickwithffl.ilure ofthe~c.~.:
. the c~~ent 'wilt pa~s· 'out of th~ body tions of the vital centres, which maj_p~ .
thro{igh that.poihtof contact of the arm, ·perm~ent ?r temporary-Wh,en the. cur~ ·
causi~g a lesion there. When the site of rentpnma:nly passes through the heart.
exit is t}le hatd; thick and. dry' sole, the . there m·ay be. ventricular fibrillation of .
·. passing out electric current causes stoppage ofthe heart contraction, w:hic}l _·
· · depends oii the amoun:t of voltage. With
greater d_a mage .t o the tissue there. The
low voltage, fibrillation and with high'
ti~sue ·may even be ruptured giving ~eep
voltage cessation ofheart contraction are
laceration-like appearance (crocodile flash more common. If the h!gh voltage ·cur~
burri); where production of heat and ex- rent causing stoppage of heart contrac-
. plqsive like effect occurs_:_so called flash · ·· ·
tion 1 is disconnected very quickly, .t hen·
. or crack bum. Even at the site of exit, the heart may start beating again, all by
. there may be generati~n of heat .U:p to · itself. Contrary to the general belief, elec-
.such an extent that there may be pro- tric current passing through the brain
· .. ·. duction of fire and flash which may cau.s e may be fatal in less number of cases in · .
· ·. ·.. -buinjng; et!!. Here ·also, microscopiCally . cqmpanson to the cases where the cur-
.·· ..there will be a pieture of coagulation · rent passes through the· heart, causing
. ne~rosis . and flatten:ing of the cells~ :v'entrictilar fibrillation. cases where the . . rn
s:·.. GeMrai featur~~The ~-ome~t of.ele_c~ ' ' .. ·... curre~t pass~s throughthe ~urlace ofthe ...
: . troeutionis painless . .'I'lu~re may be a mo- :' . .. body,:there may notbe any effect on the .
· : nientaiYfeelingof tiilglirig arid mimbness; · · .. hearran_dthe vit:al centres or'the hrmn; : : :
. :.· ·:. rhe: per&O~ .m ay'also:.get stunned~ for · a _-:.· · .. but there may l:)e.· r.espir-ator:Y a.rre~fdtJJ~:-:' .:. .·
:: ._::.' _-.: .· .·. -~li~m.ent_fi.ii~ 4e iii~y:rail:o~ the gro~d, ~ :· :.. )~ s~~sm··flri~. l>_~y8i~ of.tfi~_'~~~pirawri_ ~ ....··
. :. · . .With .the· Iow.:·volhige : ~lectr6cutio-:ri: 'iii :_:-· ·:muscles. ··... · ·. < · :- :-:- · :. : ·.··:· <: ·... .
>: :_.:·. ~.: :·.~-:-tibri~r~t~~~~~. ri~ihih~·eis-~¢a:Yha;pp~~ - ·: . _. _... · · J.:.:. ·: ·.<~<.... ,·. :/ ·. ·. ~ ~:··''.~ ·. ·~·.·,:·.
· · :. ~-·. (tli~ ··per~O.n~l'e~erlenc~ . of ··the . author . · Neur~foijicol~es..lricase-~: · .:-~ . ·.'·_:·.~ ': ··
_.· · .__ -: wi~~: Pire~~ : GurtentS:- In .fatal. or more _.' _electrocution · · ·.. '..- " .. · · · -' . ·. '.<_ :_-
_..otis con:tac_t,. the -Victim: may lie Uri-
: . .·.... : ,.. sen 'A 1.. ...:-: h. · I.e · _. · · ·cti · ·•· · · . · ·. · · , .
· · .. · · . ·:... _;· .... ··.: .. · ... : ...... : . . . . , . pua.:;la,_ ennp gta. nonrea . v~11:ess, .amne- . ·
........ CQQ:SC'l()US '(o_r v~g penod. A: sus- :a- sia; repeated attacks ofcompUlsive sleep;
' .. _.· ·. -'· pe?ded.'~~~tion.' ~~k~ _ ~tate ~may pre~ . po~turaJ tretich., he~daeh.e, vertigo and:
: · · . '.:· vaJlfor.acortstderable penbd w'Ithalmost i1 · ti~- · .. · · vul -. _· · ·· . · ·• :· -'_ ·1·1· . · :t. ·
.. _: .. ;' impe~ceptible pulse, vetYweak re'spira- e~ hepd tv~mcth op. sio:q arl_eoccasi~?a YhlllB .-·
: · ·... ·... c • • , ; · a-··....., .· ·r· .- '· > ... ·· . · . : : .· w1t . tmng . e, pos;t;,e ect.r()C1lt1Dil-p a.s e,
: -: .. · ....ttoP:· :;tn · 1pss .o _,:response ·to ,externa1 . h. · ·h·.· ,. · ·. ·t ··· · .•~ · .... " ..... " · · '
.·. . :. :· . · . • M ·,., : · · · · · .. . . . .w 1c may con 1p.ue :~.or .E\ome days.
. . stm1uh.; · 8Jly :cases ·~an bf! resuscrtated ·. : · .. · · · · · · · . -' · · .· ·
· ·...... > trtim ~ thi~\~t.a~, :ihotigh ±Iie -srumi may .· ~·-··ct.:~ · ·d'· ~~- i· . ·.
.:- .-·: ·.: ~.-·..<$d··l.i~k~'- ~ffo~: Jlbwe~~ri ·~om¢p~o!): · ..,e , 0 '·~-~- ue 0 · . Wt1~ ..
. .... .. . :_:lem!:l: ~i:ty.persist'for ~ome ho~rs ~r days~ . Caiai~ct: with. flaky:· opacity~' ~o~!c: ~tr~~y, . . .'
·.:· ;: -.~:~:~f.-~~~~~ :~~-: ~~-ntiil ;cpii~oi1,_laCk ,of_r~~ -.c~oro_id~tetlmtis niay oecud~ some_~a~~~~ .
Parvej
•!# ': • I~::. • '• I, •7 .~: • • Dr. Md. Ahsan Uddin (Nayan) CoMC-24
.• •. : • '
. ... ·.
.. ' :
..
· ..
2, · Paralysis ofth~ re~piratO~·ce'ntre-,-,This · A!t.electrocuted·p~rson m·~y b~ 1n state .a
. tlc~urs' when t~e currerit pas~es t~ough or' shock wi_t4 respiiatoey'analor cardiac ar.:
the brain affecting the· b~aJpart~ Par~y- · · rest. Cardiorespiratory res\lScitati~n sho~ld
-sis of r espiratory centre c;mses stoppage · be trie:d a_~·a ~rst:aid, If d'oes noth~l'P~-- tben it
ofr~spiration l;iU:t the h~art'contmties t~ . 'he'shauld iminediatel:y-betslken·to: a medical
be-a t. Death in m~ny of th ese eases may centre~- The mml'>r wounds at the. sites.ofen- .
. .be pt evented by artificial ~spiration o~e~ ·· 'tran~e and_exit ·of electric current may be
· :-_ ~ prolonged period. · · · .. · _· given due.cafe subsequently . . ·
. - ~- -- ~m:aly~is. ~f~he. res~n.
. : rato_:r..
y riluscies.
. ~ ' . : ·fh
..· f a d or:s li.-n,venang ···e -f.a ta ·, ity.
-
Qf
· · •
an · ;~
· .. :·..
. _. Spas~ : ~d_ para1ys~~ o~ the respiratory _·e~eCtriccurreO.t . · · ·· · · · · · ·· --
.·-~- ~tls~l~s - 6ctiiT .w:he~ 'the -c~ent·-pas_ses ·: _. · ,_ .- . -. .. . --:... ··· ·. · .···:· .. ·-
___ . :..· t~ough. tpe. s{itfa~e ofth~- bOdy and do~s : ..The usual household supply is·ordinan_ly le-
. ..: ...·: .i ot. pftss t'fn:oU.g};i the he~rt- ~r ~when th~ .th~ with itS vo}tage, a,mperage ~d fre<it+t!mcy ..
: ·. -.' :'Jilie~ity. ~f th e.~utient i~ no:t.l~\uffident : .. ·of_cy~les 'per ~ec;on1. ·o_ertaiil co'nditi()ns:how_." . . .: . :
. ·,. ·_ .· .: ·..- .tb. <;arise ;~ntrl~ufu.t·. fib~illiitiori. ~d 't he . ..::~ve,r· !D-ll~ ~u:e_nc;~ tli:e acti~n- of electi·ocu~ .~ ; ....
. . .- ..·.-. . .f . . ; . . . ·. .· . . . . .· .. : .. .: .. ·tion.to a: great extent .' . : :· ' .
. • .~ ·.= --~~ o - c~tac.t .I~ ,co.~pai"ativ~ly -l~nger. .. . · ·... .. ·. · .. :.· · .· .. : ·. · .. .' :.· ·: .·,·,. ·
_. . ·. ·. ~Pilsm.: a,lid. para~ysi8 , 6f_tiie. Fespiratori. _· J,.-: the site Qf_co~ta.:ct..;-,:G.eherallY; spe_
.·. .;
akirii· :.
·. ,:: .·: : roufiGle~ ·m:~:i-_.caJ.se ' d:eatli· d.u.e -to:~s:. · ·.:·.· ·: th~;e:Pidemu~ ·havmg oo·b!oqd supplY' is: · .·
·. . ·.
:k=~~-- :~tli/~;;;2.·. ·.. ~;:]:::~~~;:::::: .
..· ... ·' . · · .. ·.. .. . . _ . _ . . .. · . · ·. -. . . : t,l_le p;Issage of the elect:nc current mto .
. . __ . . D?-~Y o.o cm",- ::J:Ctualls due·.to. sustam mg .. ·--'·· .- . · - . ... · . . · .. · . · · .. · · , ·
: · .- --· ·h· ' ..:.:.. 1 • • - • fj.. . · d · . t·. · · . · · . <- .,t he· body.- ~ut if the body ts wet due to . . ·
.. :-' -... mec aml.d:U iilJ\lrl s, secon ary . o a -mr.-·. ·( : b th : · , hi:ti.
' ·· · · . - .· h · - · · · ·
··· .·.,.. · ";,t ' ·.·.--f l 't_.._. · .,~ :.--, .:.; h . . · ·,·-..-' .. a . mg; wa,s g or.· sweatmg,.t en :tts · .·
.: . · · · cum., anc~o e ec ro~....on--asn· appens ·- . ·<·. ·:· · ·: ·.. · · · ..- ,_ · . · · · ··. · ·
.-_. ·· ·.-;:.: ~ ··"' . . -r- ': · (' -'· ' ' kfu: · · ·:~ ;. reslStanceoopacity isvery much reduced. --
: _· '. ·.. .- · lJ?-·ea.t?:~ 0: -~ e1~c- r~ "'~r '•. g ~n-~i~h ~-· ·.·-=.-· .--.~imiJarly) 'i f#om the·. ~~ea of contact the'· ,..
.. .. :vhl,tage.supplys.ystem, wh~;~n he gets elec" . ·. ·: ... e'p· d .. ' ' .. .··...... d·b .... ' ·' ff ·; t' . -~· ..
., · -~.:\-~~~t~~~~:~~r~A~~it-~o'in:~ ~jgbt$,d :-.-.··: < :-; .th:ne::~sl~;a:J:J.Jb;zt:~s~c::& .. _. _·:_ ..
.: >
. •
::~ .di~sdiJ.e'toheatinjuryorduewrtiechani"
. •. ·• , . ..•. .. . • .. . ·. .
:·.. ·: .·:g··-~o
"
.-:d·...··c'v~-n····a·.,u
··· c·· <-~r
· IAJ
'.·b·e·..c·;:a·:u
:. ;..e•'t-
" .
·h'·e·· I··a:·y.-r
·i · ·'r· ~~;:... .... · ·:
o · S1UJ.1·
..,_ _..· __ -. ~l"in.;~· to~·soni_ey.i~a~?rgans. · .. ~-: · - · .:: b.eloW: the :~:Pid~~i~1~ a:~(5i-y ·gbod, .eoii·~ --·.: · .
~ ...:. .'.:·· ':·_. .;. . ,· ..... ::·. ;·.· ./,._.,.' .·-. >·- :'·_< ...·< ... . . . ~...:-.·/-~_·<-~. ~ ... ·. ,-. -.-. ::
···•
- .
·_·. _:,_.. .- -~_.,· ··~: . . .. . ··'.-···.... .._·.·.:,·.·._·~(
:. . . ·.. ·..'.. ·..· .
~ • . :' ~ ~ : •. ~:. ·./: -, ._ < ..: ·.:.
• ;i-..'• t • '.
-· ·,: . .
. ,· :"'-~
.,'.. . .:;.
. ~ ..
. _.,:,.·I
.. ·
• · ·,. •• :.· §':. . . .J

ductor for the electricity due to presence ness of the skin at the site, whether the skin
of blood vessels there. In case ofhigh volt- is dry or moist, the voltage, amperage, cycle
age contact, where there is immediate of the current, the duration of the contact and
charring of the tissue locally, the conduc- the area of contact with the earth. Thus, at
tivity of the area diminishes to a great the site, the picture may be anything from no
extent due to charring. external sign to charring and contracture. The
2. The duration of the contact-The more metallic dust from the conductor, if not ap-
is the duration of contact, the worse is preciable in the naked eye examination, may
the outcome. In some cases, high volt- be noticed by microscopic examination with
age may not end fatally because of mus- special stain. If death was due to respiratory
cular convulsion which may throw the failure, then sign of asphyxia will be promi-
victim down; cutting short the duration nent, both externally and internally.
of contact. But in some other cases, where However, a moderate voltage electrocu-
voltage and amperage is moderate, spas- tion will have a lesion at the entrance of the
modic contraction of the muscles of the electric current, with crater formation, the
hand maY not allow the separation of the shape of which is like that of the conductor,
victim from the contact, the point of con- with margi.D.al ridge formation. Beyond-the ·
duction being in the grip. Such an inci- crater, there will be a pale zone surrounded
dent prolonging the duration of contact by a line of hyperaemia. Burning and char-
may ensure fatality· ring may be present in case of high voltage
3. Earthin~ontact with the ground with and high resistance· At the site of exit, there
wet soles causes easy flow of the current may be crack in the tissue, which may be rup-
through the body and thus the chance of tured, particularly, if the lesion is on the sole-
fatality is. increased· If a pair ofgood in-' . At.both 'sites, the lesions a.re dry; and micro-
on
sulating shoes is ' foot, then. chance of . . scopic:illy coaiulatiOJi necrosis will b~ noticed
conduction of electricity is minimum and at both sites with deformed cells and there is
it may 'thus be life saving. Earthing of flattening or'theGells at the site_of ~ntrance~ ·
the .body, i.e.? contact Qf the ~dy ~ih 4
~
In c~se of death due to fall from .a height
• ••
~h~ earth nee~tnh.ot be drretc t.' .Iflthhe .boh.~Y .. due to electrocution at-a high leVEil, second-
· lS m contact w1 some rna ena w 1c 1s · . . · .. ·. : .. . . . ·
·· . · · · . . , . ·. · ary mech~cal mJunes w1ll be present.
a good cond:uctqr ar1d w~uch 1.s m d1rect · : . . · . · .. . . · , .:
contact with the· earth, .then also earth- . P.M . find:. . · ·b. · · ~ . 1-...a-....:..·~
ing is ~stablished. . . .. · · · · 1 ~5 ·I I;) _ram •.o-e ~~~ :u'-unon
4. A diseased heart, like with coronary in- Tearing of nervous tissu~, shrjnk11ge of~erv
sufficiency, is more likely to suffer car- ous tissue around the vessels, petechial
diac arrest or fibrillation in case of elec- haemorrhage in the brairi, medulla, spinal
trocution. cord, specially in grey matter, chromatolysis
of nerve cells of pyramidal tract, medullary
nuclei and purkinje cells of cerebellum, dila-
Post-mortem appearance
tation of perivascular spaces, swelling and
Appearance ofthe lesion at the site ofentry of softening of nervous tissue, ballooning of
the electricity and at the site of its exit will myelin sheath of peripheral nerves are the
depend on various factors like exact site, thick- noticeable changes.

chapter 12: INJURIES DUE TO ELECTRICilY, LIGHTNING AND RADIATION I 457
Acroreaction test · at Kolkata (the then Calcutta), the over-

head electric wire for trams became loose
It is microchemical test for metals at the site and touched the roof of a double decker
of entrance of electric current. The test is
bus which got electrically charged. Of the
applicable for detection of metals which are several passengers inside the bus, three
soluble in hydrochloric or nitric acid- tried to get down from the bus and as
soon as their feet touched the water-
Joule burn logged road, with part of their bodies still
These are the lesions produced at the site of in contact with the body of the bus, they
entrance of electricity of not-very-high-volt- got fatally electrocuted. Others inside
age into the body, when heat is produced by the bus were safe. Accidental electrocu-
the resistance offered by the tissue of the tion occurs while repairing supply lines·
body. Joule burns are different from the Accidental electrocution death may oc-
burns and chars produced by the flash or cur from lightning-
flame caused by very high voltage electric Suicidal electrocution- Though a rare
current, coming clos~ to the body. Rightly, method adapted for the purpose, cases of sui-
joule burns are called 'endogenous' burns, as cidal electrocution are met with occasionally-
these are caused by the heat; generated as Live wire from a switch is connected with
the electricity enters the body i.e., after the one electrode tied around one upper limb and
contact ofthe body with the electric current, the other around the opposite side lower limb.
and the flash or flame burns (during electro- In a case of suicidal pact, all the four mem-
cution) are called ectogenous burns .as ·the . bers of a family committed suicide by com-
· flameis produced outsi<:l~ the body; i.e., the bined arrangement for simultaneous hang-
·heat generated before-the contact of the body ing and electrocution, at a time, for all. They
· with the electricity. ·: used live wire with one electrode for each,
tied around the neck and the other tied
around the ankle. They also tied themselves,
Medicolegal as~
fixed between two sticks one placed in front
· f · Death_dtie to ·.electro~ution, ·is acciden- of the trunk and the other on the back. Then
of
tal in ·inosi the cases• Accident may all of them standing on a table, placed sepa-
occ~r, froni a fauity)ine; while working rate hanging ligatures around their necks .
. with an electri~a:t '~ooklng .heater, room Strings were tied with the electric switch and
peatet or ·inside .·t he. b.athroo~ from a were held by them. When they all jumped
heating electric coi~, 'which, if defective; down from the table at a time, the ligature
_m ay charge tl~e water in the bath tub or material constricted their neck and the au-
bucket w'lth elE~ctri~ity. Accidents may . 'toinatic pull on the string in their hands
occur while repairing high tensi~~ over- pressed down the. bottom of the switch , es-
head wire connections: It may occur d_tie . tablishing the electric circuit.
to short circuit in temporary.wiring in a Homicidal electrocution- Though this is
festival pandal. Accidental ve:O:tricular fi-· not a common mode ofhomicidal death, peo-
.brillation has been recorded in cases of ple may be killed by electrocution- This may
intra-cardiac catheterisation and from be caused by placing live wire at some place
the site of pace-maker. On a rainy day ·which the .victim is expected to touch- In a

~;.:~~~~·~;Pl~:-~~;~~E~-J~.~~~~·E :·~ · :..>._::·.·:.. ::".-.... . .· .. · ·.·.. ~:.~ : ::~··:: ...::· : .. ·:. ..
. .. : .. ·. : .:· . . . . . . ..... ..
• • .; ",
.·· · ·~:;_ ·: .. .:·. :. ·.:. .. .'·- .. . ·~: , · ; :,· ·.~....:-.··.: ·. ~:- .:·: .. ~ .. · ·.
- '·. · ... .
.
. .:
:
·:
'
. ......·.. . ... . .
.. . . . .
:K-oik~ta: suinitbati'· are:f~'4-e :-:li.ous·e·~:CJ_wn~r ·_.. v:arietie~ of.liglitn.ing strokes ·may occur. · · ·
-~laG~t:tii1r.e~I~tri~-~~{~letig-t"l\~.;fe~C1ng·of:_.· " Th~~ a:r~:-·. ·. _.:·. ·. ;~ : .. ::_. . :-.-. ·..· ..
.· ·th~ h.~~s~:.~~~iliise.-~~-·:~:e~.~~:~r~·sp·~~-~i~~ ~i .: ) . .izit~a;:iou~~htp·i~~~iler~~Iigl;ltnipg'oc-. ·. ·
· c_h~l4r~ ::Wp:o :.Us~d,~? ~~~.. ~W~Y.f~·nl~~ - ft()m · :riegati_ve ch;arge : · , :curs ~u(do)l'OW. :of th¢
. t?.-,e ~?.fdAA~O~e:}~lW-4. ~~fataJ!Y.::~~~~pc~~!~ .· . .,.: :· -~~ t~eiow~r:sui:fa:~~ ?fth~ ~ioud', ti?w_a!_ds~ .:. :.
. . i~:th~~e;xt q~~:.:~~lj~~s-~ ?~~~ -~a:s .P,ros-:. . '·,: ... ;t~' P.9~itive ·c~arge 'i1:tlhe .u,pper snifB:ce: . . ....
: ~cllt~p :' · . ' ......... ,_. '·::.f· .·,.. :: .. '· · _:: · bf fu~, s~me ·Qioh,~::~These lightni.ri.gs are·.·
J~dici~ eiectrocutio::q..i~-· th~. meth~d;· of . . :'~.. _: ~o('u~~aiiy ~i~ibi~.'· .Qcly:' ~ gl~~ ~(the .
:· -··:·
- ~~ecution-~fel,lp~talp~~ltin~~t m~~~ero~ . ·;:_ . ,-~Iou~~a~- ~e 1 see~: ···_":. ·.·. ·::: . . :. ..... ~
tries, \y~ich is:~u~t1fi~ble hO~Cide._ · .: :_._ : ·. ~ ·. ) t : htte~.;cio.ud !i~pnrig_~H~ie·l!g~tn;irig o¢- ·.
· ·.· ·' ···;,::.Jtididin ..eJe~tro'~ti.m:~~i~ ;~~oXn~. - ~~iiii., . ' ·· .~l,ir~ ~u.e.to.flow,=ofthe~n~g!ltiye .~h_a~e· or·
· :.tries like.u;s:A;::G;;hrtie .st~te.s oftLs :a~ )) · ·on.e Ci(ma i~ the; po.sit~vely·_eharged ~art ·
. . .keath sentenc¢ i~-exe~U:.~.d by eleclro~utioll:.' ~f~~r·.~io.U:d: rr'hi~, va.riet)t is;_app;reci~:
·Tlie-c~ildeinne<i: pnso~~ds ·rna# e.t6 _si~ ~rn a ·. ·.~bi£i i>lli-ticlilaxi;r 'd~ririg ni~ht,_~he~ the ..
~66den charr . One electrode ·is.plac~d ~n the · ~: spark is:Seento ;~ov~ trO'rn_qne region of
. · · hea~r and 'the other ~ri the rlght IEig. A~~~ · · . il;le skY.to · iill~ther. . · _- · .·... : · .· .
r_(mtofabout 2,00.0voHs _i,s ~a_s·sedtwi~e sue- 3.'- CI~ud · to · e~h - lightrrlng~rhis occ~s
eessive_ly, each. time for .one minute , to en-. 'when th~ ·n.eg·at.ive· ·th;lr.g~ from 'the
. . s~fi tha:t the;e win be no chance off'~iiO,re . ~dei-sti'rlac~ of~ d~~d paSses t~· tiie posi.'
.()f the m~thod··~f executi~ri ofthe death se~~ .Uvely eharge<fel:lrth;s.·surlace.: (_)~dlruu:- ·.·
. tenc.e. . . : .ily:th~- ~~tli's: a~~o~phe'ie act~ as a good ..
, ,, : · ·· : in:.S~ator to,p~~~ilt the pass1;1ge bf th~
el~ct:rical charge fr~m the do~d· to pass .
·. . ,. UGH'{ I G DEATHS ... :i~ ih~ earth.: Brit ..wh~n the. po~~nti~lity ·..
· ., ·, · . · . -.. · ... · · · ~ .... , .. -.' .·:. . : ···.; o~ tJ:!~ charg~'on>th~ l9wet silrl~ce: 9f:the : ·
:·. ~ight~g occurs ~aS a . ~~Q~el~e tO~~ ~· ~¢c,u:,. · · . ·cloud jric:f.ecis~s ·aild the ·p.otentilifdiff€r: · . l
.:'. . .niJia~ed eJec~iilly'ch.8.4~d: p~itle&pli ~p~·:. ~ '~ :·..: .eil~e :b~t~k:ei{ihe' ~ioi.ld·· ~a) tlie eatth's' ... : .
· :~niifuc~·$·--~r. c)~ii·d ·; : ~<s'~o~; ~tQ~~';._ :~~:~piiSt.· ;. ·.:· :~~---~-~r(at/ts - ~~li(:_tii~{D.~g-ative. iharg~ ;... ···
.,s -~torm/4?Vol6iltii~~e~:Ptlo.n. :_iin.<t ~::-~~ciear :; :·. :.:fri>m'_.the ·~l~ud>~;osses tb~· ~~osp4~c · · :. : ·
·. -~~i_ol)ia?~ ':Liihtm~g ?~-'c1~~d;l>i)wn_:i_s· ~o~~-: :kiii~,·and'~t~blis'he.~'a.· e~h~l ~P ·t~. . . / :. - . :·
.7t;·~·-; :'::(: .~·: ':\:<;.:!:·;:;;· .,~ ·.:.-::: ~;;:::1;~~hlt~::;::~: · .: ;
.~lg_~~i~g-~r~~.fr.o~- ~~~.d'·> ~.. -·;·:~. :·:. ··~ ~-: ~: :~:.;_·; .._.: 9(~9Wp.~~·d. s~li~~ <if~_eg~ti.~.~ :c~~g~ .. ·. · :. :
I •'·- .~: ,.~.,:
: '·~,
•., .. ••~'\ ~.:: ., ,~ • '•'.;_ :. : · ·: . ~
.. · : : . ... ~ , ..., • ,••:''1'" : ,•• '• ,·;.. :· • .• •• .. : • •' • .• •' • ":,. • ' • • : ''
Worid\~rlQ.~i :data oflightl:iin~fana thunde-r- - .. '.? .-' _···:.-.- ···-. ·' ··: ~-·,. ~,-.;; · ·... . ·..: ··.: ··. ::--. :.. : .·
·. ~tci~~wuif<f~Hle\~~~~;.~f-.~~~~4~~-to~ :.' _. t~e.:_ph_eo~m~ooii.Cif. U9ht~io~· -.~·- ~ .. :·::.: ;. ·:· ... -~-. . ··.:
\~ ,. .-tiV~h(c)}wged:-Fro-in.·tliit¢16u§.~~ ~e~ ' · _.:#ii$jl~w. -~. ·~ojneth.~ng : m?reJl~aiJ.JO~~ ~ : ..

~~~~r;~-/:t~:;·::~~;:r:;.;:?.,;.f~-<~ .: .-. ~ ·:_._;,.·. .:·:·:. :~~· .· : ·.-'. -~ : ·. ~.. -.~·:. _:_·:_·.;,:. : : _._:):; r:,·~ :.::~·:~·;::~.:~-~~·:_~~--- .·:::-<''~. .~;~: ·; ;·. . :· ~;~·
as filigree marks or light ning marks , may The effects due to compression of air in
appear on the body surface , due to promi- front of the moving spark , is no less severe
nence of superficial vessels , particularly the in its action to cause mechanical injuries.
veins which are very much congested due to
flow of electric current through· them. They Post-mortem findings
appear like branching stem of a tree and pass
External findings -Any type and any extent
off in a few days if the person survives ·
ofmechanical and burn injuries may be no-
If such high strength electricity passes ticed. With milder electrocution, there may
through muscles then ''zenkers " degeneration be arborescent marks on the skin. These ·
of muscles may occur. marks may also be present in severe elec-
Due to the effect ofthe high voltage electrocution, when only a small part of the cur-
tric current, the metallic wearing materials rent passes through the surface of the body,
like the metallic wristwatch band , metallic the rest passing through in deep. In some
rings ,cause deep burn injuries at their sites , dead bodies no external signs of the effects
as extreme heat is generated when they at- of electrocution or fire or any mechanical
tract the current . These metallic belongings injury may be present on the body. In these
also get magnetised due to passage of high cases, death does not occur due to the di-
voltage electric current through them. There rect effects of the lightning, but occurs due
may ionic deposition of the metal in the depth ·to shoc;k. when lightning occurs nearby , mak-
of the tissue "current pearls ". ing tremendous sound.
Due to the effect of the generated heat ,
Internal findings ·
flash and fire ,any degree of buni injury may
be sustained. Depending on the approximity Where death occurs due to high voltage elec"
of the flash, the burn injuries will vary froin trocution and where there has not been much
superficial epidermal burn to deep charring. mutilation of the body, h,ae~orrhagic points
Further, here de-ionisation ofCa-phosphate may be seen on the surface ~d .in the mat-
and seggregated deposition of Ca++ causes ter of many organs including the brain . The!'e
round dense area fbone-pearls !wax dippings ), may be tearing of the arteries . There maY: be
The clothes may be totally burnt. shrinkage of the tissue surrounding the ar- ,
As a result ofexpansion of the heated air , teries. In addition, · the brain may be oede-_.
there will be a blast effe.:;t . This causes ex- · matous .
'terisive mechanical injuries likelacer a:tion s · Thunderstorm may cause rtJpture of ~ar
' . and bruises . There may be gross·dist ortion ' drum ·
·and mutilation of the body: The body ma:y
·even tear into pieces ._There may. also be .. :circu...nstqnces ~ acxidentallightning
multiple . tears on· the Clothes . Ap~rt from . stroke
the injuries .directly caused, expansion of air
may also forcefully throw the body of the vic- The vulnerable circumstances are :
tim on the ground , against a wall , causing 1. Open field
further mechanical injuries . 2. Top of a building or a structure
Regression of the expanded air due to 3. Under a solitary tree
cooling has similar effects but is less inten- 4. Non-conductive or ''ungrounded " build-
sive than the effects of expansion of air. ings, where iron and iron strip for earth-

chapter 12: INJURIES DUE TO ELECTRICITY, LIGHTNING AND RADIATION/ 461
ing of the lightning current has not been grounded buildings, not to go near
used as protective device. ungrounded window rods or grills.
5. An aeroplane passing across a cloud may 8. If lightning starts while in outdoor, shel- ·
face or even precipitate a lightning ter should be taken in a building or in-
stroke. But mostly no harm is caused as side a closed car (with windows closed),
the electric current passes through the or inside grove of trees (not under a soli-
surface of the plane. Sometimes th ere tary tree). If nothing available then to
may be some damage to the weak points squat as low as possible if on an open field,
of the body ofthe plane and in the r arest but not to lie down in the open field. To
occasiol\ the fuel tank may be ignited by keep away from any metallic fence , me-
the heat generated, in which case the tallic stand or structure.
plane may crash.
6. Swimming during lightning is specially
dangerous because, ifthe pool suffers the
lightning stro}m, then the swimmer may Iatrogenic effects ofdiagnostic and therapeu-
get electrocuted by the charged water of tic uses of X-ray and different radiations are
the pool. Salt water itself being more con-
matters of constant concem for the clinicians.
ductive, is less dangerous to the swim- Simultaneous attempts continue to prevent
mer in such a circumstance.
and cure such hazards. Cautious and vigilant
7. " Ungrounded" window grill or even application of these agents add to the benefit
"grounded'' window grill in buildings, of their uses. A careless attitude is definitely
without protective devices for the entire harmful and dangerous.
house, is also dangerous.
General harmful effects of radiation
Recommended precautionary steps to
ovoid lightning stroke Acute manifestations:
1. Nausea, vomiting, general indisposition
1. Not to go to an open place during light-
occur in the initial phase.
ning.
2. A symptom free period follows.
2. Not to go on the open roof of a building
during lightning. 3.
Systemic involvement with excoriation of
skin, erythema, blistering, followed by
3. Not to take shelter under a solitary tree.
dermatitis and in a few of these cases pro-
4. Not to touch a metallic fencing or such longed ulceration of the skin; GI tract' dis-
substance. turbances; haemorrhagic ~ondition occu,r.
5. · Not be neaJ" an "u~-arrested" telephone
to ·4. Sec'9I1dacyi~fectim~.s.'. · ·__· ·.·.·, ,· :·.... .
wire or antenna, computer or near 8:n in~ Chronic· mMifestations: In so~~.:i:·ase:S
flammable fuel source.
. ·. , . · . · . . .. ·
· delayed effi
- • f d
. i
• • · ·art · 1 ··' -
ec~ o r~ atwn occur . era ong .
6. . No~ to hand).e ~Y-.i~flammaljl~ .f~~l;d~~ penbd :oO;herapy. or expesii;e. ~ ·gairo(#~q~
.. · ... in~.lightni.ng: ,.. , :: .·~ .··'·-:. ,:. ·. _ riu1y.~\r~n -b,~ ·a.fe~ y~ai-s·::rP.::.:s.om~;;rfi, ~li~~~
·.
.. : -. 7.· · .In .unp·~ole~ted buiJdin.gs, :fiot J <t g(} n~~r s"ubje¥s; :rtialigilaht ch~g~--:hiay ~c9~.r.:·:#'i:
; · · ·. t~~- :~~taiii~ .~inio~- - ~·nl<>~: rod.~~ .ih:e~_- · <iiii'¢r~nft.:6r~~~< .~i>a.rt'!rq~c).t~~~~prp~l~i£·5::_:
. . - spectiy~ of V.:h~t~:er the gr'ilfs i¢d;the rod.s. :.. to·ngiile t)le. d~~li:y~d QQinplibitions _Qfr8_di~~ ·. ·:
_ ·: · · ,~re gro~{ld~d: -~~- .~of~?~:; l>ro~~·c¥.~- \l~.-·~:.-:ti?h:;t~~s~·:_~.r~·= ··:_:~f.:~·)?'\.~-.;._L· ~ :~.· ;,.; ;, - ·"}~;;~~··;:t:::-·
--<

.b:·-~~-~k/ c-:f; ,;·.:; ; :·. ·fJi ·.;;_;:·.; :.·, .: ··<: :.. ?.· · · · ·{:·Zt;;~.; : .\ •· .: : :.·.•>•
·.i162 (--P;I?INCif~ES__9F f~~SIC, M~Q!Clf\1(.; _-.l .•. ·-:~_,·.:-. :.... · ; ". •::. ::. :. : · : ~- .. :, . . :, : '· ·:·; '~~; : • ..· . . . . . . · · . : :-
... ·. _ :._.· .. .·. ·_.:.·.· .
."t:.'\:~:-.::.~_·_:__ ·· .... -':i:·:~t:_·~· -::: ·: ·.·.' ._: ._·_:") . ·.·.... : . . ~(; .::·<:·.i:-~.:.~·:· -~-:-.-.·. ~
.. i {<M:~i~~t~· ·-~~a~gis . tri :d~ffoc~~~ -~;~~ns·. ~:. 3_:: ': .&~~iti~ti ot the.qrg~b{t~ ~adiati9ti~ ~- . .
.\;~·: <. a,h~r-~sst~~~; na~~ly:· Ha:eiD,op9etic ·sY..S~> -:; -~· : ·c~rt~i~·t1s~ues ·or o;g~·s ·a~e highly: s~n; . :. · · .
':· _
?:··.:::. • tem;- ~~g,::~~V.er;_ ........ -~, >;~:: :.<~:-· ..... :.·.' _ ...... · .. ~itive·to'radiatipn, ncUri~{y,bone mart~w .
. ·~.:.·.. e~bsure 4v:;in:g:: ~~e~aiic~-~~;,~ie~d ~~: · ·...· ·: --~rg~r;mii).al. ceus . o~·.the. oilier liana·s.ome .· ·.
.. ::> ~-: ··. ~rir.i'g_ehit~i. a~h:6;¥~1itie~.' ~n~th_e·_~P.il{. -?.. ~· ··· .. · 6f.-tlie. bt)dy.t4;sue~;ar.~. ~~ite ~esisuint i9 ·
;3:::_ :co~Aitions I_ik:{ ~tei-ni ty( ca.t~~-a~t .rri~Y. : . ·.
t~e ~ffect~ of J,"a:dia ~i~n.;.n.amely ~th~ con,- ·
.:~,~-· de~ei~p :· ..~. ··~··
\',',l'l '
0
'=.-~ ..• ~.
_:.:-.< . ·:
.'~
....···.:··. · .. ·. ·.. ·:
0~
0
· n~ctjve. tissue. · · · .::·. _. ... · .. · 0 0
. ·:. :···· ·. . ._, · ·. ,.·. :·. . :. > -.· ·.' :·....·' .·. ·•:__ . ·4 . . Mo~e ofadnrinistratipn,. .,. .,Adose rece1v~d ..
0
0
•t. o • • .-. "'..: lo • :.• ..... , •• • • - ,,'•, • OO O I , '. • • '
0 0
··~n~~ ofe~~~ :t.o X-iQ~> .... ·r-: :_.:. > .:.": :·· }~::a ~~oi-t· period fs·flio~· diulge~qu~ tha.ti· . l
·· ~~fie:~~~~fu·i ~~~~tis>,tii~;· b~ ~J(tli~\~~;i~n~~ <~ ·:. :·_ ·.tl\e·s~.e><iose taiten ·;Q~wg s~rea4e<I aver .
;,
·•··!.;:,-_:~~tw;::~~~~)fd:""tli~t"j~~~·,
·,~· ·· ,·:~1:< :
..
~ .' •~; •~~~~~t:L;;~ti-:'
·.- .. .._:; .; ;:.....:::;· .: · : ··:t ·:· ·x· · :: ·b··' .-,. >- . .· . of
hJ~,~.~~;•?n. :
halflW~
Q.iffer·e nt tad~ations:; tlieir ··.
··
' ~ · -~_a:r y .:reactiQRtU:O:'patieii :So: -r~y . urn: ·. ·. . ,;.·: . : -: . ·. . ·. ; · . . . ·. · · ·. . · . .· . . .
•: .·. · : ·· ·· ·· ·. · . . ·. ·,. . · ... · ,· :. ·..··· ·: ·.· · · ehnunfft;1bns, etc; . ; :·• .. ·. · ·. · .. :
·.ru. the :form. of ~:ryt.b,~~~ with ·gurface capil- .. · : ·. ~ . ·· . · . : -: · . . , · : ·. ..
.· i~·;iiiaiat{p~·~(ii·p~~~ta~tori. . . : : ··. •. :_·:. ·:. ·. ·• ~-~lflife of il radjqa.ctiv~ ~.ubst~c~_is . :
. L ·.t . . ;t. ·.: -.': ···. . · .' .._·. t . ·· ..;..,1· .' h. · .
a e reac 10n>7: rn; pa~Ien s: .n ui_s .
the ·p· eriod 'req.uired
. . ·.: ..· . .· . .
rl:lduet!o"n· of the ·
· . ·· · . . ·. . . : · . .- .
'for
discolouration of the. subcutanMus tissue rad.ioact~I~~r~o half~of 1ts oti~mal
with necrosis and slough formation. strength. a I e m~y e e:x;presse a~ :
(a) Radioactive half life - Time required
In radiologists and radiographers: Con-
tinued prolonged exposure may cause epithe- fc!' reduction of radio-activity by 50%,
lioma. by way of decay of radio-activity.
(b) Biological half life -Time requir ed
by the body for natural elimination
loser Beam ln'ury of 50% of the substance.
(c) Effective halflife - Time required for
Laser tf..ight amplification by stimulated reduction of the radioactivity of the
emission of radiation ) beam may cause dam- substance to 50% of original, by the
age of the tissue in subjects who work in the combined process of decay and elimi-
laboratories or institution where LASER is nation.
in use. The commonest of the danger is dam- 6. Type of radiation -Type of radiation (e.g.,
age to the retinal vessels . X-ray, radium needles, etc.) is very im-
portant in that, not all types are _equally
harmful. · ·..· .
7. Level of precaution adapted during the
use.
The following factors have influence on the . .
effects of radiation on human body- Sign$, symptoms ·. .. .' ·. ·.':: .:. . . ·· ·:.
1. ~~;-Yo~~:s~.?.J~~.~ · a:re'in<?r~"·v.~lqer- :·.: ~a~i-~~i~~·· i~j~~ in_ay·~ffe~t..b~~h :~~~~~~~ . ..
. :.·. flhJ~..to,~he/x.P~:sure.-o.f ~~~tio~:· :. .: _-. ;:·:: :-. ) ,l<!dl sW:t'a.c~ ·~1'·;-w~n ~· ~y: ·:iiJ.t~r!lal · ·..:·· ~ c_ali$e
·_· ;,~: :'J:>.9~-~ ·::~f. t~ ja:4i~tion~Wifii: J50'!. r~d,S:; ·" >~±Ury:dep~Jid.l:~g ri)a,imet oi.e~P.~s~t~ '9r.c~.- ·:\ . _::_,_ ·
·...·,,·.:.~2:-. ..•..~·::~A\. . '~~frf~-~~ ?f;~~r~~il1:;~~~~:~
,}lie.oang~r. rs._ })() _.
-~~\~.-~~~:~-: ~~~~·, :::.;: ·-~~~~:::~5~.:~~t~~~'~~qt::~~ai?~~~~~~#~.:~:~-.t~e.~:· ~;.
, .._, . .·· ...•.. ,.......... ·.·.....-s.our{:e. -.. .·.,; . ·..... ,, ...... ·.··· . .. : . - · ..
.·=;·:.::·.. ·
;~:;_:}i~~sl~~J~f~Jf·?:;;;:.~~':;ii\;->WJ!~\;}.:.::))r.~~~i?1::~~.6~:t::~;,:;.~\){'_:
,· Parvej .:·_ .~<:.:~~-:::~··;,~t(·~~/;~?{:.:
Dr. Md. Ahsan.': Uddin (Nayan) ~;:}~~:/.:~~::.:-_:: ~,~ ·:.:~~<: ..::~i~: ·:·: CoMC-24
·. :·.~.:~ ~:: ='.- :;,
-~::·:;·.-:·_~;:/~>::;_ ;~//:N~{;{:: . ~·: :!j: .· :'. ,_·:~:-:::r. ·.:: :·..-.~-·:;:,., .:/<·.:::: : ~ :~:: ~ ;-.:s-~~~:~~~.;<:~··_ : ,~:.:J:~~; -~:~·:::~~--~:~::::.,.;·~~ar~:::·~<: .::~-~~{::. -~ ~:. . ··:. :
:-.: ~:. '·. :: :··:·:· .-..·.··-~_:. \:;~-~~·/:·/:--i~ ;··< ::.~x-:- :¢haP.!~~- i.2~ rN~uR!Es :D9.t~T~:El_E.ctr~,6J:&, l.1~t!~JN0_-ANo _RAo",~t.,~.t·f..r.~ · :-
.. :. :·. ::··:·;,:.:_ :_..::· ':_·<:-.·~ <:< ·:·; ·~. .::.-: ::·.·.· . ·. '{;~ ~.·. -~::·. \. -~~:_ . : :·/~f..·.,_. ::·:. '-::·::?;·;~·.>/\//~~~·--:?:.?: :>·-·. ~<:;:.. .,·.:·.', ·....·
· ·.:· :· : ·: . · Ifth~ expQsure i~·ext~rtial, 'tl;i¢n:depend:.: : :_1._'~·· With que,atiini~ . o(]le~~~I1c~ ·agamst ~ ·
·: •kg 0~ ·the·p~Jnetr.at~ori ~~pacity' ':s tren~h of :·t: ~-. ·tr~'atiJ:lg' ,docti>t ' for .·~v~r : eX:pds.~rfi and ..
.. · ·..:the-~gent-aqdp~tibd-·of:~xp~sur.~; ~her~- ina'y. ::·-: .:·~· c~usb:i~ 'itam-ag=~· to:the,ph_tient. ;: ·.· ·~:=· :•.. ·.. · ...
. . . .: ~-~ .ini~~llj, ~~s~)>wn~~~ke:c~~~t~~~·;<?f_t.h~ :~· ;~:i: :d~mpertsatio~ ~s~ ~h~;e wd~:k~_r;;:v.w~·
·. ·~. &kin ·wi~~-~pj~_ati_on ~d _de_a th·? f th~· tiss•1.ie. :·..-·:>(•:ru;;r~ble~~ .radiati.o'n. e~~sW:e; d~ s~ffer .
.. :?qhe e~posed . area, Witf;l, ..ul ti,m(lte·:.s·~·<?u$li" .. ·.; :.... ::'t heharm··Ciue'to:the fatrlt tirestablishment.
. ing ofthe ·tis·sQe oO.l\e' ~ea: tf:th~-·r8,di9~c>-:-"/· ·[.·· ...-· .. ·.· .•. · ·· < '· -·· · .... · :.·. :.·>·
·\ive . substau.te . is swiill.o.~e.d~ th~:rdhat ·will ._'.: ._....·.. . . ... -. ' -·
· ~ause 'Gi
~tract·:il:rikd~~ --in:d:'!ia~a~~- ~th. ~:··_.. ·Referenc~s ··
·. ·i:Jth~t ~ecf~ ~:~a:thci~> J.i:o.iQ~~~~ :r.~~n:b.g :qr:-:·..--~- · ;....:..~: :,_::~ :··. :- :·.....;' .:· -:_··, ~-. ·-~- :.... , . . ". . ..
·. . In
· al.a'I.Su · · .d.i:SC
· ·,.,: an·d · '0·m' fo-" · ··..:..:h·l OS,<>v
.r.~'\"h~
· ·,,; -Af.. 8.·c·a···-I·p· .,..._, · '·!.-.• .· :.[.la01lltor::~-
a-rid'· ,··.·; . .. .•.••
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., .... , .·.· .· .. ·.:·. .· • .. · . , .:
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.
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.. · - ~r~c;aqti9os.; ·.:: ·
:-< :.. :'-:~~.: ·::· . . \: ··:·' · ,_'-: .·.:: \.. :~ :·~- ·ik·k_eiv.' i(:1 ff!3al~IH~-~~;e:~t.f.l~·qiatiqX~~d~·aJtie~. ·
· .1.: ri~·~, . i~ . ~~se .or .the.r~ileutic: · ~~e, . ~h.6~1~- ·. ·:·~ . ·::·-~~cfli..i( ·~; 'o93-l')~~adioi_;;~·i i~~ relat·i~~ .tb:Mect.
b~ caref~ly decid_ed.:.· . ; ·. . .. _.: . . . ' J~rispru'~h~~· -:- .:· .... ·. ;._;.·' >. .: ...:....
2. T~ a~ofd accidental ingestion, inhalation •. Armstrong N, Kai~~ff W, Cfin:e jP, Applic~tion of the
ofthe used radioactive substance. Maximum Entropy Method to Profile Analysis.AAX499
3. Those who are exposed to r adio-active fAustralianAnalytica!X-RayAssociation). Melbourne.
substances, should be subjected to regu- (E5).
lar check-up investigation, so as to be sure • David Dolinak, Evan Matshep, Emma 0 Lew - Foren-
that there has not been, any o:ver-e,xposq.re · .' :. :·sic fathOkfgy: Principle~r:id P!ar;tice -; 4Q05..
or t~ere ~s ~? sig:rl o~_~hy ~~a;gip~:~ife~t; ·..'\ ~ .: :.: tv1icha~,:~J:;s~u~. ~~~ D~.~~p~oH·A: R'a~~y-'_:_ ?~~~;,~_ ·
4. Dispo.s·al.of'radl6.~~Hve wa~'t~s s.f:l~ui;d be ·.: .:: :,:.:arfy.ot JF~t!mB ·..:.:iooo.:· (_." ; :·:·.<~ >.··. . ·· .. : ··. J ..·
in :a~c;~rd~~~e:~t~~-~h~-sf~n~~rd· ~e.toin~ ;."< / .>R~ha·r~ ·~h~ph~~~ i i~P;6~~fo;h~{6.:;.},~~i~!~~·-:- ..'. ·. ·.
5. ·. ~:~::~~-~e~~·~~~~-~~o1Jld·~~~ m~;~· c~u>'::; ·...~_}OO~. >:~/ ·:. ··>~·:_f .'.~i:~)'J~~:·: . :_'._::::~·~:~/:;.·<.·~~~::·- : ·~;·:·:~:~ .:
._. tious· and: h.~v_e· ~rb~r knpwl~dge .an.~ .:· Q : sf·. · · . . . . .. ; . · . ..::
. . . ; . .. · . - . .• . - .. . ue JOOS . . ~ . ~
trai~g to avoid ejfposure. :· · ~-· · · ·. ~ · .. :. . .. . · . , . . .. . . . ,. .· .
· ··. · .. ·;~ ·. ····: ·:· · : · · •··.. .:::·: ·shart.·N~t~~~·oiker~~~~·~krirar~~~sti~~~-; .··; .: ~· ·.-.:, . _...· .<
Medicolegal aspect~ ·.··· : ·. · ·. -' · ·· · '· ·... · . · :.· · · ·. ·
Lesions produced a~ .the ·;ite~.-ofe'ntrance ~ncfe:x(i of..:. -~ .
Usually victims of radiation injuries do not electric current, Jo~le burn. Causes of ~deat~.'due16 · : ·. •·
come to a medicoleg!st. However , legal prob- electrocution, Arborescent or filigree ·mc1rks f~ot6i's· · ' : '
Iems m~y ·B;rise .~n ~. V:uf.fol,lowirig: ¢ir~ll!ll- . · · ~e)atedte·~a~mful .clfetts'Offcl.~i~fo.~;t01}. ~f fa~~-

NOTES
.... .· ...:: .~:. . :. ... ~ .·.

.... ~ ~..
.. 0 -
: ... :· •. ... ~ ~
....
'•, .. - ..
.: ... . . ·.· :··· .· -.:
,; .
·.· . ·_: '• .

These injuries include injuries on roads, rail- 4. To search guidelines towards prevention
ways, vessels, and avi!ltion injuries . Drown- offuture accidents.
ing deaths figure more prominently in a trag- For these purposes, road traffic accidents
edy involving a vessel, a boat or a ship. Deaths should be investigated by a team of experts
due to drowning has been elaborated in the which, in addition to an experienced investi-
chapter of violent asphyxia. Hence, the oth- gating police officer, should also include au-
ers will be considered in this chapter. tomobile expert and medicolegal expert .
.....
The investigation should include

ROAD I URIES/ACCID N S
1. Collection of history.
Due to heavy casualties of human life on 2. Examination of the deceased or the in-
roads, in every country each year, extensive jured.
investigative research works have been done 3. Examination of the vehicle/vehicles in-
and are still in progress, on the possible pre- volved in the accident.
ventive aspects. Road traffic accidents involve 4. Examination of the spot or place of oc-
a good many complexities which to a large currence of the accident.
extent is known to all concerned. But, in prac-
tice the investigation of individual cases is Causes of vehicular accidents
far from satisfactory, rather often it is just
perfunctory in nature and it is more so in Accidents may occur due to the following
countries like ours. causes-
1. Fault of the victim
The investigation of road traffic accident
cases has the following purposes, 2. Fault of the driver.
1. To know the cause of accident, 3. Fault of the vehicle.
2. To allow adequate compensation to the 4. Fault of another vehicle, not involved in
victim, if he is alive, or the next-of-kin, if the accident.
the victim is dead. 5. Bad road condition.
3. To punish the offender, if any offence is 6. Wrong signalling.
involved. 7. More than one of the above causes.
.tf66 I Pi<INCIPLES OF FORENSIC MEDICINE
A medical man is not the proper man to Examination of the body should be car-
investigate on all the 6 aspects. However, by ried on as any other case of death due to in-
virtue ofhis knowledge to interprete differ- jury. Grease marks, blood stain and stain due
ent injuries from different angles, he can pro- to soil, mud, sand, etc. should be noted with
vide many infonnations, which help to come care, as to their number, size and placement.
to a final conclusive opinion in many regards . Proper recording of the injuries is very much
Not only that, visit ofthe place of occurrence important for solving many questions which
by the medical expert, who has examined or arise in a road traffic accident case.
will examine the deceased or the injured, can
Injuries and their interpretations in
be very much helpful to reconstruct the cir-
vehicular accident cases
cumstance of the accident.
Road traffic injuries are blunt force injuries
Examination of the dead vi dim with forceful impact. According to the man-
(post-mortem examination) ner of production, they have three distinct
types. According to the sequence of occur-
The post-mortem examination should include
rence these are -
examination of the body ofthe.victim, exami-
nation of the clothing and any other mate- 1. Primary impact injuries
rial, if sent along with the dead body. 2. Secondary injuries
Examination of the clothing is important 3. Secondary impact injuries.
and the autopsy surgeon while doing the
Primary impad in juries
same, should try to find out and note the re-
cent tears, grease mark , blood stain, soil, Primary impact injuries are caused when the
mud or any other stain, if present on cloth~s. vehicle hits the victim, say a pedestrian, for
Table 13.1: Typesof\llc m ofro'Jdtrafficar:adents
Types of ctims of road traffic aoode ls

l
Pedeslrian victims Occupan vict1ms of V1ctlms who are occopants

the offender vehicle of the offe ded veh1cle
+
t
Driver Other Front Rear seat
seat occupan occupants
~------~-.--------~ ~---------i~-----------
Victims walkif19 Victims wa king Victims who or slow moving of fast movmg of standing
in the direction in the oppoSJte ace accident vehicles veh c!es veh1cles
direc ·on while crossing
of movement
of the vehicle the road
t +
+
moving i mov1ng the moving in moving in
the opposite d1rection of the the same the opposite
direction offending vehicle direction directiof'l
------------------------------~--- ------ --~------~-------------

. chapter 13: COMMUN ICATIO N AND TRANSPO RTATION INJURIES I 467
the first time, to knock him down . These in- However, according to the type of the
juries are very much important to detect the · victim, these injuries will have various pres-
offending vehicle , because, being the result entations and effects.
of the impact by the vehicle, these injuries
may bear the design of the part of the vehi- A Injuries sustained by a pedestrian and
cle causing the injuries, in the form of im- interpretations of these injuries -
print abrasion or patterned bruise . Thus, if The distribution of the primary impact
the front of the vehicle strikes the body, the injuries will vary according to whether he was
design of the grill of the vehicle may be im- moving along the direction of the vehicle or
printed on the body of the victim. The height against it, or if he was crossing the road at
of the primary impact injury on the body of the time of being knocked down, and if so,
the victim by some particular part of the body whether with the offending vehicle coming
of the vehicle may give an idea about the from his right or left. Sometimes, the level
height of the vehicle . of the primary impact influences, at what dis-
tance and in which position, the body will
Secondary injur!as strike the ground. Thus, at times , the pri-
mary impact influences some features of the
These injuries are sustained by the victim ,
secondary injuries . Though, primary impact
after being knocked down by the vehicle, due
to fall and friction or impact with the grouhd . injuries are mostly caused by the front of the
vehicle, it can also be caused by the sides of
That is why, detailed examination of these
the vehicle, e.g., when the vehicle takes an
injuries may help to detect some sand , soil
acute tum or when a person is struck by the
or gravel on the injuries which help as evi-
side of a running vehicle. Depending on the
dence to link the place of occurrence with
part of the body of the vehicle and the rela-
the injuries. The injuries may be any of the
tive direction of movements of the yictim and
hard blunt force injuries. Among abrasions, the vehicle, the type , size , shape , site and
grazed abrasions and among lacerations, direction of the injury will vary. From the
stretched laceration are most common due force of impact point of view, irrespective of
to friction with the ground. the relative direction of the movement of the
victim and the vehicle, the speed of the vic-
Secondary impact injuries tim is so negligible in consideration to that
of the vehicle that, to explain the injuries,
These injuries are the result of impact be- the victim can be taken as being in a static
tween the body and the vehicle for the sec- position or in a state of inertia of rest. Hence,
ond time . When, after the primary impact, in case of impact over the head, the skull cage
the victim is thrown forward and falls on the will move first and will, in its course, strike
ground in front of the vehicle, if the vehicle the still static brain, causing injury of the
is still in motion, then the wheels of the ve- brain against the site of impact. Similarly,
hicle will run over the victim. Hence second- the skull will come to a static position first,
ary impact injuries bear the tyre marks of when the brain will be still in a state of mo-
the wheels . Run over may be caused by the tion . This will cause another injury on the
fi-ont or the back wheels. Avulsion laceration surface of the brain at a place diagonally op-
is the most frequent injury,. caused due to posite to the site of the impact. The injury at
run over by the vehicle. the site of impact is called coup injury and

Fig. 13.3:
A run
over
road
traffic
case
Fig. 13.1 : Secondary impact (tyre)

brain with the uneven inner surface of the
· mark (road traffic)
skull bone.
the injury caused at a place diagonally oppo- Pedestrians are the single largest group of
site to the site of the impact, is called the victims of road traffic accidents
contre-coup injury. In case, the head is struck B. Injuries sustained by occupants of vehi-
at an angle, then there will be a shearing cles -
movement of the brain inside the skull cav-
Occupants of the vehicle who fall victims
ity. In such a case, there will be larger contre-
of an accident, may be the occupants of of-
coup injury which may not be restricted on
fended vehicle or may be the occupants of
the opposite side of the impact, because the
the offender vehicle.
shearing movement will cause friction of the
The offended vehicle may be a standing,
slow moving or a fast moving one, may be a
two wheeler or a four wheeler and may be
moving. in the direction of the offending ve-
hicle or against its direction In case of a traf-
fic accident, injury to the victim will depend
not only on these factors but also on the ex-
act location where the victim was sitting at
the time of the accident, i.e., whether he was
sitting in the front row or rear row.
1. When the victim is on a slow moving light,
two wheeler vehicle like a bicycle, and if
he is moving against the direction of the
offending vehicle, then due to impact; his
bicycle is likely to be smashed or grossly
Fig. 132: A road traffic run over case
damaged For him, the effect will be as if

chapter 13: C O MMUNICATION AND TRANSPO RTATION INJURIES I 469
his forward inertia of motion is higher. cause infliction of three types ofinjuries .
He will have serious impact in the fron- If the two wheeler is moving in the di-
tal aspect of his body with the anterior rection of the offending vehicle , obviously
parts of the vehicle. In other circum- the force ofimpact will be less which will
stances, if he is not thrown away of his depend on the speeds of both the vehi-
bicycle, then he will be knocked down and cles. In these cases, maximum danger lies
may be run over if the vehicle does not with the injuries sustained on head which
break the speed in the meantime. Ifthe may be directly hit by the vehicle or may
victim runs on a bicycle ahead of the of- itself strike the ground after being
fending vehicle and in the same direction , knocked down . The head or any part of
then due to the impact of the vehicle he the body may be crushed subsequently
may be thrown a few feet ahead on or by being run over by the wheels of the
outside the road . Thus in the first in- offending vehicle. Different types ofhel-
stance in such a case, the victim may not mets are available to absorb the force and
sustain any primazy ip1pact injury . How- their uses are recommended to avoid fa-
ever, he will sustain gross secondary in- tal head injury of the users of these two
juries due to forceful fall on the ground wheelers. In some states of this country,
and then he may also sustain secondary it is mandatory to use helmets by the
impact injuries, if he is run over by the users of two wheelers . In scooters or
vehicle after the fall. However, the back motor-bikes, the driver is more vulner-
part of the bicycle will bear the effect of able in a head-on-collision, and the back
the primary impact . The danger for the seater, when the two wheeler is struck
victim on a bicycle in an impact with a from the back by a vehicle moving in the
moving automobile vehicle is that, even same direction. If the two wheeler hits a
if the victim does not sustain any primazy standing heavy automobile, then he (the
or secondary impact injury, chances of rider) may sustain fatal injuries depend-
fatality remains high , because the head ing on the speed of the two wheeler and
remaining unprotected may sustain fa- the part ofhis body facing the impact (tail-
tal injury, in case the head strikes the gating or under riding).
ground when thrown ahead by the auto-
3. When the offended vehicle is a three
mobile.
wheeler-Three wheeler vehicles may be
If the cyclist strikes a standing vehicle a cycle rickshaw or an auto-rickshaw.
then ordinarily there should not be any Both these vehicles being partly covered,
serious injury. He may sustain injuries provide minor degree protection from an-
due to impact with the vehicle but there other vehicle which is not moving very
will not be any secondary injury or sec- speedily. But the protection being mini-
ondary impact injury. mum, may not be helpful when the offend-
The body of the victim may be pushed or ing vehicle is a heavy one and runs at a
rolled ahead by some parts of the vehicle very high speed. The occupants of the
causing external injuries due to rolling three wheeler may be thrown out of the
ofthe body. vehicle and are susceptible to any kind of
2. If victim's vehicle is a two wheeler and a injury . Primary impact injuries may be
speedy one , then face to face collision will sustained with the innerparts of the three

wheelers. Three wheeler vehicles are less will strike the dash-board and his reflexly
stable when on move and may get top- straightened legs may sustain fracture of the
pled, if hit by speedy heavy vehicles or calcaneum or the tibia of either or both sides.
when they themselves take acute tum The other front seaters-The injuries sus-
with high speed. Type ofwounds produced, tained will be same as in case of the driver
when the victims are not dislodged from
except that, injury due to the steering wheel
the vehicle, will be in some way similar will not be there and depending on the posi-
with those sustained by inmates of four tion of the legs, injuries over the two legs
wheelers but the degree will vazy.
will also be different
4. In case of hand pulled cart, injuries will
Sparrow foot mark type multiple local-
be similar to those sustained by the pe-
ize or small laceration may be seen over the
destrian victims, except that, in some
face front row seaters due t; impact of bro-
cases the cart puller may not sustain any
ken pieces of the front screen glass.
impact injury from the offending vehicle,
if the puller is on the other ~>ide ofhis cart.
Injuries sustained by the rear seat
5. In case of a four wheeler, when the acci- '
occupiers
dent occurs face to face, the intensity of
the impact is much more than when the Injuries sustained by the rear seat .occupants
offensive vehicle strikes the offended ve- will be somewhat different from those sus-
hicle fro~ behind, both running in the tained by the front seat occupants. There is
same direction. In any case, the front seat no glass screen for the forehead and no dash-
occupiers can anticipate the accident im- board for the knee and leg to strike against.
mediately before the accident occurs. As Instead, the forehead may strike the back side
a result of this, the front seat occupiers of top of the front seat and the knee may
react in a way which causes them to sus- strike the back of the body of the front seat.
tain certain injuries which they would
After getting first impact inside the vehi-
have not sustained if they would have
cle the occupant may get a thrust in the op-
been in the rear row. Further, the inner
posite direction, to strike another part of the
structure of a vehicle is different in front
vehicle, sustaining a "second collision" injury
and back, which causes difference in the
which is comparatively minor.
site and type of injuries which the occu-
pants suffer from. Ifthe offended vehicle is struck from be-
hind by a vehicle moving in the same direc-
Injuries sustained by the occupants of a tion or if the offended vehicle was static and
four wheeler struck from behind by a moving vehicle, then
there may be impact injury on the back of
The driver-The driver, by virtue of his posi- the head of both front and rear sitters due to
tion sustains certain injuries which others the impact of the back of the head with the
don't. His body being in the inertia of motion top of the back of the seat. There may be
and the vehicle being in a state of rest just dislocation of the spines. But there is no
when the collision occurs, his body moves for- chance of injury due to glass screen, dash
ward. His forehead strikes the glass screen, board or steering wheel. These are due to
his chest strikes the steering wheel, his knees the fact that, a motion is either initiated or

chapter 13: COMMUNICATION AND TRANSPORTATION INJURIES I 471
the motion is accelerated in the body of the nalling or a third vehicle. Of all these, fac-
offended vehicle, the bodies of the occupants tors related to the responsibility of the driver
being either in a state of inertia of rest or in and the pedestrian victims have been included
a state of motion at a lower effective veloc- under the purview of the present discussion.
ity, because either the offended vehicle is "In hit and run" cases the responsibility
static or it moves in the same direction at a of the driver increases many fold as there is
comparatively slower speed. even no attempt on his part to take the vic-
Internal sitting arrangement etc. in the tim to a health centre and save his life. It
vehicle and use of sit belt by the occupants, also places the investigation agency to a dif-
particularly those in the front row may help ficult position to trace the vehicle and the
to avoid serious injuries by them, if the vehi- driver.
cle along with the inmates is not crushed.
Responsibility of the driver of the offender
vehicle
Examination ofthe place of occurrence
Apart from the lack of driving skill and knowl-
Though, generally the autopsy surgeons or the edge of the mechanism of the vehicle, which
doctors who examine the injured persons are do not come under the purview of the present
not included in the team which undertakes discussion, some other defects or short-
examination of the place of occurrence of the comings of the driver of the offender vehicle,
accident, to include them would be ideal . This may be best considered by a doctor. These
is because, being the person to interprete dif- are:
ferent injuries and identify the pri:rruuy im- 1. Whether the driver was intoxicated. Al-
pact injuries he can contribute much to the cohol and some other drugs act adversely
spot investigation by explaining the relative affects the driving capacity in many ways.
position of the victim and the offending vehi-
1. Alcohol affects the visual acuity.
cle. In other words, he can help to a great
2. It also affects the alertness.
extent to reconstruct the circumstance of oc-
currence of the accident. Unfortunately, in this 3. It blurs the sensory perception.
country, we don't have yet the infrastructure 4. It delays the reflex response.
for such a coordinated team work. 5. Capacity ofjudgement is diminished.
Examination of the offending vehicle, the 6. It gives disproportionate overconfi-
road condition, wrong signalling, collection dence.
of the story of the accident from the eye wit- Due to its effect on the visual acuity, as-
nesses, are not the job of the doctor in any sessment of the position of another vehi-
way. But in the interest of proper investiga- cle or the road turnings may be wrong.
tion, in many cases the doctor should have Due to loss of acuity of colour vision, sig-
knowledge of the result of these aspects of nals on roads may be wrongly inter-
investigation and enquiry. preted. Due to diminished alertness, the
driver may not act immediately or prop-
It is obvious that, in road.traffic accident erly when, say for example, all on a sud-
cases, the responsibility may lie on the driver den he faces an acute curve or another
of the offender vehicle, faulty mechanism of vehicle in front. Blurring of the sensory
the vehicle, the pedesttiani·vi~tim, the of- perception may result in over-pressing of
fended vehicle, bad road condition; wrong sig- the accelerator and over-oscillation of the

steering wheel . If the reflex response is

delayed, then the driver cannot react in
time in emergency circumstances. Safe
driving needs quick judgement and action.
Overconfidence makes the driver reckless ,
and rough and rash driving is the result
which increases the risk of accident.
For drivers , different countries have
specified upper permissible limit ofblood
alcohol . But in our country there is noth-
ing specific in this regard. To assess the
blood level of alcohol of drivers, road side
test of expired air of drivers is possible Fig. 13.5: Vehicular crush injury
with the help of breath analyser or
alcometer. In India it has already been them heart attack precipitates due to
proposed that driver of a vehicles run- apprehension of an imminent accident.
ning the vehicle rashly may be liable to No extent of thorough post-mortem ex-
be imprisoned for up to 10 years, (pro- amination and tests can decide this mat-
posed modification of Sec. 304A IPC). ter, in absolute term.
2. Heart disease in drivers-Sudden cardiac 3. Defects of visual and hearing systems-
infarction or coronary ischaemia of the Cataract or deafness reduces the driving
drivers has been claimed to be the cal;I.Se capacity by limiting the visual and hear-
of vehicular accidents in some cases. But ing capacities. Thus, the driver may not
it is probably rightly argued that cardiac properly see the reflection of picture of a
infarction or ischaemia should not be re- bus in the mirror or he may not hear the
garded as a factor to make an accident sound 6f a hom, which are very much
inevitable. It is also a question, how many essential for safe driving of a vehicle.
of the deceased drivers meet the accidents 4. Physical and mental exhaustion of a
due to heart attack and in how many of driver makes the driving accident-prone.
Fig. 13.4: Vehicular accident-Victim crushed under

rear tyre of a lorry
Courtesy- Dr CD Pande, MD, Lucknow Fig. 13.6: A case of road traffic accident

chapter 13: C OMM UNICATION AN D TRANSPORTATION INJURIES I 473
Fig. 13.7: Vehicular run over and crushing of head Fig. 13.8: Extensive subdural haematoma ; case of
head injury due to forceful fall on road on
being knocked down by a vehicle
5. Epilepsy-This condition makes the serv- 8. When the head or some other part of the
ice of a driver very much risky. body is extended out of the door or win-
These factors also act in pedestrian vic- dow of a running train.
tims who meet with an accident. Hence, in 9. When two trains collide.
resolving a case of compensation, or in the 10. When a train is derailed.
criminal side of a vehicular accident case, the
11. When there is outbreak of fire in a run-
role of a doctor is definitely more than con-
duction of post-mortem examination in a per- ningtrain.
functory way. 12. When passengers standing on the roof of
the train· are electrocuted by the high
tension live wire carrying electric cur-
rent, or are struck against an overhead
structure, e.g. , an overbridge.
Fatal railway injuries may be sustained in
the following ways In any case of run over by train or if there
is collision or derailment , there will be gross
1. While walking along the rail or track.
mutilation of the bodies of the victims with
2. While crossing the rail or track. loss of detailed features of the individual in-
3. Jumping in front of a running train. juries.
4. When a person is pushed suddenly in front 1. If the victim was walking on the rail
of a running train. track, then depending on whether he was
5. When a suicide lies down on the railway moving in the. same direction with the
track when a train is coming. train or in the opposite direction, the
6. When an unconscious person is laid on impact injuries will be on the back or in
the track. front. If he is thrown out of the track,
7. When a person accidentally falls or in- then, there may not be any gross mutila-
tentionally jumps oris pushed down from tion of the body, but there will be sec-
a running train. ondary injuries on the body. If he is run

Fig. 13.10: A grossly mutilated dead body-a case of

run over by a train. Some are due to P.M.
FIQ. 13.9: Case of run over by a train-suicide dissection
over, then there will be gross clumsy impact injuries will be on one side of the
mutilation of the body and then it cannot body as while crossing the road. But the
be made out which of the injuries were chance of being thrown out of the track is
the result of the primary impact. less and hence chance of total mutilation
2. If the person sustains the injuries while of the body is comparatively more.
crossing the track , then there will be pri- 4. If the victim was pushed in front of the
mary impact injuries on one side of the running train, then due to stooping of the
body. There is some chance that, the body body, chance of the train knocking the
may be thrown outside the track, with- upper part of the body is more with re-
out gross mutilation. sultant amputation of the body at any
3. When a person jumps in front of a run- level.
ning train to commit suicide, then primary 5. When with the intention to commit sui-
Fig. 13.12: Not a case of ' 'vehicular accident on road-

A case of atrocity on open road (victim
Fig. 13.11 : Reconstruction of a railway track tied with a police officer two-wheeler
run over death case sitting on a "token punishmenf')

chapter 13: COMMUNICATION AND TRANSPORTATION INJURIES I 475
cide, a person lies across the track with 11. If fire outbreaks inside a compartment
the neck resting on the rail, then there of a running train, then in addition to
will be severance of the neck Except the burn injuries of any degree and any ex-
head, in such a case, rest of the body may tent, some of the passengers may sus-
be grossly mutilated. tain mechanical injuries due to jumping
out of the compartment.
6. When a dead body is laid on the track
with an intention to obliterate the cause 12. Passengers standing on the roof of a
of death by a running train, considerable train, may get electrocuted, sustain flash
burn injury and may also sustain me-
success may be there to cover the nature,
chanical injuries due to subsequent fall.
if post-mortem examination is not done
In some other cases, such passengers
very meticulously. When a person is
may sustain only fatal mechanical inju-
strangled to death and the dead body is ries, pmticularly over the head, when the
subjected to be run over within a short train, say for example, passes through a
period by placing it on the track with the tunnel or the head strikes any overhead
neck on one side rail, then very impor- structure like an over-bridge.
tant findings on the neck in support of
strangulation, will be lost Medicolegal aspects
7. When the victim falls accidentally or
Railway deaths are mostly accidental and
jumps down intentionally or is pushed
down from the running train, then he then suicidal Homicidal deaths are very very
rare.
sustains blunt force mechanical injuries
like bruise, abrasion, laceration and frac- Identification of the victims may become
ture of bones. These bodies may not be difficult due to gross mutilation, though iden-
run over and may be detected by the side tification is very much essential for compen-
of the railway track. sation and succession of property points of
view and many other purposes.
8. If the head or a body part. is extended
out of a running train through a window In cases of a body run over by a train,
due to the chance of obliteration of the ac-
or door and strikes a pillar or any struc-
tual cause of death, the postmortem exami-
ture, then gross damage occurs to that
nation must be most thoroughly done. In any
part due to the forceful impact. case, the possibility of railway injuries being
9. When two trains collide, then any injury post-mortem in nature, must be kept in mind
of any severity may be caused to passen- by the autopsy surgeon.
gers due to impact with different inter- In some cases of collision or derailment,
nal parts of the compartment, or the fear and vagal shock may alone cause death.
overhead luggages. There may be frac-
ture of the vertebrae and compression of
the spine (Railway spine).
10. When a running train is derailed, then
any type of injury of any severity may be Barring some recorded interesting cases,
caused, to any number of passengers. If aviation accidents have always been exclu-
the derailed train ju;mps down a bridge sively and totally devastating. Hence in an
in a river then mass drowning deaths aviation accident, saving the life of the vic-
occur. tims is not usually the main issue. Identifi-

cation of the victims from the grossly muti- cases, the dentition and the denture may be
lated body parts of the victims, scattered over helpful.
an wide area is the main problem . Many a Contribution of the medical man in the
times the remains of the aircraft and the vic-
investigation of different aspects of aviation
tims cannot be traced. There is a qualitative
accident is not limited within identification
difference between the civil aviation accident
of the victims of the accident. He may help
and airforce (military) aircraft accident, which
much in the reconstruction of the accident
causes quantitative difference in loss oflives
from his study of the extent of mutilation of
(number of casualties). In a civil aircraft ac-
the body of different victims , from the extent
cident, loss of human lives is not less than
ofbmn injuries sustained by the victims, dis-
two figures. But in a peace-time training ex-
tribution of different injuries in different vic-
ercise, an air force plane accident, hardly
tims, the state of anoxia in different victims,
causes more than a few casualties. This is
the level ofCOHb in the blood, etc. fuforma-
primarily due to less number of crews or pas-
tions on these aspects not only help in the
sengers on board in the aircraft and the bet-
reconstruction of the accident but also in the
ter safety provisions in the army aircrafts.
efforts towards future safety steps .
Role of a medical man in the investigation
Hazards of air travel
procedure of an aircraft accident
Critical hazards of all air travels essentially
1. To help the aviation authority to estab-
include fatality. The h.!lZards may be linked
lish the identity of the victims.
with any of the followihgs:
2. To help in the reconstruction of the acci-
dent. 1. Hazards related with complications of
high altitude .
3. To ascertain human error contributing
2. Those related with mechanical defect of
to the accident, if it is due to physical and
the aircraft .
mental factors of the pilot of the plane .
4. To study the different aspects of air travel 3. Defects with the pilot .
and to participate in the future safety 4. Unforeseen problems .
plans . 5. Problems related with emergency evacu-
ation of the craft.
Identification of the victims
1. High altitude complications are not faced
It is one of the greatest problem which arises in present day flights . One of the com-
out of plane crash. The bodies are often so mon complications ofhigh altitude is an-
much mutilated or bmnt out that, identifica- oxia or hypoxia . Nowadays, there is lit-
tion of the victims seems impossible. But tle chance of this problem arising in high
identification of the victims is an essential altitude flights, because internal pressure
job. Sometimes the pocket articles , like , iden- is well maintained inside the craft. An-
tity card ,passport , letters , etc., tattoo marks , other high altitude complication could be
dentition and denture , may help to identify a decompression syndrome . This is also
the body parts of an individual. But if the plane not seen in present day flights. Hypoxia
was on fire , then with clothings , the pocket and decompression symptoms can occur
articles , etc. may be bmnt out . Not only the only in very few rare circumstances due
complexion may be distorted but part or even to development of some mechanical de-
whole of the body may reduce to char. ill these fects in the plane .

chapter 13: COMMUNICATION A ND TRANSPO RTATIO N INJ URIES I 477
2. The problems commonly related with me- chute after landin~ In high altitude
chanical defects of the plane, usually evacuation and parachuting, everything
prove disastrous. These may be occurs without manual operation. For the
(a) Failure of an engine pilot, the arrangement is that, he is
(b) Fire in an engine
ejected out of the cockpit forcefully, just
after the opening of the cockpit canopy.
(c) Failure of the signalling system
The parachute system gradually acts dur-
(d) Failure of the radio-communication ing the fall Here hazards may involve
(e) Failure of the wheels to project out (a) Failure of the canopy to open in
or go in while landing and taking of time.
Any of the above defects may lead to blaz- (b) The force of an ejection may not be
i~g or crushing of the plane. tolerated by the evacuee.
3. Defects with the pilot (c) During descent from a high altitude,
(a) Diseaset particularly heart ail- anoxia may prove fatal.
ments-This factor is not ignorable. (d) Parachute openini may cause a
(b) Effect of alcohol or other d~Al jerky shock here also.
cohol or any other intoxicating drug (e) Rotational movement of the body
is totally prohibited for the pilot dur- around its own axis maytake severe
ing and before the flight. form.
Periodical and before-flight check up of (f) Danger from the landing impact
the pilots are essential precautionary arises when the parachute does not
steps. work due to drop from a lower than
4. Unforeseen problems may be necessary altitude.
(a) Storm or disturbing air pockets.
(b) Planes striking a bird or an agitated
bird striking over some parts of the
plane. • Modern Trends in Forensic Med. , Vol. 3, K. A. Mant,
1973.
(c) Present day terrorist activity.
(d) Very rarely, a lightning stroke. • Aviation Accident Pathology- A study of fatalities, J.
K. Mason - Butterworths- London, 1962.
(e) Foggy weather, defect in runway, etc.
• Reconstruction of accidents from examination of in-
5. Problems related with emergency evacu- juries- F. E. Camp. Medicine, Science, Law, Vol.- 3,
ation of the craft.-Emergency evacuation P. 545, 1963.
is not a matter of concern for civil avia-
tion In conventional method oflow alti- • D. F. Huelke, P. W. Gikas -InveStigation of fatal auto-
mobile accidents from the Forensic point of view. J.
tude evacuation the dangers were less
Forensic Science, Vol. II, P. 47 4, 1966.
and were limited to non-functioning of
parachute causing a rapid forceful fatal • Modern Trends in Forensic Med. 2nd Vol. (1967) .
impact with the ground, sudden jerk dur- • Drugs and highway crashes- J. A. Waller. JAMA-
ing the opening of the parachute, sudden Vol. 215, 1971.
unconsciousness during the descent and • Fatal Civil Aircraft Accident- P. J. Stevens, Williams
being covered and suffocated by the para- and Wilkin, 1970.

• Michael J Skrun and Davidson A Ramsay - Pathol- • W Doglas Hemming -Forensic Medicine and Toxicol-
ogy of Trauma - 2006. ogy- 2008.
• Warner U, Spitz David J, Spitz Ramsay Clark, Russel
S Rsher- Spitz and Fisher's Medico/ega/Investiga-
tion of Death - 2006.
• Stiffen Timmenmanas - Post-mortem: How Medi- Oral questions
cal Examiners Explains Suspicious Death- 2007.
What are Primary impact injury, Secondary impact
• Pekka Saukko and Bernard Knight- Knights Forensic injury, Railway spine, Secondary injury in traffic acci-
Pathology- 2004. dent cases, Coup-contre-coup lesions; Injuries sus-
• Richard Shephard -Simpson's Forensic Medicine- tained by inmates of a vehicle; Identification of victim
2003. in aviation accidents.
NOTES

If the students have assimilated the chapter with fist blow is common if the impact is on
on general aspects of injury, then it will be the malar prominence, on the eyebrows, on
easy to go through the chapter of regi.()nal the forehead and in the inner aspect of the
injuries. lips due to impact of the lips with the teeth
behind. With fist blow, there may be fracture
of the nasal bone with bleeding from the nose.
Similarly, there may be fracture-dislocation
of the teeth. If on the eye, then there may be
Head accommodates one of the most vital or- damage to the eyeball, dislocation oflens, dis-
gans of the body, the brain. Generally speak- placement of the retinal vessels. Blow over
ing, it is well protected within the bony cra- the forehead and the eyebrows may cause
nial cage. But once the impact of a force black eye due to settling and accumulation of
crosses the protective threshold, then life is blood in the loose tissue of the eyelids. In
invariably in danger. The external injury on addition to these, there may be subconjuctival
the head and the face may or may not be rep- haemorrhage. A fist blow on the ear may cause
resentative of the internal injury and the rupture or tear of the pinna and bleeding
extent of danger of the impact. from the ear. A forceful fist blow on the tem-
ple may cause cerebral apoplexy and instan-
External injury on the head and the face taneous death.
Blow with a hard blunt weapon, other
Head and face may suffer blunt force injury
than fist, e.g., with a wooden or iron rod will
as other parts of the body. But it must be
cause more severe and dangerous injuries,
remembered that fatal blunt force injuries
including fracture of the bone and internal
inflicted with intention to kill a person will
injury. Externally, if a long rod like weapon
be on the head.
is used over the forehead , scalp, eyebrow or
The specific features and peculiarities of over the malar prominence, then an incised
blunt force injuries on the head and the face looking split laceration will be produced. On
the scalp, a bruise is better palpated than seen
Fist blow or a similar blow on the face may due to the general bluish colour of the scalp
cause abrasion, bruise and if with a ring on a because of hair roots. Split laceration may
finger, may also cause laceration. Laceration also occur on the chin.

In case of smothering, there may be ance of the mucous membrane of the mouth
bruises, abrasions with occasional nail and the tongue. In case ofvitriolage, evidence
scratches present aropnd the mouth and the of spilling of the agent will be there on the
nose with similar injuries on the inner as- face. Pouring of acid or alkalies on the eyes
pects of the lips with occasional dislocation may cause total damage of the eyes with loss
ofteeth, fracture ofthe nasal bone , and bleed- of the eyesight. (see Figs. 29.1, 29.6, 29. 8,
ing from the nose. In these cases, petechial Pages 750, 751, 752 respectively).
haemorrhages may be present in the con-
junctiva, over the temple , the eyelids and the The subcutaneous tissue
forehead . In case ofhard blunt impact, the loose tissue
Cut injury over the face and the head is of the scalp may show extravasation which
common only in homicidal circumstances. may be diffused or may form extensive frank
Stab wounds are comparatively uncom- haematoma at times. In case of impact over
the forehead or the front of the head, there
mon on head and face. Concealed punctured
may not be much accumulation of blood at
wounds may be caused at the inner canthus
the site of impact but the extravasated blood
of the eyes , over the nape of the neck and
may settle down into the tissue of the eye lid
over the fontanelle in case of infants, all of
causing black eye. Subcutaneous extravasa-
which are homicidal in nature.
tion in the loose tissue of the scalp may be
Suicidal gunshot wounds may be present present all around the head or may be local-
on the palate inside the mouth cavity, over ised sporadically at and around the sites of
the temples, on the forehead , on the eyes and impact.
below the chin. All these suicidal wounds are
•
likely to be contact wounds. Injury to the bones of the head
In case of burn injuries , except the part Frcidures of skull

of the head covered by the hair, there may
be any degree burn injuries, elsewhere on Mechanism offracture of skull bone: Fracture
the head and the face. The scalp hair show of skull bone may occur as below -
singeing and give the smell of the fuel in sui- 1. Localised impact-Forceful impact by a
cidal and some homicidal cases. hard blunt heavy weapon over a small
area of the head. When a person hits
In case of ingestion of corrosive agents ,
another person on his head by a ham-
there may be corrosion and stain on the an-
mer, the affected part of the skull gets
gles of the mouth, over the lips, with evidence
fractured and depressed, see below.
of trickling of the corrosive agents in front of
the chin. Inside the mouth cavity, there will 2. Compression fracture-When the skull is
be signs of irritation, desquamation , forcefully compressed say under the
haemorrhagicpoints, discolouration, depend- wheel of a vehicle or in a rolling machine,
ing on the type and concentration of the agent. the head with the skull gets compressed
In case of sulphuric acid, there is carboniza- and the skull bone fractures into pieces.
tion of the corroded area and white brittle 3. The skull bone may get perforated by a
appearance of the teeth. In case of corrosive hard blunt I sharp pointed weapon. This
alkalies, in addition to corrosion, there will is also one example of localised impact
be bleached, sodden and translucent appear- caused by a heavy weapon.

chapter 14: REG IONAL INJURIES I 481
Fig. 14.2: Laceration by heavy blunt weapon on the

back of head
FIQ. 14.5: Haemorrhage in the scalp tissue. There was

also intracranial haemorrhage FIQ . 14.6: Fissured fractures of skull vault bones
[F. M. - 311
482 I PRINCIPLES OF fORENSIC MEDICI NE
Fig. 14.7: Cut fractures of skull - Rt. parietal bone_ ! FIQ. 14.8: Sutural fracture and fracture separation oj
l- - occipital bone
- - - - - - - --- - -
Fig. 14.10:Punched out hole -exit hole of bullet, appea-

L _ _r_ ance at the outer table. Note the bevelli~
I Fig. 14.9: Right side wound of exit on skull

bone. Lt. side trifining
I Fig. 14.12:Punched in hole -entrance hole of bullet-

outer table (tt)e bevelled appearance at the
l Fig.14.11 :Punched in hole- entrance hole of bull,.,._,l
--
inner table of skull. Note the bevelling
-- --- --- - - .
I
~ ---
upper margin 1is due to the bullet striking the
skull at an angle)
--- -- -- ---
chapter 14: REGIONAL INJURIES I 483
f? ("') . A.lo - 5 Z. f? M· No. 5 Z.

;/:>ft. TE -I?· o1 ·06 ~ATE-I?·ot.o6
Fig. 14.13: Punchure wound of exit on skull bone with Fig. 14.14: Punchure wound of skull bone with suture
bevelling and suture separation or suture separation or sutural fracture
of fracture
PM-No- 52.
7)A TE _ r7W·· ot.o6
Fig. 14.15: Fracture of skull bone , fissured fracture and Fig . 14.16: Fracture of skull bone with surface 1
sutural fracture haemorrhage
Fig. 14.17: Fracture of skull bone (sharp cutting heavy

weapon)

FIQ. 14.19: Fracture skull bone (base) with

Fig. 14.18: Fracture of mandible haemorrhage in middle and post fossa and
scalp tissue with haematoma formation
Fracture of the skull b9nes may be sim- of a person the weapon which has caused
ple or compound. However, irrespective of the fracture may leave its impression on
whether closed or open, the fractures of the the fracture from which the shape and
skull bones may be of the following types - size of the striking part of the weapon
1. Fissured fracture - These are linear or can be known. Thus the depression may
thread like fractures running in a line, be circular, if the striking surface is cir-
straight or curved. A fissured fracture cular; it will be elongated if the object of
may be continuous over one or two or impact is an elongated one. This type of
more bones . Fissured fractures are fracture may occur in case of primary
caused due to impact with hard, tough impact by a vehicle. In such a case, from
and flat surface. This type of fracture is . the size and shape of the fracture , part of
often the result of a fall on the ground or the vehicle striking the head can be
after being knocked down on the ground known. In homicidal cases, if a hammer
by a vehicle. has been used, then that also can be
2. Comminuted fracture-When a part of
guessed from the shape and size of the
the skull bone cracks into pieces, it is depressed fracture.
termed comminuted fracture. This oc- 4. Pond fracture- This type of fracture is
curs often in radiating fashion, with the seen in case of infant skull, where the
centre being at the site of the impact and bones are not yet fully calcified and hence
fissures radiating from that point in more are soft and yield on application afforce.
than one direction, along the direction of Thus, at the site of impact of the force
radiation of the force of impact. there is a localised depression but there
3. Depressed comminuted fracture- This oc- is no cracking anywhere or there will be
curs due to foreceful localised impact very small or minor cracking.
causing multiple linear fractures radiat- 5. Gutter fracture- Tangential impact by
ing from the site of impact with depres- the sharp edge of a sword or a high ve-
sion of the site of impact where the bone locity bullet over some part of the skull
breaks into pieces. Depressed commi- bone may cause the superficial layer of
nuted fractures are called 'Fracture Ala the bone at the site of impact to be slashed
Signaturea', because like the signature out. Usually the outer table of the skull

chapter 14: REG IONAL INJURIES / 485
is affected and there is no effect on the and at the site of the exit of the bullet,
inner table. Also, there is no cracking of there will be a punched out hole with
the bone. bevelling at the outer table of the bone.
6. Ring fracture-This occurs due to indi- This is an example oflocalised punctured
rect impact on the base of the skull, when fracture (see Figs. 14.9- 14.12, page 482).
a person falls from a height on his feet or 10. Crush fracture-In case of crushing of the
buttock. The force travels along the ver- head by heavy substance the skull bones
tebral column and strikes the atlas and are crushed into numerous small pieces
thence the part of the occipital bone with total distortion of the structure of the
around the foramen magnum. This may head and the face. Such crush fracture of
cause separation of the base of the skull the skull bone is seen when the head is
from the rest. The separation starts about run over by the wheel of a heavy vehicle.
2 to 4 em away from the foramen mag- It is an example of compression fracture .
num and then travels by the side of the 11. Heat fracture (see page 437).
ear bones and base of the eye bones .
12. Contre-coup fracture-When the impact
Sometimes the separated part of the base
is over the occipital region, then the force
is pushed inside the cranial cavity. Ring
will be directed anteriorly. In course of
fracture may be caused due to a shear-
its path the force causes vibration. Where-
ing force resulting from an impact on the
ever the force passes through a thin and
frontal or occipital bones.
weak bone in its path, it may cause frac-
7. Cut fracture -Sharp cutting heavy or ture of that bone. Thus, in a case of rea-
moderately heavy weapon causes straight sonably heavy impact on the occipital
linear cut when except the line of con- bone, there may not be any fracture at
tact with the edge of weapon there may the site of impact due to toughness of the
not be any lack of continuity of the bony occipital bone, but the force, when passes
substance anywhere. If the edge is not anteriorly, causes fracture of the thin or-
very sharp and if the weapon is quite bital plates of the frontal bone. Mecha-
heavy, then there may be any of the con- nism of contre-coup injury to brain is to-
ventional types of the fractures present
tally different.
along the direction of passage of the force.
8. Suture fracture , diastatic fracture or
sutural separation- When the impact is
over an wider area of the head, there may
be separation of the bones at the sutures.
In case of elderly subjects where partial
calcification of the sutures have occurred
there may be fracture in the line of the
sutural obliteration, if similar impact is A B
applied on the head over an wider area. FIQ. 14.20:Mechanism of Coup-contre-Coup injuries.
9. Bullet fracture-In case of punctured A- Site of impact (coup) injury and contre-
coup injury at a place diagonally
wound of the head due to bullet, there opposite.
will be punched in hole on the bone at B - Shearing action due to rotation of head
the site of entrance of the bullet with causing co ntre-coup injury.
(Both in brain)
bevelling at the inner table of the bone,

Fig. 14.21: Transverse fracture of mid-cranial fossa

Fig. 14.22 : Haemorrhage on the surface of skull bone
and scalp tissue. These were blunt force
injuries of scalp over occipital region
Fig . 14.23 : Haemorrhage on the surface of skull with

haemorrhage in the scalp tissue with sharp
cutting and blunt weapon Fig. 14.24:Haemorrhage on the surface of fractured
skull
0
B
(a) (b)"---../
-tirY Jit)D b a
(a') (b')
Fig. 14.25: Mechanism of fracture-a-la-signature

A- (a) Shape of fracture circular (similar)
being struckly the circular surface of a FIQ . 14.26: Different types of fractures:
hammer (a') (a) Fissure fracture ,
B- (b) Semicircular shape of a fracture (b) Comminuted fracture ,
when struck by the margin of hammer (c) Depressed comminuted fracture,
head (b') (d) Suture fracture

Fracture on the anterior fossa Fracture of the maxilla '

At the base of the skull-Fracture at the an- It occurs due to direct impact, when the face
terior fossa of the base of the skull occurs of a person directly gets an impact with some
mostly due to an impact in front of the head. hard structure like a wall or a tree, as usu-
Fissured fracture of the orbital plates of the ally happens in motor-cyclists, colliding
frontal bone may occur due to impact over against a wall or a tree when he is forcefully
the occipital bone posteriorly. If the anterior thrown forward.
fossa fracture extends up to the sinuses, then
there is a chance that this will lead to infec-
tion inside the cranial cavity. In some cases, CEREBRAL CONCUSSIO
fracture of the anterior fossa may be the ex-
(Old term 'Commotio Ce.rehri')
tension of fracture of the middle fossa.
Fracture of the middle fossa This being a sequelae of trauma is a more

complicated condition ofbrain structure and
A linear fracture may extend across the mid-
furiction than the term suggests. Literally,
dle fossa including tne pituitary fossa . Such
cerebral concussion means a 'jar' or 'shock'
fracture corrrmonly occurs due to heavy side
to the brain. Though that is what actually
by side compression (see Figs. 14.21, 14.28).
happens in cerebral concussion, there are
Middle fossa fracture may extend to the ante-
something more to consider.
rior fossa.
Its pathological and legal status have been
Posterior fossa fracture questioned in many occasions. Some claim
Posterior fossa fracture may occur due to the that, it is a condition which essentially is a
direct impact over the posterior part of the sort of shock neurosis without any real pa-
skull. thology or damage to the brain and the 'cause'
of the condition is the individual himself and
Fracture of the mandible himself alone, which should not be linked with
Fracture of the mandible occurs due to di- any circumstance of assault or accident. It
rect impact . Vertical fractures by the sides of cannot be denied that the condition may be a
premolars are the most corrrmon ones. feigned one after an accident or assault to claim
j in the soft tissue aad.-bruise over scalp and

I
Fig. 14.27: Blunt force~injiJry.ll\fiir, head. Haemorrhage
,____ _ _haemorrhage:. on >the surface of skull _ j Fig . 14.28: Fracture middle cranial fossa
'------

488 I PRIN CIPLES OF FORENSIC MEDICINE
Fig. 14.29: Extradural and subdural haemorrhage Fig. 14.30: Extradural and subdural haemorrhage
Fig. 14.31 : Extradural and subdural haemorrhage Fig. 14.32: Extradural and subdural haemorrhage

chapter 14: REGIO NAL INJURIES I 489
Fig. 14.34: Subdural haemorrhage __

Fig. 14.35: Haemorrhage at the subdural level ____,
Fig . 14.36:Haemorrhage in the middle fossa along Fig. 14.37:Cut fracture of skull with intra-cranial
with the contusion of brain haemorrhage
Fig. 14.38: Subdural haemorrhage

compensation. But that should not give an nying fracture of the skull bone . But in many
impression that the condition does not e~st cases, intracranial haemorrhages may be
or that it is always negligible or trivial. fu oc- without fracture of the skull bone, though
casions , death occurred in circumstances traumatic in origin .
which appeared as post-accidental concussion . According to the levels, intra-cranial
During post-mortem examination of these haemorrhages may be of the following types :
cases, no gross or microscopic pathology could
1. Extradural or epidural
be detected in many of these cases.
2. Subdural
The most constant post-concussional fea-
3. Subarachnoid
tures are headache, dizziness and nervous-
ness, though there may be other features 4. futra-cerebral
depending on the extent of internal pathol- 5. Ventricular
ogy. During necropsy , in many cases, cerebral
contusion, oedema or minute haemorrhagic Extradural haemorrhage
spots may be noticed macroscopically and In most circumstances, haemorrhage at this
degeneration of the tigroid.cells and changes level is traumatic in nature. The vessels in-
in the nuclei of the nerve cells may be ob- volved in the trauma are middle meningeal
served by microscopic examination. No doubt, artery (most common due to the peculiar site
there is decreased or some deranged function, of involvement) and dural venous sinuses .
but, for this "diffuse neuronal injury" may still The accumulation of blood occurs most com-
be considered a hypothesis, though some dif- monly in the temporal region , with fracture
fused changes may or may not be apparent. ofpetrous part of the temporal bone . The frac-
Cerebral concussion is more commonly ture may be so small that there is a chance
complained of in impacts received on the brain that it may not be detected during post-
due to sudden deceleration of the moving head mortem examination or by X-ray examina-
than in an impact received by a static head . tion. The blood which accumulates causes
fu cerebral concussion, there may or may compression of the brain substance and ex-
not be any morphological pathology of the erts pressure effects . The blood is not encap-
brain. Though the condition may have some sulated and may not be absorbed for over a
functional element in it, the individual should long period. Thus chronic cases of extradural
not be made responsible outright, inspite of haemorrhage are seen . Chronic extradural
the accepted fact that the condition may be haemorrhage is more common on the poste-
feigned for extracting certain benefit from a rior fossa .
circumstance of accident or assault.
Extradural haemorrhage may occasion-
ally occur due to blood dyscrasias in children.
Fatality is due to compression effect and
timely evacuation of the blood may save the
Haemorrhages inside the skull cavity may life of the patient.
occur at different levels and at different sites . Such effects may occur due to compres-
Intracranial haemorrhages may be trau- sion of any origin, e.g., (1) depressed skull
matic·, or atraumatic (pathological). When fracture, (2) intracranial haemorrhage at any
traumatic in origin, there may be accompa- level, (3) cerebral contusion or concussion.

chapter 14: REGIONAL INJURI_ES I 491
Fig . 14.40: Extradural and subdural haematoma Fig. 14.41 : Haemorrhage in the subdural level
Fig . 14.42: Subarachnoid haematoma Fig . 14.43: Haemorrhage and laceration of brain
Fig. 14.44:Haemator'na h'n the 'brain surface and

brain matter Fig. 14.45: Haematoma in !l cerebellum

Subdural haemorrha ge In the general conception, subdural

haemorrhage is more common a phenomenon
Subdural haemorrhage is almost always trau-
in young adults. The experience of the present
matic in nature. Traumatic subdural haem-
author is that, when due to trauma, it in-
orrhage occurs due to laceration or rupture
volves victims of almost all ages and in many
of the superior cerebral veins or when due to
cases almost the whole of the surface of the
an indirect shearing force , there is rupture brain. Even the base may have accumulation
of the superior longitudinal sinus near the of the blood, particularly in acute state.
debouchment with the superior cerebral vein
of the side of impact. This causes PRIMARY Subdural hygroma is a condition, if there
is a tear on arachnoid matter resulting in
SUBDURAL HAEMORRHAGE when the ac-
leakage ofCSF in subdural space.
cumulation of the blood usually occurs at the
dorsolateral aspects of the upper surface of Subarachnoid haemorrhage
either or both hemispheres. SECONDARY
SUBDURAL HAEMORRHAGE occurs due to May be traumatic or n atural. When trau-
injury (laceration) of the bra.in substance matic, it may be primary or secondary. In
when the primary site of the haemorrhage is primary subarachnoid haemorrhage the ves-
in the brain substance and the extravasated sels of the circle of Willis, anterior cerebral
blood accumulates in the subdural space. artery and less commonly the posterior cer-
ebral artery are involved. Young and elderly
In the primary type , the blood over the
adults are the usual victims and it is assumed
dorsolateral aspects of the upper surface of
that even in traumatic subarachnoid haem-
the hemisphere may spread both anteriorly
orrhage trauma may actually be a minor fac-
and posteriorly. The accumulated blood ex-
tor in causing the haemorrhage. More im-
erts pressure , as a result of which there is
portant is the condition of the vessels. Sec-
widening of the sulci on the same side and
ondary subarachnoid haemorrhage occurs
flattening of the gyrus on the opposite side .
due to contusion and laceration of the cer-
Pressure for a long duration may cause sof-
ebrum, the blood defusing to the undersurface
tening of the brain surface, particularly over
of the arachnoid mater.
the frontal area. Evacuation of the primary
subdural haemorrhage gives good prognosis. Natural subarachnoid haemorrhage is
primarily due to degenerative changes of the
Secondary subdural haemorrhage may vessels in elderly persons or due to rupture
cause accumulation of blood on the medial of congenital aneurysm in the young, which
aspects of the occipital lobes or in the mid- usually occurs in small amount, mostly near
brain or above the pons . Secondary subdural the base of the brain.
haemorrhage may get encapsulated to form
a cyst, (pachymeningitis haemorrhagica Intracerebral haemorrhage
intema ). Prognosis of exploration of the sec-
Intracerebral haemorrhage may be pathologi-
ondary subdural haemorrhage is generally
cal or traumatic in nature. It may be primary
grave .
or secondary. There is one school of thought
Apart from acute subdural haemorrhage, that, primary intra-cerebral haemorrhage is
subacute or chronic subdural haemorrhagic not actually of traumatic origin but are due
conditions also may occur. t o pathological causes like degenerative

chapter 14: REGIONAL INJURIES I 493 ·
Rg . 14.46: Haemorrhage in brain with laceration Ftg. 14.47:Haematoma and laceration of brain.
(Courtesy - Dr Nayan K Mahantj)
Rg . 14.48: Haematoma and laceration of brain Ftg. 14.49: Haematoma and laceration of brain
Courtesy - Prof VCS Verma, Darbhanga
Medical College
Ftg . 14.51 :Haemorrhage in brain substance "and

Fig. 14.50:1ntra-cerebral haemorrhage with laceration ventricle"

Fig. 14.52: Haemorrhage (in ventricle and) brain Fig. 14.53 : Haemorrhage and laceration of brain
substance substance
changes in the vessels and hypertension. But pathological origin, occurring after a month
Curville and others were certain in their ob- or two of a traumatic incident, has also been
servation that primary intracerebral haem- linked in some cases with the old incident of
orrhage may be due to direct injury to the trauma with the contention that, 'delayed
cerebral vessels . Traumatic primary intra- traumatic apoplexy' may occur even after 1
cerebral haemorrhages occur at the centrum or 2 monthE 1 sustaining the tr auma. Ac-
offrontal and the temporal lobes . In the fron- cepting th"tt, 'delayed traumatic apoplexy'
tal lobe, they are slit like , vertical and passes occurs, with an interval of some period be-
slightly lateralward. When in the temporal tween the incident of trauma and the onset
lobe they pass backward into the occipital offatal or dangerous signs and symptoms, it
lobe . During post-mortem examination, there can be safely said that, in case of delayed trau-
is no difficulty in diagnosis of the traumatic matic apoplexy, the interval for the starting
nature of the bleeding. But clinically, there of the signs and symptoms should always be
may be some problem in the diagnosis and within one week and not more than this, in
location of the haemorrhage. Even, some of which case it should be thought to be due to
the natural intracerebral haemorrhages of some pathological reason.
Rg. 14.54: Haem atom a and contusion of brain

substance ____
Fig. 14.55: Haemorrhage-a nd laceration of brain
......__
1 substance (contre-coup)

I
I
FIQ. 14.56: Haemorrhage and la<~eration of brain matter. • Fig. 14.57 :Haematoma with extensive haemorrhage on
(Courtesy - Dr Nayan Kishore Mahan f))) I brain surface
Secondary intra-cerebral haemorrhages one, will in addition to the haemorrhages

are due to gross contusions in the brain Sl_lb- cause contusion or laceration of the menin-
stance. Outcome of secondary intra-ce:robral ges of the affected part. There may even be
haemorrhages are always grave. depression of the area injured When a static
head is struck, then, there is usually similar
Intraventricular haemorrhages lesion over the part of the brain of the area.
But when the head being in motion, strikes
Intraventricular haemorrhage is always sec-
a static or relatively static object, then, there
ondary, mostly to intra-cerebral haemor-
will be coup lesion at the site of the impact
rhage or sometimes to subarachnoid hae-
and a contre-coup lesion at a site diagonally
morrhage. Intraventricular haemorrhage is
opposite to the site of the impact or the coup
always fatal. injury. However, a lesion is .n ot conunon over
the occipital lobe in the coup-contre-coup
Other injuries of the brain
phenomenon Because, when there will be a
In case of blunt force impact, there may be coup lesion on the frontal lobe surface, then
fracture of the bone which, if is a depressed instead of contre-coup lesion on the diago-
Fig. 14.58:Haematoma and laceration of brain Rg. 14.59 :Haematoma and laceration of brain
substance substance

Fig. 14.61 : Haemorrhage in the brain matter on

Rg. 14.60: Haemorrhage in the base of brain dissection
. nally opposite area of the occipital lobe, will be gross laceration of the meninges and
contre-coup lesion will be over the tempor~l the brain matter at the wound of entrance
lobe, possibly due to the uneven bony base at and exit, with a straight lacerated blind track .
the middle and the posterior fossa. When the If the bullet strikes the bone on the opposite
force does not strike the head perpendicu- side of the entry, then it may take another
larly over the midpart of the forehead or the course (backward ) inside the brain or may
occiput, there may be slight rotational move- pass out by making an exit wound .
ment of the skull cage, and the contre-coup
In case of gross burn injury there may
lesion may be due to the shearing effect caus-
ing lesions on the upper, middle or the lower be production ofheat haematoma (see page
surface of the temporal lobe. From the 437), along with heat fracture of the skull bone
changes in these injured areas also called (page437).
gliding contusion, their time of infliction can
be said. The area of brain tissue in between Complications of the intracranial injuries
coup and contre-coup lesion if contused, is 1. Meningitis is more likely, if there is a
also termed intermediary contusion . The communication between the inside of the
contre-coup lesions may be on the vessels cranium and the frontal air sinuses.
causing haemorrhages or may be on the sur- .
2. Subdural abscess .
face of the brain causing laceration (Fig. 14.55).
3. Cerebral abscess .
In case of use of a sharp cutting , heavy
4. Delayed meningitis .
weapon , there will be incised wound on the
brain matter with corresponding cut of the 5. Cerebral softening due to occlusion of the
covering meninges . In these cases there will injured vessel.
be haemorrhages outside and in the layers 6. Dissecting aneurysm, due to injury to the
of the meninges but only a little bleeding will vessel, particularly to the carotid artery
be there in the substance of the brain . and its branches.
In case of a stab wound in the brain with 7. Arteriovenous co:rmnunication between
a sharp cutting pointed weapon, there will the terminal portion of the carotid artery
be a narrow stab in the brain substance. and the cavernous vein due to fracture
When a bullet enters the cranial cavity, there of the base of the brain.

Anterior com municating Artery

Anterior Cerebral Arter)'
Midle Cerebral Arl~ ry·
Post communicating Artery
Anterior inferior cerebellar

Artery
Vertebral Artery
Posterior inferior cerebellar
~=''!I 4.6~ Circle o f wl lis
8. Post-traumatic anmesia (antegrade) and of self-confidence. (c) Circumstantial dis-

neurosis. ability - when the person is not consid-
9. Post-traumatic epilepsy. ered fit to continue in his job though he
may actually be fit.
10. Post-traumatic encephalopathy in boxer
(see next page), 13. Alcohol or any depressive drug may lead
11. Post-traumatic tumours like meningi- to serious condition.
oma, malignant glioma and acoustic neu-
Age of the intracranial injuries
rofibroma. ...
12, Disability - (a) Physical - paralysis, sen- Reasonably accurate relationship may bees-
sory disturbance, visual defects, head- tablished between the infliction of the inju-
ache, ataxia, epilepsy. (b) Psychic ~ Lack ries and the time lapsed. This time interval
[F. M. -32]
in case of a subdural haemorrhage is related Head injury and legal responsibility

with presence of the clotted state of the blood
This is a pertinant question raised, occasion-
(3 weeks) or its liquid state (3 months). At
ally for the victims of the head injury. In fact,
the beginning part there is presence of in- post-traumatic psychosis, mental defect, per-
tact leucocyte (24 hours). Fibroblastic infil-
sonality disorder, all may be considered to
tration occurs within the 2nd day and for- affect adversely the power of understanding
mation of cellular layer around the clot, of the sufferer. Obviously questions arise,
within 4 days , which gradually thickens . how much civil responsibilities can these per-
Phagocytic activity starts by 5th day and sons shoulder and how much should they be
break of the clot by the mid-part of the 2nd responsible criminally for their acts. With-
week. Further thickening of the wall of the out bringing much controversy in the discus-
capsule occurs by the end of the 2nd week. sion, it can be safely said that, in some cir-
Further breakdown of the cells and comple- cumstances the person may be wholly ab-
tion of the healing may take some months solved from any responsibility, in some other
or even a year or two . circumstances the doctrine of diminished re-
sponsibility may be rightly considered and in
Interval between brain injury and death the rest he may be held fully responsible. It
all depends on the nature of brain damage,
CW Rand and CB Courville undertook exten-
extent of incapability and the circumstance
sive work on time interval between brain
in question. Post-traumatic automatism is a
trauma and death. Interested readers may
reality and a person and the theory of no re-
refer to those works published between 1932
sponsibility or diminished responsibility (vide
_ 1936 in "Archs. Neurological Psychiatry",
Forensic psychiatry chap. of the book), may
Chicago. Brain stem injury or compression
arise in such a circumstance.
directly or indirectly due to increased intrac-
ranial pressure may cause immediate or rapid Lucid interval in head injury case~A
death. person who, due to sustaining intracranial
injury, is unconscious and non-responsive to
stimuli, may regain consciousness and behave
Post traumatic encephalopathy in boxers
normally for some time only to be uncon-
It is the disability which develops in a boxer scious again after some period. This period
after a long period . There is deficient when he behaves normally is termed lucid
memory, judgement and emotional balance, interval in head injury patients.
with lack of intelligence. There is loss of cor-
tical cells and the cells of corpus striatum and
there is secondary overgrowth of neuroglia.
Parkinsonism-like state may develop .
Ligature marks with intermittent abrasions
PUNCH DRUNK - It is a condition in a on the skin .-of the neck is typical in hanging
boxer, who during the events of boxing might and strE(Iigulatjon. In case of strangulation
have sustained minute haemorrhages in the with a lig~t:u:r;e, ill addition to the typical liga-
brain. He ,may behave li~e a drunk person ture mark, .wi:t h. abrasions there should be
with cloudy conseiQl.J,Sness, unst;eMy. gait and bruises On'the-slqn. In case of strangulation
blunting offaculties .. by some ham.materials like a rod, there will

chapter 14: REGIO NAL INJURIES I 499
should be gross damage to the soft tissue of

the neck, which is most marked in case of
throttling and strangulation by any hard blunt
substance. In violent asphyxial deaths, there
may be laceration of the carotid sheath
(Strangulation by ligature) and transverse
tear of the intima of the carotid artery (hang-
ing). Among other injuries (related to vio-
lent asphyxia) in neck, there may be fracture
of the hyoid bone (hanging and throttling, in
victims above the age of 40 years), fracture
of thyroid cartilage (strangulation), fracture
of tracheal rings (strangulation) and fracture
and dislocation of the 2nd/3rd cervical verte-
brae including bruise and laceration of the
spinal cord with the covering meninges Gu-
dicial hanging). In violent asphyxial deaths
injury to ~he sterno-mastoid muscles and con-
tusion of the posterior wall of the oesopha-
gus may appear as important findings .
Apart from the injuries due to the vio-
Fig. 14.63 : Haemorrhage in the deeper tissue of neck lent asphyxiation, there may be sharp cut or
in a .case throttling
stab injuries related to suicidal and homicidal
deaths. Suicidal and homicidal cut throat in-
be extensive injuries over the surface of the juries have been described on pages 363 and
neck, which may include abrasions, contu-
366 (table). Chop wounds on any side of the
sions, and lacerations. These injuries may be
neck are almost always homicidal
of any dimension and may be placed at any
level or site of the neck, but are most com- Decapitation cuts at the level of the neck
¥lonly present in front. In case of throttling, may be along with homicidal cut throat or
there will be abrasions and bruises represent- may be entirely post-mortem in nature ,
ing the nail scratches and finger tip pres- where, after killing the victim by some other
sures, the sites and numbers of which will means, the body is decapitated.
vary according to different influencing factors Decapitation should compulsorily suggest
(see chapter 16). homicidal nature of the death except when
In the subcutaneous tissue, the effect of this occurs due to certain machinaries, or
ligature material compressing the neck is over a railway track, when this may be acci-
reflected by drying, whitening and glistening dental also.
of the tissue, as is seen in case of hanging. In the neck, incised or cut injuries may
But in case of strangulation by ligature, in- be either suicidal or homicidal in nature,
stead of drying and glistening, the subcuta- whereas incised wounds involving the ·front
neous tissue may appear contused. 'In case of can be suicidal or homicidal, those on the back
strangulation by any other method, there and many of the others, placed on either or

both sides, go in favour of being homicidal in ary injuries in the form of extensive grazed
nature. Stab injuries over the neck are mostly abrasion, bruise or laceration. In these cir-
homicidal in nature. Chop wounds causing cumstances, there will be corresponding gross
death, are homicidal irrespective of the site internal injuries in the form of subcutaneous
and level. These are also usually more than haematomas, fracture of clavicles, ribs and
one in number. sternum at one or more than one place. There
Firearm wounds at the upper part of the may be varying degree of injuries to the in-
neck, i.e., below the chin and the mandible trathoracic structures with or without rib frac-
palate, temple forehead, go strongly in favour ture. These may be in the form of contusion
ofbeing suicidal in nature, particularly if these or laceration and may involve pleurae, lungs
are-contact wounds. Any other type of fire- and mediastinal structures, including the
arm wound at any other site goes in favour heart. The heart, due to compression may get
ofbeing homicidal in nature . separated at the base. There may be rupture
of the ventricles, but the auricles may be
spared or there may be just some degree con-
tusion. In traffic accident deaths involving the
intra-thoracic structures, there is invariably
Injuries on the chest will be different accord- huge accumulation ofliquid and clotted blood.
ing to the different circumstances, weapon In cases, where death occurs late, pneumot-
used and the nature ofthe injury which may horax, pyothorax or haemothorax (due to in-
include, fracture of clavicle, ribs and sternum jury to lungs and intrathoracic vessels) may
along with intrathoracic structures. be the cause. Extensive haemothorax causes
Accidental injuries of road vehicular ori- rapid death.
gin are generally extensive. When it is a case Accidental blunt force injury on the chest
of run over, there may be crushing of the chest may occur in some other circumstances also,
with presence of tyre marks. In case of a per- e.g., fall from a height or getting pressed un-
son simply being knocked down, there will be der a machine, in between buffers of two bo-
primary impact injuries, or extensive second- gies of a train, or in other traumatic asphyxia
circumstances. Crush injuries may be caused
when the chest is under the wheel of a vehi-
cle or compressed in between two rollers of a
machine. The type of injuries and the depth
of involvement will depend on the force of the
impact and the type of the causative agent.
The injuries may thus be anything from ex-
ternal abrasion to gross internal injuries.
Homicidal blunt force injuries are compa-
ratively superficial with abrasions, contusions
and occasional lacerations on the chest wall.
Fig. 14.64:Haemorrhage in thoracic cavity with
With comparatively heavy force impact, there
fracture of ribs (not shown). may be fracture of the sternum, clavicles and
(Courtesy - Dr Nayan K MahanfY!
ribs, with corresponding internal injuries.

Fig. 14.65: Trauma of thorax with fracture of ribs and Fig. 14.66 : Deeper tissue of neck in a case of death
intra thoracic haemorrhage and injury to due to throttling . Also there is right side
organs fracture of ribs
The diaphragm lnay have any type of in- those rare circumstances where these may
jury due to broken ribs or punctured W<_Jund be accidental in nature. Self-inflicted incised
and there may be subsequent herniation of wounds on the chest wall may be fabricated
diaphragm at the site. ones and bear the characteristic features of
The oesophagus may also suffer any in- self-inflicted incised wounds as seen else-
jury like other intrathoracic organs as de- where. Deeper incised wounds on unap-
tailed below. proachable parts of the chest wall are not
suicidal in nature . It is not a necessity that,
In case of blunt force injuries of the in-
incised wounds on the chest wall will be su-
ternal organs of the chest, it may often be
perficial in nature. Often their depth may be
difficult to assess its extent from outside.
extended up to the chest cavity, particularly
Incised wounds over the chest wall, if in case of chop wounds. Accidental incised
reasonably deep and if are chops , go much in wounds may result from fall on sharp edge of
support of being homicidal in nature. Chop a cutting weapon or object or during opera-
wounds are exclusively homicidal except in tion of a sharp cutting machinery. When a
chop wound enters the chest cavity, then the
injuries to the internal organs will have simi-
larity with penetrating wounds.
Penetrating wounds of the thorax are
very much significant in many ways. Pen-
etrating wound of the chest may give deceiv-
ing informations about the length of the blade
of the weapon and the direction of the pen-
etration. When from the front, the length of
the blade of the weapon may wrongly appear
more than what it actually is and the direc-
FIQ. 14.67: Intrathoracic haemorrhages with injury to tion of the wound may wrongly appear more
mediastinal structures including heart
upwards , when the lung is injured, due to

Fig. 14.69:Atheromatous changes in the intima of

Fig. 14.68: Old infarCted area of heart aorta
Fig. 14.71: Atheroma and narrowing of lumen of

Fig. 14.70: Atheroma on the intima of heart vessel coronEiry artery
Fig . 14.72:Stab wound of heart- seen from inside. the ·heart

chamber

Fig. 14.73 : Injury and haemorrhage of heart Fig. 14.74:Ante-mortem blood clot in the chamber of
ventricular muscle heart
backward and upward movement of the in- Occasionally, accidental stab wounds may
jured and collapsed lung because of their pos- be sustained on the thorax either due to a
terior and upper attachment. The position is fall over the pointed projecting part of a
reversed when the stab is from the back and weapon or object, or accidental penetratio~
penetrates the lung. The depth or for that of the chest wall by some pointing substance
purpose the length of the blade of the weapon or weapon.
will appear shorter and the direction of the Stab wounds over the auricles, aorta or
penetration will appear more upwards than the superior vena cava shall be immediately
what it is. fatal whereas the same on the ventricles may
Fatal suicidal stab wounds on the chest not be immediately fatal, and may give suffi-
are typically located over the precordial area cient time to undertake operative treatment.
of the anterior chest wall. With one centrally Stab wounds on the ventricles, particularly
placed deep penetrating wound there may on the left ventricle, may not be fatal if that
be cluster of superficial tentative stab does not reach the cavity of the ventricle.
wounds . Death may not be quick even if the weapon
has entered the ventricular cavity, if the di-
rection of the wound is oblique in relation to
the wall of the ventricle because in such a
case the oblique openingofthe ventricle will
close during each contraction of the heart so
that there will be minimum loss of blood.
Similarly, haemorrhage will be minimum, if
the weapon remains in situ with the blade
occupying the space made by the penetration
of the weapon.
In course of searching for the bullet or
Fig . 14.75: Petechial haemorrhagic spot on the inter pellets or splinters of a bomb, difficulty may
faces of lung in a case of death due to arise, particularly if these are lodged inside
slrangulaoon the lungs or the vertebral bones. Hence, it is

Fig . 14.69:Atheromatous changes in the intima of

Fig. 14.68; Old i~farcted area of heart aorta
Fig. 14.71 : Atheroma and narroWing of lumen of

Fig. 14.70: Atheroma on the intima of heart vessel coronary atle f)l
Fig. 14.72: Stab wound of heart- seen from inside the heart
chamber

very helpful if the dead body is subjected to In case ofbeing run over by a vehicle over
X-ray examination before the startingofpost- the abdomen, there may be rupture of the
mortem examination. An interesting feature abdominal wall with exposure of the intes-
notable with bullet or pellet injury of the ven- tine and other abdominal organs.
tricles of the heart is that life may be com-
Self-inflicted incised wounds may be
patible for years, with these foreign sub-
stances there. In some cases, poisoning with present over the anterior abdominal wall,
the metal of the projectile (usually lead) may where they are multiple, parallel to each
occur in case of long term stay of the projec- other, grouped together, superficial and
tile. In case of bullet injury to the chest wall, mostly transverse across the midline (Fig.
the splinter from a fractured rib may cause 10.39).
penetration in any direction. Incised wound on the unapproachable
parts of the body, if not very superficial and
grouped together (as are fabricated wounds,
INJURIES ON ABDOMEN produced with the help of an accomplice), are
mostly homicidal and occasionally accidental.
Injuries on the abdomen may similarly be When homicidal incised wounds are caused
caused by blunt weapon or sharp cutting, or by way of drawing the sharp edge em the skin,
sharp cutting and pointed weapon or projec- then the tailing produced will tell about the
tile of a firearm weapon. position of the assailant in relation to the
Blunt force, when applied over the abdo- position of the victim. When reasonably deep
men may cause only external wound, only incised wounds are multiple and scattered
internal wound or both. Due to the soft and over different parts of the body, including the
yielding nature of the abdominal wall, appli- self-un-approachable parts of the body, then
cation of even a heavy force may not cause they canilot be anything but homicidal in
any external wound on the abdominal wall nature . As in case of accidental incised
but the transmitted force may cause serious wounds over the thorax, accidental incised
internal wound. This occasionally may leave wounds over the abdomen is also possible,
an external abrasion only. But internally but this is not usually more than one in
there may be extensive haematoma with con- number and ate not scattered over different
tusion, laceration or even gross rupture of parts of the abdomen.
the organs like liver, spleen or kidneys with
or without injuries to the intestines, stom- Chop wounds are also possible on the
ach, urinary bladder or very occasionally the abdomen and they may even penetrate the
gall bladder, ureters and ovaries. Enlarged abdominal wall to enter the abdominal cav-
spleen, liver, gravid uterus and full urinary ity. However, on the abdomen, chop wounds
bladder are more vulnerable to blunt force are usually located over the flanks or on the
injuries than the normal organs. Laceration back side.
or rupture of intra-abdominal organ or or- Punctured wounds on the abdomen may
gans may cause extensive intra-abdominal be caused hY.J~o,i{l~d weapons or firearm pro-
haemorrhage. If the person survives for a few jectiles. PUnctured wounds are more com•
days with injury to the intra-abdominal or- monly found in or near the flanks and front,
gans, then ultiiilately peritonitis may develop. but in so~e cases they may be present ort

fig. 14.76 :Congestion and haemorrhage in the Fig. 14.77: Tardieu's spots on lungs
undersurface at visceral pleura
Fig. 14.78: 1njury, haemorrhage and collapse of Fig. 14.79: Through and through perforation of both
lungs lungs
Fig1 ~4-~Q;}ptt:,a ;~dominal haemorrhage in a case of rupture of

spleen

Fig . 14.81: Intra-abdominal hae.morrhage due to stab Fig . 14.82 : Extensive contusion of kidney with internal
wound on abdomen haemorrhage
Fig. 14.83: Rupture of spleen Fig. 14.84: Rupture of spleen
Fig. 14.85 : Contused and haemorrhagic kidney

chapter 14: REGiONAL INJURIES I 507
the back side also. These wormds on the ab- impression that, the direction of the punc-
domen are mostly homicidal and only very tured wound was upward. though in reality
occasionally may be suicidal or accidental it was not
Though less common the pancreas also Intra-abdominal injury may also be
may sustain any of the above injuries. caused through the vaginal route, e. g., in case
Stab or prmctured wormd by a dagger, on of an attempted abortion by an instrument.
the abdomen may create problem so far as-
sessment of the length of the blade of the
weapon and the direction of the stabbing are INJURIES ON UM8S AND OTHB AREAS
concerned. Confusion about the actual depth
of the prmcture, i.e., the length of the blade Injuries to the upper limbs act as very im-
may arise when the victim is stabbed on the portant landmarks for various medicolegal
anterior abdominal wall Ordinarily, if arormd informations. Apart from the different types
the wormd of entrance there is a hiltmark, of injuries located at different sites, there are
then that is in4icative that the whole length many other informations which can be known
of the blade of the weapon went inside. If in from them These are as follows :
such a case there is no exit wormd on the 1. Self-inflicted or fabricated injuries, are
opposite side, then it is further indicative that most commonly inflicted on the upper
the depth of the wormd in such a case should limbs and sometimes on the lower limbs
give the length of the blade of the weapon. and other places. The sites of self-inflicted
But when a stab wormd is caused on the an- incised wormds on the upper limb may
terior abdominal wall, due to soft and yield- be at the anterior aspect of the wrist or
ing nature of the wall, the force of the im- forearm.
pact will reduce the anteroposterior dimen- 2. Defence wounds are most conunonly in-
sion of the abdomen at that spot and the tip cised wormds, and are most commonly
of the blade will reach further posterior than located on the medial and postero-medial
its length should ordinarily allow. When the aspects of the forearm, on the dorsum of
weapon is withdrawn, the anteroposterior hand, wrist, and on the palmar aspects
distance comes back to its normal and dur- ofhand and fingers. On the arms and the
ing post-mortem examination we may get a dorsal aspect of the hands, these injuries
greater depth of the wound which may are due to the attempt on the part of the
wrongly give the impression that the length victim to prevent a serious assault. The
of the blade of the weapon is more (than what features of the defence cuts on the pal-
it actually is). In case of penetrating wormds mar aspect of the hand and fingers will
over abdomen, its direction may also be independ on whether the blade of the
terpreted wrongly during, post-mortem ex- weapon is single edged or double edged.
amination, if the perforation or penetration Here the defence cuts are caused due to
was caused in erect or upright position The holding of the blade of the weapon by the
injured internal structures ~h~ch were at a victim ~it:P, an attempt to prevent its use
lower position during susta~ning the punc- on.hun '
tured wormd will obviousf§/ils~~ a com- 3. ~~iation' 10fthe · arm or the hand at
paratively higher level in lying position on any level may be caused due to chopping
the dissection table. This tky·give a false with a sharp-cutting heavy weapon.

·.
4. . Abrasions or sometimes contusions may Incised wound over the scrotum may take
be caused during struggle or due to fall irregular shape due to looseness of the skin
on the ground, these injuries may be and due to the presence and contraction of
caused over the back of the elbow or at the superficial dartos muscles .
the base of the palm. Any type of injury may be caused on the
Injection IIUlrks over the deltoid area, at thighs and the legs due to various types of
the fold of the elbow or on the dorsum of the impacts. Abrasions are common on the ante-
hand may easily be overlooked , ifnot searched rior aspects of the knee joints, due to a fall .
for very cautiously. Snake bite punctures are usually found on
the legs or feet . Medial malleoli are the usual
Over the BUTTOCK,.there may be lin- sites for venesection .
ear bruises or abrasions due to whip. GrMed
Fracture of the neck of the femur is a
abrasions over these areas may also be
common occurrence in elderly subjects which
caused due to traffic accidents as secondary
may be caused even due to fall from a cot of
injuries . Recent or old injuries may be
low height . Fracture of femur is particularly
present involving the anal sphincter in a pas~
likely to cause fat emboli .
sive sodomite in case of recent or old act of
sodomy respectively. In road traffic accident cases , fracture of
hip bones is very common with excessive
Injuries over the PRIVATE PARTS may haemorrhage in the pelvic cavity.
be caused in connection with sexual assault
or otherwise. There may be nail-scratch abra-
sions or bruises over the labias and inner FRACTURE OF VERTEBRAL COLUMN
aspects of the thighs, in addition to the rup-
Fracture of the vertebral column may occur
ture of the hymen and congestion around the
at any level due to direct or indirect impact.
introitus and in the vagina, in a woman who
This may involve, spinal process, lamina,
has been recently ~Sexually violated . pedicle and articulation. With fracture of ver-
Nail scratch abrasions on the penis and tebral bone or bones, there will be correspond-
tear of the frenum may be present in the rap- ing injury to the spinal cord , along with the
ist , when the victim attempts to prevent in- covering meninges . As a result, there may
termission of the penis. be paraplegia or hemiplegia with loss of sen-
Occasionally, the penis of a rapist is sory function along with. Fracture of the lum-
amputed. bar vertebrae at 3rd or 4th level may cause
impotence .
A kick over the scrotum may produce a
RAILWAY SPINE is a condition which
ha.ematocele . In being run over by a vehicle ,
occurs due to mild to moderate degree com-
the skin from over the penis and the scro-
pression of the spinal cord , met with in cases
tum IIUlY ~t removed , exposing the testicles .
of railway accidents , when there is tempo-
Attempt to procure abortion with the rary paralysis of the parts of the body cov-
help of an abortion stick or a root or an_ in- ered by the spinal cord and the nerves, at or
strument may injure the vaginal wall, par- below the level of the compressed area. The
ticularly near the fornix, the cervix, the compression of the spinal cord is usually due
uterus and the intra-abdominal structures. to effusion ofblood , haemorrhagic contusion

or due to oedema. Such paralysis is gradu- CORROSIVE INJURIES (See vitriolage)

ally relieved within 2 - 3 days. Whip lash in-
jury (contusion) or commotio cordis or con- For POST-MORTEM INJURIES see pages
cussion of the spinal cord is caused due to 342, 343, 355, 358, 365 and 382.
forceful to and fro movement of the verte-
bral colurrm, in case of vehicular or railway References
accident.
Injury to the vessels or nerves usually • Gurdjian E.S. (1978) -Impact head injury.
occurs along with injury of the neighbouring • Jokle E. (1941) - Medical aspect of Boxing.
soft tissue or the bone. In suicidal or homi- • MantA. K. (1978) - The Pathology of violent injury.
cidal attempts, sometimes the superficial veins
or arteries are selectively cut. The vessels
• Moritz A. R. (1 954) - Pathology of trauma .
usually injured are - jugular vein, radial or • Symonds, C (1940) -Injury of skull, brain and spinal
brachial artery or femoral vessels. Sharp tear cord.
of a vessel with excessive haemorrhage may • Courville, C B. (1 942) Coup -Contre-coup Mecha-
occur even due to a blunt force impact, when nism of craniocerebral injuries- Archives of Surgery
the vessel is superficial and over a bone. Arte- quoted in Gradwohl's Legal Medicine, 1984.
rial bleeding has a spurting effect but venous • Courville, C. B. (1 953) - Commotio cerebri: cerebral
bleeding occurs in drops. Loss of about l/3rd concussion and post-concussion syndrome in their
of the total amount of blood of the body in a medical and legal aspects.
short period if not replaced immediately at
least partially, may cause rapid death.
• Holbowrn, A.H.S. (1 943)- Mechanism of brain injury,
Lancet 2, 438.
Injury to the DIAPHRAGM may occur due
to the upward punctured wounds of the ab-
• Outline of fractures- Crawford Adams J ., Livingstone,
E.S. 5th Edn. 1970.
domen, downward punctured wounds of the
chest or transverse punctured wound of the • David Dolinak, Evan Matshep, Emma 0 Lew - Foren-
lower part of the chest. Though very unu- sic Pathology: Principle and Prac6ce- 2005.
sual, rupture of the diaphragm may occur • Pekka Saukko and Bernard Knight- Knight's Foren-
indirectly due to heavy pressure over the sic Pathology- 2004.
abdomen. Fracture rib or crush injury involv- • Warner U, Spitz David J, Spitz Ramsay Clark, Russel
ing the chest and abdomen may cause rup- S Rsher - Spitz and Fisher's Medicolegallnvestiga-
ture of the diaphragm. 6on of Death- 2006.
BURN INJURIES of any degree may in- • Richard Shephard -Simpson's Forensic Medicine -
volve any part of the body, but burns ofpalms, 2003.
of the scalp tissue (being covered by hair) and
the soles are comparatively less common. - 2008.
Burns of the face, neck, and pudendal region
• Michael J Skrun and Davidson A Ramsay - Pathol-
are most dangerous. Absence of burn injury
ogy of Trauma - 2006.
on the back part, when it is present on all
other parts of the body, indicate that the burn- • W Doglas Hemming- Forensic Medicine and Toxicol-
ing is either post-mortem in ogy - 2008.
,. nature or has
been caused in an unconscious state of the • WB Woodman and Charles M Tidy - Forensic Medi-
victim For further detail see chapter 11. cine and Toxicology- 2007.

~10 I PRINCIPLES OF FORENSIC MEDICINE
• Stiffen Timmenmanas- Post -mortem: How Medi- Short Notes, Differences and Oral questions
cal Examiners Explains Suspecious Death- 2007. Pond fracture, Gutter fracture, Ring fracture, Contre-
coup lesion, Cerebral concussion, Whip lash injury,
Railway spine, Lucid interval in head injury, Punch
drunk.
long questions
Why is it difficult to assess the length of the blade of
1. What are the different skull bone fractures ? an weapon and direction of application of force in
2. What are the different intra-cranial haemorrhages ? case of stab wound on chest and abdomen ?
NOTES
'!'
('
, , ... 4

FACTORS WHICH INFLUHJ TH,E FAC1'0RS WHICH I LU NCE THE
INF ICTIO , DE F 1 OF AN INJURY PROCESS OF+ AliNG OF AN IN URY
1. The weapon-The type, nature and extent 1. Type of the injury.

of an injury depends greatly on the type 2. Number and dimensions.
of the weapon. It is important, whether
3. The part of the body involved.
the weapon is blunt or sharp edged;
whether pointed. If sharp edged, whether 4. Whether the injury got infected
one edge or both edges are sharp. The 5. Physical condition ofthe victim
weight of the weapon-whether it is 6. Treatment given.
heavy, moderately heavy or light.
7. Age of the injured.
Ifitis a firearm weapon, then whether it
is a rifled or smooth bored gun. What is
the type of the projectile or the ammuni-
OTHER M DICOLEG f. SPEC1S OF
tion used? What was the relative posi-
tion between the assailant and the vic- 1NJURY
tim ? In case of firearm weapon the dis-
tance of firing is also important. Important Medicolegal Questions Which
2. Which part of the body has been affected ? are Asked to a Dodor
3. The sex and age of the victim.
1. How many injuries were present in the
4. The physical condition of the victim.
body?
5. In case of injury due to heat, whether it
2. What was the type of each ofthem?
is dry heat or moist heat.
3. What was the dimension of each of them?
6. In case ofinjury due to either heat or cold,
the duration of exposure to heat and cold. 4. Their locations on or in the body.
7. Whether the body was covered with 5. What was the type of weapon used ?
clothes at the time of sustaining the in- 6. How was the injury caused ? Was it
jury. What was the type of the covering ? caused by striking with the weapon, by
8. What was the amount -of-force applied? drawing the weapon on the body _of the

victim, by saw-like movement, by push- (viz., injuries on the neck in case of death
ing the weapon, by pu shing the victim due to strangulation) ?
on some object, due to fall of the victim, 25. Did the injuries give indication of any
due to an explosion, by being knocked other offence ? e.g., abrasions or bruises
down or run over by a vehicle, etc. ? on the breasts and near the private parts
7. Was the injury simple , grievous or dan- of a girl may indicate sex offence having
gerous ? been committed on her.
8. Time lapsed after infliction of the injury. 26. Did anything on the injury tell anything
9. What were the relative positions of the about the place of sustaining the injury ?
assailant and the victim? e.g., dust particles on the wormd may tell
about the site where the person sustained
10. What was the direction of application of
the wormd.
the force ?
27. Was the complication complained of, the
11. Was the number of assailant one or more
than one? result of some injury ?
28. Has the complication arisen due to neg-
12. Did the victim offer any resistance ?
ligence during examination and t reat-
13. Was the victim given any treatment ? ment ?
14. Was there any corresponding tear or cut 29. Power of volitional act in case of sustain-
on the covering dress ? ing a fatal injury.
15. Has there been any fabrication of the
wormd ?
16. Was there any defence wormd ? EXAMINATION AND CE TIFICATION OF
1
ANWOUND
17. In which precise manner, the injury or
the injuries might have caused death ?
18. Was the injury ante-mortem or post- Examination of a victim of injury
mortem ? The attitude and approach of the medical man
19. For what period the victim survived af- should obviously be different, when he ex-
ter sustaining the injuries ? amines a living subject than, when he exam-
20. Which of the injuries sustained, were fa- ines a dead body. In case of examination of a
tal? living person, it goes without saying that, the
21. Was the injury or were the injuries suffi- doctor should give priority to the safety and
cient to cause death in ordinary course well being of the injured. Thus, on the basis
of nature ? (See pages 287, 288, 333, 515). of the severity of the wormd and the general
condition of the injured, he must assure op-
22. Whether any other factor contributed to
timum treatment that can be offered to him
the cause of death ? (See pages 287, 288).
If and when necessary, after administering
23. Whether the injuries were self-inflicted first aid, the doctor may refer the case to a
or inflicted by others or were they acci- nearby hospital for better treatment. This
dental in nature ? must not be done in haste to avoid a litigacy,
24. Did the injuries indicate anything about which may rather badly implicate the doctor
a specific method applied to cause death in a "negligence" case.

chapter 15: MEDICOLEGAL ASPECTS OF INJURIES I 513
A model wound certificate

Wound certificate
To Station ..................... .
The Officer in Charge, Date ...............,.......... .
. .. .............. ..... Police Station, Time ........ ................. .
Ref: ...................... P.S.. ................ Case No./Gen. Diary Entry No ..... ................ .
Date ....... ... .. ...... ... .
Brief history of the case ............ ......................................................................................... .
... ... ................. ..... .. ........... .... ... (as stated by the victim/police or the accompanying person)
N arne of the injured .......... .. ....................... ........... ... ............ ..... ...... .
Address ........................................................................................ .
Sex .. ...... .... ..... ..... ....... ..... .... ...... Stated age ................................. .
Identified by .. .. .... ...... ......... .. .. .................. ...... ........ ...................... .
Identification marks 1 ............................................................... .
2. ············································ ·········· ·········
Consent for examination taken from ............................................. .
General Appearance .......... ........ .............. ............ Mental state ................. .
If the injured complains of any pain, or if there is tenderness, difficulty in respiration, swal-
lowing or speech, urination or defecation ............. ............. .................................... .............. .
Posture and Gait ............. .............................................................. .

Any sign of intoxication ........................ :........................................ .
Dress-blood stain or any other stain, recent tear or cutmarks ....... ........ ... ....... ........ ........ .. .
····························································.···········································
Any blood or other stain on any part of the body ....................................................................... .
. . . . ..- . '
• . • • • • • • • • • • • •• • • • • • • • • • • 0 0 •• 0 • 0 • 0 ••••• . ••• i • • • • • • • • • • • • • • • • •• • • 0 •••••••••••••• ~ ••••••••••• 0 • ~ • 0 0 0 0 • 0 •••• 0 •
·~articulars of injuries present
Serial Type of Sae Site Simptelgrfevor.Js Weapon used or Remarks !

I No. irJIJI)I or dangerous ~nannerofpnoduction
I
1.
2.
3.
4.
5.
Examined in presence of (when a female is examined) ..................................... .................. .
Signature or thumb impression of the injured Signature of the Medical Officer

Date ..................... . Date ............ Hour .......... Place .......... .. .

While dealing with an injury case, the our and other features of the wounds, the
medical man should record the name, ad- stage of healing, whether bleeding or oozing
dress, age and sex of the victim and brief still continues, whether any foreign body is
history of the case as to when and how the present in the wound, the nature of staining
person sustained the injuries. Before exami- and tear or cutmarks on the dress, peculiar
nation, he should take the consent of the marks on the wound and the dress, etc. He
injured, for examination. The victim of an should also mention whether the wound is
injury case should not be examined without simple, grievous (see pages 332-333) or dan-
his consent. But in case of an accused per- gerous (see pages 332-333) and the time
son certain amount of force can be applied passed after its infliction. The doctor should
for his examination, if a magistrate or con- mention in the record about the treatment
cerned authority so orders (sec. 53 CrPC). given by him with recommendation of fur-
For an under-aged person, consent may be ther investigation and treatment, if any.
taken from the accompanying guardian. If
The doctor should collect the signature
no guardian is accompanying and available or thumb impression of the person exa-
then court's order may act for this purpose,·
mined, on the body of the certificate and
or the person under whose custody and care
should himself sign his name with mention
the boy or the girl, legally is at the material
of date, hour and place of examination, name
time should give the consent (surrogate con-
-of the person who accompanied the injured
sent). If an adult-injured is not in a position
and the name of the person who was present
to give consent, then he may be examined
during examination (in case of a female vic-
and treated without his consent ..The injury
tim).
report in such a case may be submitted with
the consent of the injured when he recovers In the "type of ilijury" column it should
and is able to give consent, or by order from be mentioned, whether it is abrasion, bruise
the court or for the purpose of police inves- or incised wound, etc.
tigation. In case of death of the person of To describe the size of the injury, bruises
course, the doctor should send the report to and abrasions should be described in two di-
the proper authority in any doubtful circum- mensions (i.e.; 'length x breadth) and all oth-
stance. If there is any impending danger to ers should be described in three dimensions
the life of the injured, then the doctor must (i.e. length x breadth x depth).
arrange for the record of a dying declara- The site 0r. location of the injury should
tion from the injured. . be described in relation to two external ana-
, · Ob~ervation during the physica1 ·exami- tomical landmarks of the body. For example;
nation, and general condition of the patient the site of an ipju.cy on the anterior wall of
should have mention in the report. the abdomen ~y be described as "3 em left
He should note the number, type·, size of midline and 5 em below the level of the
and site of the injury or injuri~s aiid'should umbilicus". . • j .
give his opinion as to the nature o:(the in- To opine ~P.~t}.ler an wound is simple or
jury, whether self-'infll~ted , o'f-cinflicfud by grievous, the:lii¢ ,of grievous wounds under
other or accidental in origin. He should sug- sec. 320 IPC should be remembered (page
gest the type o~ ~he weaP,dp., which might have ~32). X-ray examination must be advised in
been
' ' used. He.. should
' . _,mentiQu
. .. . . . ....-.whether
~. '~ .. the doubtful cases of fracture . Wounds involving
injuries_,v,vere._s:til~ pai!].fu.l; o~:tender, the col- vital organs or those which affect the vital

chapter 15: MEDICOLEGAL ASPECTS OF INJURIES I 515
functions of the body or cause excessive loss CAUSES OF DEATH DUE TO INJURY
of blood or multiple simple injuries involving
wide areas of the body, by their collective
I. Immediate Cause
action may pose danger to the life of the in-
jured. About the weapon of infliction , it (a) Haemorrhage
should be mentioned whether the weapon (i) External haemorrhage-Loss of
could be a blunt , hard and blunt, sharp-cut- more than 1/3rd of the total volume
ting, pointed , heavy, moderately heavy or of body blood at a time may cause
light one. About the manner of infliction , death due to circulatory failure. Ex-
whether the injury has been caused by strik- ternal haemorrhage is more and
ing with the weapon or by drawing the rapid in cas·e of incised wounds of
weapon or saw like movement of the weapon arteries.
on the body, should be noted. If the injury is
(ii) Internal haemorrhage- Depending
due to the result offall on the ground or some
on the site of internal haemorrhage ,
material, that also should be noted.
the quantity which may cause death
In the colurim 'remarks', the colour of varies. Thus, when it is inside the
the injury, bleeding and other featwes of the abdominal cavity, haemorrhage of 1
injury along with the time of infliction , litre may not cause death. When it
whether self-inflected or inflicted by othe11> is in the pericardia! sac 100 ml bleed-
or otherwise , the treatment given , further ing may also be compatible with life.
recommendation about the treatment and But when it is in the pons or base of
investigation and any other point of medical brain, bleeding of only a few drops
and medicolegal interest should be men- may cause quick death .
tioned. (b) Injury to the vital organs like brain, heart,
While issuing an injury certificate, ·two lungs, liver or kidneys may cause imme-
points must be remembered. diate or rapid death.
(a) Deep extravasations may appear late (c) Vagal shock from injury may cause rapid
as delayed bruise. death.
(b) Deep dangerous wounds inside the (d) Primary or neurogenic shock-Excessive
chest, abdominal or cranial cavity and extensive pain as in cases of burns,
may occur without any superficial may ca~e d~ath within a few minutes to
or surface injury. a few hours, due to neurogenic shock.
(e) Secondary, or hypovolumic shock-This
Another important precaution, the doc-
tors must take is that, in case of punctured may occur due to loss of blood in case of
wound, he must not use a probe to know mechanical'injuries and due to loss of fluid
the depth of the wound. Probing may inin case of burning and scalding (through
crease the depth of the wound, may injure a blister formation ). Death may occur
vital organ and may cause fresh bleeding. If within about 48 hours.
depth of the wound cannot be visualised and (t) Embolism .
if the patient is to be operated upon , then (i) Air-'-When some big veins or sub-
the depth can be measured during the op- cUtaneous veins are injured, air may -
eration . be sucked in them Ordinarily, about

100 ml of air, when enters the cir- Ill. Immediate or delayed

culation, may cause death. But in
Due to wrong treatment or neglect in the
case of patent foramen ovale or ven-
tricular septal defect, 8 ml of air in treatment.
the circulation may cause death .
Lungs are good barriers to the pas-
sage of air to different vital organs.
But in cases of auricular or ventricu-
lar septal defects, air in rt. side of • Major Criminal Acts--Central Law Agency, Allahabad,
heart (coming here through veins) 1989.
can reach different vital organs with- • Indian Penal Code (Act No. XIV of 1860 as amended,
out any barrier. During PM exami- 1988).
nation air bubbles may be seen in
arterioles and capillaries at differ-
• Gradwohl's legal Med- F. E. Campls, 1984.
ent places and froth may be present · • Fat embolism-Simon Sevitt, Butter-worths, Lon-
in the chambers of the heart. don-1962.
(ii) Fat embolism-Due to injury to sub- • Wound healing-Sir Charles I Wing -worth J & A
cutaneous fatty tissue with rupture Churchill Ltd., 1966.
of veins there ; fracture of femur • Warner U, Spitz David J, Spitz Ramsay Clark, Russel
causing fat containing bone marrow S Fisher- Spitz and Fisher's Medico/ega/Investiga-
emboli; fatty abortifacient fluid ention of Death- 2006.
tering the system through a rup- Stiffen Timmenmanas- Post-mortem: How Medi-
tured vein in the uterus; wrongful
•
cal Examiners Explain Suspicious Death- 2007.
I .V. injection of oily preparation
meant for I.M. injection. • · Universal Law Publishing- Criminal Mannuals- 2007.
(iii) Thrombus formed inside an injured

vessel may act as an embolus and
may be taken to a distant place due
to atrio-ventricular septal defect or
may be obstructed by lung. Death Long questions
may occur in either case.
What medicolegal informations can we have from
(g) Asphyxia-May occur as in case of chok-
different types of wound ?
ing due to inhalation ofblood in cut throat
injury. Oral questions
Causes of fat embolism, causes of death due to
II . Delayed Causes
injuries; injuries likely to cause death in ordinary
(a) Infection-like tetanus, peritonitis, septi- course of nature; causes of air embolism. What
caemia, meningitis, encephalitis, pneu- amount of external haemorrhage can cause death ?
monitis, etc. What is the minimum amount of haemorrhage which
(b) Complications of injuries like stricture of can cause death and at which place ? For examina-
oesophagus, diaphragmatic hernia, para- tion of a person when is consent essential ? When is
plegia due to spinal injury. it not ? What should be the contents of an wound
(c) Mismatched blood transfusion. certificate?

In violent asphyxial deaths, the process of 4. Suffocations-Here respiration is pre-
respiration i.e., exchange of air between the vented by mechanical means other than
atmosphere and the lung beds is prevented constriction of the neck and drowning.
by some violent mechanical means.
Violent asphyxia can be caused by
1. Constriction of the neck.
2. By closure of nose and mouth .
3. By occlusion of the lumen of the air pas- Definition
sage by some materials.
Hanging is a process in which the body is
4. By restricting the movement of the res- suspended with a ligature around the neck
piratory muscles . which causes constriction of the air passage
preventing exchange of air between the at-
Types of violent asphyxia
mosphere and the alveoli oflungs, leading to
Hanging-Here the neck is constricted
1. asphyxia and death. The constricting force is
by a ligature; the constricting force be- either the weight of the whole body or the
ing endogenous i.e. , the weight of the weight of the head alone.
body or part of the body of the victim.
The body is vertically suspended by the Types of hanging (on the basis of the
ligature round the neck. position of the knot used)
2. Strangulations-Here constriction of the
1. Typical hanging- In a typical hanging, the
neck is caused by a ligature , hand or
knot of the ligature should be at the nape
some other material. The constricting
force is exogenous, i.e., active force from of the neck on the back. Typical hanging
outside being used to cause the constric- is not very common in occurrence.
tion. 2. Atypical hanging-In atypical hanging, the
3. Drowning-Here the respiratory tract or knot of the ligature may be at any site
the lumen of the air passage is occupied other than the nape of the neck. It may
by some fluid , as it happens in case of be near one angle of the mandible, near
submersion under water. the mastoid process, or below the chin.
5 17
Hence in case of typical hanging, maxie through the point of suspension above. When
mum pressure is exerted in the front of the the body is in inclined position, then the whole
neck, on the midline, i.e., ov~rthe wind pipe. of the weight of the body except the weight
The pressure over the jugular veins and the of the head may be transmitted to the earth
carotid arteries are comparatively less but through the touching point and in these cases
equal on both sides. the weight of the head alone acts as the con-
In atypical hanging, the commonest site stricting force . It is generally taken that the
for the knot is near one side mastoid process precise cause of death in partial hanging is
or near the angle of mandible. Occasionally, due to asphyxia alone, though there' are many
other causes of death in cases of hanging.
it may be below the chin. When a knot is on
one side, the pressure ·over the vessels on Partial hanging is taken to be diagnostic of
being suicidal in nature.
both side is not equal and it also takes more
time for total occlusion of the wind pipe. The ligature materials in cases of hang-
When the knot is belo~ the chin, there may ing- The ligature material may be anything
not be much evidence of asphyxiation as the which may be tied around the neck with some
respiratory tract is not directly compressed. additional length for fixing it to the point of
suspension. This may be a rope, electric wire,
Types of hanging according to the degree belt, neck-tie, saree, ~dsheet, scarf, dupatta,
of suspension cycle chain or any such thing.
According to the degree of suspension i.e. , The knot- The knot may be a fixed one
whether the body is fully suspendeq on not, (double or more), or it may be a slipping knot
hanging may be complete or total and incom- or a running noose.
plete or partial. Signs-symptoms of hanging- The signs-
Complete hanging-In this variety, the symptoms are related with the effects of com-
body is fully suspended and no part of the pression over the neck. Thus, when the pres-
body touches the ground. The constricting sure over the larynx is prominent, then the
force here is the weight of the whole body. signs-symptoms of asphyxia predominates,
Here the weight of the body is transmitted with evidence of respiratory distress, cyano-
to the earth, through the point of suspension sis and in the last phase convulsion with
ofthe ligature material above, e.g. the trunk mental confusion, ringing in the ear etc. The
of a tree or like, which depends aceording to effects of pressure over the jugular vein may
the place of suspension. · lead to helplessness, a feeling of excruciat-
ing pain over the side opposite the side of the
Incomplete or partial hanging-In this va-
knot and there will be appearance of petechial
riety the lower part of the body is in touch
haemorrhagic spots, on the forehead, eyelids
with the ground. Sometimes only the toes,
and conjunctiva. Pressure over the carotid
sometimes the whole foot or feet, sometimes
artery causes immediate unconsciousness
th~ knees Changing in kneeling position),
sometimes the buttock (hanging in sitting followed by failure of the respiratory centre
position), may be in touch with the ground. due to cerebral anaemia, when death is rather
In partial hanging, a part of the weight of the painless.
body is transmitted to the ground through Precise ciiuses'af death due to hanging-
the touching part of the bbdy and a part Though a form of violent asphyxia, not in all

chapter 16: VIOLENT ASPHYXIAL DEATHS I 519
cases ofhanging death occurs due to asphyxia. to asphyxia resulting from the pressure over
Any of the followings may be the actual cause the larynx, the fatal period varies according
ofdeath- to the level of the ligature. When the liga-
1. Asphyxia along with apoplexy due to si- ture is placed at the level of the cricoid carti-
multaneous pressure over larynx and lage, complete asphyxiation occurs earliest.
jugular veins. The combined effect of as- When the level of the ligature is slightly above
phyxia and apoplexy is the cause of death i.e ., over the larynx, the fatal period is
in most cases. slightly more . Fatal period is maximum when
the ligature is between the chin and the hy-
2. Asphyxia alone.
oid . In case the subject is released from
3. Apoplexy alone. suspension and there is some degree apo-
4. Cerebral anaemia or ischaemia due to plexy, then death may be delayed even for a
pressure over carotid and vertebral ar- few days depending on the site of damage in
teries. brain, having residual signs like amnesia,
5. Vagal shock. This may occur due to inhi- mental confusion and neurogenic distur-
bition of the heart due to irritation of the bance.
carotid sinus. Treatment- inunediate - artificial respi-
6. Fracture dislocation of the 2nd and 3rd ration and then in hospital - rest, stimulant
cervical vertebrae, which causes injury and symptomatic.
to the medulla and the upper part of the
spinal cord, as in case of judicial hang-
ing. POST-MORTEM APPEARANCE
Force of constriction necessary for causing

these effects A. External Findings
1. The ligature mark- In most cases of death
1. For closure of the jugular vein a pres-
due to hanging, the ligature mark around
sure of 2 Kg is sufficient.
the neck is very much conspicuous. The
2. For causing obliteration of the carotid ligature mark in a case of hanging is ob-
arteries the constricting force should be lique , non-continuous , placed high up
equivalent of 3- 5 Kg For closure of the around the neck, is grooved , parchmen-
trachea , a force of about 15 Kg is neces- tised and abraded at places . The upper
sary, and that for the vertebral arteries margin of the ligature mark has a line of
it is about 18 Kg. post-mortem staining, all around above
Fatal period-When deilth occurs due to the l~gature mark. This is due to settling
fracture and dislocation dftlle cervical verte- o( ·blood, from head and neck above the
brae and injury to the medulla, the process level of constriction, caused by the liga-
of fatality is said to be sp~ellie~tc, due to fail- t-qr,e. material. The ligature mark is non-
ure of the respiratory centre. Death in case c;ontinuom; because of a .gap at the nape
of closure of the caidtid" artd the vertebral 9f ~eck :J~e to hair interveniD:g between
arteries occurs very quickly due to- cerebral the ligature material and the skin under-
• J... ,.. • ~ v '\ -
anaemia, but not as quick as in case of injury .peflt~; · ~~ .W:lY also~ s_ome gap near
to the cervical vertebrae .· Whendeatl~ ~is due ~~'~'i,te pf. ~e ~(}(t.,du~_ t.o file :p_vl~ on the

knot from the point of suspension above. prevent formation of a deeper ligature
When the knot is in contact with the skin, mark at the original site of the ligature.
it i's usually inverted "V" shaped, due to On the other hand in such cases, wider
extension ofligature material downward abraded area may be noticed due to the
on both sides from the knot above. The effect of such frictional displacement of
point of contact of the skin with the knot the ligature material. Deep mark is pro-
if present may leave a deep parchmen- duced where the ligature material set-
tised "A" shaped abraded impression. tles after slipping.
(h) When the ligature is applied in multiple
Factors which influence the appearance of
turns, then there will be multiple, paral-
ligature mark
lel, grooved ligature marks.
(a) The ligature material-If the ligature ma- (i) Design of a ligature material, e.g. of a
terial is tough and narrow, then the liga- rope or a _cord may get imprinted on the
ture mark is deep and prominent. If on ligature mark.
the other hand the ligature niaterial i.s (j) The ligature material may be in situ
soft and broad, then the ligature mark is around the neck or may be sent along
less prominent and less deep. · with the dead body or may be absent al-
(b) Period of suspension- If the period of sus- together.
pension is more , then the ligature mark 2. The dimensions of the neck-Due to pro-
will be prominent, deep and parchmen- longed suspension, the neck becomes
tised. slender and increases in length. This
(c) Degree of suspension-Ligature mark be- however will not be seen in suspension
comes deep and prominent in case of to- for a short period.
tal suspension of the body. In case of par- 3. Bending of the neck-The neck gets
tial hanging, it may be less prominent or flexed to the side, opposite the side of the
prominent on one side only. knot. The state of bending will continue
(d) If something, say, the collar of the shirt until the onset of decomposition.
intervenes between the ligature material 4. The face may be pale or flushed or con-
and the skin of the neck then the liga- gested.
ture mark will not be prominent. 5. Tardieu's spots may be present on the
(e) The weight of the body of the deceased- forehead, over the eyelids, under the con-
The ligature mark will be more promi- junctiva and sometimes near the temple.
nent and deep if the weight of the body is 6. Tongue may be partly protruded out in
more . between the lips and during the stage of
(f) Tightness of the ligature-A tight liga- rigor mortis may also be bitten in be-
ture keeps a deeper impression. tween the jaws.
(g) Slipping of the ligature material-If the 7. Dribblingofsaliva-Itis a very constant
ligature is originally fastened at a lower and important finding in a case of death
level of the neck, then, during suspen- due to hanging. Dribbling of saliva occurs
sion when the body slips downward, the from the angle of the mouth which is at
ligature gets a higher position. This may a lower level i.e., froJU the angle oppo-

chapter 16: VIOLENT ASPHYXI A L DEATHS I 521
site the side of the knot. When the knot position in a state of suspension with a
is on the nape of the neck it occurs across ligature around the neck, then similar
the middle of the lower lip. When the knot distribution of post-mortem staining will
is under the chin, then it occurs through be there, provided that sufficient time has
either or both angles of the mouth. The been allowed to pass, in that position of
saliva drops down in front of the chest the body.
when the body is bare or it stains the 9. The hands are usually clenched. Some-
clothes in front, when the deceased is time the hands may show presence of fi-
dressed. When dried or partly dried, it bres, like that of jute when a jute rope
becomes quite fixed and cannot be easily has been used.
removed or rubbed out. However, plac- 10. Fingertips, nailbeds, and lips show sign
ing the dead body inside the cooling of cyanosis.
chamber and 1rough handling may re-
11. In males there may be involuntary dis-
move the stain.
charge of semen.
Dribbling of saliva is considered a very
12. In both sexes there may be involuntary
important phenomenon in support of discharge of faecal matter and urine.
death due to ante-mortem hanging, as
13. In addition, there may be some abrasions
because, excessive salivation is an ante-
at places like lateral aspects of shoulder,
mortem reaction which occurs due to ir-
due to friction with a wall or a post or
ritation of the submandibular salivary pillar, which occurs during suspension,
glands during life, due to the pressure particularly during the last phase oflife
and friction caused by the ligature ma- when there is convulsion.
terial.
14. In some cases, the right side eye remains
8. Peculiar distribution ofthe post-mortem open with more dilatation of the rt. pu-
staining-As the body remains suspended pil, whereas the left eye remains closed
in the upright position after death, the and left pupil less dilated. This is known
post-mortem staining will be present over as "Le facie Sympathique".
the lower limbs, lower parts of the upper
limbs and the upper margin of the liga- B. Internal findings
ture mark, which are actually the lower 1. In some cases, the tongue is slightly pro-
parts of different body segments in this truded out and in others the tongue is
posture. Occasionally, in the lower limbs, pushed back.
there may be multiple haemorrhagic 2. Larynx and trachea are congested. There
spots due to rupture of the capillaries, may be Tardieu's spots under the mucus
due to being over-distended by blood. membrane of the trachea and larynx.
This distribution of the post-mortem 3. Lungs are congested. There will be pres-
staining is however not confirmatory of ence of Tardieu's spots on the
the death being due to hanging. It only undersurface of the pleura which are par-
speaks that the .body was in a state of ticularly abundant at the interfaces of the
suspension in uprightyosition for a con- lobes. This is another finding which along
siderable period after death. Thus, if a with dribbling of saliva is diagnostic of
dead body is placed after death, in upright death due to hanging.

4. All the organs are congested . In avulsion fracture, traction due to pres-
5. Brain is congested ,oedematous with pressure on the thyro-hyoid or crico-hyoid
ence ofhaemorrhagic spots . Similar find- ligament is primarily responsible.
ings are present in the layers ofmenin- (c) Many authors noticed transverse
ges . tear of the intima of the carotid ar-
6. Maximum findings are available in the teries . But to the experience of the
TISSUE OF THE NECK. present author, ordinarily the in-
(a) The subcutaneous tissue under- tima of carotid artery is expected
neath the ligature mark is dry , only in some cases, to show hyper-
white , firm and glistening . The aemia in young individuals and mi-
platysma and the sternomastoid nor degree tear in elderly subjects.
muscle may show haemorrhages (d) For findings in larynx, see no. 2 of
and are even occasionally ruptured. the internal findings.
(b) The hyoid bone may be fractured in
(e) In a few cases, posterior wall of the
persons, more commonly above t:l].e
oesophagus may show congestion
age of 40 years . Though early au-
due to compression against the cer-
thors have claimed that, fracture of
vical vertebrae.
hyoid bone occurs in hanging deaths
in about 25% cases, in the experi- (f) Fracture dislocation of C2 and C8
ence of the present author, it does vertebrae or C8 and C4 vertebrae
not occur in more than 5 - 10% may be seen in cases of long drop
cases. Contrary to the findings re- hanging as in case ofjumping down
corded by other authors, Polson and with ligature around the neck from
Gee found fracture of thyroid carti- the branch of a tree. The other end
lage in about 50% of cases. But, so of the ligature material being tried
far the present author is concerned, around the branch of the tree and
fracture of thyroid cartilage in hang- as in case of Judicial hanging (see
ing cases seems to be a rarity . below).
In hanging, hyoid bone fracture may be
JUDICIAL HANGING-In case of
due to any of the three reasons
judicial hanging or where there is a
1. Antero-posterior compression drop from a reasonable height, the
2. Side-wise compression ligature around the neck causes a
3. Fracture due to traction ,also known forceful jerky impact on the neck
as avulsion fracture . at the end. of the fall . In such cases
In antero-posterior compression, the there will be fracture dislocation of
fracture commonly occurs at the midpart the C2 and C8 or C3 and C4 verte-
with tear of the soft tissue at the inner brae. In case of fracture of C2 and
surface, with haemorrhage in the sur- C3 , the fractured piece of the odon-
rounding tissue. toid proeess of the C2 vertebra
In sidewise compression, either or both causes damage to the medulla . In
cornu may be fractured due ·to compres- other cases there is corresponding
sion from one or both sides: injury to ihe meninges and the spi-

nal cord. Injury of the cervical ver- MEDICOLEGAl ASPECTS OF HANGING

tebrae along with medulla is more
common in long drop hanging which
is comparatively less in short drop A. Suicide
hanging. Long or short drop hang-
Hanging in its face value goes in favour ofbeing
ing is caused by making the con-
suicidal in nature. _The age of the victims may
demned person to stand on a trap be anywhere between extremes of ages, i.e.
door atop an empty well or cham- between 10 to 80 years. Both sexes are eqmtlly
ber, which opens downward when prone and incidents in both sexes are more or
a connected lever is pulled. The less same. In suicidal hanging, any of the
ligature material is placed around things mentioned earlier may be used as a
the neck of the convict. The other ligature material. The place of occurrence is
end of the ligature material is fixed secluded. The point of suspension is or is made
at a point above the head of the con- approachable to the suicide. Partial hangings
vi~t. The length of the ligature are almost always suicidal in nature. There
material is fixed according to the may be a suicidal note left behind. There should
desired length of the drop . The be a motive for committing suicide. Often a
hands of the condemned person are suicide failing in other methods to end life,
tied on his back. When the trap door may lastly adapt this method successfully. In
on which the condemned person these cases evidence of some other adapted
stands is opened downward with the methods may be present on the body. The fi-
help of the lever, the person falls bres of the ligature material e.g., jute fibre in
downward inside the well or cham- case of use of a jute rope, may be present in
ber. The fall stops suddenly depend- the clenched hand. Suicidal hanging may oc-
ing on the length of the ligature ma- cur in other circumstances like due to prob-
terial. This sudden forceful stop of lems at place of service, in the family--per-
the fall with the specific placement sonal life and livelyhood. A person may chose
of the knot causes a sudden jerky, it as peaceful method of death, or due to ex-
forceful and rotational thrust on the treme shock. It may occur due to mental sick-
neck resulting not only constriction ness.
of all structures in the neck but also
may cause fracture dislocation of B. Homicide
the cervical vertebrae with corre- Homicidal hanging is rare. It is not ordinar-
sponding injury to the medulla. In ily possible to hang an adult person, if he is
some countries judicial hanging is not intoxicated or not made unconscious by
executed by plain suspension of the some other means, like head injury. Alter-
body with ligature around the neck natively, the victim is either a child or a very
and then lifting-up· the person by debilitated person. Usually the rope is first
the ligature with· tl~e help of a pul- fastened around the neckand then it is pulled
ley. In such cases there is no chance .ove.r a high point of suspension. He])ce, there
of fracture ·dislocation of the cervi- will be presence Qf evidence ofpullingor drag-
cal vertebrae,- _~See also page 528). ging of the victim on the groUnd as also pres-

j
Fig . 16.3:
Suicidal
partial
hanging.
Note the
feet
touched
the
ground.
The chair
was used
to
approach
Fig. 16.4: Partial hanging from the branch of
the pt. of
tree
suspension
Courtesy
-Prof AK
hands , feet and the mouth of the victim may
be tied . Signs of struggle may be present on
the body of the victim and at the place.
Lynching is an example of homicidal
hanging. Here persons enraged by an offence
committed by another person kill him pub-
licly by hanging, to demonstrate the punish-
ence of evidence of friction at the point of ment given to him. This method of punish-
suspension , with the ligature material. The ment was prevalent in South America, where
hand ofthe victim may show presence offor- a black rapist was used to be lynched by an-
eign material like foreign hair or button . The gry white mob. Now this term is used more

Fig. 16.4(b): Death due to hanging

Fig. 16.4(a): Death due to hanging. Mark state of
decem position
Fig . 16.4(d):Attempted suicide by hang ing. Part of

abraded ligature mark (scab partly
removed) is seen on 7th day
Fig. 16.4(c): Parchmentised S.C. tissue of neck in a

case of hanging
Fig . 16.4(g) :
Death due to
hanging .
Courtesy-
Prof CB
Tripathi, BHU
Fig. 16.4(1): Ligature mark of hanging

526 I PRINCIPLES OF FOR ~ ~SIC MEDICINE
Fig. 16.6: Partial hanging

Courtesy-
Dr PK Ghosh , Calcutta
Fig. 16.5: Partial hanging--diagra-
Medical College
matic view. (kneeling
position)
Fig. 16.7: Partial hanging
'
\~·
Fig. 16.8: Suicidal partial hanging FIQ . 16.9: Suicidal hanging; see the protrusion
of tongue; ligature mark is too deep
liberally , for an~ type of killin~, of a social and can not be seen from front. See
the''image of the back side of neck
offender, publicly by a mob.. ~~;/ with ligature material, reflected from a
mirror
C. Accidental hanging
1. In factories,, awo;rker working at a height
The following ci'rcuniStances
t r •
,
of 'accidental
1 I I · ~
if falls aecident~Hy; may get hanged on a
hanging may·be encountered- - sling or Fope.· Siim1arly, if during such a

Fig. 16.1 O:Suicidal hanging -ligature material around Fig. 16.11 : Ligature mark of hanging appearing
the neck (shifted down). Note protrusion tranverse due to curving of neck. This
of tongue and position of ligature mark caused confusion to the 1.0. who fJund the
body lying on floor. He did not look for the
full length of the ligature mark
Fig. 16.12: Same case as in Fig. 16.9; when the neck is

straightened the ligature appeared oblique
Fig. 16.14:A hanging ligature mark, less prominent due Fig. 16.15 :Suicidal hanging broad ligature mark due to
to broadness of ligature material and short soft broad Jigature material (dhoti)
period of suspension · Courtesy'- CB Tripathy, BHU

Fig. 16.17:
Subcuta-
neous
tissue
under-
neath
parch-
Fig. 16.16: Ligature mark of hanging mentised
area and
other
fall the neck-tie gets fixed at some point, injury in
then the victim may die due to the effect case of
ofhanging. hanging
2. Similar deaths may occur in case of a

trapeez player when his grips slip and his'
chin gets entangled on the swinging sling.
3. When a person on the top of a ladder sud-
denly misses a step, in course of falling in female dress with pornographic pictures
down, his head may get fixed in between at the place of occurrence. Often, some soft
two steps and he may die due to constric- cloth is placed around, in between the rope
tion of the neck in suspension. and the neck. (See page 718).
4. Infants while accidentally slipping down
D. Post-mortem hanging
in between the side grills ofthe crib , may
die due to constriction of the neck with Often a victim is killed by some other means
the body being in a suspended position. and then hanged to simulate a suicidal death.
5. Children while playfully acting judicial AJ3 in case of homicidal hanging, there will be
hanging, may actually be hanged to death. evidence ofdragging of the body on the ground
6. In course of masochistic practice the vic- and friction at the point of suspension of the
tim may accidentally die due to hanging. ligature material, as the ligature is first tied
Such person gets sexual gratification by around the neck of the dead body and then
partial asphyxiation . He arranges the situ- the body is h anged. The unapproachability of
ation by placing a noose around his neck the point of suspension by the victim, the signs
and creates a state of partial asphyxiation of disturbance and the evidence of the actual
in himselfby pulling the other end of the cause of death, present on the dead body, are
rope, across a pulley type arrangement. the other feature s which make the fact (post -
After getting sexual orgasm he releases mortem hanging) clear.
the pull on the rope. In course of such
practices the victim may fail to release the Judicial execution of death sentence. (See
ligature material and die due to hanging. also judicial hanging in page 458 and 523)
Males are the exclusive victims . The cir-
cumstance in such a case is sufficient to In countries where death sentence is still
indicate the actual nature and mode of prevailing, hanging is the method adapted by
death. The victim is found either naked or most, for its execution. Out of 58 such coun-

chapter 16: VIOLENT ASPHYXI AL DEATHS I 529
tries in over 30, hanging is the only method of a ligature material or by some other
adapted. In some other countries for execu- means, without suspending the body of the
tion of death sentence, some other methods victim, where the force of constriction is ap-
like, shooting, electrocution or injection of plied from outside (exogenous in origin) and
lethal drugs coexist with hanging. is not the weight of the body or the head of
There are antagonists and protagonists the victim.
of death sentence. The formers view is that
Types
judicial killing also amounts to use of force
and violence and cause painful death, and According to the mode of causation ,
denies " right to live" and extends strangulations are of the following types:
unmeasurable shock, distress and helpless- 1. Strangulation by ligature.
ness to the family of the executed person.
Protagonists of death sentence also have 2. Throttling or strangulation by hands
their argument that condemned man know- (manual strangulation).
ingly pushed himself and his family to the 3. Strangulation by means other than a liga-
above risk. ture material or by hand or limb.
It has been seen that proportion of re- 4. Garrotting- actually a type of strangula-
lated crimes are not less in countries where tion by ligature.
this punishment exists-in comparison to 5. Mugging- Strangulation by compressing
those countries where it has been abolished. the neck in the knee bent or elbow bent.
The other view is that if the sentence will be
withdrawn from the countries where it ex-
ists then the related crimes will increase. How-
ever, it can be said that, social education and
attention to different social problems will curb In strangulation by ligature, the ligature
those crimes for which death sentence is material is tightly tied around the neck.
awarded.
Ligature material-Anything which can
Some of the countries where death sen- be tied around the neck, can be used as the
tence has been abolished-East German ligature material. This may be a rope, a nap-
( 1949), Great Britain (1965), Australia (1985), kin, a handkerchief, a scarf, a saree, an elec-
Bulgaria (1996), Canada (1998). In Israel the tric wire, a dupatta, a belt etc.
sole execution of death sentence was of Adolf
The knot-The knot may be an incom-
Eichman, in 1962.
plete or half knot, or a full or double or mul-
tiple knot. Strangulation may be caused by
STRANGULATIONS just constricting the neck by a ligature with-
out even placing a knot.
In strangulations also, death occurs due to
Causes of death due to strangulation by
constriction of the neck.
ligature
Definition 1. In most cases, it is combined effect of apo-
In strangulation, the exchange of air between plexy and asphyxia
the atmosphere and the lungs is prevented 2. As a single cause, asphyxia is the most
by way of constriction of the neck by means common one.
[F. M. - 34]
530 I PRINCIPLES OF .FORENSIC MEDICINE
3. Apoplexy alone also may cause death but 6. Strangulation, being mostly homicidal, in
is not very frequent. most cases there may be presence of
4, Vagal inhibition. marks of resistance on the body. If any
5. Fracture of the cervical vertebrae with ofthe hands is found in a state of cadav-
injury to the spinal cord. eric spasm, then the grip may contain
foreign hair or fabrics or bu tton of a shirt
There is focal necrosis in brain due to
belonging to the assailant or one of the
anoxia.
assailants.
Post-mortem findings
Internal findings
External appearance
1. As in case of hanging, the tongue may be
1. There will be a ligature mark around the protruded and bitten by teeth.
neck . The ligature mark is at or below
2. The most important intemal findings lie
the level ofthe thyroid cartilage. It is cir-
in the neck. The subcutaneous tissue un-
cular, continuous , abraded and contused
demeath the ligature mark is contused,
and sometimes parchmentised. The ffi?Ik
of the knot is usually in front but may be often tom at a few places with gross ex-
at any place. In many cases, the ligature· travasation. In case of strangulation by
material is left around the neck after ligature, fracture of the superior hom of
death of the victim. There may be more thyroid cartilage or sublaxation between
than one tum of the ligature mark. It is the two sides may be expected.
more prominent when the ligature ma- 3. Fracture of the hyoid bone is most un-
terial is tough and narrow and is left in common in case of strangulation by liga-
situ for some time, being tightly tied ture.
around the neck. A very thin wire type
4. Fracture of the cricoid cartilage may oc-
ligature may act like cheese cutter and
cur rarely.
cut superficial tissue.
· 2. The face is highly congested and cyanosed. 5. Fracture or injury to the tracheal rings
Eyes may be partly open and the eyeballs does not occur generally but may be seen
and the tongue are protruded. Tardieu's in a few rare occasions.
spots are more abundant than in case of 6. The mucus membrane of the larynx and
hanging and are present on the forehead, trachea is congested with presence of
temples , eyelids and under the conjunc- petechial haemorrhagic spots.
tiva . There may be wide areas of subcon- 7. Lungs are extremely congested with
junctival haemorrhage . There may be
abundant haemorrhagic spots, exten-
bleeding from the nose.
sively present at the interfaces of the
3. Post-mortem staining is deep and promi- lobes.
nent .
8. Brain and meninges are congested with
4. There may be involuntary discharge of
frequent presence of minute haemorr-
urine and fecal matter. This is more com-
mon than in case ofhanging. hagic SJ?.~ts .
5. In males , there may be seminal ejacula- 9. All the or~~s are congested.
tion. This is less common than in case of The tim~ ,~qltrire<l: to cause death depends
hanging. on the !?tr;e.ngth of neck muscles and the

resistance offered by them. The amount from the front of the victim, usually there
of force applied, and the duration of ap- should be one large oval shaped bruise on the
plication of force. If death does not occur upper part of the right side of the neck, on the
immediately and the victim is left in an outer margin of which there should be a
unconscious state due to cerebral anoxia, cresentic nail scratch. On the left side of the
life supporting aids like artificial respira- neck, there will be multiple smaller bruises
tion and circulation and intubation may with smallercresent shaped nail scratches, on
alter the PM findings. the outer margins of the bruises. lfboth hands
have been used, then on each side of the neck
there will be one large bruise with a big nail
NUAL STRANGU TION OR scratch and multiple smaller bruises with
THROTILING multiple nail scratch abrasions at the outer
margins of the bruises. If the victim was at-
In this form of violent asphyxiation, the neck tacked from the back or from one side, then
is compressed with fingers. The upper part according to the position of the fingers the
of the neck is mostly affected and the pres- position of the bruises and the abrasions will
sure is exerted there, against the mandible. va:ry. The number of bruises and abrasions
The neck may be compressed from the front, will also vary according to their number com-
back or from any side and one or both hands ing in forceful contact with the skin of the neck.
maybe used.
Internal findings
Causes of death There will be diffused extravasation in the soft
tissue of the neck. The extravasation is more
Death in case of throttling is almost always
marked underneath the bruises and abrasions
exclusively due to asphyxia, though the chance
and the surrounding tissue. The diffusion is
of the death due to vagal shock cannot be roled
more likely to occur over the upper part of
out. Apoplexy and cerebral anaemia is not
the neck. Usually, there is fracture of either
likely to play any role to cause the death.
or both side cornu of hyoid bone. Sometimes
In throttling, there may also be focal cer- the fracture is over the midline. Thyroid car-
ebral necrosis due to anoxia, causing uncon- tilage is usually spared because the level of
sciousness. compression is high up and is usually just be-
In throttling, the force applied, resistance low the line of mandible. The oesophagus be-
offered by the neck musculature , the site of ing compressed against the body of the cervi-
application of force and its duration affects cal vertebrae, the posterior wall of oesopha-
the process of death. gus in particular may show congestion or even
extravasation. There will be congestion and
Post-mortem findings Tardieu's spots under the mucus membrane
of the lumen of the larynx and trachea. The
External findings level of constriction being high, there is no
Evidence of constriction of the neck with the fracture of the tracheal rings.
help of fingers will be there in the form of nail The lungs are congested. There may be
scratches and bruises caused by nails and fin- emphysematous appearance of the lungs.
ger tips. When the assailant uses his right hand Tardieu's spots may be numerous on the

5J2 I PRINCIPLES OF FORENSIC MEDICINE
Fig. 16.17(c) :Throttling-see the damage of the neck

tissue Fig. 16.17(d): Death due to throttling

undersurface of the pleura. The organs are supine position, then extensive bruises or
generally congested. Blood is dark in colour. abrasions may be found on the back, particu-
Brain and meninges are congested with larly against the scapular region and the back
haemorrhagic spots in the substance of the of the shoulders.
brain and on the meninges.
Internal findings
As in case of death due to strangulation,
if the person throttled leading to unconscious- There will be gross extravasation ofblood with
ness and the assailant leaves the victim in contusion and even laceration of the soft tis-
that state then subsequent resuscitating sue of the neck. There will be fracture of the
measures like, intubation, artificial respira- thyroid cartilage and the tracheal rings . There
tion and maintenance of circulation may al- will be contusion of larynx and trachea and
ter the local findings obliterating the classi-
also of oesophagus , particularly on the pos-
cal internal findings in the neck tissue.
terior wall, due to friction with the vertebrae.
Identification of the offender : In addition There may even be fracture dislocation of the
to suggestive findin gs available at the spot cervical vertebrae with corresponding contu-
·and other steps of investigation, X-ray of sur- sion and laceration of the spinal cord and the
face of neck by applying Grenz-ray technique meninges . Rest of the internal findings will
and subjecting the trace element for DNA
be similar as in case of other forms of
study the assailant may be identified.
strangulations.
PALMAR STRANGULATION is that
STRANGULATION BY MEANS OTHER form of strangulation, where the base of the
THAN LIGATURE OR THROffil G palm is used to compress the front of the
neck . Usually the base of the palm of one
Strangulation may be caused by compress- hand is used to compress the neck simulta-
ing the neck in between two sticks or rods, neously closing the mouth and nasal open-
by compressing the neck against the ground ings with the fingers with reinforcement of
or wall by a stick in front, or by pressing the strength of compression by the other hand.
neck on the ground by foot. "BANSDOLLA"
In palmar strangulation, there may not
is a form of strangulation in which the neck
be any external finding on the front of the
is compressed in between two bamboo sticks ,
neck, but there may be extravasation ofblood
one in front and another on the back, or with
in the soft tissue of the neck underneath and
one bamboo stick against the ground .
congestion and even haemorrhage in the tra-
chea and posterior wall of the oesophagus .
There may be fracture of the tracheal rings .
External findings
There will be gross contusions and abrasions
on those parts of the neck which are com- GAR OTIING
pressed by stick or by foot. Rest of the exter-
nal findings are in the line of other forms of In garrotting, a loop ofa thin string is thrown
strangulations. If the victim is strangled in around the neck of the unaware victim from

Fig . 16.17(e): Bruise on breast dissected (in a case Fig. 16.17(1): Deeper structures of neck in throttling
of death due to strangulation)
Fig. 16.17{g): Strangulation by ligature (1) impression

of patterned ligature material, (2) pro-
truded tongue , (3) congested face Fig . 16.17{h): Fracture of axis
Fig. 16.17(i): Strangulation with handkerchief Fig. 16.170): Strangulation by handkerchief

. chapter 16: VIOLENT ASPHYXIAL DEATHS I 535
Fig. 16.18:A case of homicidal strangu lation; see :

(1) Ligature marks, (2) Nail mark on the I
neck near chin , (3) Protruded tongue
Fig . 16.19: Pattern e d strangulation

ligature mark.
Courtesy- Prof CB Tripathi,
BHU
Fig. 16.20: Mother killed her two children by strangulation

and then committed suicide by hanging . Fig. 16.21 : Tardieu's spots on it. shoulder due to
Note different ligature materials in position pressure on chest

Rg. 16.23 : Subconjunctival haemorrhage in a case of

strangulation by ligature
Fig. 16.24: A case of death due to manual strangulation. Fig. 16.25: A case of homicidal strangulation and
Note the haemorrhage in deeper tissue of traumatic asphyxia by hard blunt weapon.
neck See the extravasation in neck and chest.
Courtesy- Dr JN Dey, BS Medical College, Courtesy- Prof VCS Verma, Darbhanga
Bankura Medical College
his back . Then this ligature material is rap-

idly twisted with the help of two sticks tied
at the free ends of the string, so as to con-
strict the neck strongly. The unaware victim
is very rapidly asphyxiated and dies. This is
just a variety of strangulation by ligature,
caused by a special method. This method is
used in lonely places to kill persons and rob
their properties (as was adapted by the
'Thagi's in India in the past). This was the
official method of execution of death sentence
Fig. 16.26: Spots of haemorrhage at the interface of
in Spain till the end of the ruling of Fran-
lobes of lung in a case of death due to cisco Francos. The method as adapted in the
ulation later period of use, was to make the con-

chapter 16: VIO LENT ASPHYXIAL DEATHS I 537
Fig. 16.28: Throttling mark on neck with bleeding from

Fig. 16.27: Rape followed by smothering nose
Fig. 16.29: Throttling strangulation by ligature
Fig. 16.30: Strangulation with stick. Fig. 16.31 : Injury to deeper structure of neck -
Courtesy- Dr Nayan K Mahanty dissected out

denmed convict to sit on a chair, his neck ture dislocation of the cervical vertebrae with
was encircled with metallic band and with the injury to the surrounding area. In some cases,
help of a wheel his neck was compressed till there may be fracture of the hyoid bone at
sufficiently constricted to pressurise the the midline. Other signs of asphyxia will be
airtube not to allow passage of air. Eventu- present.
ally death occurred due strangulation as- It was in practice in UK and USA where
phyxia. Towards the later phase an additional in isolated places , persons were snatched off
devise was in use to break the neck bones their movable articles they used to carry, by
alongwith. This method was also in use in mugging, without specific intention to kill the
Portugal and Cuba. This process of execution victims who were left at the site in uncon-
of death sentence was withdrawn in Spain in scious state and the snatchers used to leave
1957. In Cuba the method was withdrawn in the place on completion of their job. The term
197 4. Death sentence stands abolished in has now become popular all around to kill a
Spain since 1957. For some period in the past, person by strangulation adapting this proc-
"thugees" in India used to use the method of. ess.
garrotting to kill and rob a person in high-
ways. Medicolegal aspects of strangulations
During post-mortem examination, in Strangulations in their face value are homi-
ordinary garrotting nothing more than a thin cidal in nature .
transverse circular ligature mark should be
present externally around the neck. Inter- In homicidal strangulation by ligature,
nally , underneath the ligature mark there anything which can be twisted , may be used
will be a line of contusion with diffusion of as ligature material. The knot may be a half
blood in the surrounding area. There need knot or a full knot or a double or tripple knot.
not be any sign of fracture of thyroid bone There will be marks .ofviolence, at different
or the tracheal rings in the present day non- other places of the body. The site (place of
judicial garrotting. There will be other ex- occurrence) will be approachable to others and
ternal and internal signs of asphyxia. But there will be marks of disturbance at the site.
as there is no scope of any struggle, other If the hands of the deceased are in a state of
signs of violence or resistance will be ab- cadaveric spasm, then the grip may show the
sent , both externally and internally. presence of foreign substances like, scalp hair
or tom fibres of a cloth or a button. There
Mugging may be homicidal wounds on the body. In one
In MUGGING, strangulation is caused by case, the victim was strangled with a rope
compressing the neck in the elbow bent or and then his throat was cut across.
the knee bent. When a person after being strangled , is
Externally , there may be presence of pulled headward with the free end of the rope,
signs of struggle along with signs of asphyxia, then the ligature mark , instead of being cir-
but in the neck , there may not be any sign of cular and continuous, will be like that ofhang-
violence or strangulation, as the compression ing being oblique and non-continuous.
is affected by the soft muscles of the arm or Suicidal strangulation though not com-
the leg. Internally , there may not be any find- mon , does occur. The following methods may
ing. But in some cases, there may be frac- be adapted for self-strangulation:

1. A person may go on giving turns of the 4. Masochistic practice to get sexual grati-
ligature material around his neck until fication by partial asphyxiation by. ar-
he becomes unconscious. Then death oc- ranged strangulation, may also lead to
curs before the turns of the ligature ma- death due to strangulation when the vic-
terial get untwisted to relax the constric- tim fails to release the tie at the right
tion of the neck. moment.
2. A person after encircling his neck with a Throttling, for all pr~ctical purposes, is
rope may go on putting knots until he always homicidal It is claimed that acciden-
becomes unconscious.
tal throttling death may occur due to vagal
3. By tying a stick at the free ends of the inhibition when one playfully manipulates
ligature material and then placing the or presses the neck of his freind. One case
rope around the neck the suicide goes of suicidal throttling by an insane person
on twisting the stick until he is uncon- was recorded in the text book Medical Ju-
scious due to constriction of the neck risprudence and toxicology of Modi, but the
caused in .this way. Once he is uncon- description therein is not much convincing.
scious the stick is released from his
hand. But it does not untwist because Strf~?gulation caused by other materials,
it gets fixed at the shoulder, and the palmar strangulation, garrotting and mug-
constriction continues till and after ging, if diagnosed properly, then must be
death. taken as homicidal in nature, except in some
4. A person lying on the side of his bed ties cases of house collapse and similar circum-
a rope loosely around his neck and at stances when a beam like structure if falls
the other end of the rope he may tie a on th~ neck of a lying person, may strangle
weight. He then drops the weight down him to death.
from the cot. The length of the rope be- Post-mortem strangulation-May be
ing shorter than the height of the cot, caused to bring a false charge of murder
he gets strangled due to the hanging against one's enemy. A dead body while be-
weight. ing removed from water e.g., a well may be
tied aro'und neck and limbs and the marks
Accidental strangulation by ligature caused by them may wrongly lead to the di-
1. A person may accidentally get strangled agnosis of strangulation-death. The absence
when his neck-tie gets fixed with a re- of other findings of ante-mortem strangula-
volving machine. tion will clear the position.
2. Porters who carry loads on their back Strangulation-like marks may be found,
, with a supportive belt around the fore- caused by a necklace or a coni round the neck,
head, may get accidentally strangled if when the neck swells during the state of de-
the belt around the forehead slips down composition In case of decomposition, even
to the neck without these materials around the neck,
3. Death of a foetus due to asphyxia due to strangulatio~ may be doubted due to the fold
umbilical cord twisted around the neck, of the_skin at the upper part of the neck
is anotqer· example ~f ac,cidental stran- caused by swelling of the neck pseudo-stran-
gulation death. gulation.

I
further increases . Ultimately the mean spe-

DROWNING
cific gravity ofthe bodybecomes more than
that of the water, which leads to fmal sub-
Definition
mersion . This is the period of extreme agony
Drowning is a form of violent asphyxiation and fright for the victim till he loses con-
where the respiratory passage is occupied by sciousness.
fluid i.e., water, due to submersion under
Types of drowning
water andinhalation of water . To be drowned,
it is not necessary that the whole body should Depending on different circumstances, effects
be under water. Submersion of mouth and and factors, we get the following types of
nasal openings by any means is sufficient for drownings:
that purpose.
1. Dry drowning (type -I)
In a classical case of drowning, full sub- 2. Wet drowning (type- II)
mersion does not occur all at a time. The
mean specific gravity of the body is less than. (a) Fresh water drowning (type - IIA)
that of water.It is due to the buoyancy of the (b) Salt water drowning (type - liB)
body that a person can float or swim on wa- 3. Shallow water drowning
ter. 4. Immersion syndrome
Causes of drowning 5. Secondary drowning .
(a) For a swimmer exhaustion or other ad- 1 . Dry drowning: Type I drowning
versities.
In about 10% to 20% of deaths due to drown-
(b) For a non-swimmer incapability to uti-
lise the buoyancy of the body to keep the ing no water is found in the lungs during
nose and mouth above the surface level the post-mortem exalnination. These are the
of the water. cases where death actually occurs due to sub-
mersion or drowning, yet the lungs remain
Process of drowning in a non-swimmer dry or water-free . This may occur in two
ways: (i) During first inhalation of water,
Due to the ignorance how to swim and due there is severe laryngeal spasm which does
to panic and apprehension, the victim of not allow any water or air to enter the lungs
drowning first swallows and inhales water , and death occurs due to asphyxia due to la-
and thus the air in the lungs is gradually re- ryngeal spasm in a circumstance of drown-
placed by water. These increase the weight ing. (ii) When death occurs due to vagal in-
of the body which ultimately submerges to- hibition of heart before complete submer-
tally under the water surface. When the sion of the body under the water, as it hap-
panicky victim cries for help, a good amount pens in case of immersion syndrome (see
of air from the "lungs comes out . With the
page 541).
attempt of inspiration, when some water
comes in contact with the laryngeal opening, 2 . Wet drowning: Type II drowning
there is automatic cough reflex and thus a
part of the reserve air from the lungs also In this variety, the water enters the lungs .
comes out. Simultaneously, as the victim The effects of water entering the lungs de-
engulfs some water , the weight of the body pend on, whether submersion has occurred

. chapter 16: VIO LENT ASPHYXI AL DEATHS I 541
in fresh water (type IT- A) or it has occurred the mouth and the nose remains under the
in salt water (type IT - B). water. If shallow water drowning occurs in a
(a) Typ e II-A drowning-When drowning oc- drain then the debtis and dirts present in the
curs in fresh water and the water enters drain water will also be presentin the lumen
the lungs, then due to difference in the of the respiratory tract and in the stomach
salinity between the inhaled fresh water Shallow water drowning cases are either ac-
and the blood, there is passage of water cidental or homicidal
from the lungs to the circulation As a (The term "shallow water drowning" is
result, the chloride level in the blood of also used sarcastically with totally a differ-
the left side chambers of the heart de- ent sense, for being outwitted and cheated. )
creases to almost its 50% value There is
Shallow water black out-This, though
haemodilution with decrease of salinity
rare, usually occurs in under water swim-
which ultimately causes haemolysis with
ming competitors in shallow water swimming
resultant absolute and relative low count
pools. Before diving for under water swim-
ofRBC and increase in the plasma potas-
ming the subject takes deep inspiration and
sium level and decrease in the plasma
hence C02 stimulation for inhalation is not
sodium level. As a result, not only there
there In such a state the swimmer may black
is increased load on the heart due to in-
out and comes to the surface of water. If there
creased volume of the blood but the heart
is any inhalation inside water afterthe swim-
muscle also suffers from hypoxia and
mer blacks out, then death may occur dur-
there is ventricular fibrillation In fresh
ing such black out (unconscious) state under
water drowning, there may be up to 72%
water.
increase in the total volume of the blood
(b) Type JI-B drowning-In salt waterdrown- 4. Immersion syndrome
ing, when water enters the lungs, due to
high salinity of the inhaled water, water This is a condition which is found in temper-
from the blood is drawn in the lungs This ate and cold zones Usually the young swim-
causes pulmonary oedema, haemocon- mers are the victims. When they dive in very
centration. 30-40% increase in the level cold water, they may suffer from vagal inhi-
of chloride in the blood of the left side bition of the heart and die sudden death in
chambers of the heart, an overall increase water, even though they may be good swim-
in the plasma magnesiumconcentration, mers.
relative increase of the RBC countofthe
blood and microscopically, crenated ap- 5 . Secondary drowning
pearance of tile RBCs There is hypoxia ~This ·is not drowning in the truest sense , but
a complication or sequelae of drowning Af-
3 . Shallow water drowning
ter a few days of recovery from drowning,
Alcoholics, epileptics, infants, children and the victim may suffer from pulmonary in-
unconscious persons may die due to drown- fection and oedema IDtimately the person
ing in shallow water, in a shallow pit or a may die due to asphyxia of pulmonary ori-
drain In shallow water drowning, the whole gin. Due to its aetiological background, such
body need not be submerged. Submersion of a development is termed as secondary
face alone is sufficient to cause drowning if drowning

Causes of death duet~ drowning (b) Artificial respiration-mouth to

circumstances mouth breathing
1. In case ofdry drowning - (a) asphyxia due (c) Ifpossible hospital/medical care as
to, laryngeal spasm and (b) in case ofva- soon as possible
gal inhibition; due·to heart failure . (d) Use oflaryngeal tube
2. In case ofwet drowning of type II-A vari- (e) Oxygen supplementation
ety- (a)ventricular fibrillation , (b) over- (f) (Next step )-assessment of blood
loading of circula~ory function due to gas and electrolytes-supply of elec-
upto 70% increase in the volume of cir- trolytes , if necessary
culating blood, (c) due to hypoxia ofheart
(g) To keep strict vigil on the victim for
musculature, ·all leading to heart failure.
some hours .
3. In case of type 11-B variety, haemocon-
Prognosis-Depends on
centration, and pulmonary oedema leads
to death by asphyxiation . (a) Period of submersion
4. In case ofimmersion syndrome - vagal (b) Age of the victim-Prognosis is bad
inhibition ofheart. in children. The lower the age,
more is the danger
5. In case of divers , head injury may also
be the cause of death. (c) Availability and starting of proper
resuscitation measures .
6. In case ofsea water drowning- gnawing
by aquatic animals like shark fish may Prevention-To take history and alert the
also cause death. victim.Telative , if the victim is an epileptic
7. In some cases, complications like subse- patient, or is used to alcohol or other drugs .
quent infection and pulmonary oedema
Signs of submersion in a dead body
may be the cause.
removed from water
Symptoms in drowning
Most of these signs are not specific of death
The subjective features in drowning are indue to drowning and are rather signs of sub-
teresting and divergent from person to per- mersion of the body under water for some
son, as narrated by some of the victims after period.
being rescued and resuscitated. Some gave a
feeling of dullness and total lethargy, though External signs
not unconscious. Some gave a painless feel- 1. When freshly removed from water, the
ing with memory of events which were of very body artd the clothes will be wet . Irre-
remote past but interesting. Some visualized spective of the time passed after recov-
an imaginary family gathering around him ery of the body from the water, there will
while others described extreme pain and be sand and mud stain on the body, hair
mental agony, as their experiences. and clothes. This finding is not specific of
Treatment-After bringing out the vic- ante-mortem drowning or death due to
tim from the water, the immediate steps to drowning.
be taken are: • 2. Development of cutis anserina (goose
(a) Clearing the airways skin like app~arance of the surface of the

body) is another non-specific finding churning effect results from the violent
which also does not tell about the ante- effort for respiration. Another feature of
mortem or post-mortem nature of drown- this frothing is that, it continues to come
ing. This condition develops due to con- out for a considerable period, even if
traction of the erector pilae muscles of wiped out again and again. Continuous
the skin occurring due to contact of the frothing is a very very strong finding in
body with the cold water. It also occurs support of death due to drowning but is
in all dead bodies during the state ofrigor not absolutely confirmatory, as it may
mortis of the muscle of the skin. Cutis occur in those cases where death is pre-
anserina is not appreciable when decom- ceded by pulmonary edema.
position of the dead body starts. 7. Presence of sand and mud in the nail
3. Retraction of the scrotum and penis in beds, though not in the tight grip of ca-
males is another non-specific finding, aaveric spasm, is another important find-
which occurs due to submersion, whether ing in support of ante-mortem d~owning
before or after death. and bears weight in this respect, though
4. Changes in the skin of the palm and sole, not as forceful as the cadaveric spasm.
like that which occurs in a washer-woman 8. Water may be present in the middle ear.
is yet another non-specific sign of sub- It is not a very important finding.
mersion of a body under water for some 9. Suffused and congested conjunctiva is
hours which has no relationship specifi- another external finding of ante-mortem
cally with ante-mortem or post-mortem
drowning which also carry reasonable
drowning. The skin of the palms and soles
weight towards ante-mortem phenom-
appear bleached, sodden, conugated and
enon of the drowning.
thickened.
10. Distribution of post-mortem staining in
5. Presence of mud, sand, gravel andweed
a body removed from water is somewhat
in the hand, in a state of cadaveric spasm
different than in other dead bodies and is
is one of the confirmatory signs of death
usually found over the head, face and
due to drowning, because the cadaveric
neck. The head being heavier than other
spasm of the hands indicates the last
work of the person which he performs body parts, assumes lowest level when
during the process of his death. Presence the body floats on water. However, when
of sand, weed etc. in the hand in that state, the body continuously rolls over flowing
indicates that, just before death he tried water, post-mortem staining may not ap-
to grab the soil at the bottom of the wa- pear at all.
ter. This means that at the time of death 11. Sand and mud may be present inside the
he was submerged under the water. mouth cavity and the nose, which is not
6. Presence of copious fuie white froth near very much significant regarding the cause
the mouth and the nasal opening is an- of death.
other vital finding in a case of death due 12. A dead body recovered from a pond or
to drowning. It occurs .d.ue to the churn- river may bear post-mortem injury due
ing effect of the air in the alveoli, the to biting by fish or other aquatic animals
water inhaled and tJ:w. ntucus secretion or due to impact with some projecting
from the respiratory tract wall. The substances.

544 I PRINCIPLES OF F.ORENSIC M EDICINE
13. Ante-mortem injury over the head in case ticularly underlining the pleura near the
of diver whose dead body has been recov- lower margins. The ruptured large alveo-
ered from a diving pool is significant as a lar spaces contain watery, thin, haemo-
sign of death due to the process of drown- lysed blood, some amount of air. This
ing or diving. change in the lung is known as "emphy-
14. It must be remembered that a dead body sema aquosum" change. This change is
though is fresh when removed from the more conunonly seen at the undersurface
water, may be in an advanced state of of pleura, near the margins oflower lobes
decomposition when post-mortem exami- which is popular as ''paltaufs sign" or
nation is performed by the autopsy sur- ''paltaufs haemorrhage". But when death
geon. This is because a submerged dead occurs before total submersion or when
body decomposes very rapidly, once the the person goes under the water in an
body is removed from the water, though unconscious state, i.e. , when there is no
while in water the rate of decomposition violent effort for respiration, there may
is generally slow. not be any sign of emphysema aquosum.
Instead, some water may enter the lung's
Internal findings bed passively, causing passive oedema of
the lungs. This condition is known as
1. As discussed under the heading of exter-
"oedema aquosum". In some cases where
nal findings the mouth cavity will show
death occurs due to laryngeal spasm and
presence of sand, mud etc. which are not
the body is recovered soon after death,
of much significance.
the lungs may not contain water (dry
2. Sand, mud or weed may be present in drowning), in contrast to the aquosum
the oesophagus which is also not very conditions of the lungs (wet drowning).
much significant in support of death due An interesting negative finding in case
to drowning. of wet drowning is absence of Tardieu's
3. The lumen of the larynx, trachea, bron- spots. This is due to leakage of water in
chus and bronchioles show presence of the subpleural space.
fine froth mixed with sand and mud. This 5. The stomach may show presence of wa-
is a very important sign of death due to ter, sand, mud and weed. This is another
drowning. Presence of sand and mud in diagnostic feature of death due to drown-
the lower respiratory tract is more iming, because their presence in the stom-
portant than their presence in the upper ach indicates reflex swallowing of water
respiratory tract. etc. during the process of submersion and
4. The lungs are voluminous, oedematous, inhalation of water.
have balloon like appearance with marks 6. Presence of water, sand etc. in the upper
of indentation over the surface by ribs. part of the intestine is diagnostic of death
The lungs pit on pressure. When incised, due to drowning, because passing of these
the cut surfaces ooze frothy thin fluid substances through the pylorus needs
blood. When the person submerges con- ante-mortem process of peristaltic move-
sciously, violent respiratory effort may ment and opening of the pyloric sphinc-
cause rupture ofthe alveolar walls, par- ter.

7. The blood is thick in case of death due to (c) Microscopic changes in the blood -
drowning in salt water (wet drowning In fresh water drowning there is
type- II- B), and is thin due to haemoly- both haemodilution and haemolysis
sis in case of drowning in fresh water (wet which leads to both absolute and
drowning type- II- A). relative low count of the RBC. In
8. Laboratory findings- salt water drowning, there is haemo-
(a) Detection ofdiatoms in some remote concentration which causes relative
increase in the RBC count. The
organs and tissues including brain
and bone marrow. This is one of the RBCs shrink and appear crenated.
most dependable signs of death due The findings concerning the chemi-
to drowning but there are falacies cal changes in the blood definitely has
(see this page). some value. But the study of the chlo-
(b) Blood chemistry - The chloride level
ride level in the blood of both side
in blood of both side chambers of the chambers is useless, if the deceased
heart is almost equal According to had a patent foramen ovale or some
Gettler, in case of fresh water ventricular septal defect or if drown-
drowning, haemodilution occurs in ing has occurred in water with salin-
the right side chambers of the heart ity equal to that of blood. Study of
early and for this the chloride value blood chemistry in drowning cases
of the blood on the right side cham- becomes meaningless altogether, if
bers may come down to the 50% of decomposition has reached advanced
the normal value of 600 mgm/100 state, because decomposition as such
ml. Conversely, in salt water drown- alters the blood chemical levels to a
ing, there is haemoconcentration great extent.
which affects the left side chambers
of the heart first and as a result
there is increase in the level of chlo- DIATOMS
ride in the blood of the left side
chambers of the heart by 30% to These are unicellular algae which have inert
40%. silicon coating around them. These are
Apart from the chloride level of the present in all natural water sources, more
blood of both side chambers of the abundantly in pond water or in a lagoon, or
heart, certain other chemical where the water is stagnant. They are less
changes occur in the blood. In case frequent in streams or in rivers where the
of fresh water drowning there is water is frequently polluted by chemicals and
haemodilution and haemolysis industrial refuge.
which causes increase in the potas- When a drowning person inhales water
sium level of blood plasma and de- and when the alveoli get distended with wa-
crease in the plasma sodium level. ter and air, the alveolar walls may get rup-
In salt water drowning, there is tured exposing the capillaries which are also
haemoconcentration and there is ruptured alongwith. The water from the al-
increased magnesium level of the veolar sacs along with diatoms it contains,
blood. enters the circulation and are carried to dis-
fF. M. - 35]
546 I PRINCIPLES OF fORENSIC MEDICINE ·
tant organs and tissues. Hence, in a body high refractive index. One or more than one
removed.from water, if diatoms can be dem- type of diatoms may be seen under the high
onstrated in the tissues of some distant or- power observation.
gans (distant from the lungs and the body Alternatively, diatom test can be per-
surface, to exclude the chance of contamina- formed by dealing the tissue with cone. ni-
tion of the tissue by surface diatoms), then it tric acid alone and then observing under the
goes strongly in support of death due to high power observation of a microscope.
drowning. There are of course certain falacies
of the presence of diatoms in the tissu~ (see · Value and falacy of diatom test
below).
Along with test of the tissue for diatoms, a
Test for presence of diatoms sample of the water from which the body
has been recovered, should be subjected to
1. By histological examination diatoms can control test. If similar type of diatoms are
be demonstrated in the lungs or rarely not available in both the test sample of the
in some other tissue, provided that pJ.enty tissue and the sample of water for control
of diatoms were present in the submerg- test or if diatom is only present in the tis-
ing water and a good number of them sue then it can be concluded that diatom
entered in the circulation. entered the body tissue of the victim during
2. Diatoms can be demonstrated, alterna- the usual process of drinking water which
tively and comparatively more easily, by contained diatoms. On the other hand, dia-
acid digestion of the bone marrow (con- . toms may not be observed in the tissue, even
sidered most suitable for collection of con- if drowning was ante-mortem and the water
tamination-fi:·ee sample of tissue and for contained diatom. If diatoms are present in
most satisfactory interpretation) , brain both test sample of tissue and control sam-
tissue or tissue from other organs. ple of water, then it is strongly presumed
that drowning was ante-mortem in nature
The procedure and occurred in that water. But still it is not
conclusive in all cases. Even if the drowning
Collection of non-contaminated bone mar- was not ante-mortem in nature, similar dia-
row-The femur is the bone of choice. About tom may be present in both the test sample
3 em x 2 em area is chipped out after mar- and the control sample, if the victim was
ginal sawing. The bone marrow is scooped habituated to drink water from the same
out. 5 - 10 gms of bone marrow is subjected source during his/her life. This is because
to 10 - 12 hour's acid digestion in a mixture when a person drinks water a little of the
of 10 ml. of concentrated nitric acid and 0.5 water may trickle down the larynx and tra-
ml of cone. sulphuric acid. Sulphuric acid car- chea etc. and may reach the lungs bed and
bonises the organic substance and hence the through some weak point of the alveolar
fluid is decolourised by sodium nitrate. Then walls may enter the circulation and carried
to reduce the acidity ofthe fluid a little alka- away to distant organs.
line solution is.added for a very 'short period. Inspite of chances offalacy, if similar dia-
The fluid is rep~atedly w.ashec(by.distilled · ttnns are available, both in the tissue and the
water by centrifugation. The -residue is dried · water then, that acts as a strong evidence of
on a micro-slicle,and mounted· with media of death due to drowning.

Medicolegal aspeds of drowning or from the cut surface; emphysema

submersion of a body in water or aquosum change; presence of thin
questions which arise after removal of a haemolysed fluid blood in the spaces
dead body from water at the undersurface of the pleura on
the lower lobes and at the interfaces
The following medicolegal questions may
of the lobes and absence oftardieu's
arise in connection with such a case.
spots are the important features of
1. Whether drowning was ante-mortem or ante-mortem drowning deaths.
post-mortem.
(e) Presence of water, sand, mud and
2. If drowning was ante-mortem what was weed in the stomach and the upper
the precise cause of death ? part of the small intestine.
3. What was the nature of drowning, sui- (f) Presence of diatoms in the distant
cidal, homicidal or accidental ? organs or tissue, similar to those
4. What is the time of death and when did present in the water where the body
the submersion occur ? of the victim was submerged.
5. Was any other offence involved in the (g) Difference in the chloride levels in
case? the blood of both side chambers of
6. If the body is unidentified then establish- the heart.
ment of the identity becomes an impor- (h) Changes in the blood in addition to
tant step of investigation. the above, like haemoconcentration,
7. If the body has been recovered from a increased plasma magnesium level,
river, then it is necessary to know the relative increase in the RBC count,
actual place of drowning. about 40% decrease in the blood vol-
1. Whether drowning was ante-mortem or ume , crenated appearance of the
post-mortem in nature-Of all the post- RBCs under the microscope (salt
mortem findings available in a dead body, water drowning) and, increased
recovered from water, only some exter- blood volume (even upto 70%) due
nal and internal findings and some labo- to haemodilution, haemolysis with
ratory findings focus light on whether absolute and relative decrease in
drowning was ante-mortem or post- RBC count, increased potassium
mortem. These are: level and decreased sodium level in
the plasma (in case of fresh water
(a) Cadaveric spasm of the hands with
drowning). Plasma stramonium
presence of sand, mud, weed etc. in level is high.
the grip.
If death was not due to drowning,
(b) Copious , white fine froth through
then all the above findings will be
the nose and mouth . absent in the dead body and the ac-
(c) Presence of similar froth along with tual cause of death may be present.
sand , mud etc., in the lumen of the In case of dry drowning, it is very ..
whole of the respiratory tract. difficult to say if death occurred due
(d) Voluminous lungs , like balloons , to drowning, because almost all the
with indentation or presence of reliable signs of death due to drown- · .
marks of ribs on the surface; dis- ing including the laboratory tests are
charge of copious frothy fluid blood those of wet drowning. Hence, in

dry drowning, circumstantial evi- failure due to overloading of the

dences become important to come heart due to haemodilution, or ven-
to the conclusion whether death was tricular fibrillation due to haemoly-
due to submersion under water. sis or due to suboxic state of the
2. If drowning was ante-mortem then what heart.
was the precise cause of death-To know (d) Ifthere is ante-mortem head injury
the precise cause of death in a circum- and if there is a history of diving,
stance of drowning, the following points then the traumatic findings will be
must be given due consideration. sufficient to know the precise cause
(a) If from the circumstance (e.g. from of death. Similarly, if death has oc-
dependable eye witness) it becomes curred due to certain other injuries
evident that death was due to after submersion, then that also
drowning, and even then, if the in- should not create any problem in
ternal and laboratory findings are coming to the proper diagnosis. (See
negative, then the natural conclu- below and page 549).
sion should be that death was due 3. What was the nature ofthe drowning, was
to dry drowning, either due to it suicidal, homicidal or accidental ?
(i) laryngeal spasm or due to (ii) va- Accidental drowning-Most of the drown-
gal inhibition. In the former, signs ing deaths are accidental in nature. Acci-
of asphyxia should -~ quite dental drowning deaths occur in the fol-
markable with occasional presence lowing circumstances.
of water, sand, mud etc. inside
(a) For a non-swimmer- accidental fall
mouth, nose, stomach and intestine
in deep water.
and in the latter, though the splanch-
nic vessels will be congested, signs (b) For swimmers, exhaustion due to
of circulatory collapse may be no- prolonged swim, bathing during high
ticed and the signs of asphyxia will tide, by being caught in an under-
not be much prominent. current in a river.
(b) If it is a case of wet drowning and if (c) Circumstances of boat capsize, ship
there are prominent signs of as- wreck etc.
phyxia, ~xtreme degree pulmonary (d) Fall of a bus or a train down, from a
oedema, relevant changes in the river bridge.
blood in support of salt water drown- (e) While an intoxicated or epileptic per-
ing with history of drowning in salt son takes bath in a river or a pond.
water and presence of diatom in dif- (f) In circumstances of natural calami-
ferent tissues, then death can be said .·: ties like flood or cyclone.
to have occurred due to asphyxia
(g) Getting electrocuted by the electri-
due to drowning in salt water.
cal heating system of a bath tub etc.
(c) If on the other hand, it is a case of
(h) Divers diving in a shallow pool
wet drowning (with evidence of wa-
ter etc. in lung) with internal and (i) By being attacked by an aquatic ani-
laboratory findings in support of mal like shark or crocodile.
drowning in fresh water, then the G) Precipitated labour in lavatory pan
cause of death should be circulatory or while bathing may cause acciden-

tal drowning death of the newborn (d) In domestic environment inside

infant. the bathroom the suicide makes
(k) Accidental drowning death may also such arrangements with the water
occur to a newborn due to inhala- heating system of the bath tub
tion of amniotic fluid if the mem- that, he either gets electrocuted or
brane remains intact. drowns to die, the process of drown-
G) Diving for under water rescue op- ing here being facilitated by elec-
eration and other purposes is much trocution.
safe for them who use SCUBA ap- (e) In many cases, the suicide , failing
paratus (artificial respiratory appa- in some other method commits sui-
ratus with provision of oxygen sup- cide by drowning. In such cases dur-
ply) for dividing. This has reduced ing post-mortem examination of the
danger of under water drowning of dead body, some non-fatal injuries
divers, compared to unaided divers. may be found on the approachable
It has also made under water diving parts of the body or some suicidal
more effective as the scuba divers poison may be present in the stom-
can stay under water for a long peach and the viscera.
riod uninterrupted without coming In all doubtful cases motive for sui-
to the surface for respiration. cide should be found out.
For propet diagnosis of accidental
Homicidal drowning- Homicidal drown-
drowning cases circumstantial evi-
ing deaths are not very common, but do oc-
dences are very important. The
cause of death in (g), (h), (i) is not cur. Different possible circumstances are -
exactly inhalation of water. (a) Forceful drowning of an adult swim-
mer is a difficult process but may be
Suicidal drowning deaths have the fol-
caused-
lowing features-
(i) When numberofassailants are
(a) It is a common method of commit-
more than one.
ting suicide by the women-folk in the
rural side. (ii) When the victim has been
(b) If the person is a non-swimmer, then
made unconscious by injury or
he or she simply jumps from a place drug.
ofheight in deep water. (iii) When the hands and feet of the
(c) If he or she is a swimmer, then he victim are tied before pushing
or she makes certain preparations to him into the water.
be sure that the attempt will not fail. (iv) When the head of the victim is
(i) Before jumping in water the forcefully dipped in water.
hands and legs may be tied , so (b) When the victim is a non-swimmer
that, swimming will not be pos- and is deliberately pushed in deep
sible. water, all of a sudden without his
(ii) Some heavy weight may be tied knowledge.
with the body , so that, very (c) The victim maybe packed inagunny
quickly the person goes under bag with his mouth tied and then
water. thrown into water.

550 I PRINCI PLES OF FORENSIC MEDICINE
FJQ. 16.32: Frothing from nose and mouth - death I Fig. 16.33: Frothing from nose and mouth- a case
due to drowning of death due to drowning
Courtesy- Dr Aman Kumar & Courtesy- Dr Am an Kumar &
Prof Mahato Prof Mahato
- - - - - - - - - - - - ---------'
Fig. 16.34: Bodies recovered from see after about 18 Fig. 16.35: Indentation marks of ribs on the surface of
hours .._____ lungs in a case of death due to drowning

(d) As in case of suicide , the electrical the doctor while giving due consideration
heating system of a bath tub may to ascertain the time of death should
be so arranged that, the victim una- keep it in mind that, after death the body
ware of this manipulation, while in might had been left in air for some time,
the bath tub may get electrocuted then for some time it remained sub-
and die as a result of electrocution merged in water and lastly, after recov-
or drowning. ery fro~ water, it again passed some pe-
(e) Occasionally unwanted newborn in- riod in air.
fants are thrown in water. It is for these reasons that, in case of
(f) When a person is taking bath in a bodies recovered from water, to ascertain
tub he or she can be easily drowned the time of death, in addition to physical
by pushing the head down in water changes in the body, the doctor should
or pulling the victim with her legs. also take into account some other factors
like the stomach content and the find-
(In the ''bride of the bath" case a
ings which help to say for what period
person after marriage used to make
the body remained in water (see below).
life insUrance policy in the name of
the wife. Then the wife was used to A rough idea about the period of submer-
be killed in this method in the bath sion of the body in water can be formed
tub inside the bathroom, in a "play- from the following changes-
ful mood". In the third occasion he (a) Wrinkling of the skin starts by about
could be brought to the book). half an hour after submersion and
this is well-formed after about an
4. What was the time ofdeath and when did
hour.
the submersion occur ?
(b) Bleaching and corrugation of the
This is not always an easy problem to be
skin occurs by about 8 - 12 hours
solved in case of death due to drowning
after submersion.
or in case of a dead body recovered from
water. The changes which occur in a dead (c) The body temperature comes down
body after death comes ·late in a sub- to that of the water by about 14
merged dead body. That alone would have hours after submersion when sub-
not created much problem for the autopsy mersion is the cause of death or
surgeon. But the real problem lies in the when the body is disposed off in wa-
ter immediately after death. The
fact that, once the dead body is lifted out
of water, the process of these changes, rate of cooling of the dead body in
particularly the process of decomposition water is roughly twice as that in air.
progresses very rapidly imposing two lev- (d) Floating of the dead body, in our
els for consideration for ascertaining the count ry, in summer, occurs by about
time of death, one for the period the body 24 hours after drowning or submer-
was in water and the other, after the body . sion. In winter, this time iri our cowl-
was removed from water. Added to the try is 2 - 3 days.
problem is the fact that not in all cases of . 5. Was any other offence involved ·in the
dead bodies recovered from water, death case?
occur in water. In many cases dead bod- In one of the cases of the present author,
ies may be disposed off in water. Hence, a woman was first raped by the side of a
·,
Fig. 16.36: Different varieties of diatoms
•'Vf

nose;
antemortem
drowning
Courtesy-
Prof CB
Tripathy, BHU
Fig . 16.37:Ciose view of dead body of a young girl

recovered from water; suicidal drowning
Fig. 16.39: Washer woman skin-like appearance of skin

of sole in a case of drowning death
Courtesy - Prof CB Tripathy. BHU
L-----------~ -~------~
iJ
ty
Fig. 16.40: PM staining on face and neck in a case of
drowning death
river and then drowned to death by force- .

fully dipping the head under the water.
In another case, dissected parts of more
than one dead body were recovered from
a lake. Findings on the body parts were
very much suggestive that, clandestine Fig. 16.41 : Different types of diatoms
training on human anatomy were being
undertaken, may be somewhere in the many cases, due to extreme decomposi-
city ofKolk.ata. tion of the dead bodies or mutilation by
6. If the dead body recovered from water is the aquatic animals or when recovered
an un-identified one, then establishment from a river the chance that the body
of the identity of the deceased is an im- might have floated a long distance, es-
portant step for proper investigation. In tablishment of identity may require much

effort. The facial appearance , the com- SUFFOCATION DEATHS

plexion and some other features may get
totally distorted. In such cases steps to
identify the person should proceed in the Definition
same line as in case ofidentification of a Suffocation means a group of conditions of
highly decomposed dead )>ody or a muti- violent asphyxiation, where passage of air
lated dead body . The wefuing apparels , a betw.e en the atmosphere and the lungs is
few pocket articles , certain body peculi- prevented by mechanical ways other than
arities, deformities , tattoo marks , all may constriction of neck or drowning.
still help identification. Fingerprints may
also be procured. Sex, age , race should Types of suffocations
not create much problem as these can be According to the frequency of occurrence,
known from the bones and teeth even if suffocation$ are of the following types
the soft tissues have been totally or to a 1. Smothering;
great extent destroyed. Teeth may give
2. Traumatic asphyxia;
certain additional informations for id~n
tification. Superimposition technique 3. Choking;
may be used, if the skull bone is avail- 4. Gagging;
able and if the life-time photograph of a 5. Overlying;
doubtful missing person is also available. 6. Burking.
7. If the body has been removed from a
river, then it is necessary to know the
actual place of drowning, because in such Smothering
a case it is possible that the dead body
might have floated down for several miles Definition
before detection and removal. If the ac- In smothering, respiration is prevented by
tual place of drowning cannot be known, the closure of the mouth and the nasal open-
then the identity of the individual and ing.
other legal issues with the death may not
be solved. In case of a river, it .may not Cause of death
always be very easy to locate the actual In all cases of smothering death is due to as-
place of drowning. The best way to do that, phyxia.
is to undertake the tedious job to study
the diatoms of different parts of the river, Circumstances of smothering deaths
at least of the possible parts of the river Smothering deaths may be accidental, homi-
where the person might have actually cidal or rarely suicidal.
drowned, and to compare them morpho-
logically with the diatoms identified in Accidental smothering - It occurs in:
different organs of the victim. But one 1. An intoxicated or unconscious person ly-
may question the usefulness of such an ing in prone position. Similar may be the
elaborate study, when it is known that, case with epileptics , during the attack of
even in known cases of drowning, dia- fit.
toms can be detected from the tissue of 2. Children playfully covering their head and
the body in only about 10% of all cases. mouth with a plastic or polythene bag.

•·.
3.
Infants while suckling their sleeping sions over and around the face and the nose.
mother's breast The abrasions are usually crescent shaped
4. Insane or epileptics or intoxicated per- nail scratch abrasions. There may be frac-
sons falling upon a heap of dust, grain or ture of the nasal cartilage and there may be
flour. bleeding from the nose with occasional bleed-
5. During masochistic practice-self as- ing from the mouth. If smothering has been
phyxiation. caused by some soft material, then there may
not be much external sign near the mouth
6. A baby may be smothered under a heap and the nose. But there may be depression
of mattress on a bed. of the nose with bleeding from the nose. The
7. Foetus born without rupture of mem- inner aspects of the lips may show abrasion,
brane (born in cau[) may get smothered contusion or even laceration, due to friction
or die drowning death due to inhalation with the teeth. There may be loosening of
of amniotic fluid. the teeth with signs of bleeding from the gum
Homicidal smothering is caused in the In case the face is pressed against some hard
following ways- surface (see Fig. 10.52), there will be gross
1. By pressing' the face and the nose of the abrasion, contusion and even laceration on
victim by hands. the skin around the mouth and the nose In
such a case, possibility of fracture of the na-
2. Same thing may be caused by a towel, sal bone or cartilage is more. Injury to the
pillow. inner aspect of the lips, soft gum and disloca-
3. The face may be pressed on the ground tion of teeth are more common and exten-
to cause smothering. sive. In homicidal smothering, there may be
4. A person may be smothered by tying a signs of struggle or resistance over other ar-
plastic bag or some other substance eas of the body.
covering his mouth and nose. In accidental smotheringdue to compres-
Suicidal smotheringmay be attempted- sion over the mouth and nose there will be
!. By tying a plastic bag around head includ- abrasions, contusions or even laceration out-
ing the mouth and the nose, with appli- side the mouth and the nose with fracture of
cation of several knots untill the person the nasal bone or the cartilage and bleeding
becomes unconscious. from the nose and the mouth. Abrasions, con-
tusions, lacerations may be found in the in-
2. By tying a pillow in front ofhis face, with
ner aspects of the lips and on the soft gum
several knots untill the person becomes
unconscious. with fracture dislocation of the teeth. In epi-
leptics there may be injury on the tongue due
3. By arranging self burial under a heap of to its being bitten by teeth. In accidental
mattresses on a bed. smothering due to fall on dust or flour etc.
stain ofthese materials may be present out-
Post-mortem findings side the mouth and nose as also inside the
External findings mouth and nasal cavity. There will not be
any mark of resistance or violence at any
External findings vary according to the nature other part of the body. In case the smother-
and method used to cause the smothering. ing occurs due to compression against some
In case of homicidal smoth~ring caused soft material then there may not be much
by hands, there will be abrasions and contu- findings, as already seen in case ofhomicidal

Fig. 16.42: A case of submersion after suffocation by Fig. 16.44: Contusion and abrasion on inner aspect of
smothering. Note antemortem abrasion of lower lip in a case of death due to smother-
lower lip, left side of chest and on dissection , ing
bruise on lt. shoulder.
Fig . 16.45: See laceration at the inner aspect of lower

li due to friction with teeth
smothering by soft materials . In case of

. 16.43: Close view of Fig. 16.42 smothering with the mother's breast , the deli-
cate tissue of the nose and face of the infant
will be compressed and pale .
Smothering during masochistic practice
will be clear from the evidences present at
the site, like porno books or nude pictures,
exposed private parts of the victim, wearing
dress of opposite sex and the method of in-
ducing self smothering.
Suicidal smothering
In suicidal smothering the 1ethod adapted
Fig . 16.46 : Smothering-Bruise and haemorrhage in is not disturbed and thus the th may be
gums and teeth socket; also mark injury on seen to be closed with a pillow tied in front,
the lower lip. A consequence of infidelity
or a plastic bag may be seen tied around the

Fig. 16.47:Same case as in Fig. 16.46 see the prominent

injuries on lower lip
Fig. 16.49:Death due to smothering. Mark the injuries

on lt. malar prominence, nose , lower lip and
chin
Fig. 16.52:1njuries on face in smothering with marks of

injuries over face and lower part of chin against
Fig. 16.51 : Smothering death a hard and from nose

558 I PRi'~LES OF FORENSIC MEDICINE
" -J
a b c
Fig. 16.53: (a) Suicidal strangulation by ligature. Note the multiple rounds of ligature material. (b) Smothering by a
plastic bag- Accidental (c) Suicidal smothering by typing pillow in front of face by multiple rounds or rope
head and the mouth . There may be some lo- with dark fluid blood, congested organs, con-
cal effects of pressure but no remarkable ingested lungs with petechial haemorrhagic
juries will be there. spots in the undersurface of the pleura and
Other external findings in all cases of congestion and haemorrhagic spots in the
smothering will be those of asphyxia like cya- substance of the brain and the layers of the
nosis, prominent bluish post-mortem stain- meninges.
ing, involuntary discharge of faecal matter
or urine etc.
Internal findings
Internally, apart from the findings mentioned Definition

in relation to the lips , gums and teeth , in case
of smothering due to fall on dust or flour like In traumatic asphyxia, there is forceful com-
substance, the same may be found in the res- pression of the chest which prevents respira-
piratory tract lumen. Rest of the internal find- tory movements of the chest wall and also
ings will be in the line of classical asphyxia , causes injury to the chest wall.
Fig. 16.54: Victims of house collapse (Death due to FIQ. 16.55: Case of traumatic asphyxia due to house
traumatic asphyxia) coUapse : Mark the dust stains

5. When held between the buffers of two

bogies of a train.
Externally, in addition to the signs of as-

phyxia, there will be extreme congestion
along with findings akin to haemorrhagic
spots, above the level of the compression. The
part lower to that level may not show any
such finding. In case of house collapse, there
will be stain of dust and soil over the body. In
case of being nm over by a vehicle there will
·Ot tyre and grease marks on the body. In case
of stampede there will be foot or shoe marks
on the chest and sometimes laceration.
There may be external injuries in the form
of abrasion and bruise.
futernally, in case of house collapse there
Fig. 16.56:Death due to traumatic asphyxia clearly
showing level of compression on chest will be evidence of inhalation of dusts and
debris, inside the respiratory tract. Among
Circumstances oftraumatic asphyxia the other findings , signs of asphyxia in the
organs and blood, signs of injury which is of-
1. Due to house collapse. ten extensive with fracture of the ribs, in-
2. When stampeded by a crowd, nmning in jury to the liver, lungs, heart etc. and pres-
panic and without any sense, as it occurs ence of blood in the thoracic and abdominal
for example, due to outbreak of fire in a cavity, may be there.
cinema hall or at a public gathering.
Ifthepatient survives, then the external
3. By being nm over by a vehicle. spots akin to haemorrhagic spots pass off
4. Due to collapse of a wall inside a mine. within about two weeks without passing

6. When food substance gets lodged and re-

mains fixed at some curvature or con-
striction of the oesophagus , that may
cause choking from outside the lumen of
the trachea or the larynx.
7. Similarly, any swelling, abscess or new
growth of any neighbouring structure will
cause obliteration of the lumen of trachea
and larynx and may cause choking.
8. Slipping of an artificial denture inside the
Fig. 16.59: A crush case of traumatic asphyxia larynx is another cause of choking.
Exception - No. 7 of the causes above are
through the colour changes seen in case of natural and No. 5 of the cause may rarely
bruises . have some criminality.
Cause of death - asphyxia , and vagal in-
Choking hibition (occasional).
----~~--------~------------
Note : As choking is more common with
Definition very young children, often due to big
food bolus in the mouth or a coin, a
In choking the air passage is occluded either
playing article etc. The parents or
by some foreign materials or due to some
guardians need to be vigilant dur-
pathology or foreign substance in the neigh-
ing feeding a baby or selecting the
bouring structure (e.g. oesophagus).
food stuff for the child and also to be
Circumstances of choking attentive that the child does not in-
sert any play-item in the mouth
1. Slipping of a food bolus in the respira- which may slip and choke the baby.
tory tract .
2. Children , chewing a toffee , or playing Post-mortem findings
with a button or a coin in mouth , may There will be signs of asphyxia both exter-
get choked when that slips down through nally and internahy. The cause of choking
the larynx. may be detected during the post-mortem ex-
3. Children , sucking a piece of balloon to amination.
puff it or inflate it inside the mouth , may
get choked if that slips inside the larynx. Medicolegal significance
4. Fisherman , after a catch, when holds the Choking is almost exclusively accidental in
fish temporarily between the teeth or nature . Homicidal choking is an impossibil-
lips , that may accidentally slip downward ity. Though homicidal choking is argumen-
and choke him. tatively possible with infant victims, it is not
5. People may be choked due to inhalation necessary to choke the infant to fulfil the
of irritating gas like chlorine gas, vapour purpose because gagging in that case can
of an acid etc. Laryngeal spasm and ex- serve the purpose more easily. Suicidal at-
cessive mucus secretion cause choking tempt of choking can only be thought of in
in these cases. case of mental unsoundness of a person.

"Cafe Coronary" - This is a misnomer

which came into existence from a situation
of choking by a food bolus, in a restaurant, in
which the signs symptoms at the initial phase
appeared similar to those of a cardiac attack,
with pain in the chest, respiratory distress
and circulatory collapse. The person died, was
intoxicated and during post mortem exami-
nation the exact cause of the episode i.e.,
choking was revealed.
Gagging
In this type of violent asphyxiation, cloth is

pushed inside the mouth cavity which cre- Fig. 16.60: A case of road traffic run over death
ates pressure over the posterior wall of the
fauces . This is mostly homicidal and the vic- 4. Relevant signs will be available in case
tims are mostly unwanted infants. But some- of death during dental surgery.
times unconscious persons may be gagged and
after death the substance used may be re-
moved from the mouth. Accidental gagging Overlying
may occur if a set of artificial denture acci-
dentally slips and blocks the posterior wall of
the mouth cavity causing asphyxia and death. In this condition young individuals, usually
In dental surgery also , gagging effect may be infants or very young children, die due to
seen due to reflex closure of posterior end of asphyxia, when they get compressed under
the mouth, due to psychological (fear, nerv- the body of an intoxicated adult bed partner.
ousness) or pathological causes (catarrh in This is purely accidental in nature.
mouth or nose, for example). This may be During post-mortem examination, the
prevented by taking some preventive steps face , nose and the chest of the victim child
in vulnerable persons. However, during den- will appear compressed and pale . There will
tal surgery there is no scope of death of the be signs of asphyxia in the rest of the body
patient due to gagging as the patient is un- parts and the organs.
der direct care of an alert dental surgeon.
Hence, if death in such a case occurs, the Cause of death may be due to the com-
dental surgeon remains liable to be charged bined effect of smothering and compression
for negligence. over the chest arresting the respiratory move-
ment of the chest.
Post-mortem appearance
Other such conditions - Inside over
1. Signs of asphyxia, externally and inter- crowded close'd overcrowded room or in an
nally. environment with obnoxious irritant gas
2. Presence of the gagging material inside there may be environmental suffocation of a
the mouth cavity. good number of such entraped or exposed
3. Congestion and at times abrasion and persons. In such circumstances casualty is
contusion inside the mouth cavity. quite possible.
Parvej n: •• _ ->~=>1
Burking got 7 pounds 10 shillings for each body.

McDongal and Margaret were their accom-
plices. Their victims were usually prostitutes,
This is combination of smothering, palmar
beggars and in one case, personal aquaintence
strangulation and traumatic asphyxia to kill
ofBurke. Abundant availability of dead bod-
a person . The term came into use from the
ies in that institution during a period of cri-
name ofWillium Burke , an Irish descendant
sis and recognition of some dead bodies by
of a respectable family and an ex-soldier who
some medical students, created doubt and led
was deserted by his wife and family. Shifting
to an enquiry. Though the plan was hatched
to Scotland he used to live with his mistress
by Hare and his associate Margaret, only
Nell McDongal in a roadside inn, owned by
Burke and McDongal were tried. In the trial,
one Mr. Log. Burke had a co-tenant in the
Hare acted as "Kings" witness. Burke was
inn namely, WilliumHare . After the death of
condemned to death . McDongal was acquit-
Mr. Log, Hare became the caretaker of his
ted due to lack of evidence. But she and
wife Margaret. Burke started planning with
Margaret were much tortured by enraged
Hare, how to earn money easily. At tha! time
public. Hare became untraceable. Dr. Knox
there was acute scarcity of dead body in the
was not tried.
Department of Anatomy in Edinburg Medi-
cal College . They once supplied there, the After this, British Government changed
body of another tenant of the inn, who died a the rule, for easy lawful procurement of dead
natural death and got 4 pounds in exchange. bodies by the medical colleges.
Finding this an easy way to earn money, they
Auto erotic asphyxia or hypoxiphilia
started killing inmates of the inn, one after
another by way o{, smothering, palmar stran- This is a form of sexual masochism (see also
gulation and causing 'traumatic' asphyxia by page 718). It is a dangerous type of paraphilia
exerting pressure over chest, all after intoxi- or sexual perversion where partial asphyxia-
cating their innocent victims with alcoholic tion of the brain causes sexual arousal and
drink . Other sources just mention that suf- gratification. This type of sexual fantasy may
focation was the method they used to adapt, be practiced regularly or with gap. Such a
without mention of detail of the process of perversive practice does not deprive the per-
suffocation. Hare was the planner and Burke son from having usual sexual practice with
was the killer in all the cases except in one his wife or a partner of opposite sex.
episode where Hare killed the victim. Usu- Here partial self-asphyxiation is caused
ally, Burke used to sit over the chest of the usually by hanging, self-strangulation or self-
victim, closing his mouth and nose with hand suffocation in such a way or adapting such
and applying pressure over the front of neck device so that the moment gratification is
of the victim laying him supine, on the ground achieved or is at its achieving point, by ap-
till his death. Sometime Hare used to keep plying the device he can release himself from
the legs of the victim pulling. Then they used the proces~ .or risk of full asphyxiation.
to supply the dead body to one Dr. Knox, Head to
Hence, ifhe fails release himself from the
of the department of anatomy of Edinburg process of asphyxiation or if the device does
Medical College. That way in the 19th cen- not work then fatality is the out come. Obvi-
tury, within about an year they supplied 16 ously the method is practiced in an isolated
dead bodies to Dr Knox and on an average place to avoid detection and intervention.

Practitioner does not disclose his perversive • C. J. Polson, D. J. Gee, Barnard Knight- Essentials of
act. It usually comes to light with death of Forensic Medicine (1985) .
the practitioner when on search his dead body
is detected in circumstance suggesting it a
• A method of determination of death by drowning -
A. 0. Gettler, JAMA, Vol. 77, P.1650, 1921.
case hypoxiphilic death. The circumstances
of different such cases suggest some similar- • Investigation on the occurrence of diatoms in organs
ity which is common with difference in in death from various causes, J. Forensic Medicine,
method of exercise. In the place of occur- Vol. 13, P.134, 1966.
rence, the dead body will be fully or partially • The significance of diatoms in the diagnosis of drown-
nude, may be in front of a mirror with porno- ing-J . Forensic Sci., Vol. 9, P.11, 1964.
graphic literature or picture . Sometimes the Pathology of Trauma- Moritz A. R., 1954.
•
victim is dressed with the dress of opposite
sex . Sometimes, notes containing sexual or • Gradwohl's Legal Medicine- F. E. Camps, 1984.
perverted sexual matters written by victim • Recent Advances in Forensic Pathology- F. E. Camps,
may be present. 1969.
The mental aberration may develop or • W Dog las Hemming -Forensic Medicine and Toxicol-
triggered up due to deprivation of sexual out- ogy- 2008.
let with some mental perversion, though such • WB Woodman and Charles M Tidy- Forensic Medi-
persons otherwise may lead a normal life in cine and Toxicology- 2007.
other spheres. About the mental or psychiat- Richard Shephard -Simpson's Forensic Medicine-
•
ric aspect of the practitioner-he or she may 2003.
have a compulsive behaviour, or it may be
• David Dolinak, Evan Matshep, Emma 0 Lew-Foren-
the result of thrill seeking behavioural pat-
sic Pathology: Principle and Practice- 2005.
tern. Some suggest a remote complexity of
mind bearing cryptic suicidal desire or ten- • Warner U, Spitz David J, Spitz Ramsay Clark, Russel
dency. Usually youngormiddle aged persons S Fisher - Spitz and Fisher's Medico/ega/Investiga-
are sufferer in whom incidents are more. A tion of Death- 2006.
few persons who could be survived "from a • Pekka Saukko and Bernard Knight -Knight's Foren-
critical state has reflected their mind giving sic Pathology- 2004.
some of the above informations, which in ad- • Stiffen Timmenmanas- Post-mortem: How Medi-
dition reveals that they are victim of other cal Examiners Explains Suspicious Deatii- 2007.
perversive acts also . Psychotherapy can cure
the tendency along with removal of some
-2008.
contributory mental strains. (See also pages
518 and 728).
ogy of Trauma- 2006.
Referencos Qve ... tions
• Plastic bag fatality - A. Fatteh, BMJ, Vol. I, P. 875,

Theoretical long questions
1962.
• Accidental strangulation during perverse sexual ac- Classify hanging, give P.M. findings and.medicolegal
tivity, - G. T. Mann, J. Forensic Sci. Vol. 5, P. 169, aspects; classify strangulations, describe P.M. find-
1960. ings and medicolegal aspects of strangulation by liga-

ture and throttling. What are the types, causes of surest signs of death due to hanging, drowning, ex-
death, post-mortem findings and medicolegal aspects amples of suicidal and accidental strangulations, chok-
of drowning deaths? Classify suffocations, give posting, smothering, examples of homicidal drowning,
mortem findings and medicolegal aspects of smoth- smothering.
ering and suffocations. What are lynching, garrotting, mugging, choking, trau-
matic asphyxia, overlying, bansdolla, smothering,
Short notes, differences and oral
burking, gagging, masochistic asphyxia, diatoms,
Causes of deaths due to hanging, strangulations,
gettler's sign, tests tor diatoms, talacies of presence
drowning, different types of suffocations. Factors in-
of diatoms in organs; judicial hanging; Cafe
fluencing ligature mark of hanging. Differentiate be-
coronary.
tween, hanging and strangulation by ligature; Sui-
cidal and homicidal hanging; Ante-mortem and post-
Oral questions
mortem hanging; Dry and wet drowning; Ligature
marks of hanging and strangulation; Typical and atypi- Pressure needed to close, Wind pipe, Jugular vein,
cal hanging; Partial and complete hanging. Carotid artery; Time of floatation of a dead body,
Types of ligature materials in hanging, strangulation. Diagnosis of traumatic asphyxia, Le facie
Partial hanging, typical hanging, atypical hanging, sympathetique; cause of death in judicial hanging.
NOTES

Definition concentration are the chief features . Hunger
pain is more marked by 2nd and 3rd days.
Starvation is withholding offood or food and
Constipation and oliguria with increased fre-
drink from or by an individual.
quency of micturition is there, by this period.
Acute or complete starvation-When food By 3rd day, blood sugar, blood pressure, pulse
is totally withheld for a continuous period, it rate and cholesterol level fall. Pulse is weak
is acute and complete starvation. but on exertion the pulse rate is much in-
Chronic or partial starvation or malnu- creased. By this time, loss of body weight is
trition-When food intake is deficient, either appreciable. Gradually, there is emaciation,
quantitatively or qualitatively or both, then loss of subcutaneous fat with sunken eyes,
that is called chronic or partial starvation or cheeks and abdomen. The bones and particu-
malnutrition. larly the joints become prominent. The skin
is dry and dirty, lips are dry and cracked.
Signs and symptoms of acute starvation There is thick, scanty salivation, coated
In the beginning phase, hunger, followed by tongue . Then there is wasting of muscles,
hunger pain , thirst, weakness and lack of which are rather flaccid with occasional
Fig. 17.1 : Starvation death with bed sores at different Fig. 17.2: Closer view of Fig. 17.1
places
Parvej 565
where the person survives for a reasonably

long period, death may obviously occur due
to intercurrent infection. But general debil-
ity remains the main cause precipitating the
death.
Fatal period ,
In case of acute starvation, if there is simul-

taneous deprivation of water then death may
occur within 7 - 10 days. In case of depriva-
tion of food alone a person may survive for
Fig. 17.3: A case of starvation death
weeks. The maximum recorded period of sur-
cramps. The scanty urine has a high specific vival during starvation offood alone is a few
gravity, is turbid in appearance, and strongly days more than 2 months. Generally, loss of
acidic in reaction . When the condition 40% body weight becomes fatal, but much
progresses towards the worst, the person is depends on season, age, sex and body condi-
tion.
unable to move and speak, the temperature
which was slightly raised earlier, now falls.
At the terminal phase, there may be mental
confusion.
In acute starvation, first the reserve car- This condition results from partial depriva-
bohydrate of the body, then the reserve fat tion of food, either quantitatively or quali-
and lastly the protein are gradually lost due tatively for some short or long period. This
to use.
may lead to defic1ency of many bodily con-
Cause of death in acute starvation is stituents including carbohydrate, fat, pro-
mostly due to cardiovascular failur~:; . Occa- tein and also vitamins and minerals. This
sionally, death may occur due to failure of gradually decreases body weight, involving
the other vital functions of the body. In cases, loss of carbohydrate first, then fat and lastly
Fig. 17.4: Starvation with secondary infection and Fig. 17.5: (Back view of Fig. 17.4) Starvation with bed-
ulceration sore, secondary infection and ulceration

chapter 17:STARVATJON 1567
External
The body is emaciated; hair lusterless; eyes

sunken and may be half open; cheeks sunken
with prominent malar bones; lips dried and
cracked, tongue coated, pale appearance of the
skin, faint postmortem stain, early appearance
and disappearance of rigor mortis, lack of sub-
cutaneous fat with prominence of bones and
joints, occasional oedema of the ankles, dirty,
dry, lusterless and in-elastic skin are the com-
Fig. 17.6: Ulceration-back of head in a starvation case mon features. There are wasting of the mus-
cle and much loss of the body weight.
Internal
protein. The body fats and the muscles are Lack of subcutaneous, omental and other dis-
gradually wasted and the body is emaciated. tributions of fat is very much conspicuous and
The abdomen and cheeks are sunken, the a constant feature. The tissues are pale. Or-
bones and joints are prominent. The skin is gans are also pale. Spleen is smaller in size.
dry, in-elastic and often infected. The hair Liver shows degenerative changes. The stom-
is lusterless . There may be ascitis . There ach wall is thin and the mucous membrane
may be intercurrent infections. Chronic in- may show superficial ulceration. The stom-
fection like tuberculosis may add to the ca- ach may contain bile-stained mucous and
chectic condition. There is occasional hun- sometimes stones, soil, grass, swallowed by
ger pain . Various deficiency syndromes may the victim during life. The gall bladder is
appear. much enlarged in size and contains thick bile.
The intestinal wall is quite thin and is
Death in case of chronic starvation or transluscent. Blood vessels on the wall of the
malnutrition usually occurs due to intercur- intestine are less prominent. The intestinal
rent infection, different deficiency syndromes canal contains bile-stained, mucoid, fluid or
and general debility. semi-fluid faecal matter. The rectum may be
Though 40% loss of the body weight is empty. The meningeal spaces may contain
likely to cause death, yet in case of chronic more fluid than average.
starvation, it was noticed in the concentra- 2. In case of death due to chronic starvation
tion camp in Holland during the 2nd world The external findings are almost similar
war that, the body weight of some victims to those in case of acute starvation. Defi-
of chronic starvation there, reduced to less ciency signs may be more conspicuous.
than 15% of their original weight. These vic- The abdomen may be protruded due to
tims were rightly termed as "living skel- ascitis. Signs of devitalisation and inter-
eton". current infection is more common.
Among the internal findings , in addition
Postmortem appearance
to what is found in acute starvation,
1. In case of acute starvation there will be more substantial evidence
of degenerative changes in the liver and tal or natural. Chronic homicidal starvation
other organs. Signs of infection, like that deaths also occur as a result of cruelty where
of pulmonary tuberculosis may be there. the victims are usually old and disabled. In
There may be patchy Jilceration of the these cases, other signs of maltreatment or
mucus membrane of th'e intestine. negligence may be present on the body. Acci-
dental malnutrition deaths occur in diseased
Medicolegal aspeds conditions like stricture oesophagus and
malabsorption syndrome cases.
Generally speaking, if no criminality is in-
volved, then isolated starvation deaths are
of definite social concern. Apart from this, References
acute starvation deaths are mostly acciden-
tal in nature, which may occur in scores or • Cold and Starvation- Modern Trends in Forensic Med.
hundreds, in circumstances of natural calami- (1953)- K. Simpson.
ties, like, flood, cyclone and earthquake. • Glaister's Med. Jurisprudence and Toxicology, - E.
Other accidental starvation deaths may oc-
Rentoul and Hamilton Smith, 13th Edn., 1973.
cur inside a mine, in a desert or in the"vic-
tims of house collapse. Virtual starvation • Warner U, Spitz David J, Spitz Ramsay Clark, Russel
death may occur due to some obstructive S Fisher- Spitz and Fisher's Medicolegallnvesuga-
pathological condition of upper GI tract, not tion of Death- 2006.
effectively attended and treated which at • W Dog las Hemming- Forensic Medicine and Toxicol-
times amount to negligence. Suicidal acute ogy- 2008.
starvation deaths have occurred in circum- • David Dolinak, Evan Matshep, Emma 0 Lew-Foren-
stances of protest ''hunger strike" against sic Pathology: Principle and Pracuce- 2005.
some alleged injustice. Homicidal starvation
deaths are very rare and the victims are ei-
ther unwanted newborn infants or old debili- Qu..tions-
tated persons or an enemy, kept confined in
an untraceable place. Oral questions
Chronic starvation deaths, in the opin- Acute and chronic starvation, their signs and symp-
ion of the author, in most circumstances are toms, specific definite signs of starvation, what are
the result of social injustice, inequity and total and partial starvations, what are acute and
poverty. Let the society decide whether these chronic starvations, what are the circumstances of
deaths should be termed homicidal, acciden- acute starvation?

Home is the peaceful resting place for all fam- pain at home and in teaching institutions to
ily members which has an inherent centrip- introduce discipline and teaching programme,
etal force acting on the members of the fam- child labour system, all may extend upto cru-
ily. A man is more a natural being in the fam- elty and negligence on children. These atroci-
ily than elsewhere. Members of a family are ties are not new, as these were not the mat-
essential parts of a unit, the fanuly. Yet, most ter of past alone. The problem was 1.mveiled
cruel and sustained violence on one or more by Silverman (1953) and Wooley and Evans
members by another or some others of the (1955), in its exact shape, magnitude and sig-
same family occurs frequently in the family nificance, who established the deliberate trau-
environment. Acts of cruelty on child orchil- matic character of certain specific types of
dren, on wife, on old and disabled and on "pathological lesions " first detected by
husband are antagonising to the family con- J . Caffey (1946), a paediatric radiologist
cept and concept of civilized human society, (Hence the name Caffey's syndrome). Caffey
because, in these cases violence strikes the observed serious injuries of bones in some
base of sweet and intimate relationship. This children, though he thought that, the injury
chapter is aimed at focussing some search- to bones of these children were pathological
ing light on this aspect offamily lives of indi- in nature. Subsequent investigations of these
vidual members. A good number of factors cases proved them to be non-pathological and
are responsible for violence and abuse at non-accidental, rather the result of dispro-
home which are discussed in this chapter. portionate physical assault on the children,
and on this basis, Kempe et al in 1962, used
the term "Battered Baby Syndrome" for this
condition. At present the more popularly ac-
cepted term is "Non-accidental injury of child-
Battered baby syndrome or Maltreatment hood".
syndrome in children or non-accidental inju-
ries of childhood or Caffey's syndrome. Identification of the battered child
Cruelty on infants and children is not Though cruelty on children does not bear any
new. Destruction ofnewborn infants, strin- relationship with the age of the child, the
gent measures including physical torture and battered children are mostly within the ages
Parvej 569
Battered child: multiple injuries on different (Back view) Battered child multiply injuries
body parts on different body parts
- ------'

chapter 18: CRIME AND CRUELTY AT HOME I 571
. 18.6: Battered child Fig. 18.7: Battered child- multiple bruise
Complained as wife battering but caused during transportation of the

unconscious victim to Hospital (See Fig. 10.4, page 346)
of 1- 5 years, with most of the seriously bat- The vulnerable children are the victims
tered victims being of 2 - 3 years of ages. of indignition, intolerance or impatience of
The age preponderance obviously indicate parents, guardians or persons under whose
that vulnerability lies with inability to com- supervision they are expected to develop with
plain or express their sufferings properly. affection and care. They are treated harshly
Obviously, while considering maltreatment and often physically assaulted with infliction
syndrome or battered child syndrome, infants of minor to severe bodily injuries. They are
are not included. Battering occurs on a com- sometimes brought to the doctor with vague
paratively elder child with a different perspec- history, narrated by the parents for sustain-
tive and presentation. ing the injuries, like, fall from a stair or a

t
table or that the baby ''bruises very easily". is not uncommon or uncalled for. It is severe
The disproportionate delay in consulting the beating of the children, which leads to bodily
doctor, the gap between the history and the injury of the children, that are often griev-
severity of the injuries, repeated presenta- ous and in occasions may be fatal also.
tion with same type ofhistory and injury, and
presence of evidence of old injuries of differ- A. The child factors
ent intervals, all convergingly point towards 1. Age - The majority of the victim children
the fact that the child is an unfortunate vic- are around 2 yrs of age, as they can nei-
tim of Caffey's syndrome. therprotest nor narrate the matter prop-
erly to others. However , elder children
Aetiology
are not excluded.
Lack of education , tolerance , understanding 2. Sex - This condition is more common
and self control on the part of the parents or with male children . A ratio of about 2 : 1
the guardians are the immediate precipitat- is observed, involving male and female
ing factors . It is often seen that parents who children, respectively.
were the victims of maltreatment during 3. Status of the child - Illegitimate and un-
their childhood are the persons who maltreat wanted children are more often the vic-
their children. Such parents become dispro- tims ofbattering.
portionately violent on their children on
4. Usually the victim is the single child in
trivial issues like sustained cry by the child, the family.
refusal to take food , soiling the towel ordress .
5. The child may be a mentally abnonnal
The real cause can be said to be some psy-
one.
chological deficiency or psychic problems
of the parents . At the time of assaulting the B. Parent/Guardian factors
child the parent or the guardian lacks in the
sense of judgement and reality and fail to 1. Both parents or either of them or a sen-
think about the consequences. Family discord ior member of the family , who may or
and lack of understanding and cohesion be- may not be the guardian of the child may
tween the parents are other important be the offender.
causes. Apathy , alcoholism on the part of ei- Parents may be unmarried couple ; as is
ther parent are also countable. commonly seen in some Western society.
There is no preponderance on the basis 2. Usually the parents are young.
of race, religion, geographic distribution or 3. Low educational status.
nationality. But there is some degree prepon- 4. Reckless life style , often habitually indulg-
derance of male child than female child to be ing to intoxications .
the victim of atrocities. 5. Often the parents themselves were the
victims of battering, during their child-
Factors related to battering of children :
hood .
Predisposing factors
6. P sychological factors - Low tolerance
Minor assault of children by parents or guard- threshold, impulsive nature, aggressive
ians for chastisement during their childhood, personality, imbalanced temperament.

chapter 18: CRIME A ND CRUELTY AT HO ME I 573
C. Socio familial factors 6. Apart from the similarities mentioned

above, there may also be similarities in
1. Low social background.
the baby, parental and socio-economic
2. Lack of parity between members of the factors.
family. Lack of peace in family.
3. Financial hardship. Type and nature of injuries sustained by
4. Trouble at the place of work. the victims
D. Precipitating factors The injuries are usually bruise, abrasion,

fracture of bones (skull, ribs and limb bones) .
1. Act of disobedience by the child. and less commonly laceration (usually on the
2. Frequent crying may create annoyance. head). Accompanying internal injuries may
3. Refusal to take food. be in the form of intracranial haemorrhage,
injury to lung, or liver and less commonly to
4. Soilin~ of dress or bed clothes.
kidneys. Bums and scalds are also common.
5. At times any trifle act of the child may
The injuries may be caused by hand, foot,
annoy the mentally charged father or
stick, belt , shoe or any household article, hot
mother.
water, burning cigarette, hot frying pan, etc.
Some features- which are more or less The head of the child may be struck against
constant in these cases a wall or the head may be strongly shaken or
a bunch of hair suddenly pulled to jerk the
1. The parents of the battered children seek head violently. Sudden violent jerking of the
medical aid for their children rather late head may cause whiplash injury inside the
or when the condition of the children head, causing haemorrhage and contusions
becomes serious. at places.
2. They present vague history of accident The injuries may be of any type and ex-
to be the cause of the injuries, e.g. fall tent. There may be bruise or bruises of any
from stair, or cot or a similar story, which size, abrasions, fracture of bones, injury to
does not appear consistent with the type the internal organs including laceration ofthe
of injuries or time narrated by the par- intra-abdominal organs, contusion, laceration
ents. Often the parents give a history of of the brain, intra-cranial haemorrhages, in-
tendency of the child to bruise easily. jury to the spinal cord and even retinal de-
3. Often old healed injuries are detectable tachment. Some of the victims are subjected
in the victims. to bum injuries.
4. In many cases the parents later admit to Spinal cord injuries occur along with in-
have assaulted their children but "only jury to the vertebra and "nabbing fracture"
mildly" and for chastisement. at the posterior angles of ribs. Small isolated
5. In case of elderly children; (a) They may fragmentation of parts of epiphysis the re-
not disclose the distress, (b) May disclose gion of ribs when multiple, may give stringed
it indirectly placing some imaginary (non- beaded appearance.
existent) friend in his place, or (c) He or
Medicolegal aspects of the problem
she may disclose it to some specific per-
son whom he or she loves or trusts. In some cases the victim battered children
574 I PRINCIPLES OF FORENS IC MEDICINE
even die . In these circumstances, the offender provision under the law . Incidents of cruelty
parents or the guardians of the children in at home may not remain limited within as-
this country may be charged for commission sault and injury. It may be , e.g. providing the
of culpable homicide amounting or not child insufficient food , inadequate care , pro-
amounting to murder and in England for tection and education . Reports ofchild slav-
murder or manslaughter. In other cases ery (though banned) are available in this coun-
where the babies suffer injury, the offender try. Kidnapping or seducing a girl child for
parents or the guardians may be charged for immoral traffic and sexual assault on young
causing simple or grievous hurt . But often girls are the other examples of atrocities on
the cases are so misrepresented and the vic- the children. There are provisions in law for
tims being unable to open their mind, the dealing with these offences. In a highly popu-
interpretation of the injuries may be wrong . lated country of the world pre-delivery de-
Even Caffey, who was the first to record such termination of sex and abortion of female foe-
injuries in the victim children were misled tuses is posing a social problem. This is an
and made to believe that fracture ofbones in extreme act of cruelty.
those victims were due to the fragile nature
Impact on elderly children
of the bones of the victims.
This being one aspect of the problem, on Apart from attempt not to disclose his or her
the other side, reasonable arguments have plight or only i..:nited and selective disclosure,
been forwarded that such acts of assault on something more are marked and felt in the
the youngsters should not be viewed at par grown up battered children.
with assaults in other circumstances . Abso- 1. Physical injury may be present which he
lute mental soundness of the parents are may generally like to hide or may dis-
questioned when they beat their own chil- close only in selective manner.
dren mercilessly and seriously. Such parents 2. The child may take the abusive behav-
instead of punishment, require sympathetic iour as normal.
psychological treatment . This may not be true
3. Long duration of abuse or battering may
in all cases. But the vast majority of these
leave him constantly frightened , he may
cases may possibly demand such considera-
be afraid to go home or may even flee
tion.
from home .
The picture may also be altogether dif-
4. The behavioural pattern may change
ferent, when it is seen that, parents often
take their children from one hospital to an- (a) He or she may be disruptive , aggres-
other hospital or doctor, sometimes with sive may indulge in bad , antisocial
vague complaints without basis or sometimes or criminal acts.
in confusion or to create confusion. Some- (b) May get addicted to drugs or alco-
time this ''M:unchausen's syndrome by proxy" hol at a very young age.
on the part of the parents becomes compul- (c) May be self destructive and/or prone
sive- obsessive type of practice by them. to accidents. \
Among other circumstances of cruelty on (d) In some cases, withdrawn , non -com-
children, infanticide has been dealt else- municative or over obedience , shy ,
where . Abandonment of a child has separate unmindful to his dress , personal

matters, disinterested in his per- parent inside the jail, who is the only earn-
sonal affairs and attraction matching member of the family, actually punish-
ing with his age . ment is imposed on other family members,
(e) There may be mental and emotional to get nothing in return. Hence, for success-
inhibition, may think himself worth- ful dealing of these cases, a more practical
less or good for nothing, may fail to approach should be there. Along with the le-
adjust with others, may be repulsive gal provisions, there should be a programme
towards elders. to eradicate the causes, which create such
(f) He may be cruel to pets or other hostile parents. In many cases the parents
younger members in the family or may need psychoanalysis and treatment,
at school. rather than imprisonment.
(g) Sexually abused children may de- 'iocio-aetiologically, there is no difference
velop avulsion to sex in future. Nor- b~.-~ween physical battering and mental tor-
mal sexual behaviour may not de- ture. But, from diagnostic point of view, men-
velop i;n them. Some may develop tal torture is a more difficult variety of cru-
sexual perversion like homosexual- elty on children and is equally difficult to be
ity, sadism or masochism Th€y may treated or dealt properly.
totally avoid normal sexual behav- Child labour and sexual offences on chil-
iour in future. In female children dren including child prostitution are the other
vaginismus is a possible complica- varieties of cruelty or torturous treatment
tion in future. of children. These problems have different
5. Some of these maltreated children can't backgrounds which are more socio-economic
realise that they are subjected to unde- in nature and use of stern legal and execu-
sirable or abnormal behaviour. They can- tive measures may help to eradicate the prob-
not assess that they are being treated lems successfully from an otherwise healthy
differently than other children are society.
treated in their home.
Treatment of the traumatised children
Dealing with the problem Physical treatment is definitely necessary for
physical injury or trauma. But when psycho-
As discussed in the aetiological factors, the
logical or behavioural disorders develop or
problem is a complex one. The factors respon-
when there is apprehension of this, that needs
sible indicate that defect lies deep in the par-
serious thinking. For both physical and psy-
ents or guardian's developmental, personal
and environmental factors. Cruelty on chil- chological trauma, if persistent in nature, the
child may be removed from the bad guardi-
dren is an offence and there are provisions of
anship to a centre established to care chil-
punishment to the guilty parents. The prob-
lem of using the legal penal provisions, how- dren. But in our country that may give rise
ever, cannot be ignored. The legal punish- to some other problems and may not beef-
ment can't have fruitful effect on other pos- fective .
sible offenders, which is clear from the na- So far physical trauma is concerned
ture of the parental and socio-familial factors physical treatment is essential. But for psy-
responsible. Secondly, by sending the erring chological trauma and behavioural problem,

psychological treatment including individual a female is viewed as a subordinate to male .

and group counselling is necessary. Positive For the same job a female labourer is paid
result out of these is more easily available in less than a male. A woman is not entitled for
comparatively younger children. But in case certain jobs. Female education has received
of adolescent victims it may be difficult to worldwide importance only during the last
impart good result. In adolescents also indi- few decades. We still find very low percent-
vidual and/or group psychotherapy is neces- age offemale representative in different leg-
sary and may need to be continued for a islative bodies of different countries. There
longer period with patience . was a tendency to keep the woman confined
at home or push her in a club or theatre as a
Psychotherapeutic counselling of the err- performer and if she was not under the guardi-
ing parent, guardian or caretaker of the child anship of a 'superior' male then in some cases
should continue simultaneously. even she could be made to lead a life of pros-
titute to earn her livelihood.
In India, the condition is still worse. For-
getting the past 'Sati' cult where a widow had
to die a violent death by being burnt with the
Though incidents of atrocities on women has dead body of her husband, the still-existing
presently drawn maximum attention all over dowry system and hurdles of marriage for the
the world and corrective steps are taken by second time by a widow, sufficiently estab-
way oflegislations and other social means to lish the greater importance attached to the
remove the problem of inequality in the soci- husband in our society. The feeling given to
ety or at home on the basis of sexuality, we a married woman that if her husband dies
in this country are confronted, for over last she would have to lead a bachelor's life for
four decades, with more number of bride the rest of her life, enforces importance and
deaths in matrimonial houses. Interestingly, respect in her for the husband.
we get some similar reports from developed
True, there has been a feminist move-
countries also. Friedman, MDA (1979), ob-
ment in the society and at present we find
served that "If child abuse was 'discovered'
more frequently organised movements by
in the 1960s, then wife battering seems to
women's organisations for establishing rights
have emerged as a problem a decade later".
of women and to protest against atrocities
Wives at home and women in general are
on women. But the movement has not yet
viewed as subordinate to their male counter-
been very much successful in correcting all
parts since the unknown past, till today.
the wrongs at their roots.
In a family environment, minor differ-
ence in opinion or dispute is not only com- Position of women at their parental homes
mon but should be taken as a normal way of
Though, at the parental home generally
family functioning. Thus, we should be in a women do not face any specific cruelty, it is
position to differentiate between "dispute" and here that the woman inherits the sense of
"brutality" or "cruelty". subordination to men. The mother prefers
to build up her daughter as a good house-
Status of a woman in the society
wife like her. The father finds it more rea-
As has been mentioned in the first paragraph, sonable to allow more exposure to his son

th.a n the daughter. All in the house wait for on the children. The extent of the problem
the day when the guardianship of the girl may be realized if we consider the fact that,
along with her title will change and she will keeping aside mass killing in natural calami-
be under care ofhernew in-law-parents and ties, due to drowning and due to road traffic ~
husband. Rightly, it is a conunon say in India and other transportation accidents, unnatu-
that a woman is never free in her whole life. ral deaths are maximum at home in compari-
From birth till the day of marriage she is son to any other circumstance. This means
under the care of her father, then she is un- that, most of the intentional deaths occur at
der the care of husband and after that till home, and most of the victims there are the
death she is under the care of her son. house-wives.
It is true that, for a woman who is re-
Status of the woman in the in-law or the
matrimonial house
peatedly cruelly treated, divorce is the only
way oflife. But divorce is not the natural con-
In the Indian society, it is the onus of the sequence of marriage as it does not serve the
new house wife to adjust with all, in the in- purpose of marriage, Hence, divorce cannot
laws' house. She is to obey her husband and be the solution for the problem. This clari-
other seniors in the house and look into the . fies further, the exact nature and extent of
comfort of all members. Such a circumstance the problem. Most ofthe incidents of cruelty
is very likely to give rise to personality clash, on wives do not come to public knowledge.
The psychological clash may one day take For the sake of self-prestige or prestige of
physical shape and almost always it is with the family , the wife often prefers to be mute
the husband initiating physical assault on the and does not ventilate her grievances to oth-
wife. The cruelty may one day end ultimately ers . It is only when the battering of the wife
with death of the wife or a divorce. takes a really bad shape, the state of affairs
come to the public. Then also, it may be a
The Problem very difficult matter for the police or the court
to reach in depth of the problem. True, the
Ifwe consider the house as a sweet, safe shel-
wife also may be responsible for the family
ter for the members of the family, then no discord, The wife may be a constant source
amount of atrocity by any of its members on of mental torture for the husband. But that
the other is at par with this idea. If the hus- cannot always justify cruelty or physical tor-
band for example, always tries to demonstrate ture on the wife . That is never the remedy.
his superiority, then there will be an increas- It is generally accepted that the wife being
ing sense of inferiority complex in the wife. weaker physically, socially and in resources,
This is bound to break the family harmony might easily be physically and mentally tor-
and the sweet, free marital relationship is tured by the husband, if that is the story.
bound to break. This not only exerts its bad
effects on the other members of the family, Factors responsible for cruehy and
particularly the younger members, but also, atrocities on wife
the family being the unit member of the so-
1. The type of the husband
. ciety, it also damages the normal social psy-
chology. The maximum sufferer is the fam- (a) Alcoholics, gamblers .
..
ily itself. Such an in-cohesive relationship is (b) Badly brought up ~ spoiled children
bound to have its maximum damaging effects (during childhood).
n= M -:371
(c) Sense of male superiority, irrational The physical assault

expectation of submissiveness and
service from the wife. Physical assault may lead to simple injury or
grievous hurt. It may even lead to unexpected
(d) Psychopathic personality. death of the wife. On the other hand torture
(e) Lack of proper education, mental may be a deliberately planned one, to kill the
immaturity, intolerance. wife.
2. Factors concerning the woman The physical assault may be free hand
(a) Bad temperament, lack of under- assault, or she may be assaulted with a stick,
standing and sympathetic attitude a whip, a cane, a knife or a household appli-
towards the hardship or distress of ance. The wife may even be strangled to death
the husband. or may be set on fire. To add insult to the
(b) Lack of sense of reciprocal respect,
assault, the women may be taught a "good
lesson" by subjecting to be mentally tortured
persistent lack of interest on the
husband or affairs of the husband. and assault~d by a third member of the fam-
ily. There are records of use of fire-arm
3. Factors concerning both partners weapon also.
(a) Lack of mutual understanding, ri-
Negligence may be deliberate lack of care
gidity in both. and attention to the well-being and basic
(b) Unplanned and undesired preg- needs of the wife, like paying no attention to
nancy. her health during pregnancy or ill health,
(c) Attempt to have full control in the providing no medical care·, over-work, not
upbringingofthe child. allowing any entertainment etc.
4. Socio-economic factors
Dealing a case of cruelty with wife
(a) Influence of social subculture to
which the family belongs. All cases of negligence and cruelty cannot be
(b) Financial hardship. dealt with the same yardstick. In a case of
physical assault while steps for punitive meas-
(c) Prevalence of dowry system in some
ures against the husband is processed, the
societies. following points must be given due consid-
(d) Low status of the females in the so- eration. :.
ciety. 1. The gravity.Q{the•assault.
The degree of cruelty and assault 2. The will or desireofthe assaulted wife.
The cruelty may be

of
3. The backgfuth';id the present assault.
4. Any his~ry ot~ast assault.
(a) Ill behaviour
5. The repal:)mty,,of.the complaint; if there
(b) Mental torture
is any :Wi~;~.~ ~·.. ·: :'
(c) Physical assault
6. The char;:t~;r- ~~.P.Il:St record of the hus-
(d) Negligence. band.
Til behaviour and mental torture may lead 7. Whether the wife is solely dependant on
to commission of suicide. the husband.
·I
8. The extent of responsibility of the wife , problem for the wife. In Indian society in
if any. most circumstances, the wife takes shel-
9. How much the family will be affected if ter in parental house. In many occasions,
the husband is affected (punished with im- this also may be problematic. In absence
prisonment etc.), particularly if the of- of parents, the woman may find it diffi-
fence is trivial. cult to take shelter at the house of a rela-
tive. The government has some 'Homes'
10. Precautionary step should be taken so
for such helpless women. But the condi-
that the offender cannot cause further
tion of these homes are horrible. These
harm to the wife after the punishment,
homes accommodate, criminals, prosti-
if any.
tutes, delinquents, often all within one
The remedy boundary.
3. If the wife is to live separately, then she
The remedial measures should be directed also requires economic support. If the
on the following lines husband has not been prosecuted, then
1. Justice to the victim wife . she may get subsistence frotp the hus-
2. Safeguarding the interest of the family band's earning. But if the husband has
and other members of the family. been prosecuted and if his earning is sus.
3. Minimum disturbance of the family struc-
pended, then she may haye to prefer to
go to the Government owned Homes. If
ture.
she has a few dependants to take care of
'
Justice to the victim wife then she may have to beg from relatives
for financial support until she can make
1. The wife may need good counselling_In som~ of her own earnings, which is not
most circumstances the wife has either easy to do, ~
no knowledge or hazy knowledge as to
4. If the husband has been prosecuted, then
what she should do during the crisis. Dif-
the wife needs legal help. There is provi-
ferent legal advisory fora have come up
sion for this help free of charges, for a
for the tortured women. Many of the po-
woman,
litical parties have their women's wings
which take interest in the well being of 5. Another help needed by the woman
the sufferer women. In 1988, Calcutta whose husband has been punished on h~r
police has started a women's cell (followed complaint is protection and security for
by many others elsewhere), exclusiy~ly herself and her children from the enraged
to look after the grievances of the husband, after he returns from his pun-
women particularly, the tortured wives. ishment term.
Thus, increasingly, it is becoming the As a matter of fact, no remedy can be
concern at all levels in the ·society. sufficient to do good to a broken family.
2. For the wives, who cannot continue in This is the first thing which both the
their matrimonial homes or if with the spouses must realize, No extraneous help .
arrest of the husband, the wife has to can match their own effort to make their.
leave the rental flat of the husband then ;h ome a sweet, sacred shelter for peace
' and happiness.
accommodation may be another burning

CRU LTY ON THE OLD A D DISABLED

IN EFAMILY
Cruelty on husband is rather a less culpa-
ble, less concerning problem which was so- The problem here is something different both
to-say not recognised or 'known' in this coun- qualitatively and quantitatively. The victim
try, about 30 - 35 years back. All the while of cruelty here is a person who does not have
it is not entirely a new problem. Cases of much 'importance or value' in the family. He
killing of the husband by the wife by use of is often considered a burden to the family.
poisons or killing the husband with the help Unlike battered child, he can protest, but
of the paramour are not very infrequent. there is none to listen to his complaint.
Physical assault of the disabled husband is Rather, by experience he learns that com-
occasionally recorded. Assault on the hus- plaints or grievances are retaliated by more
ban9. by the wife may also be an act of recip- cruelty. Physical assaults are not unlikely,
rocation. rather quite common. The torture thus may
Psychological cruelty is a more common be in the form of physical or mental trallil¥1,
suffering for the husband from the wife. negligence in the form of non-providing
timely and sufficient food, non-maintenance
Rarely does an incident of cruelty by the
wife on her husband comes to the knowledge of cleanliness and lack of provision for nrini-
mum scope of entertainment and recreation,
of the public. This is primarily because the
husband does not want this due to various These cases very rarely come out in the form
reasons. Generally, it is less convincing to of direct complaint. The scope of proper rem-
edy is also very meagre. However, provision
others that, a husband may be physically as-
saulted by his wife. Secondly, ventilation of the law is same as in case of cruelty to
children.
hurts the sense of superiority of the husband,
it adds insult to his injury to propagate that
he has been assaulted by his wife. Thirdly, in
CRUELTY TO OTHER MEMBERS OF HE
this country, the general sympathy goes in
FAMILY
support of the weaker sex, the wife. How-
ever, the few cases which get publicity show
that the wife may not be less cruel than the The victim may be any member of the family
husband. or the domestic servant.
The investigation of these cases should For the domestic servants the cause
proceed in the same line as the investigation may be improper service or allegation of
of the cruelty of husbands on the wives. The theft or allegation of improper behaviour
problems arising for the family are also to to the female members of the family. In a
some extent of the same nature as in case of case of sexual relationship between the
taking action on a cruel husband. But here male serva11-t of the family with a female
finance and accommodation may not pose a member, the penis of the servant was
problem. Rearing of young children rather amputed.
appears to be the greatest problem; if the wife For other members any minor dispute
is to serve a term as punishment. may terminate to a serious incident.

chapter 18: CRIME AND CRUELlY AT HOME I 581
Condition in Western Countries • Cruelty at Home- Freeman, M. D. A.
In western countries also women are more • Comparison versus Control- A. A. Rosenfeld, E. H.
tolerant than men so far abuse and torture Newberger. JAMA, Vol. 237, 1977.
is concerned. But in those countries abuse of • The Battered Child, 2nd Edn. 1974, Chicago Union
husband by wife is more common than in our Press.
country. Wife battering occurs in retaliation • Cruelty on Children- G. Reming. BMJ, P. 421, 1967.
to continuous abuse and mental torture of
• Child murder by parents - P. Resnick. Am J of Psy"
the husband. In many western countries it is
chiatry, Vol. 126, 1969.
said that law is gender biased with inclina-
tion to view the wife as innocent and the • Battered wives- D. Martin, 1974.
husband as offender. If in retaliation of con- • Human violence- A. D. Pokorny. Journal of Criminal
tinuous abuse and mental torture by wife the Law, Criminology, Police Science, Vol.. 56, P. 488, 1965.
husband slaps her, then the husband will be
• Violence in the American Family- M. Straws et. al,
booked as batterer. Tortured husband often
1978.
prefers to keep ·abuse physical and mental
torture undisclosed or presents as his own • Assaultiveness and Alcohol use in Family disputes.
fault or some other matter as the cause. Tor- Criminology, Vol. 12, P. 283, 1974.
ture of wife by the husband may be retali- • Recent advances in paediatrics - A M. Sarette -
ated by the wife by leaving the home , by kill- 1954.
ing the husband "before he kills her" or she
• WB Woodman and Charles M Tidy -Forensic Medi-
may seek the help oflaw . But in many cases
women tolerate , abuse, humiliation, physi-
• Pekka Saukko and Bernard Knight - Knight's Foren-
cal and mental torture by the husband with-
sic Pathology~ 2004.
out much reaction or protest. Abuse, irrita-
tion, physical and mental torture can be from • Michael J Skrun and Davidson A Ramsay - Pathol-
either side on provocation or as such. ogy of Trauma - 2006.
• Warner U, Spitz David J, Spitz Ramsay Clark, Russel
The matter is almost equally similar in
S Fisher- Spitz and Fisher's Medico/ega/Investiga-
case of a man staying with a woman under
tion of Death - 2006.
the same roof though not legally married .
:Rather intolerance from both side in such a • Georg in Beers- Finding home- 2006
circumstance is more as there is no legal and
less moral bindings.
What is battered child, What are the causes? What

are the social problems? How can these cases be
• Recent advantages in Forensic ·pathology (1969) . F. recognised? What are the different forms of cruelty
E. Camps.
.
~ .. ·
,
on wife, husband, old and disabled?

NOTES

Blood transfusion is an emergency and life- transfused to 'A', 'B' or 'AB' group recipient.
saving therapeutic measure . But the therapy Apart from signs and symptoms of mismatch-
involves certain·risks and hazardous compli- ing in the form of rigor and compression over
cations. chest, proper investigations will reveal the
Keeping the hazards of blood transfusion mismatched transfusion.
in view, it should not be given to a patient (a) There will be free haemoglobin in the
who does not consent for the same. Instead, blood of the transfused patient.
the patient may be treated by other best avail- (b) Haematin, methaemalbumin and hili~
able means and a record refusal of transfu-
rubin Clater event) in more than normal
sion signed by the patient, should be kept to
ranges in the blood of the patient or the
counter any subsequent charge of negligence
deceased, who was given transfusion, if
against the doctor.
he had no such thing in his blood before
The hazards ofblood transfusion are : transfusion , are also indicative of mis-
1. Serological - arising from mismatched matched transfusion.
transfusion. (c) Blood, subjected to microscopical exa-
2. Transfusion of infected blood. mination may show clumping of the do-
3. Infection due to wrong technique . nor's cells.
4. Transfusion of excess volume . (d) If no clumps are observed, coomb's test
5. Air embolism. may show clumping, suggesting
6. Transfusion ofhaemolysed blood. sensitization of donor's cells by recipient's
serum factor, which in spite of mismatch-
1. Serological Problem ing, failed to agglutinate the cells due to
some reasons. However, it should be re-
Due to mismatched blood transfusion there
membered in this context that, a living
may be haemolysis and clumping of blood
body will try to remove clumped cells very
cells. Mismatching occurs when there is in-
rapidly. ·
correct grouping and cross matching of the
donor's or recipient's blood , or when under The serum and cells of pre-transfused and
compulsion, blood _from J:Y group donor is post transfused blood of the patier:tt and
the serum and cells of the donor's blood 5. Air embolism

should be subjected to re-testing by vari- During transfusion, air embolism may
ous methods. occur under positive pressure. Entrance
In the recipient's blood, the responsible of minimum 60 to 100 mi. of air may be
antibody may not be detected due to serious. The effects are noticeable near
wrong preservation or due to neutraliza- the end parts of vessels. In case of septal
tion of the antibody by the donor's cells. defects of heart chambers , much less
Sometime high titre antibody in donor's amount of air may be dangerous.
blood may agglutinate recipient's cells.
This is possible in case of transfusion of 6. Transfusion of haemolysed blood
'0' group donor's blood in 'A' 'B' or 'AB' The effects are more or less the same as
group recipient, without proper cross in case of transfusion of mismatched
matching. blood. The danger of transfusion of
(e) There will be Haemoglobinuria, and haemolysed blood originates: (a) due to
hence, test for urobilin and urobilinogen transfusion of old blood, (b) badly pre-
will also be very much suggestive. served blood, (c) when haemolysis occurs
due to over cooling or over heating. Bio-
2&3. Transfusion of infected blood and chemical tests for blood and urine of the
infection due to wrong technique transfused patient as recommended in
case of transfusion of mismatched blood
Infection may occur in 2 ways: are also recommended for investigation ·
1. From transfused blood and .. of these cases.
2. From a contaminated transfusion
set.
This will cause corresponding infection
in the recipient, particular danger being for • I.P.L. Mollision - Blood transfusion in Clinical Medi·
Hepatitis "B" virus , AIDS virus , Malaria, cine, 15th Edn. 1972.
Syphilis and in other cases bacteremia. Even • H. Payling Wright et. al- Effect of post-operative bed
if the blood did not contain living pathogenic rest and early ambulation on rate of venous blood
bacteria, there may be complicated pyogenic flow- in Lancet, Vol. I, 1951 .
reactions , like rigor, pyrexia, severe shock. • Michael J Skrun and Davidson A Ramsay - Pathol-
In the event of death due to pyogenic reac- ogy of Trauma - 2006.
tion there will be subendocardial haemor-
rhage in the septum ofheart and straining of
non- pathogenic bacteria in the Kidney net•
work.
Oral questions
4. Transfusion of excess volume may What are the possible hazards of
cause two hazards mismatched blood transfusion
(a) Overloading of heart old blood transfusion
(b) Pulmonary oedema. blood transfu~ion due to wrong technique?

fresh infection in world 3.4- 6.2 million with
o hesoa
total infected people as estimated was be-
tween 33.4-46 million (2005). On the eve of
World Health Day of 1997, WHO published a
Acquired immuno deficiency syndrome,
booklet for the Southeast Asia region which
which was of little significance and worry
mentions that at that time reported AIDS
about 25 years back, already struck a blow to ·
cases in India were 2,996 and estimated HIV
the root of Alma-Ata Declaration of 6. 9. 78,
infected persons might be about 25,00,000.
'Health for all by 2000 AD'. The threat of
Thailand topped the list in this region, with
AIDS is already a serious global problem and
44,471 AIDS reported cases and 80,00,000
concern. Though comparatively a new dis-
estimated HIV infected cases. But as in 2005
ease, it has spared no parts of the world. It
India topped the list in whole of Asia, with
has been designated as 'indifferent to the
approximately 5.7 million (3.4- 9.4 million)
. sufferer's place of stay, and contemptuous to
being infected by HIV which is numerically
their hopes and dreams'. In a sense "we all
highest figure (not in terms of percentage of
are living with AIDS". In an estimation in
population) among the countries of whole of
1989, about 450,000 people were suffering
from AIDS, and another 5 millions were in Asia. In fact, inspite of discovery of some
way of being infected. These statistical fig- therapeutic measures and counting out the
ures were later proved to be less than the sufferers who may die within this period, now
real number. In another study, published in it is thought that, number of infected per-
New England's Journal of Medicine, in 1989, sons will be on an increase .
it was reported that in USA alone, there were According to WHO estimation, there are
137,000 infected persons and that the possi- at present (2005 estimation), about 5.7 (3.4-
ble world wide figure could be over 2 millions. 9.4) million HIV CHuman Inununodeficiency
The 1990 statistics put the figure of infected Virus ) infected persons in India. WHO fur-
persons at that time to be about 8-10 mil- ther cautioned that, with the rate of spread,
lions. It was then feared th,at by the end of number of infected persons India would sur-
the past century, number.~f~he infected per- pass the same in any other country, and in
sons would . be 15-20 million or even more. India number of HIV infected persons will
The (2005) es~imation pU:ts figure of annual surpass the total' number of presently in-
585
fected persons all over the world . AIDS is Diagnosis primarily rests on detection of
alarmingly affecting low income groups in IllV antibody in serum and (b) identification
India, Thailand and Indonesia, among the ofDNA and RNA pattem in the infected cells.
Asian countries. These are apart from clinical history and his-
The fatal nature of the disease with symp- tory of chance or opportunist exposure . Both
toms surfacing as slow poisoning, years after non-specific and specific diagnostic serologi-
actual infection, is one of the main reasons cal tests are available . Study ofDNA and RNA
pattem in cells infected by HIV is a good
of concem. Further, it gives a stigma to the
method ofdiagnosis of the disease at an early
sufferer and the family members and creates
asymptomatic phase . It is specially useful in
a horror to all concemed in the society. As a
newbom infants who might have been in-
matter of fact, it is looked upon as a greater
fected by the infected mother very recently,
danger than cancer due to its fatality, in_fec-
where PCR test is most successful. However
tivity, without discrimination for age or sex.
at present this cannot be expected to be ap-
The sub-Saharan countries and USA had plicable in mass scale in our country.
been the most sufferer and it was thought The greatest problem for early diagnosis
that India may beat them in near future. In is that, in the initial phase, for some years
one of our eastem states, the infection al- the disease remains asymptomatic HIV in-
most took the shape of epidemic for some fected period from its starting has been di-
time. However recent development shows vided in 4 stages:
that , AIDS may not always carry themes-
sage oftotal hopelessness . Newer, more ef- Stage I ~IV infection is asymptomatic
fective and comparatively less toxic drugs are and not categorised as AIDS
coming up; one such is protease inhibitor.
Stage II Minor mucocutaneous manifesta-
Life expectancy is increased and death can-
tions and recurrent upper respi-
not be said to be all certain due to AIDS. The
ratory tract infection
fear psychosis for contacting the disease has
now taken a more realistic shape. Stage III Unexplained chronic and recur-
rent diarrhoea; severe bacterial
infection and tuberculosis
Medical Problems
Stage IV Toxoplasmosis ofbrain; candidia-
The rapid worldwide spread of the disease sis of oesophagus , trachea ,
and the slow destructive effects on the suf- bronchii, lungs and Kaposis's sar-
ferers along with other different dimensions coma
of the disease, have shaken the medical re-
searchers and practitioners, who are pres- Hence, in the early; phase, in absence of mass
ently totally concemed with therapeutic and screening, most of the infected cases remain
preventive aspects of the disease. The belief undiagnosed. Once j.t becomes symptomatic,
was that, it is a disease which must spread it may be the terminal phase of life of the
and engulf the whole population, ifleft to it- unfortunate victim; at any time during the
self. But hopeful light is in vision with newer different future st~ges of infection.
drugs , longer life expectancy and control in It is Cuba which dared to screen its total
its spreads population and arranged quarantine meas-

chapter 20: SOCIAL, ry1EDICAL, LEGAL AND ETHICAL PRO BLEMS WITH AIDS I 587
ures for the infected persons. In our country (c) Therapeutic measures have already de-
it can be proposed that high risk group peo- veloped many facets -
ple should be subjected to screening. High 1. Attempt to destroy the virus in the
risk subjects are identified as lower class fe- infected persons.
male prostitutes, their visitors, I.V. drug
2. Attempt to retard the activity of the
abusers and their sex partners, persons ear-
virus in the body.
lier infected with syphilis or other STD, with
presence of genital sores, sex prone drug bar- 3. Attempt to protect body immunity by
ters, infants oflllV infected mothers, homo- providing and promoting therapy of
sexuals and bisexuals. Among the two sexes, substances which are attacked and
females are more vulnerable. The reasons used by the virus in the human body.
to an extent, may also be due to factors other 4. Attempt to provide exogenous im-
than bio-molecular. Bisexual males usually mune therapy or stimulants.
act as the bridge between homosexuals and 5. Attempt to preserve life in the ter-
heterosexuals, for transportation of the dis- minal phase, when due to lack ofim-
ease virus. munity various infective problems
arise.
1. Attempt to kill the virus has
failed. Various drugs used and
tried also do not give optimum
A comprehensive remedial programme is
result. Zidovudin (retrovin) is
necessary which should be strictly adhered
an anti-retroviral drug. It de-
to. In poor and high risk countries, preven-
creases or partly retards the
tive measures should be more stringently
action of HIV. That way it in-
followed. In addition to the screening of high
risk group, the remedial steps include the creases the life span. It is more
followings: effective and used in persons
infected with the virus, show-
(a) Education
ing no or mild symptoms. DDI
(b) Research (dideoionos in e) and DDC
(c) Therapeutic measures (dideoxycytidine) are less toxic
(d) Preventive measures. and they slow the progress of
(a) Education should be to prevent further the virus. Multi-drug therapy
spread of the disease. This should not only is preferred to single drug regi-
cover the high risk group, but the gen- men, as this reduces the toxic-
eral population too. Education should also ity danger of the drugs and in-
comprise of to promote or foster under- creases their efficacy against
standing and develop compassion for af- immunity deficiency and viral
fected persons and to safeguard their vari- activity. Ditiocarb also lessens
ous interests. AIDS infection.
(b) Research - Continuous research is nec- 2. A chemically akin preparation
essary to know all features of the virus ofthe receptor for virus is CD4,
and to eradicate it. a constituent of cells attacked ~<~

588 I PRINCIPLES O F FO RENSIC MEDICINE
and used by virus, may be used Recent information provides that

as a substitute receptor for vi- zidovudin produced indigenously, will
rus. Experiments in Apes have cost less than the import cost. Indian In-
proved success. stitute of Chemical Technology CIICT) has
3. Lamivudine (3TC), Navirapine, given the technology to Cipla phannaceu-
Saquinavir, Indinavir and ticals for its production in the conn try.
Ritonavir are some other
legal, Ethical and Moral Aspects
antiretroviral drugs.
4. Cells used to culture the virus The following questions arise automatically
may be used for therapeutic in connection with HIV infection -
purposes . . 1. Newborn infants are highly susceptible ·
5. Killed or attenuated SIV virus to the disease if their mothers are in-
may sometime be used. HIV fected. A study showed that 27% of 117
antigen gp-160 is effective and infants of infected mothers were infected
safe. · within 18 months . Infected mothers give
6. Foscart, used for treatment of premature births. Weight of babies is
cytomegalovirus (CMV) retini- low. Most of the infected babies die by 4
tis which in AIDS leads to blind- wks. Serological diagnosis in newborns
ness has serious side effects. may be deceiving due to presence of art-
tibody in them from mother which inter-
7 .. Erythropoeitin is used for
feres interpretation. Hence it is a
treatment of anaemia in AIDS.
pertinant question whether infected
8. Pentamidine aerosal inhalation mothers should be compulsorily sub-
is the treatment against jected to termination of pregnancy , In-
pneumocystis carinii pneumo- dian law is more or less clear here. The
nia (PCP). provision of MTP Act also covers this
(d) Preventive measures - For newborn chil- condition .
dren -Infection from mother is usually 2. Among the risk groups, women and ado-
transmitted during para-natal period.
lescents are more prone to the disease.
Hence induced delivery followed by seg- Two of the some reasons being sex and
regation and PCR test may help in many drug abuse . Hence it needs consideration
cases. Infection may occur during preg- to introduce more stringent rules for the
nancy, during birth and on consumption professional prostitutes and definitely a
of mother's milk.
total war against parenteral drug abuse .
High risk group should be educated to
3. Blood transfusion being another way of
adopt methods suitable for the nature of
infection , testing of the donor's blood must
risk e.g. Quarantine of infected persons.
be made compulsory by law.
Steps as detailed above nnder (c) 3 & 4,
zones salk (Polio vaccine famous ) has 4. With the same re~soning , use of dispos-
made certain progress in inventing vac- able syringe and needle must be made
cine against HIV and SIV, tested in chim- compulsory .
panzee and monkey (attenuated and dead 5. If control of polygamy is not possible,
virus). some consideration may be given for en-

chapter 20: SOCIAL, MEDIC AL , LEGAL AND ETHICAL PROBLEMS W ITH AIDS I 589
actment of t ougher law against bisexu- For children of infected mothers - They
als. However, some useful general guide- should be reared in segregation from the
lines for the members of the society are: mothers with sympathy and compassion un-
(a) abstinence in young people; (b) to be der the guardianship of the state, if neces-
faithful to the committed partner, (c) fruit- sary (e.g. when the father is already dead due
ful use of condoms by all others. to the same or some other disease or cause).
6. Clandestine use of secret formula drugs A very painful picture of the victim children
must be prohibited by law enforcing au- of such circumstances have been deliberated
by JS Makumbi, Health Minister of Uganda
thorities.
in the 2nd International Congress on AIDS
7. Law should also be framed and enacted for Asia and Pacific countries held at New
to protect the interests and rights of (a) Delhi in 1992, where 40 countries participated.
patients, (b) the other spouse, (c) children He narrated the terrific condition which had
of infected mothers, (d) other members arisen in Uganda due to abandoning ofHIV
of the family, (e) co-employees, (f) em- infected children due to "compassion fatigue",
ployer, (g) h ospital patients, (h) doctors as he termed it. They were simply uncared
and other staff of the hospital and orphans. In one district of Uganda, there were
(i) members of the society in general about 50,000 such orphans, out of a total
population of 4,500,000.
8, The HIV infected person cannot avoid
certain stigma, which includes homosexu- Other members of the family - Compas-
ality, bisexuality, promiscuity, drug abuse, sion, sympathy, moral, and ethical considera-
discrimination and rejection. These are tions for the patient should not in any way
hamper the interests of the members of his
not helpful for the society because in pre-
family. Segregated treatment should be
sence of the adversities HN infected per-
made compulsory.
sons wjll not transmit their disease which
ultimately banns the society in controlling Co-employees - HIV infected persons
should not be discharged from service for just
the spread of the infection.
being infected. But to give effect to such a
Rights of the patient in each circumstance proposition, the Govt. should also see that,
may clash with rights of the other groups. adequate steps are taken at the place of em-
The patients need - Proper diagnosis and ployment so that, there must not be anything
tre.a tment - including dangers from thera- right or wrong, which can create sense of
peutic agents, subsistance/rehabilitation, insecurity among the co-employeeil.
compassion and sympathetic dealing Employer - Indiscriminate service by an
HIV infected person may in various ways af-
For other spouse - The other p artner of
fect the productivity adversely, which will
the infected husband or wife should be allowed
damage the interest of the employer and the
divorce.
State. The law should provide safeguards in
Here, it ma;y be mentioned in any type of this regard.
sexual contact, vaginal, anal or oral, chance Hospital patients in general - Cross in-
of infection is about double in "receptors" fection in hospitals must be avoided. It should
than " insertors", when one of the partner be enforced by law for the hospital, where
carries the virus. · · '~ · AIDS patients will be treated along with other

patients , that , all precautionary steps are RolfM Zindernagel a Nobel Laureate in
taken to prevent cross infection . medicine predicted that within 10 years there
.. Doctors and other hospital staff - Those will be a vaccine to delay the outbreak of full-
who are connected with treatment of AIDS blown AIDS in people infected with HN. The
delay may be 20- 40 years in place of 10 years
patients should have the facility for time to
presently.
time free testing of their blood . They also
should have free insurance benefit . Informa- There are some misconceptions about
tions about this disease by a doctor to the HN infection which are not true .
proper authority should be considered as 1. HN can spread through casual contract-
"privileged communication ". It is not true . HN can spread due to con-
tact of body mucous membrane through
Members of the society in general - The
body fluid like blood or plasma of an in-
steps which have been suggested in the pre-
fected person if transferred to another
ceding paragraphs, should also guard the in- person, or semen of a person passed into
terest and rights of the public in general. But, another person by vaginal canal or oral
· for special circumstances suitable rules route , by way of hypodermic injection
should be there. with a contaminated needle, i.e. sharing
Complex situation may arise in many a corrnnon needle between an infected and
other circumstances e.g., if a person alleges non-infected person .
that another person knowing himself to be 2. HN infection can be cured by sexual in-
infected by HN, has intentionally acted to tercourse with a virgin : No , rather the
transmit the disease to him Our law has virgin so deflorated by an infected per-
sufficient provisions for dealing with such son will have a very high risk to be in-
· cases both in the criminal courts as well as fected .
in the civil courts. 3. It only infects homosexuals : No, it can
Though legal problems have not yet sur- infect homosexuals as well as hetero-
faced much , it will do so after more and more sexual (vide no. 1 point above).
people get infected and start showing symp-
toms. Many ethical problems have already
cropped up, some with genuine causes (dis-
charging a patient for lack of proper facili- • AIDS - etiology, diagnosis, treatment and preven-
ties ) and some due to lack ofknowledge and tion -Vincent T. Devita, Gr. Samuel Hellman Steven
education in this regard (doctors refusing to A. Rosenberg, 1988.
attend AIDS patient). It is on these back-- • Pascal Kintz- Drug abuse- 1996.
grounds that a medicolegist has to play his • Laurence B, MD Erlich- A handbook of Forensic Ad-
role. He may not have much to do with each dition, Medicine and Psychiatry- 2001 .
individual case. But he may be included in
• Tristan Tormino- The ultimate guide to and sex for
the team of workers and policy makers, and
women - 2006.
its implementation team, to assess, analyse
and guide the ethical and also medicolegal
aspects of the problems which the infected Questions
persons and others around them may face,
arising at different stages and at different Short Notes and Oral questions
levels. Medicolegal and ethical problems of AIDS.

Th Fore s1c Psychiat sf Role of a Forensic Psychiatrist in litigations
involving questionable mental soundness
of a person
In this country, Forensic Psychiatry is one
of the least developed branch or field for both The functions ofForensic Psychiatrist in such
Forensic Medicine and Psychiatry. Neither cases are variant in nature. He has to certify
a Forensic specialist is encouraged or is in- mental capacity and soundness of a person
terested in this superspeciality, nor a psychia- in the following circumstances.
trist is ever seriously interested to be well
conversant with relevant legal aspects ofhis (a) In relation to criminal cases
service. However, in matters oflegal disputes, 1. When a defence is attempted on the ground
needing specialists opinion about the mental that an act which is otherwise considered
condition of a person, the service of a psy- as a crime, has been committed by a per-
chiatrist is more often summoned by the le- son in a state of mental unsoundness.
gal people than of a Forensic specialist. Of 2. When an accused on the ground of in-
course , many a time the man of Forensic sanity, expresses his inability to plead his
Medicine is a member of a board along with defence during trial.
the psychiatrist, in the examination of anal- 3. When after being convicted in a court of
leged mentally unsound person, either by law, petition is filed before the court, to
order of the Ld. Court or otherwise.
' '
Instead defer the execution of the punishment till
of dissatisfaction over this issue of non-in- the convict is mentally sound or, to send
volvement or partial involvement in these him to a mental asylum for treatment,
cases, the Forensic specialists in this coun- instead of sending him to the prison to
try need not be dissatisfied, so long they are serve the term of imprisonment.
not well conversed with the discipline of psy- 4. When it is claimed that a person has com-
chiatry and its development. For bridging the mitted suicide due to the effect of mental
gap, either a Forensic specialist should have unsoundness.
additional training in psychiatry or a special- 5. In connection with criminal breach of trust
ist in psychiatry should in addition have at or fraud committed against an insane re-
least a some training in Forensic Medicine. lating business or property matter.
<; O l
6. In connection with abetment to commit Mental health

suicide of an insane person.
By implication, mental health includes men-
7. When an insane woman is raped. tal wellbeing or mental soundness as well as
mental illness both.
(b) In relation to civil cases
Mental soundness retains possession of
1. Testamentary capacity or capacity to mental well being, good understanding and
make a valid will. proper assessment of oneself, his environ-
2. Continuance or dissolution of a business ment and surrounding; balanced dealing with
contract on the ground of mental abnor- affairs , proper emotional outlet; positive
mality of either partner. thinking and relationship with others; accept-
3. In connection with nullity of marriage or ing himself and other, capacity to manage his
divorce cases. affairs effectively, gradual mental growth
with age and experience; consciousness about
4. Regarding capacity or validity to act (or
competence) as a witness . his position in his family, society and place of
work; capacity to face and deal with critical
5. Regarding validity of consent given by an
and odd situations effectively in accordance
insane person.
with personal status and social norm; to ac-
6. In certain contingencies, like appoint- cept others around him as they are and make
ment of a curator or caretaker of a men- himself up accordingly. Friendly behaviour
tally unsound person who is unable to and helping attitude from friends and rela-
look after his property. tives acts as food for good mental health.
To decide the above cases, it is necessary Similarly, engagement in good physical and
to have a clear idea as to whether a person is mental activities are also helpful. Mental
mentally sound or not, i.e., whether a per- soundness and wellbeing of an individual is
son is insane or not. There is no legal defini- ~~ set to the· society.
tion of insanity . In the truest sense, law does
not require also a clear definition of insan-
Mental illness . -~
ity. The purpose of law is to know whether With mental illness one is in a state of men-
at the material time , the person concerned tal disturbance with lack of capacity to un-
is or was mentally sound or unsound and if deQJt.a nd affairs in their proper perspective.
he was mentally unsound then, whether the He lags in judgement capacity and to act co-
mental unsoundness or abnormality the per- hesively, harbours false beliefs with distur-
son is/was suffering from, is linked with his bance of perceptions . He cannot guard or con-
act in question . Thus, as a sane person is trol his emotions and feeling. In absence of
responsible for his act, a mentally unsound positive thinking aim and determination and
person also may be responsible for commit- restraint he may be a nonproductive person.
ting an offence, if it is not the result of un- His attitude and behavioural pattern are not
soundness of his mind (inspite of his being in conformity with the society, the surround-
mentally unsound). ing and environment. He is cut off from real-
The special legal entity of an insane per- ity and society. He is considered as a prob-
son was first recognised and approved in Ro- lem and burden in every sphere of life in his
man law (in Justanian law). society.

chapfer 21: FORENSI C PSYC HI ATRY I 593
Definition of insanity 3. Mental conflicts

4. · Personal or familial loss
It is difficult to define insanity in such a way
as would serve legal requirements. The con- 5. Psychosocial stress
dition can be perceived as one in which the 6. Cultural background of the so-
patient suffers from some defect or disease of ciety.
the mind which affects his personality, men-
tal status, critical faculties, emotional proc- Classification of mental illness
ess, and his relation and interaction with his 1. Organic disorders -
immediate as well as total social environment. (a) Acute - Delirium.and subdelirious
states, toxic confusional states, Kor-
Causes of insanity or mental unsoundness
sakow's syndrome.
As jt is possible in physical illness, it is not (b) Chronic - Disorders due to degen-
so, to fix up one or more single cause for any erative, epileptic, traumatic, drug
type of mental i.llness. For insanity, complete and other intoxications, metabolic,
interaction offorces within the individl,.l.al and infective, demyelinating, neoplastic,
his environment is probably mostly respon- cardiovascular causes.
sible, Accordingly, the causative factors may 2. Affective disorders (involving the mood
be classified as - primarily) - Manic-depressive psychosis
A Intrinsic factors (mania and melancholia), anxiety state,
(a) Genetic - phobic state.
1. Specific gene or genes 3. Psychosomatic illness - In these condi-
2. Chromosomal anomalies tions, emotional and physical factors pre-
cipitate or aggravate some somatic dis-
3, Biochemical anomalies.
orders. These may affect, respirat ory,
(b) Constitutional -.
gastrointestinal, skin, menstrual and re-
1, Physical or physique of the sub- productive , endocrine , cardiovascular
ject systems and muscles and joints.
2. Personality 4. Compulsive conditions - Obsession, im-
S. Temperament pulse, psychopathic disorders.
4. Autonomic reactivity. 5. Others (not grouped in anY. specific type)
B. Extrinsic factors (a) Schizophrenia
(a) Physical - (b) Mental subnormality
1. Intoxication (c) Personality disorder
2 Injury (head)
(d) Psychosexual anomalies
3. Infection
(e) Hysteria.
4. Malnutrition
5. Others. Some terms which are commonly used in
(b) Psycho-social - psychiatric disorders
1. Early upbringing .. ILLUSION--' Illusion is erroneous interpre-
2. Adversities tation of some extemal object or stimulus.
[F' M. - 38]
Thu8 a person, out of illusion may think a this condition hears voice or sound with-
rope , a snake. An insane person out of illu- out any source or any such thing.
sion, may think a dog a tiger. 3. Olfactory hallucination - Here, there is
Illusion may be in relation to shape , size , a false sense of smelling without any
length, contour, figure appearance or motion source.
of an object or related to touch, temperature 4. Gustatory hallucination - Without any
etc. food or drink the sufferer experiences
Illusion may occur both in a sane or an different tastes.
insane person. A sane person, after close scru- 5. Tactile hallucination - The sufferer ex-
tiny or examination will. realize his mistake , periences crawling of insects over his body
whereas an insane person will persist with without any such thing.
the wrong interpretation, even after repeated 6. Psychomotor hallucination - There is a
demonstration of his error. feeling of movement of a part of the body,
say a limb, though in reality there is no
Medicolegal importances
such movement.
A criminal act committed by a sane person,
due to illusion will make him responsible for· DELUSION
his act and he will be liable to be punished. Delusion is a false belief in something with-
But if the act is committed by an insane per- out any basis and the beliefcannot be removed
son, out of illusion, then he may not be held from the mind of the sufferer. It is rather
responsible or may be held partially respon- persistent, even after the falsity of the belief
sible for commission of the act. is clearly demonstrated or explained with all
possible arguments. Some false beliefs and
HALLUCINATION
understandings arenot unusual in normal
In hallucination, there is false sense percep- healthy persons . For a sane person there
tion without any extemal object or stimulus. must be some reasonable. basis for that and
after reasonable arguments, explanations
Apart from insanity, hallucination may
and demonstration he can be convinced about
also occur in conditions like, high fever, de-
the falsity of his belief But in case of an in-
lirium of any origin, delirium tremens, drug
sane person the false belief is persistent and
intoxications (hallucinogenic drugs, like can-
cannot be removed in any way. Further, in
nabis, LSD, mescaline etc.) and as withdrawal
delusional belief mass or a section of people
symptom of some drugs of addiction. It may
is not involved. That is the reason, why
affect one or more than one of the special
though we can't prove or demonstrate exist-
nerves or nervous system. Accordingly, hal-
ence of God,,-l;J~t FlS a good section of popula-
lucinations are of the following types -
tion belief in the existence of God which can't
1. Visual hallucination - In this condition be removed from their mind, we won't say
the sufferer experiences (visualizes) non- such a belief as delusional. Delusion indicates
existent sights. He observes something some sort of. :mental abnormality which is
without anything being present in his more commonJy.fowd in some severe men-
front. tal illness lilre.s~hjzophrenia, manic depres-
.' ' .
2. Auditory hallucination - Th.e suf.ferer in sive psychosis, paranoid psychosis etc.

chapter 21: FORENSIC PSYCHIATRY I 595
Types of delusion 4. Delusion of reference - Here the sufferer

believes that, he is being referred to by
According to the nature of belief, delusions all agencies , media and persons around
may be of various types him in all matters concerning him or oth-
1. Delusion of grandeur - It is also termed ers. This ml':ly put him to unnecessary
as delusion of exaltation. This is a delu- conflicts with strangers and he may get
sion of pleasant belief or feeling. The suf- involved in some undesirable acts.
ferer remains exalted with feelings of 5. Hypochondriacal delusion (Psycho-so-
greatness, power and wealth . He may be matic delusion) - Here the person be-
expansive in his thoughts. · The sufferer lieves that there is some pathology or ab-
may be extravagant in his thinking and nonnality with some part or system or
action and may commit some crime in organ of his body, though in reality he is
such a state of mind or may squander his physically healthy. This sort ofbelief~l
money or property. timately may lead to delusiop. of perse-
Eratomania is a variety of delusion of cution. In ext~me cases some of these
grandeur, where the sufferer believes persons may commit suicide.
that a person of very high rank or social 6. Nihilistic delusion (nihilism) ..:.. The sufc
status loves him/her. The sufferer also ferer does not believe in the existence· of
believes that the imaginary person com- earthly matters or happenings. He even
municates his love in some manner or may not believe in his own existence.
other, by posture or by communication Such persons suffer from an . extreme
in secret or symbolic way. negative attitUde about everything. These
2. Delusion of persecution -This is an un- subjects may be the victims of accidents
pleasant delusion. The sufferer believes and they may even commit suicide.
that something bad is going to happen to 7. Delusion of infidelity - Males are the
him. He fears that he may be killed by usual sufferers. Without basis, the suf-
somebody or his property may be robbed. ferer strongly thinks that his wife is not
He is suspicious and apprehensive and faithful to him and is not trustworthy so
leads a life of distress and pain. Such a far her private life is concerned. She does
person may feel himself so helpless that not love him and has intimate relation-
he may even commit suicide or may kill ship with some other person. Such a
his own family members -to "save" them mental sufferer may torture his wife ,
from some imaginary danger. He may may kill her or may himself commit sui-
even kill some innocent person thinking cide.
him to be his enemy who is "out to de- 8. Delusion of self-reproach or selfcriticism-
stroy him, his family and his property", The sufferer unnecessarily censures him-
3. Delusion of influence (Delusion ofcontrol) self for some imaginary offence or rriis-
·- The sufferer strongly be'lieves that his deed "committed" by him. In serious
thought process, activities and behaviour cases, the person may punish himself by
all are controlled by some external power tetnlinating his own life . ·
- often a superpower. Such a person, on A person may suffer from mult1ple
the basis of some imaginary "command" dilwio~al disorder for a short p'eriod say
from some supernatural power, may com- without any other specific mental prob-
mit any unlawful act. lem or mental disease.

Medicolegal importances In an insane person, delusion of grandeur

may change to delusion of persecution. A man
Delusions, without any doubt, reflects men-
who wrongly believes that he possesses enor-
tal abnormality. Hence, it has many legal mous property, may at a time start to think
bearings. When a person does some act due
wrongly that, another person is out to kill
to the direct effect of delusion he suffers from, him to succeed his property. Alternatively, a
then he will not be held responsible for that person suffering from delusion of persecution
act. Example - when an insane person kills may after some period suffer from delusion
an innocent person thinking that he (the in- of grandeur just in a reverse way. After some
nocent person) is about to kill him and to day's wrongful belief that some person is af-
protect himself, he hits that person fatally, ter his life, the sufferer may start reasoning
as a result of which the innocent person dies, for such "intention" of that person that, as
then he will not be held responsible for his he possesses huge property the other person
act. But, by virtue of delusion he suffers from is thinking to kill him to grab his property.
if he thinks that another person is out t~
EMOTION (mood, feeling) - Emotion is
cheat him and on such a false belief if he kills
a mental state expressed as love, hate, an-
that person then he will be responsible for
ger or fear. There may also be some physical
the killing. This is at par with the provision
signs during the period of emotion, namely,
of the law and natural justice, because law
high or low pulse, mild rise in BP and body
provides that a man reserves the right to pro-
temperature. Emotion is expressed in way of
tect his own life, if necessary at the cost of
temporary mental breakdown, often with vio-
the life of the person who attempts to kill
lent expression of anger, or the subject may
him But law does not approve the killing of
be delighted with pleasant stimulus like love.
a cheat. The doctrine of diminished respon-
sibility is applicable to an insane in such a ANXIETY DISORDER - It is an emo-
case who does certain unlawful act due to de- tional state with apprehension, uneasy feel-
lusion, e.g., when the delusion reduces his ing, nervousness, fear, tension, sleeping prob-
power of reasoning and understanding capac- lem In severe anxiety, sweating, tachycar-
ity which leads him to commit some act which dia, raised BP are noticed. Anxiety with mi-
is not directly related with the effect of the nor to moderate degree problems is natural.
delusion but has indirect bearing. When a When anxiety is excessive - it leads to anxi-
person suffering from delusion of grandeur, ety disorder. When too less, it amounts to
believes that he will be killed by another per- lack of alertness. Anxiety disorder may be
( 1) generalised anxiety disorder, (2) phobias,
son for the huge property he possesses and if
(3) obsessive - compulsive disorders, (4) stress
as remedial step he kills that person then he
disorders.
will be taken to have diminished responsibil-
ity for the commission of the act because 1. Generalised anxiety disorder - The pa-
though in this case there are elements offear tient suffers from excessive anxiety and
and apprehension about his own life and to worry ab~ut routine day-to-day issue
safeguard his life he has killed the person, which is intense and uncontrollable. It
yet he is not fully absolved from the act he interferes ~ith the concentration and per-
· has committed because in such a case he could formance of the person. The person is
have tried 1awfu1 protective steps f~r his life also irritable .
.. dl• ' l
i.e., he could h~l.Ve sought for the heJp of the PerS011f!-N~r-,.,-:: rersonality makes a per-
police. · son distinguishable from others. Develop-

chapter 21: FO RENSIC PSYCHIATRY I 597
ment of personality depends on interaction tries to ignore, prevent or suppress with-

between his hereditary and environmental out success. Some psychological disorder
factors as different environmental factors or abnormality in the brain is the causa-
play important role on the development of tive factor. Though instinct and inhibi-
personality. From the personality, possible tion both persist side by side, only the
reaction of a person in different circumstances instinctual part is effective, not the in-
can be assessed which is based on his behav- hibitory part and as a result to keep the
ioural pattern matching his personality. Psy- obsession suppressed irrational acts are
chologists can assess the personality of a per- performed by the sufferer. In totality
son from answers and reactions to various about 2% of population suffers from some
selected, fixed and ambiguous questions degree obsession but clinical manifesta-
· placed before him. tion is much less. Obsession is the per-
Insomnia -In insomnia a person does not sistent thought which the suffer realises
get sleep or sufficient sleep. Physiologically, as untrue but can't get rid of. And com-
insomnia is the result ofhyperactive thyroid, pulsion is repeatative response or behav-
diabetes or result of stimulant drugs. But, iour or mental acts which the sufferer
psychological cause is more relevant which can't resist.
arises out of anxiety of any origin e.g. a prob- Signs, Symptoms - ( 1) Repeated similar
lem, how to deal with a problem what will be compulsive thoughts , (2) Repeated doubts,
the outcome (any possible harm) etc. Some (3) Intensive desire and distress to set things
may suffer from insomnia, thinking and wor- in right order, (4) His own specific counting
rying that he may not get sleep. Such insom- system, (5) Set things orderly and symmetri-
nia is treated best with tranquilizers which
cally, (6) Fear of acting aggressively or to
relieves the anxiety and bring sleep. Anxiety
shout, (7) Fear of contamination by touch fol-
based insomnia should be treated by removal
lowed by repeated wasting or cleaning,
ofthe anxiety.
(8) Repeated thinking of sexual images ,
2. Phobia - Phobic anxiety occurs in the suf- (9) Repeated verification of doors bolted from
ferer in connection with some specific inside, (10) Dermatitis and skin lesion due to
situations, activities or objects. There is hand washing epidermal picking, (11) Hair
intense fear to face them though he real- loss due to hair pulling etc. and many other
ises that his concern is absurd but inspite similar symptoms.
of all his efforts he cannot avoid the fear.
Examples are (1) Claustrophobia (fear to Causative factors -From personal habit,
be inside enclosed place), (2) Aerophobia insufficient serotonin , Group AB haemolytic
(fear of high altitude), (3) Aviation jour- streptococcus infection , stressful life event,
ney, (4) unexplained and unnecessary fear genetical. Any or more of the factors may be
of animals like snakes ett; (S) fear from the cause. Diagnosis is from signs and symp-
social performances, (6) of being embar- toms. Diff. diagnosis - anxiety disorder as a
rassed or (7) to be critically evaluated: whole.
3. Obsessive-compulsive.cf..isorcf€r - It is per- Treatment - Medication and joining sup-
sistent thoughts causing ~etyt ·. ~ . '
and dis-
t
port group for interaction, avoiding isolation
tress, having no relationship with real- participating in pleasant functiqns , ~voiding
life issues, which the sufferer realises and abusive drugs and alcohol .
. ''-;• '•~J IJ~
598 I PRINClPLES OF FORENSIC MEDICI NE
Compulsions in relation to each obsessive IMPULSE

phenomenon are mentioned in sign and symp-
• toms of obsession. They are in relation to ob-
Impulse is sudden and irresistible desire or
force in a person, compelling him to the con-
session and are just execution of the things as
scious performance of some act for which
noted in the signs-symptoms of obsession.
there was neither any motive nor any fore-
They are inseparable. Treatment noted above
thought and preparation.
are treatment of compulsion as well.
There may be several types of impulsive
4. Stress disorders - Stress is emotional
acts
and physiological reaction to critical situ-
ation. Some like to define stress as a criti- 1. Kleptomania - This means an irresistible
cal condition itself Some like to define desire to steal articles which may be of
as the effect of critical situations on the small value and even, may be of no use
concerned person. In some it may present to the person stealing the article.
as distress in an affair or a thinking or it 2. Dipsomania - This is found in alcoholics
may be the outcome of thinking, of some who feel irresistible desire to take alco-
past distress. Stress may have positive holic drinks.
or negative outcome. Distressing stress 3. Pyromania - Here, there is an irresist-
developed in a person, may be counted ible desire to set fire on things, which
to have a positive effect when the person may be important and valuable. The per-
concerned overcomes this, increasing his son is not conscious or careful, at least
efficiency, absorption and tolerance ca- temporarily, to the possible dangers of
pacity. Negative effect of stress leads to his act.
persistent and increasing anxiety, pho-
4. Mutilomania - This is an irresistible de-
bia, depression and panic. The former is
sire to injure and mutilate animals, com-
termed problem focussed stress, ~hen the
monly the domestic pets.
concerned person finds how to solve it,
or it may be emotion focussed when it 5. Sexual. impulse - The person may feel
only increases the emotional distress of compulsive urge to perform sexual inter-
the person concerned without attempt to course, often in a peiVerted way. There
solve the problem. may be some psychic problem concern-
ing the sexual behaviour; or the person
Post-traumatic stress disorder - Differ- may be a victim of mental subnormality.
ent traumatic events may cause serious stress
in some persons which becomes difficult for 6. Suicidal impulse - There is definite men-
them to overcome. For example traumatic tal prqblem Often intoxication like, that
· with LSD may lead to suicidal impulse.
life threatening circumstances like, an earth-
quake, railway or aeroplane c_rash, severe 7. Homicidal impulse - Here also mental
traumatic assault, being raped or kidnapped abnormality is mostly responsible. In cer-
etc. may cause permanent stress effect on tain chronic intoxications, as in case of
some persons, and they may not get rid of chronic use of cannabis, a man may de-
the memory. They sUffer from persistent anxi- velop sudden killing spree.
ety depression, distress insoninia and other A sane ,p erson having self-control and
emotional pains. To counter these unpleas- judgement capacity, may not finally give
ant effects they may start taking drugs to shape to his impulsive or compulsive de-
which they may ultimately get addicted. sire. But an ihsane person ~ho lacks in

chapter 21 : FORENSIC PSYCHIATRY I 599
self-control and judgement capacity, can- OBSESSION

not resist the impulse and may commit
In obsession, the sufferer constantly enter-
any offence. Thus, in connection with
tains an idea, unnecessarily, inspite of all his
commission of an unlawful act, impulse
efforts to drive the idea out of his mind. This
is a good defence for an insane person
is a sort ofcompulsive phenomenon. The clas-
which is not so for a sane person.
sical example of this condition is, a person
DELIRIUM while going to bed at night, bolts the door of
the room from inside, but after going to the
In delirium, the consciousness of the person bed he feels the necessity to verifY and does
is disturbed with impaired orientation , so to see if he has bolted the door or not. He
blunted critical faculties and irrelevant or in- repeats this act again and again, inspite of
coherent thought content. A person may go his consciousness and inspite of his desire and
into the state of delirium in many conditions, efforts to stop the act. Obsession is consid-
namely: ered a borderline state between sanity and
1. Due to mental unsoundness insanity. In the above case, a sane person
will stop after repeating the act of verifica-
2.. In acute conaitions, like high fever
tion for a few times. But an insane person
3. In acute poisoning cases, as in datura may continue the act all throughout the night
poisoning without sleeping.
4. As a complication of chronic drug intoxi-
Amnesia - It is impairment of memory of
cation, as in case of chronic alcoholics. any degree. It may be temporary or perma-
(a) Psychosensory imbalance nent. It may involve recent memory or past
(b) Head injury memory or both . Amnesia may be
(1) organic, due to brain damage as a result of
In delirium, the patient is restless, agi-
head injury, brain· infection, stroke, chronic
tated, maniacal and may even be violent. He
use of alcohol, cerebral concussion, psycho-
suffers from insomnia, hallucination and diso-
tropic drugs or anoxia. (2) Functional (psycho-
rientation. He may fail to recognise known
logical). It may be antegrade where capacity
things and known persons . During such a
to remember recent events is lost. In retro-
mental state the person may commit some
grade amnesia memory of past events are
unlawful, destructive act for which he is not
impaired. In amnesl.a, hippocan1pus as well as
legally responsible, because delirium is con-
frontal and temporal lobes of brain are in-
sidered as a state of definite mental abnor-
volved. If organic in origin with brain damage
mality.
then it is very difficult to regain the lost
Delirium tremens is a condition of deliri- memory. However, with effort and treatment
ous state which occurs in chronic alcoholics recorded events can be recollected.
due to sudden increase of the dose of alcohol
or sudden withdrawal or some diseases and SOMNAMBULISM
head injury etc. There is incoherency, coarse
or violent tremor, hallucination; disorienta- This is a condition in a subject when he walks
. tion etc. Sedation, use of tranquilizers are during sleep. In the state of somnambulism,
required to calm the patient, alG>ngwith main- the person while sleeping, may ~et up from
tenance ofhis diet m1d nutritional intake. (For the bed, open the door, walk out a distance
further details, see page 849). and return to his bed to sleep again to :re-
member nothing in the next day. During the SLEEP is physiological way of taking rest.
whole episode the subject is in a state of dis- During sleep, both sensory and motor
sociated consciousness, and may perform functionings are decreased. There is eyeball
automatic acts, over which he has no control movement during sleep. During light sleep
and which he does not remember afterwards. rapid eyeball movement is more (more REM)
He is in a state of hallucination and his acts with dream. But during deep sleep, eyeball
are not in consonance with his immediate movement is not rapid (NREM) and the sub-
environment. His mind is apparently undis- ject dreams less. 20% of total sleep is deep.
turbed and is uninfluenced by too many fac- After physical exercise one goes to deep sleep.
tors, as is usual during the busy hours of the Partial insomnia or light sleep is more in case
day. For this reason he can concentrate much of some mental diseases. Light sleep and deep
in such act of automatism, he performs in sleep follows a pattern. Accordingly REM and
the state of somnambulism. NREM also follow a pattern.
This is why it is occasionally observed NARCOLEPSY - An irresistible attack
that, a person can solve a difficult problem of drowsiness and sudden unexpected sleep
during the state of somnambulism which he at irregular interval, lasting for minutes to
could not do otherwise. The same act of au- 1-2 hrs. lt most cases there is catalepsy (loss
tomatism may be repeated in different attacks of muscle control and sudden emotional out-
of somnambulism or often, a coordinated break). In more than 50% cases the sufferer
work may be performed part by part during though mentally conscious experiences a
the phases of different attacks. The act of "sleep paralytic" state for a minute or two.
automatism remains limited within the sleep- Just before or just after the phase of sleep
ing hours and does not influence the rest of the person may be emotionally charged and
the period of the day, and he has no mental has unpleasant visual hallucination. For con-
abnormality when he is awake. If in a fit of firmation of the condition, pattern of daytime
somnambulistic automatism, a person com- sleeping, pattern of REM (Rapid eye move-
mits a criminal act, he will not be held re- ment), study of brainwave and polysomno-
sponsible for the same. gram is recommended. The condition can be
SOMNOLENI'IAorSEMISOMNOLENCE kept under control by using antidepressant
-It is that state of mind when a person is in or stimulant. However, cause of narcolepsy
a condition in between sleep and awakeness . is not known but thought to be either genetic
The state of mind is comparable with the or an auto immrme disease .
same of a person, who is suddenly arousing PANIC DISORDER - This is a condition
from deep sleep. In such a state, a person of vulnerability to stress with repeated sud-
may behave very abnormally for a short pe- den attack of panic with sustained anxiety
riod, say for a few minutes. During the pe- and recurrence cif panic. This is a period of
riod his mind is untouched with the reality distress and ~~prehension , agoraphobia (see
and the circumstance. The condition is often below) with somatic symptoms of feeling of
termed as sleep-drunkenness. When suddenly choking, breathing trouble, trembling with a
awaken from a deep sleep, such person may fearful feeling tliiit·he may go insane or may
perform some violent act without awareness even die. Th'ou gh: the attack ma.y last for a
re\t
,")
and understanding. He is not responsible for few seconds'fd-'8. hourS, usually the peak
any criminaL act performed by him during of distress is felt· by' about 10 minutes after
such a state of mind. · . starting. ·:RecU.rre'nce is also sudden .
.. · '.
Though not grouped in that category it AGORAPHOBIA

can be said to be a part of anxiety, phobia The sufferer from this condition fears to be at
and stress disorder group of syndroFlS· a place or situation from where he thinks it is
It is treated by (1) Psycliotherapy, difficult to come out.
(2) Benzodiazepines group of drugs, (3) im-
parting cognitive behavioural therapy, (4) im- AEROPHOBIA
parting the skill of physical and mental re- Fear to be at a high altitude.
laxation, (5) encouraging thoughts to be free
from anxiety. CLAUSTROPHOBIA
This means suffering from fear and appre-
Dissociative identity disorder or multiple
hension, inside a closed place.
personality disorder
Here the sufferer fails to integrate the vari- DEPERSONALIZATION
ous aspects of his personality. As a result The person does not believe in his own exist-
he feels to have .different self-identity at dif- ence, or identity. This occurs in schizophre-
ferent time, place and situation which he nia or depressive psychosis.
again forgets in another place or time or situ-
ation where he presents himself with an- DEREALIZATION
other identity. In course of such shifting of It means feeling of unreality or unreal things,
personality there is simultaneous vague com- as it happens usually in a dream during sleep.
plaint of disease or trauma due to assault. It commonly occurs in schizophrenia and de-
Such dissociative identity occurs due to pressive psychosis.
chronic mental trauma or stress. Treatment
is by psychotherapy, hypnotics and for de- ABREACTION
pressed patients- antidepressant. It means an emotional reaction seen in cir-
cumstances of narcoanalysis, due to memo-
A TIENTION DEFICIT HYPERACTIVITY risation of past painful experiences.
DISORDER
' ;_:Il DISORIENTATION
This occurs in children usually below 7 yrs.
It means lack of clear awareness regarding
age but in many it continues in adolescence
one's environment, particularly regarding
and adulthood period. It is more common in
time, space and person.
boys. The child cannot con~entr&te his mind
on a task, disturbs
. otherriii._ th~~ 7Ll
Class,
..
j
is inat-
•. AMBIVALENCE
tentive, non-perform~ti\te',' 1 caiuiot sit at a
place and fix his mind ~ri ~-~6f~. Does some- It means contradictory emotional reactions
towards.a person, at the ·same time.
thing without any input.t •. ~~ without think-
• :!. ~...J-: ~
ing. He only creates nuisance at school and

EUPHORIA
at home. Academic achievement is very poor,
. J
socially not accepted,, has, .no ,friends. It is An exaggerated sense of wellbeing.

thought this condition .~ ~~~J-~Jll some ab-
APATHY
normality of brain:. In . s.orne ,children the
cause may be of ge~~t~-~~~· ,_. , Ab~o~llack of activity and interest.
PERSEVERATION NEOLOGISM
Inability to change the idea about something, Coining or using new meaningless words.
though the circumstance or the matter is
changed. In some cases when a patient of Cl RCUMSTANTIALITY
schizophrenia or dementia is engaged with (}Qing into unnecessary details of things or
some idea, it becomes difficult for him to incidents.
change his mind to something else. Thus, if
the person is once shown the picture of a cow , DISTRACTION
he may recognize it , but after that any pic-
ture shown to him, he will repeat the word Diversion or lack of concentration of mind.
'cow'. NEUROSIS
MANNERISM Functional disorder related to mental disor-

der, of which the patient is unaware . Hyste-
Constant repetition of a trick or gesture or ria , anxiety state , obsession and reactive de-
speech. pression are the common varieties.
STEREOTYPY NEURASTHENIA
Repetition of same act or same phrase tire- A condition arising out of physical or mental
lessly. exhaustion.
PSYCHOSIS
NEGATIVISM
Types o~mental iilness arising out of mental
Doing just the opposite of what he is asked
causes and not due to environmental or ex-
to do.
traneous factors. In psychosis, there is loss
of touch with reality.
NARCOANALYSIS
LUCID INTERVAL ·
Analysis of mental content of a person , done
after application of a light general anaesthetic It is a period during which the mentally un-
agent. sound person be_haves very much like a nor-
mal person. During this LJeriod all the signs
ECHOPRAXIA and symptoms of insanity are absent. The
person is _responsible for all his acts , per-
Repeating the act of another. formed during the period of lucid interval.
ECHOLALIA
a
But if he conunits hard crime. then, he
may take the plea that ,· his abnormal -be-
Repeating the words uttered by another per- haviour has -started again, which will be
son. convincing because, he is a known lunatic.
In fact, after a period ofnonnal behaviour ,
the mental a};):(l:onna]ity of an insane per-
VERVIGERATION
son, may in reali.tl}', start again with some
Use of clusters of needless words. violent act.'

chapter 21: FO RENSIC PSYCHIATRY I 603
DER the development of the abnormal behavioural

pattern. The first two categories may respond
to punishment for their antisocial behaviour
Psychopaths or sociopaths have repeated or
but the third group, if treated harshly may
recurrent episodes of impulsive behaviour not
develop the pattern of mentality of the fourth
desirable and agreeable to the social struc-
group, which does not respond to any type of
ture. The activities of a psychopath are es-
treatment.
sentially those of an anti-social They learn
very little or have least desire to learn from Lack of intelligence, though may more
their past experience to correct themselves. commonly accompany psychopathic disorders,
Hence, they perform similar or different it is not an essential ingradient. Many of
types of antisocial acts again and again, which these persons are of average intelligence and
are clearly, impulsive, unwise, without a trace a few may be even more than average and
of judgement, inconsiderate and insensible. may have quite pleasant and channing per-
sonality and approach, when they are not
Aetiology - Some have tried to describe
indulged in antisocial activities.
the condition as.moral insanity. Others have
recorded these disorderly behaviours in Henderson's types of psychopaths -
hypomaniacs, in subjects with history of en- Henderson (1939), classified psychopaths as
cephalitis, or due to alcoholic intoxication and (a) Predominantly aggressive (who turn vio-
during the manic phase of manic-depressive lent and may even commit homicide ),
psychosis. Another clumsy idea about the (b) Predominantly inadequate (in their edu-
aetiology is that the psychopaths willfully cation, training, behaviour and personality)
become the victim of psychopathic behaviour. and (c) Predominantly moral and mental de-
This leads to the beliefby some that, a psy- ficient type (the behaviour is neither essen-
chopath can't help but to be a psychopath. tially aggressive nor inadequate).
Scott (1960), tried to classifY or group the It is the aggressive variety which both-
psychopaths according to their aetiological ers the society maxi111:um. These people may
backgrounds. His observation shows that turn violent out of very trivial issues. They
some develop psychopathic personality due have minimum self-controlling capacity.
to adverse surrounding during the period of In general, the psychopaths have least
their upbringing, in their early childhood,
sense of social responsibility, their conduct
which taught them to follow an anti-social
is persistently antisocial, they cannot con-
way oflife in future. The second group of the
tinue with any job. A psychopath is an easy
psychopaths have deficiency and defects in
lier, addict, and may have sexual and other
personal education and training. They be-
offences in his account. Any tough attitude
have, as they were taught to behave. They
towards him may turn him t? a dangerously
may have inner feeling of anxiety, inadequacy
vindictive and antisocial element .
and unconscious instinctual drives. The third
group also develop the abnormal behaviour To diagnose a case of psychopath, instead
due to weak and inconsistent training and of attaching too much importance on his vio-
rearing during childhood which may not be lent or anti-social activities, ·more importance
clearly deficient or defective. In the fourth should be attached towards his personal his-
group, excessive frustration is the cause of tory - present and past.

The established psychopaths should bet- sensitivity to dopamine . Other neuro

ter be treated by psychotherapy, instead of transmitters like serotonin and norepine-
subjecting them to punitive measures for phrine may also have some role to con-
correction. However, for the interest of the tribute to the causation of schizophrenia.
society, to protect others from a habitual ag- 5. Structural brain defect - Brain imaging
gressor or trouble maker, stringent measures techniques like magnetic resonance
of any degree and description may have to be imaging (MRI) and positron emission to-
adapted. mography structural abnonnality in brain
Further, diagnosis of psychopathic disor- like - enlarged brain ventricles, overall
derdoes not, by itself alone, bring an accused less brain tissue, lower activity of frontal
within the protective fold .ofsection 84 I.P.C. lobe which controls abstract thought plan-
or McNaughten rule . ning, judgement of a person. There may
also be abnonnality in hippocampus, tha-
lamus, temporal lobe, temporal gyrus,
SCHIZOPH E lA basal ganglia, and changes at these ar-
eas explain abnonnal thought, behaviour
This condition includes all those illnesses, and perception of a schizophrenic.
in all age groups which are characterised B. Extrinsic factors
from the onset of the illness, by primary or
1. Early parent-child relationship
fundamental disturbances in personality ,
2. Social class
thinking process , behaviour, emotional tone ,
interest in different affairs and relationship 3. Psycho-social stress
with other people and loss of contact with 4. Physical illness
reality . 5. Head injury
6. Alcoholism
Causes
7. Child birth.
A Intrinsic factors
8. Stressful life .due to -Chronic family ten-
1. Genetic factor -A single dominant or re- sion or hostility, death of a beloved rela-
cessive gene or polygenic factors may be tive or friend and chronic tension of any
the cause. origin.
2. Physical and constitutional built - 9. Maternal and birth factors - Low nutri-
Kretschmer's theory states that subjects tion of mother during pregnancy, influ-
with narrow athletic and dysplastic phy- enza of mother during pregnancy, forceps
sique have predominance in vulnerabil- delivery and qthe)r complications.
ity over other physical types.
General Fiiitures - In schizophrenia,
3. Honnonal cause - Endocrinal disturbance there is withdraWal from reality; deta$ment
may have some role to play in some cases. from the environirietit; change in the affect
4. Metabolic cause - Disorder of nitrogen or mood ; thoUght and speech disorder; dis-
metabolism and chemical activities in turbance of moMr ffi.I1ctions , perception (hal-
brain e .g. chemical neurotransmitterS- lucination) and oeh"B.Vi.bUr; delusion and para-
excess activity of dopamine·ur. ab:o:ormal noid disposition .
. ···'
.. .
..... . "'.
• ... ~- ....... 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
~
;,
,_ •'
chapter 21 : FORENSIC PSYCHIATRY I 605
Types tized delusion. There is also hallucina-

1. Simple schizophrenia - The onset is in- tion and thought disorder. There is dis-
sidious with gradual deterioration of the turbance of the personality.
condition. There is lack of interest, defi- 5. Schizo-affective disorder - Here depres-
cient ideation, poor performance in all sion or mania occurs concurrently with
activities. There may be delusion of ref- schizophrenia.
erence. Ultimately they are totally spoiled. 6. Pseudo-neurotic schizophrenia - Here
2. Hebephrenia - The onset is insidious in there is pan-anxiety and pan-neurosis.
the early life . There is emotional distur- There is hysterical manifestations, ano-
bances, delusion, thought disorder, audi- rexia, vomiting, palpitation, hypochon-
tory hallucination . The subject is driacal delusion and delusion of refer-
mischievious, eccentric, grimacing or in- ence, compulsive phenomena, obsession,
ert and apathetic. There if': mannerism phobias, depersonalisation and sexual
and silly behaviour. perversion.
3. Catatonic sphizophrenia - The onset is 7. Periodic catatonia - Here, there are
acute . There is disturbance in motor phases of stupor and excitement with
metabolic changes resulting to nitrogen
functions with abnormal behaviour. The
retention and excretion.
onset is in adolescent age or early adult-
hood, or occasionally in the 4th decade of 8. Late paraphrenia - Occurrence is com-
life or later. paratively more in widows and spinsters
who live alone. Usually there is delusion
There is extreme alteration ofbehaviour
of persecution and olfactory, auditory and
from stupor (catatonic stupor) to excite-
visual hallucination.
ment (catatonic excitement).
9. Capgras syndrome - In paranoid schizo-
There is mannerism, automatic response phrenia, there may be in some selective
like automatic obedience, spontaneoul:i cases, feeling of positive doubles or nega-
overactivity, negativism, echolalia, echo- tive doubles. The subject may think a
praxia, maintenance of imposed con- relative or a friend as a different person,
strained posture, emotio~al and thought an imposter, claiming his/her relative.or
disorders, delusions and hallucinations. friend. The sufferer may even mis-iden- .
4. Paranoid schizophrenia _: The onset is tify somebody as a person who is in fact
late. There is delusion of grandeur, per- already dead.
secution or hypochondriacal delusion, but 10. SclJ,izophrenia spectrum disorder - The
delusion of persecution is the most com- subject keep himself engaged with past
mon one. thinking, speech and behaviour but does
Delusions may be variable,' poorly held not u5ually lose contact with reality.
or systematised and highly complex and
relatively fixed. Personality of the sub- Legal qnd social asped
ject is usually preserved. · L The subject may get infected with HIV,
In paranoia, there is fixed delusion and and may act as a carrier.
there is no thought disorder and no hal- 2. At one time schizophrenics may lose
lucination. The personality of the subject home and become wandering lunatic.
is well preserved. 3. Suff~ring from a:hxiety, ·depression, he
In paraphrenia, there is semisystema- may commit suicide.
In HYPOMANIA there are pressure of

talk and psychomotor overactivity, ceaseless
activity, with flight of ideas , increased drive ~
Schizophrenic disorders may have a relation-
circumstantiality and dis tractability. The sub-
ship with epilepsy, particularly with tempo-
ject is enthusiastic , witty, humorous , over-
ral lobe epilepsy . In epileptic schizophrenia,
confident , alert, expansive and friendly . He
catatonia is less common .
is interfering in nature and acts dispropor-
In epileptics, abnormal behaviour may tionately.
occur during-
In ACUTE or DELIRIUS MANIA the
1. The actual fit (ictal) - During this stage, above features are notable in greater degree
there is usually spontaneous and stere- and severity in their manifestations. There
otype activity. The phase is short-lived may be delusion of great physical and intel-
and the activities have no relationship lectual strength. Excessive excitement and
with the circumstance. The acts and be- restlessness may lead to frequent exhaustion
haviour are aimless and purposeless. may be destructive and hannful. Hostility
2. Post-epileptic -The post-epileptic abnor- may be present.
mal activities are due to a state of men-
tal confusion and are simple in nature.
These may occur due to certain stimuli DEP ESSIVEPSYCHO I
or may be performed on the basis of past (MELANCHOLIA)
experience and may be repetitive in na-
ture. The subject is restless, aggressive, In this condition, the sufferer has intense
or fugue . The acts are automatic in na- feeling of depression and grief without any
ture. The person walks, fumbles or per- reason .
forms routine works blindly. He resists
Depressive stage of the mind develop due
help or interference. Any purpose of any
to many factors which may often be explain-
act is immediate and crude. This phase
able and often not. The cause of depression
also stays for a short period. may be (a) endogenous , when some genetic,
3. In case of status epilepticus -The abnor- biochemical , metabolic, senility, or puerperal
mal activities may last for a few hours. reaction or hormonal disturbance is respon-
Prolonged , elaborate , intelligent and pur- sible; (b) reactive , when svme psychosocial
poseful acts may be seen in many varie- interaction or problem or failure , frustration
ties of mental unsoundness but not in <md sirrrilar factors are :responsible and (c) a
case of epilepsy . person may suffer from depression as a re-
sult oflong term use of psychotropic drugs .
Signs and symptoms - General appear-
ance and behaviour - The face is either rigid
These are essentially affective disorders or and immobile or there is expression of sor-
disorders involving the mood of the subject row, anxiety or despair feeling. The subject is
with manifestation of excitement and elation slow in movement and has heavy, tired gait.
of the mood . The patient is optimistic , over Mood - There is feeling of sadness , de-
confident with general feeling of well being jection and lack of energy. Condition is usu-
and marked euphoria .. ally worse in the morning.

Talk - Output is less or may occasionally Danger - Depressed psychotics

be continuous. There may be complete mute- (melancholies) a're, or, may be potential sui-
ness or constant chattering. cides and they may al$0 commit homicide.
Thinking capacity - Diminished, in- Bipolar diso.r der (manic depressive psy-
ability to concentrate or formulate ideas or choses) - In bipolar disorder the mode of a
taking decision. person alternately varies between ext~me
Thought contents - He only counts his mania and extreme depression
difficulties, there is delusion of persecution Along with other symptoms the subject
and hypochondriacal or nihilistic delusion. may be hypersexual during the mani_c phase,
There is derealisation and depersonalisation. called bipolar hypersexuality. In females it is
Disorder of perception - There are illu- reflected as nymphomania, and in males as
. sion and hallucinations. satyriasis (see sex offence chapter) .
Attitude towards personal affairs and oth-

ers - There is loss of interest in work, home, MENTAL RETARDATION
family, hobbies, recreation and personal vvell
being. The subject may be agitated.
Synonyms - Mental deficiency, Mental handi-
Sleep - disturbed sleep, insomnia, early cap, Mental subnormality, Amentia.
rise.
Mental ret;1rdation is a state of an:ested
Muscular activity - There is retardation development of :milld froni birth or early child-
or slowness of motor activities. hood.
Other physical signs symptoms - There 5% of all babii;!S born and 1 to 4% of.all
is loss of appetite with loss of body weight. chiid.ren in school going age are
to a varying
There are headache, bodily pain, dyspepsia, exten~ mentally.retal"!led. ·
feeling of tightness in the chest, constipation,
increased urinary frequency, palpitation, Grades, of mental retardation
blurred vision, dryness ofmputh, paraesthe-
1. Slightly retarded (high grade defectives
sia, loss of libido in men and menstrual dis-
or feebie nrinded subjects, morons) -
turbance (mostly insufficiency) in females.
These subjects lack in·alertness and cu-
In extreme cases, the patient may lie riosity, are inert, passive, easily fooled,
stuporous in most of the time ..
easily led to crimin~l acts. Their IQ (in~
(Simple melancholia or simple depression telligent quotient) varie~ between 50 -
is the mildest form and acute .m elancholia or 70. They may be rehabilitated in simple
acute depression is the severe form. In routine jobs.
chronic melancholia or chronic depression, 2. Moderately retarded ( medium grade
there is marked improv~pl,Elnt of the physi- defectives or imbeciles)- They are inca-
cal signs and symptoms but not of the men- pable of earning their living and protect-
tal signs and sympto:qlS) .. · · ing themselves, but they can be taught
Depression may be seasonal or periodi- to look after themselves, to wash, dress_
cal also. The depressive feelings are more and feed themselves. Their IQ varies be-
acute during the morning hoblrS. tween 30 to 50..

608 I PRIN CI PLES O F FORENSIC MEDICINE
3. Severely retarded (low grade defectives should be taken with maximum patience and
or Idiots ) - They have anatomical and should include -
physiological abnonnalities . Dispropor- (a) Present complaints, difficulties,
tionate and stunted growth of head and
(b) Family history - Parents - alive or
limbs , neurological phenomena like
hemiplegia and epileptic fit. Their IQ is dead,
below 30 . Their life span is short . They (c) Personal history - Date and .place
cannot guard themselves from ordinary of birth, whether the birth was nor-
dangers of life , and cannot be trained even mal or after prolonged labour or if
upto mip.imum degree of satisfaction. the labour was instrumental. If the
birth was premature. What waS the
state of mother's health during preg-
nancy? Whether breast fed or not.
Whether brought up by mother or
Dementia means degeneration of the men-
any other person.
tal faculties after full development .
Infancy and childhood - Milestones of
There is lack of memory , judgement and
intelligence , mental depression , lack of in- development , e.g. teething, talking, walking,
terest and initiative . The sufferer may lead a general health and nervous traits. If there is
vegetative life . At some phase the person may any history of nightmare, fear-state, phobia
become agitated , aggressive and violent . (school or otherwise). Any history of stam-
mering, chorea, convulsion or somnambu-
Dementia may occur due to old age (se-
lism. History of any febrile condition, head
nile dementia ), due to organic conditions like
arteriosclerosis or organic diseases involving injury etc.
brain or it may be caused due to addiction to Schooling - .Age of starting, age of leav-
some intoxicating drugs and their prolonged ing, class upto which studied, performance
use . in the school, extraordinary or mentionable
success or failure , subject or subjects of in-
terest, attitude towards teacher and class-
ENTAL
mates.
Occupation and place of work - Age of
Diagnosis of mental unsoundness needs care- starting of the job, his interest in the present
ful examination and involve the following job, any change in the job, how many changes,
steps- how long continuing in the present job, the
1. History taking causes of change from the past jobs.
2. Examination of the physical state Menstrual history in case of females -
3. Examination of the mental state Age: at menarchy, length of each cycle, regu-
4. Special investigation. larity, duration of the period, premenstrual
terrsion, dysmenorrhoea, menopause, reac-
1. History taking tion to menopause.
It should be done very intimately , bringing Sexual life - Inclination to sexual prac-
the patient in total confidence . Interview tice, masturbation, attitude towards same sex

chapter 21: FO RENSI C PSYCHIATRY I 609
and opposite sex, sex-relationship with wife Speech , dress , manner - whether in con-
or husband, heterosexual experience apart formity with and whether in touch with the
from with the husband or wife, homosexual situation.
practice, if any; sexual fantasies and perver- Stupor - If there is no spontaneous ac-
sions, if any. tivity, if does not respond to stimuli.
Marital history -Compatibility with the Overactivity - restlessness, agitated
partner, temperamental difficulties, sex re- movement.
lationship with the partner, any history of Behaviour -tics, mannerism, stereotype
divorce; children, miscarriage, attention to- movements, abrupt, fitful , eratic or constant
wards children, relationship with the children. behaviour, automatic obedience, echolalia,
Personal habits - If accustomed to alco- echopraxia, waxy flexibility, negativism.
hol, tobacco or other drugs of addiction or Personal habit - cleanliness, eating and
habit formation. sleeping habits, hobbies.
History of physical illness - Acute or Talk - talkative, uncommunicative, re-
chronic diseases, suffering at present or suf- tarded speech, mutism, continuous chatter-
fered in the past; if underwent any operation ing, circumstantiality, if only answers toques-
then its nature and outcome. tions, hesitant in talks, slow, fast, discursive,
History ofprevious mental illness . disconnected talks, change of topics, strange
words, perseveration.
Personality -Whether timid, over-smart,
shy, temperament- if aggressive. Mood - reflected in his speech, behav-
iour, manner and facial expression.
2 . Examination ofthe Physical State Mental content -Attitude to himseif and
others, reaction to the environment, pre-
A detailed examination of all the systems of
dominant thought, delusions - pleasant or
the body should be performed. It should in-
painful.
clude the respiratory system, cardiovascular
system (pulse, B.P. etc.), nervous system in- Disorder-of perception - Any hallucina-
cluding sensory and motor functions , re- tion ; if present, its type and timing with hours
flexes, gait, stance, posture etc., condition of of day and night. Any illusion.
the skin, tongue, lips, body temperature, State of consciousness - alert, dull, self-
muscular weakness, numbness, tremor, co- absorbed, confused, delirious, stuporous.
ordination etc. Judgement and insight.
Orientation of time, place and person.
3 . Examination of the mental state
Compulsive phenomena -like obsession,
General appearance and behaviour. impulse etc.
Whether appears younger or older than -Memory , intelligence.
his age. Sleep - disturbed, contents of dream,
Attitude and posture . insomnia.
Facial expression - tense, anxious, de- Grasp on general information and over
pressed, dejected. current affairs .
- .I
fF M. - 391
4 . Laboratory investigations · Dangerous Lunatic
Laboratory investigation in the following A dangerous lunatic is a lunatic who is ei-

lines may be necessary. ther dangerous for himself or his property or
1. Blood and urine analysis dangerous for others or others' property.
2. X-ray of the skull Wandering Lunatic
3. C.S.F. analysis
A wandering lunatic is a lunatic who aimlessly
4. E.E.G. I roams on road.
5. Scanning test.
Observation of mental. patient

INSANITY AND lAW
For the purpose of diagnosis and certification,
an alleged mental patient, may be kept un- Mental Health Act 14 of 1987 - This Act has
der observation of a psychiatrist with order the following provisions-
from a magistrate. The period of observation .
1. It prov ides the guidelines for esta-
may be up to 10 days at a stretch. During this
blishment and maintenance ofpsych.iat~
period of 10 days the doctor not only exam-
ric hospitals and nursing homes.
ines the person regularly, but also observes
him at different hours of day and night, in 2. It describes the procedure for admission
his different activities, with and without his and detention of mentally unsound per- ·.
knowledge. ·If diagnosis cannot be reached sons, in psychiatric hospitals and nurs- .
during the period of these 10 days' observa- mghomes. '
tion, then the magistrate can order for an- 3. It describes the provisions for inspection;
other 10 days' observation and that way, the discharge, leave of absence and removal
total period of observation can be upto a maxi- of mentally ill persons from psychiatric .
mum of 30 days. hospitals or nursing homes.
4. It provides for judicial inquisition regard-
Feigned insanity
ing possession of property by alleged
With some motive a person may pose to be an mentally ill person, custody of the per-
insane. Insanity may be feigned by a person son, and yp.anagement of his property_
to avoid punishment or trial in a criminal case, 5. It provides for the liability to meet cost
to avoid certain civil responsibilities or to avail of maintenance of a ment ally ill person
certain advantages. A san~ person may be
detained in psychiatric hospital or psy-
presented as an insane person with some bad
chiatric nursing home.
motive like tO deprive him of his property. It
is in such circumstances that observation of. 6. It provides for protection ofhuman rights
·the person as described in the preceding.para, ofmenta~ly ill. persons.
is essential, particularly w}:len there·. is _any 7. It provides for. penalties and procedure
reason to doubt or when there is ~ reason or for awarding.t he-same, for violation of
motive to feign insanity. · ·- . the provisions of the Act. ·
To differentiate feigned insanity from true 8. It also provides for certain other miscel-
insanity, guidelines may be talt.en·from:table laneo-uS aspects ·regarding lunacy and the
no. 21.1. lunatics.' ,1 • :, • )

chapter 21: FORENSIC PSYCHIATRY I 611 ·
;,,
I Table. 21 .1: Differences between true insanity. and feigned insanity t
Pojnts ofdifference rru~ insanity Feignedt'ijls8nltr -( ' ~
r,1".
' Onset Usually insidious Sudden

'
2. Signs-symptoms Specific for some type of insanity Not directing to any particular type of '
insanity
3. Motive Nothing Must have some motive
'4. Activity Careless Carefully does something to indicate •,
insanity
5. Attention to personal affairs No attention Pays at least some attention to personah
affairs, though may pose inattentive
6. Existence of features Continues irrespective of presence Noticeable mostly in presence of others
or absence of others
'?< Physical exhaustion Minimum, even with continuous over- Gets exhausted like a normal person
activity
8. Sleep May pass sleepless nights With effort may pass one or two
sleepless nights only
9. Habit Usually filthy. Careless about personal Maintains minimum personal clealiness
cleanliness and dress and is dressed reasonably property
10. Skin Dry and dirty Not so
'
11. Ups Dry, cracked Not so

12. Tongue Coated Clean
13. Look Vacant, agitated or worried Not so
14. Mood Excited, depressed or fluctuating May overact to show abnormality in
mood
15. Repeated examination Does not mind Resents for fear of detection
Admission and detention of a mentally ill medical officer in charge of a psychiatric

person in a psychiatric hospital or nursing hospital or a nursing home, for his ad-
home mission there as a voluntary patient, if
he so desires. In case of a minor, the re-
A Restraint of a Dangerous Lunatic - A quest for admission should come from his ·
dangerous lunatic can be restrained imme- or lier guardian who thinks that the mi-
diately for short term till attangement for nor is mentally ill If the medical officer,
his treatm~nt and admissi<;>n to ·a hospital after inspection within a pe:ri,od of 24
is made. hours after prayer, thinks that the per-
B. 1. Admission after vohmt8.:cy approach - A son i.s a fit ~:person to be admitted there
person who is major. by age, if considers then; he can admit such a ' person as a.
himself as mentally ill, may request the voluntary patient.

612 ! PRINCIPLES OF FORENSIC MEDICINE
2. Reception on application - If a mentally (b) The husband or wife of a mentally

ill person is unable to apply himself, then ill person or in absence of husband
if a relative of such a person applies to or wife or due to inability of the hus-
that effect to the medical officer in
I
band or wife due to any reason, any
charge ofth~ psychiatric hospital , enclos- other relative of the mentally ill
ing two medical certificates in support person , if not minor by age , can ap-
of the mental illness of the person and ply.to the magistrate within whose
on receipt of such application , if the jurisdiction the mentally ill person
medical officer thinks the person to be usually resides, for passing a recep-
fit for admission in the hospital then, he tion order in favour of the mentally
may admit the person. If the application ill person, for his treatment or de-
is not accompanied by medical certifi- tention in a psychiatric hospital or
cates then , the medical officer in charge nursing home , if the applicant feels
of the hospital may arrange examination that it is necessary for the interest
of the person by two medical officers of of treatment of the person or for his
the mental hospital and if the findings safety or for the protection of oth-
of the two medical officers are supporters . To be valid, the application
ive of mental illness of the person then should be accompanied by two medi-
he may admit the person in the hospi- cal certificates , from two registered
tal. medical practitioners , on.e of whom
3. Reception and detention order from a must be a Government servant ,
magistrate on application - which should state that the mentally
ill person is suffering from such
(a) When the medical officer in charge
mental disorder that he should be
of a psychiatric hospital or nursing
detained in psychiatric hospital or
home where a mentally ill person is
nursing home for the interest of his
already undergoing treatment , is
satisfied that , for the interest of t reatment or safety, or for the pro-
tection of others. The two medical
treatment and safety of the mentally
practitioners should examine the
ill person or for the protection of
person independently and should
others , he should be treated or de-
also form their opinion independ-
tained in that hospital or nursing
ently, depending on their own ob-
home for a period of more than 6
servation and the informations, pro-
months , then the medical officer
vided to them.
incharge may apply before the mag-
istrate having jurisdiction over the For consideration of the application,
hospital, for a reception order from it is also necessary that the appli-
the magistrate in favour of recep- cant must have seen the mentally
tion and detention of the mentally ill person within 14 days prior to
ill person. If the magistrate on ex- submitting the application.
amination of the application and the If after going through the applica-
accompanying medical certificates, tion and the accompanying medical
thinks it necessary for passing are- certificates, the magistrate thinks it
ception order then he may do so . proper that, an order of reception

should be issued forthwith, then he The Magistrate arranges for

does so. If he thinks that the mat- the medical examination of the
ter requires further consideration, person and if on enquiry and
then he arranges for enquiry about on the basis of the medical cer-
the case. During such enquiry, the tificate the Magistrate is satis-
magistrate may require the pres- fied that the mentally ill per-
ence of the applicant, the alleged son should be sent to a psychi-
mentally ill person (if the magistrate atric hospital or nursing home
thinks it proper he may not require for the interest ofhis treatment
his presence), a person appointed by or safety or for the protection
the mentally ill person to represent of others, then he passes a re-
him and any other person, if the ception order for detention of
magistrate thinks it fit. the person in such a hospital
or nursing home. If at any
After the enquiry, on his satisfaction
phase of this procedure any
the magistrate either passes a re-
relative of the mentally ill per-
ception ·order in favour of the men-
son expresses the desire for
tally ill person for his detention in a
admission of the mentally ill
psychiatric hospital or nursing
person in a particular psychi-
home, or dismisse:; the application.
atric hospital or nursing home
In his order, he records the reason
and if the relative gives the
for making such order. The magis-
undertaking to pay for the
trate gives a copy of the order to the
maintenance of the person in
applicant.
that particular hospital or nurs-
(c) Reception order on production of ing home, then the Magistrate
mentally ill person before a Magis- may pass order in favour of
trate - such a prayer.
(i) The officer in charge of a po- (ii) If thepolice officer in charge of
lice station may take a men- a police station or if a private
tally ill person into protection, person finds that a person is
if he finds that the person, by mentally ill and that he is not
reason of mental illness moves under proper care and atten-
at large within the limit of his tion or that the person is ill-
police station or that, he is dan- treated or neglected then, the
gerous by reason of mental ill- police officer or the private per-
ness. In such a case, the officer son may report the matter to
in charge of the police station the Magistrate havingjurisdic-
should produce him before the tion over the locality con-
Magistrate having jurisdiction cerned. The Magistrate on his
over the police station, within satisfaction on the submitted
24 hours of taking the person report, summons the relative
into protection, and then act or the guardian of the mentally
according to the directive of ill person and directs him to
the Magistrate. take proper care of the person
614 j PRINCIPLES OF FORENSIC MEDICINE
and not to neglect or ill-treat Certain common provisions and

him. If the guardian fails to guidelines in connection with reception
carry on the directive, then the and detention of a mentally ill person in a
Magistrate may impose a fine psychiatric hospital or a nursing home
on him which may extend upto 1. The medical certificates attachedwith the
Rs. 2,000=00. application for issuance of the reception
If the mentally ill person has order must have not been issued more
no guardian or if the person is than ten days before the date of applica-
unable or fails to take care of tion.
the ment'ally ill person then, The medical certificates received by the
the Magistrate can pass a re- court in all other cases, for issuance of
ception order in favour of the reception order, must have not been is-
person for his detention and sued more than ten days before the is-
treatment in a psychiatric hos- sue of the reception order.
pital or nursing home. 2. When the reception order has been is-
4. Admission and detention of a mentally sued against an application, the applicant
ill person in a psychiatric hospital or nurs- . is authorised to carry the mentally ill
ing home under judicial inquisition - person from the place of his stay to the
Ifunder judicial inquisition held by a Dis- psychiatric hospital or nursing home
trict court, regarding the alleged mental where t~e patient is to be admitted.
illness of a person possessing property, 3. If there is no vacancy in the psychiatric
for custody of such person and manage- hospital or the nursing home, the medi-
ment of his property, and if finding the cal officer in charge of the centre will first
person men~ally ill, the court is of opin- 1;1dmit the patient there and then inform
ion that it is necessary to admit the per- the Magistrate who has issued the order,
son to a psychiatric hospital or nursing about the position. The Magistrate then
home, then the Court may pass such an will consider further action on the mat-
order. ter.
5. According to the Prisoners Act, Acts of 4. The validity of the reception order ceases
Air Force, Navy, Army, and according to if the patient is not admitted to the psy-
the CrPC section 330 and 335 of 1973, chiatric hospital or the nursing home
directive can be issued in favour of a within thirty days from the date of issue
mentally ill prisoner for his admission in of the order.
a psychiatric hospital or nursing home. The validity of the reception order also
6. A mentally ill person, for the purpose of ceases when after reception in the said
his diagnosis and certification may be de- hospital or ~he nursing home the patient
tained and kept under observation in a is discharged from the centre on valid
hospital or any such other place by order ground of being cured or otherwise .
from a Magistrate, for a maximum pe- 5. The Magistrate issuing the reception
riod of 10 days in one instalment and for order sha11 send a copy of the order to
a total period of 30 days at a stretch, or- the concemed hospital or the nursing
dered in phases. home.

6. Ordinarily a Magistrate cannot issue re- 4. If a person was admitted in a mental hos-
ception order for a psychiatric hospital pital on the strength of reception order,
or nursing home located in a state other on the basis of fraudulent reports and
than where he serves. But with special false information , then the reception or-
order from his employer (Government) der is ammended and the person is re-
he can do so. leased frOm the detention centre.
5. Except in case of voluntary patient and
Discharge of the patient from the mentally ill prisoners, the medical officer
psychiatric hospital or nursing home in charge of a psychiatric hospital or nurs-
1. When a voluntary patient O! the guar- ing home, on the advice of two medical
dian of .a minor voluntary patient practitioners, one of whom should be a
makes a request for discharge from the psychiatrist, may discharge an in-patient
centre ·then, the patient should be dis- of the hospital or the nursing home.
charged w"ithin 24· hours of making 6. Any person on whose application the pa-
such request. tient was admitted in the hospital or the
nursing home, if subsequently applies·for
2. Whe~ a mkor vol\mtary patient attains
the release of the patient then, the pa-
majority , then ifno request comes from
tient will be released on the basis of such
him within one month after attainment
application.
of majority, for his continuation in the
hospi~al then, he should be released be- 7. If a ·mentally ill person was admitted to
fore . th.e expiry of this period. However, . the mental health centre, on application
irrespective of submission or non-submis- from a relative to a magistrate or on pro-
sion of requests for continuation in the duction before the magistrate , then he
hospital of the minor voluntary patient may be released from the centre by the
medical officer in charge of the centre,
attaining majority, the Medical officer in
if he is so directed by the authority who
charge of the hospital or the nursing
ordered for the reception of the patient,
home will form a board within 72 hours
after consideration of the application
before tak.i ng a decision about the pa-
made by the relative in this regard to
tient's continuation in the hospital or his
the medical officer in charge, who for-
discharge.
wards the same to the authority who
3. When a mentally ill person was admit- made the reception order, for his con-
ted to the psychiatric hospital or nursing sideration.
home on the request ofhis relative , then, 8. If a person, other than a mentally ill per-
if subsequently the patient or any rela- son, applies before the Magistrate for dis-
tive or friend of the patient applies be- charge of the mental patient from the hos-
fore a Magistrate for his discharge from pital on the ground of his recovery, sup-
the mental health centre, 'with intima- ported by a certificate on that behalf from
tion to the person on whose request the the incharge of the psychiatric hospital
patient was admitted, then the magis~ or nursing home where he was being
trate after enquiry may allow and con- treated, then the Magistrate on enquiry
sider the application for order of discharge may· 'Order the discharge of the person
from the hospital or may dismiss the ap- frdm: the centre or may dismiss his appli-
plication. ·cation.
9. If a person who was detained in a psychi- Within one month ofhis escape from such
atric home after a judicial enquiry, is a hospital or nursing home, the patient can
subsequently found to be of sound mind be retaken there.
and that he was admitted there wrongly, 10. Judicial inquisition for appointment of a
then he is released forthwith. guardian for the protection of a mentally
ill person and for the management of his
Leave of a mentally ill person from a
property, ifhe possesses any property.
psychiatric hospital or nursing home
If a mentally ill person possesses prop-
Except in case of voluntary patients, leave erty, then on application from a relative of
for a period may be allowed to a patient on the mentally ill person or from any other
application from the person on whose appli- authorised corner, the District Court having
cation the patient was admitted in the hospi- jurisdiction over the area where the mentally
tal. lfthe same person, due to some reason- ill person ordinarily resides, with the help of
able ground cannot make the leave applica-
two assessors holds inquisition as to whether
tion then, any of the relative of the patient
the person is actually mentally ill, and if so,
can do so along with a bond to take care ·of
whether he is unable to take care of himself
the patient and look after his safety and pro-
and his property. If the person is really men-
- tection of others, during the period of leave
of the patient from the hospital. The medical tally ill and if he cannot take care of himself
officer in charge of the hospital can grant a then the District court appoints a guardian
leave of 60 days. If the medical officer does for him and if he is unable to manage his
not allow the leave, then an application may property then he also appoints a managerfor
be made before the magistrate of the locality his property. The Court may appoint one or
who after enquiry may or may not pass an two persons for the two purposes. In some
order of leave in favour of the patient. If the circumstances the District Court may autho-
patient does not return or is not brought back rise the Court of Wards or the District Col-
to the hospital or the nursing home on ex- lector to perform these jobs for the mentally
piry of the leave, then the Magistrate is in- ill person.
. formed about the same, who takes further If a manager and a guardian are ap-
action in this regard. . pointed then, the District Court may arrange
for the payment, for the services they render,
Removal of a mentally ill person from one
from the property of the mentally ill person.
psychiatric hospital to another
Such a guardian with the permission from
In case of removal from one centre to an- the Court can take any step necessary for
other inside the state the approval of the state the interest of patient, and the manager can
government is necessary. If the patient is to take any step with permission from the Court
be removed to a psychiatric hospital or nurs- for proper management of his property.
ing home of another state then, permission Within 6 months of appointment_, the man-
from that other state government should be ager should prepare an inventory ofthe prop-
there. . erty of the· mentally ill person and he will
Readmission of a mentally ill person to · submit an account of the property to the Dis-
the psychiatric hospital or nursing holl}e fro~ trict Court within three months of the clo-
where the patient had escaped - sure of every financial year.

Responsibility of insane person for his ads respects. Authorities questioned about the
correctness of the theory of monomania, but
An insane person may not be held responsi-
there was little dispute about the correctness
ble for his criminal acts, if the acts are the
of the verdict in McNaughten's case. How-
product ofhis mental unsoundness. Similarly,
ever the general public of England became
an insane person is absolved from certain civil
concerned over the case and the judgement.
duties and obligations.
Upon this development the Supreme Court
Criminal responsibility and insanity Judges of Great Britain were summoned by
the House of Lords to know the position of
Sec. 84 IPC describes the law of this land re- the law of England regarding crime and in-
garding the criminal responsibility of insane sanity. The Ld. Judges were asked certain
persons. questions by the members of the house and
Sec. 84 IPC states that, "Nothing is an the answers given by them are usually known
offence which is done by a person who, at the as MeN aughten Rules.
time of doing it, by reason of unsoundness of The most important ·and relevant part of
mind is incapal.Jle of knowing the nature of the MeN aughten Rules states as follows
the act, or that he is doing what is either "Every man is to be presumed to be sane,
wrong or contrary to law''. and to possess a sufficient degree of reason
There is minor difference between the to be responsible for his crimes, until the
provisions of Sec. 84 of Indian Penal Code contrary be proved to their (Jurors') satisfac-
and the MCNAUGHTEN RULES, which is tion; and that to establish a defence on the
the guideline followed in British Courts for ground of insanity, it must be clearly proved
consideration of the liability of a mentally ill that, at the time of committing the act, the
person who commits a crime. party accused was labouring under such a
defect of reason. from disease of the mind as
'
The McNaughten Rules not to know the nature and quality of the act,
he was doing or, if he did know it, that he did
The origin of the Rule- In 1843, Mr. Edward not know he was doing what was wrong'.
Drummond, the private secretary of the then
prime minister of England, Sir Robert Peel, To assess the criminal responsibility of
was shot dead by one Daniel MeN a ugh ten insane persons, certain other rule~ have come
in use in subsequent periods in different coun-
MeN a ughten suffered from delusion of per-
tries at different times. To quote some of
secution and statedly believed that his life
them, these are -
was in danger due to the acts of persecution
by the Tory Party on him. He shot dead Mr. Durham's Rule of 1954- This rule states
Drummond on the belief that he was killing that an accused person is not criminally re-
the Tory Party Prime Minister Mr. Peel It sponsible ifhis unlawful act is the product of
was established that MeN a ugh ten suffered mental disease or mental defect
from paranoid delusions, and was acquitted Curren's Rule of 1964 - This rule states
on the ground of insanity. Prior to that, Eng- that an accused person is not criminally re-
lish law accepted the theory of partial insan- sponsible, if at the time of committing the
ity, under the concept of' monomania' which act, he did not have the capacity to regulate
means that a person may suffer from one his conduct to the requirements of the law,
delusion alone and may be normal in all other as a result of mental disease or defect.
The American Law Institute Recorrunen- The position of the Forensic Psychiatrist
dation : The American Law Institute recom- is in no way better in these cases than the
mends that a person is not responsible for law court people. Diagnosis of some psychi-
criminal conduct if at the time of such con- atric problems for clinical purposes is totally
duct, as a result of mental disease or defect, different from diagnosis ofthe same in crimi-
he lacks in adequate ·capacity either to ap- nal circumstances or where litigations are
preciate the criminality of his conduct or to involved. Hence the Forensic Psychiatrist
conform his conduct to the requirements of must work without any preformed idea or he
law. must not be superficial in his method of work.
These rules, particularly . the It is better that he does .not try to pinpoint
MeN a ugh ten Rules are given the status of the position where it is not possible to do so
''legal test" for insanity. This is because these in absolute term.
rules are the yardsticks for assessment of The provisions of different rules of-dif-
legal status of the insane persons so far their ferent countries, have one common feature
criminal acts are concerned. In fact, in prac- in them It is that, in most cases the law court
tice, inspite of existance of different rules in people are not much interested to know· the
. different countries, the interpretation and type or intensity of the mental unsoundness
application of the rules in indiyidual ·case of the accused person. They are more or re-
have not been simple. It remains always a ally interested to know , if in the particular
problem for all concerned sections namely case under consideration, the criminal act
the prosecution, the defence and Ld. Court committed by the person was ·the product of
if the provisions of the existing rules have unsoundness of his mind. It is not necessary
not been properly used in a particular case. that the factors like, the intelligence, emo-
The problem not only lies in the fact that , a tion, perception, orientation, judgement ca-
criminal may try to seek the shelter of the pacity and understanding capacity should be
provisions of the criminal niles for the in- assessed, all in their absolute terms. But the
sane persons even though he may not be an court should have a clear understanding as
insane or ifhe is an insane then even though · to, whether, the person who has committed
the criminal act committed by him is in no the act, would have committed the same act
way the product of his mental illness . Prob- in same condition with average intelligence,
lem may also arise in just reverse way ..Even rational emotion, having good understanding
if some criminal act (usually of some trivial and judgement capacity with same type of
nature ), !night have been committed by a perception, orieni;ation and belief, as he had
person as a result of defect ofhis mind , the at the time of committing the act . Or ,
defence lawyer may just speak in the line of whether, his state of mind is at such an ab-
the prosecution that, the act was done in a normal level as to make all these factors ir-
state of compose mentis (i.e., in a state of relevant for him. It is not easy, to give a clear
sound mind). This may so happen because opinion in these regards. Hence, it is desir-
the defence may prefer a punishment for a able that a ''psychiatrist's opinion will be ten-
short term, instead of the accused being per- tative rather than dogmatic, a matter.of prob-
manently blended as a lunatic and being sent abilities rather than of absolute". The Foren-
to (the horrible environment of) a mental sic Psychiatrist must realize that, he is deal-
asylum. ing the case for law-court purposes and not

chapter 21: FORENSIC PSYCHIATRY /619
in his clinics, where he has the scope to alter of crimes, the offender has an accomplice, on
his diagnosis after following the case in dif- the other hand somebody, with some crimi- .- · :
ferent ways which also includes prognosis and nal motive may take the advantage of un-
response of the patient to different treatment soundness of the mind of a pe:rSon and may
and where there is no question of any mouse him as an instrument for commission of ··
tive to play a role in the matter under con- the crime or a part of the crime. ··
sideration. So far motive for commission of an un-
It is claimed by some writers that a truely lawful act is concerned, an insane person will
insane person will behave indifferently after not have anything as such. But innocent kill-
commission of an unlawful act. It is gener- ing of a member of the family or his business
ally so. Even after killing a person the in- partn~r, may benefit the tnsane person finan-.
sane may !J.Ot try to hide the fact, rather he cially which may obviously appear as the · ·
may himself try to bring the act to the notice motive for commission ofihe act.. '
of others. For an insane person, there should That, when an insane person commits an
not be any accomplice. Also, there should not offence, there is no preplanning or prepara-
be any motive or preparation for the act. If a tion for the act, is not always true. A person
•.
Forensic psychiatrist rests plainly on these
suffering from delusion of p!=!rseciition against
points, that may not be helpful in all cases.
another perso~ for over a long period,· rna.y
All cases may not be so clearly understood
kill the latter with preplanning and with full
·and may not be so easily solved.
preparation, as efficiently as a sane, cold
It is not only an insane person, often a blooded criminal.
sane person may not try to hide the commis-
Thus, not necessarily all the acts of an
sion of a crime. On the other hand, bringing
insane person will appear innocent in all these
the commission of the unlawful act to the
respects and not always the crime commit-
notice of others by an insane person does not
ted by a sane person will be indicative of his
necessarily mean that, the act was the prod-
purposeful involvement.
uct of the unsoundness of his mind ·a nd .he
did not understand the nature and conse- As has already been pointed out, the es-
quence of the act, at the time of commission sence of all · the rules concerning criminal
of the act. He may be an insane without in- responsibility of insane persons._is that, an
volvement of his faculty in all respects. He innocent mentally unsound pe~on who has
might have committed the act 'witho~t the committed some unlawful act due to the un~
influence of any abnormal mental factor and soundness ofhis mind, should notbe awa'rded
with full understanding of the nature and with any punishment which is meaningless
consequence of the act, though he suffers from for the insane and thus the purpose of.pun•
some degree mental abnormality of mind, and ishment is frustrated there. He should rather
subsequent to commission of the act he may be sent to a psychiatric centre for his treat-
try to establish the defence. for himself on ment a:hd well~being and for protection of oth-
the ground of the abnormality of ,his mind ers, which is his rightful demand to the soci-
from which he is actually -suf.fering, though ety.
irrelevant in the present .case.
The ultimate ptirpose of a,ll the concerned
It is a fact that an Msdne'·pliis'on -cannot rules being s~iiie; ·fhere ·are-certain, though .
have an accomplice. But t'Fi~rl; hot in all cases minor, basic differences betwe~n th~ . _ap- .
proaches of these rules. In British concep- for his criminal act, if the act is the product
tion of the MeN aughten rules we find that, of the unsoundness of his mind. Thus, like
the party accused has to establish a defence MeNa ughten rules, this rule also admits that
on the ground of insanity. Defence against an unlawful act performed by an insane per-
what ? Obviously, it is defence against the son has to be viewed as a crime committed
possible conviction and punishment. Thus, it by him. And like all other rules, this rule also
is the feelingof the author that, McNaughten states that though a crime has been commit-
rules while giving due importance to t he ted by him, he is not to be punished for the
mental unsoundness of an offender also gives act as the criminal act is the product of his
due importance on the harn1 caused to the unsound mind.
victim. Hence the term of verdict in a case of Both Curren's Rule and the American
a crime committed by a mentally unsound per-
Law Institute Recommendation are more at
son is guilty but insane. This essentially indi-
par with McNaughten Rules and Durham's
cates the stand of the British law that, the
Rule, because both recognise the criminal
.offender (person) is guilty of commission of an nature of the act but provide acquittal for the
offence against an individual and the society, person concerned on the ground of the act
but he is not to be awarded with any punish- having been committed by the person due to
ment because he has not committed the of-
the unsound state of his mind. Thus the ar-
fence with full knowledge and understanding
guments of these rules is that a wrong has to
and had he not been so unsound mentally, he
be recognised as a wrong. Whereas Indian
would have not committed the offence.
Law emphasises that an insane should not
On the other hand, according to the probe blamed.
vision of Sec. 84 IPC, even if an unlawful act
In any way, in relation to trial and pun-
is committed by such a mentally unsound per-
ishment in a criminal case the onus to prove
son, he will not be designated as an offender.
insanity lies with the accused, who may raise
Thus Sec. 84 IPC, appears to be more con-
cerned with the mental condition of the per- the matter ofhis insanity before the starting
son who has committed the unlawful act, and or during or after completion of the trial,
while doing so the law forgets about the fact when convicted.
that there is a sufferer, a victim in the case
Insanity and Civil responsibilities
and the society has been harmed, though may
be innocently, by another person. Here the A sane person has to meet up all the civil
argument is that an insane cannot be pun- responsibilities. The position is diffe~nt for
ished because he cannot be considered as an an insane person. It all depends on the men-
offender. This implies that an act committed tal capacity of the insane person. If, by vir-
by an insane cannot be an offence from his tue of his mental unsoundness he does not
point of view. understand the responsibility involved in its
Durham's Rule, in the opinion of the au- nature and its magnitude, or if he is unable
thor, has an edge over the others in that, to meet up the responsibility then lie will be
without going into the complicated twisting absolved from the responsibility. But the prob-
words of law, it h as successfully expressed lem is not so simple always . A few circum-
the provision of the law by stating that a stances of some such problems are discussed
mentally unsound person is not responsible below.

1. Management of property - As discussed either party then it can be legally contin-

in page 616 (under judicial inquisition), if ued after taking some precautionary
a mentally unsound person is unable to steps.
manage his property , and if it is brought 3. Marriage contract - If at the time of
to the notice of a District Court then on marriage either party suffers from in-
being satisfied, the District Court will ap- curable mental illness then a nullity of
point a manager ofhis property, who will marriage may be allowed on the prayer
prepare .an inventory of the property of the healthy party. If either of the
within 6 months of such appointment. He spouses suffer from incurable mental
also prepares the annual account of the illness after marri~ge , then a decree of
property. He does whatever is best for divorce may be allowed on the prayer
the management of the property of the of the sane spouse . Incurable mental
mentally ill, many a times with the know l- illness here indicates mental disease
edge and under the guidance of the Court, which could not be cured even after con-
as discussed earlier. The manager is paid tinuous treatment for a period of not
for his semce from the property or the less than 3 years .
income of the mentally ill person. 4. Testamentary capacity and mental ill-
2. Business contract -If one of the partners ness - Sound disposing mind or mental
of a business is found to be insane from state is necessary to prepare a valid will
before his entrance into the business con- or testament, to arrange the disposal of
tract, then so far he is concerned, the one's property. The other necessity is
contract may stand invalid or void. But if that the maker of the will should be an
it can be shown that the contract was a adult or above the age of 18 years . A will
fair one and the mentally ill person can or testament prepared by very old per-
carry on with the terms of the contract son draws special attention of the doc-
or if the continuance of the contract will tor to assess the mental state of the tes-
not be harmful for him, rather his with- tator, when it is prepared. During the
drawal from it may be harmful for him preparation of a will, the presence of a
and the other party or parties then the doctor may as such be necessary who
terms of the contract may continue. But certifies about the mental soundness of
if it is seen that, he was brought into the the testator. This is to avoid future com-
contract by the other partner or partners plications. To verifY the mental state·of
to take advantage of his mental illness, the testator, the doctor should examine
then the contract will stand void. Simi- him in accordance with the need. The
larly, if a person becomes mentally ill doctor may do this by verifYing, if the
after entering into a business contract testator can narrate the extent of his
and if it is found that the continuation of property exactly and if he can explain
the contract will not be hannful for ei- . with reasons the manner of the proposed
ther party then, its continuation will be disposal of his property, particularly if
legal. But if its continuation is likely to the manner of the disposal appears to
cause harm to either party, then its con- be unusual.
tinuation will not be valid. Like-wise, if In connection with disposal of property
its dissolution is likely to cause harm to the following points are important. A

.b lind or illiterate person can make a 7. Guardianship - An insane person cannot

valid will if the term of disposal and act as the legal guardian of a minor .
.•
preparation of the 'will' is as per his will
or desire and is witnessed by doctor, law- Responsibility of intoxicated persons
yer and othe.r witnesses and the content Generally speaking, in criminal cases, an in-
·- of the will is read out before him in pres- toxicated person may not be held responsi-
. ' '· ence of the witnesses and if he thinks ble for his act, if at the time of committing
t~at the content of the will is at par with
the act, due to the effect of intoxication he
his desire. A deaf and dumb person can did not understand the nature and quality of
prepare a valid will. A very old and de- ·the act and its consequence and legal posi-
bilitated person also cap make a valid tion. But ifhe has taken the intoxicating agent
will if he possesses a sound disposing on his own and with a mind to perform the
mind . ~A mentally ill person also can . criminal act easily, then he will be held re-
. make a valid. will, i(the illness of his sponsible for its commission and will be
nrind does n'o t affect his capacity of d.is- treated accordingly.
posal of.the ·p roperty. If the illness does
In civil matters, an intoxicated person
···' . not affect his capacity of understanding
cannot take up any civil responsibility dur-
~he nature of the disposal and the con-
... sequence of the same. Ifhe suffers from
ing the period of his intoxication. In case he
performs an:r ..ct involving civil responsibil-
any delusion which may affect the man-
. ity then, the case will be considered accord-
ner 'of disposal, then the will is invalid.
ing to the nature of the work and merit of
An alcoholic can make a valid will, so
.. · ' ·the consequence .
. long he is not intoxicated and if the al-
. cobol does not affect the power of his Unlawful Act and Hypnotism
understanding and judgement capacity
about the nat}l-._!8 and consequence of the Hypnotism or mesmerism is a state which is
manner of disposal. believed to be a sleep like condition produced
'5. Competency as a witness -Though, gen- in a person by way of suggestions. It is
erally speaking, an insane person is not claimed that during such a state of mind of
a competent witness, yet, if such a per- the hypnotised person, he can be made to
son has a personal know ledge about the perfolTI_l some work by the hypnotiser, by way
occurrence of an incident.and ifthe per- of suggestions:' Even if the reality of hypno-
son call. understand the meaning of tak- tism and h~notisation is accepted with some
ing "oath", and if he can narrate the in- reservations, 'it 'is certain that such a hypno-
cident properly, then the presidmg of- tised person cannot be made to commit any
ficer of the Court can allow his deposi- . major offe~ce by way of suggestions, if he
tion. himself has ·~~f desire to surrender to the
"suggestio~;".' r,·
6. Con11ent - Consent given by ·~ rrte'n.tally I ~ ~ I"V.. t
ill person stands' invalid if it cannot be Theory of Dim~ished Responsibility

proved that he Un.deFStands th:~' n.:atll.re, ,.
;quality ·and · consequep.~ of th~ , ~ct;' for There i~ ~ s~~'il_ol ·~f thought that, unlawful .
which he is conse~ting. . .. ( act comn;riJ~d ,l;>y, a person who is suffering

chapter 21: FORENSIC PSYCH IATRY I 623
from some degree of mental illness should

not be treated at par with the unlawful act
committed by a sane person, though such a
• Indian Penal Code of 1860, Central Law Agency,
person need not necessarily be declared free
Allahabad, 1989.
from any responsibility inspite of committing
such an unlawful act. They recommend a • The Criminal Law, 2nd Edn. G. Williams, 1961 .
separate status for partially mentally unsound ., Criminal Responsibility in Mental Illness - F. A.
persons, so far unlawful acts committed by Whitlock, 1963.
them are concerned. According to this theory, • Insanity and diminished responsibility as defences on
such mentally ill persons have diminished re- criminal charges- L. Minty in Medicolegal J.. of Lon-
. sponsibility. Punishment for them for com- don, Vol. 39, 1961 .
mission of an unlawful act should be less. This
• irtsanity as a ground for annulling Marriages- PR.H .
should particularly be so if it becomes evi- Webb in Medicine, Sci. Law, Vol. 5, 1965.
dent that the commission of the act is not
directly due to t~e effect of the nature of his • The Epileptic Murderer- E. Podolosky in Med . legal
J. London, Vol. 30, 1962.
mental illness, though he suffers ~m som«?
sort of established mental illness. If a schizo- • Kenny 's Outline of Criminal Law, 18th Edn. - J. W.C.
phrenic believes that, sotnebody is thinking Turner, 1962.
to do some harm to ·him and the belief being • The Mental Health Act. 14 of 1987, Ministry of Law
the result of delusion of persecution, if he and Justice, Govt. of India.
kills the person then, he should be held only.
• A Psychiatric Assessment of Criminal Offenders,
partially responsible, even if the act was not Robinson, Patten and Kerr, in Medicine, Sci, Law, Vol.
explainable as to be the reasonable conse- 5, 1965.
quence of his delusion. The reasonable con-
• Psychiatry, Criminology and the law- Sir F. Lawton in
sequence of such a belief should have been Medicine, Sci, Law, Vol. 5, 1965.
to try to protect himself than to kill the other
person. Obviously, the doctrine of partial re- • Psychiatric Evidence in Court- D. Henderson in British
Med . J. Voi. 2, 1956.
sponsibility or diminished responsibility is
recommendative of reduced punishment for • Psychological Disorder and Crime- W. L. Neuslatter,
the mentally ill persons in general. This 1953
theory could not gain much popularity as it • Psychopathic State- D. Henderson, 1939 .
is not much impressive, because the crimi~ • Role of Psychiatrist in Criminal Trials- J. B. Cumming,
nal responsibility of insane persons shpuld Am. J. of Psychiatry, Vol. 115, 1958.
be considered in such a way as, it either rec-
ogni~es the responsibility of the person com-
• Forensic Psychology- Christopher Cronin, 2006 .
' nutting the unlawful act or does not recog- • Kaplan and Sadock's Synopsis· of Psychiatry;
behavioral sciences, clinical psychiatry - Benjamin J
nize his responsibility in any way. There
Sadock and Virginia A Sadock, 2007.
should not be anything like partial or dimin-
ished responsibility and diminished punish- • lntroductor Textbook of Psychiatry - Nancy C
ment. If the person is responsible, then he is Anderson and Donald W Black.
fully responsible and if not, then not at all. • Medical Jurisprudence, Insanity and Toxicology -
There cannot be any status in between. Henry C Chapman, 1999.

Questions lunatics, epileptic insanity, mental retardation,

amentia.
Theoretical
1. Describe the procedures of restraining an insane per- Oral que..c;tions

son in and his release from a mental asylum.
2. Describe the Criminal and Civil responsibilities of a Lu- Questions from long and short questions, and, types
natic. Differentiate between true and feigned insanity. of Delusion, Hallucination, Impulse ; McNaugten Rule,
Section 84 I.PC. Durham's rule, Curren's rule,
3. Classify insanity. How do you diagnose mental ill-
Circumstantiality, Negativism, Echolalia, Echopraxia,
ness?
Neologism, Claustrophobia, Flexibilitus cerea, Cata-
tonia, Paranoia, Hypnotism, Alcohol and criminal
Short questions
responsibility, Neurosis, Psychosis, Neurasthenia,
Testamentary capacity, Legal tests of insanity. De- Mannerism, Mutism;
lusion, hallucination, illusion, impulse, delirium, ob- What are -·Manic depressive psychosis, Idiocy, Im-
session, somnambulism, somnolentia or becility, Moron, Affective disorders, Phobic stage,
semisomnolence, observation of an insane person, Compulsive phenomena, Automatisms related with
diminished responsibility, lucid interval, wandering insanity?

These conditions are getting increasing le- ner may appear to him "oversexed". Satyria-
gal importanceg in our society. Before dis- sis is the term used for oversexed males hav-
cussing these conditions, for better under- ing high drive and nymphomania is the cor-
standing an expressable conception of sexual responding term for a female. Sexual arousal
intercourse or coitus should be there. may occur due to various stimuli in either
Sexual intercourse or coitus consists of a sex, which may be similar or different in na-
chain of events, the usual stages being, ture in both sexes and may include vision of
specific body parts, dress, particular posture
1. Sexual drive, or hearing some words or phrase or actual
2. Sexual arousal, bodily touch or manipulation or friction of
3. Genital union, particularly some parts of the body, e.g., clito-
4. Orgasm in the female and orgasm ris, 'G-spot or Grafenberg spot' on the wall of
and ejaculation in the male, inner part of vagina-where the Skene's
glands which cause secretion on stimulation
5. Resolution. the so called ejaculation or "milking" of
Sexual drive is mostly psychologically women, the breast, particularly the manipu-
controlled and is an effort to materialise a lation or gentle squeezing of nipples - in fe-
desire of sexual performance. Depending on males and fondling of glans and shaft of pe-
the degree of sexual drive, some persons are nis, particularly the meeting point of frenu-
termed "oversexed" and some "undersexed", lum below the meatus, manipulation or fon-
majority being taken "normal" being in be- dling of scrotum and testicles and physical
tween these two conditions. However, the manipulation of prostate per rectum in males.
terms oversexed and undersexed should not With arousal there is penile erection in males
be given absolute status, should rather be and erection of clitoris with congestion of
considered in relative terms. A so called over- neighbouring structures in females. Gener-
sexed husband will find an oversexed wife to ally speaking, arousal time required for fe-
be normal but a "normal" wife to be under- male is more than in male. It is also argued
sexed. Similarly, a so called undersexed fe- that distension of seminal vesicle with semen
male spouse may find the "undersexed'' part- causes arousal in male and a female may have
ner as normal, but the so called "normal" part- easy arousal during any time ofher menstrual
ferent physiological abnormality, having dif-

ferent legal implications in different circum-
stances.
Potency means, ability to perform sexual
intercourse and to achieve gratification.
Impotence means inability to perform
sexual intercourse and achieve gratification.
In males it also essentially includes failure
to have adequate erection of penis and ejacu-
lation. Dictionary meaning of 'impotent' is,
'a person who is unable to copulate'. Frigid-
ity refers to women who are sexually .<;:old.
· Some consider it as absence of desire for
sexual intercourse, others consider it as in-
. ' capacity of an worn~ to achieve vaginal or-
Fig .. 22.1 ; Perforated hymen
~--- gasm and yet another group likes the term
frigidity' to represent psychosexual defect in
cycle, which is specific for each particular ~omen which may include any or more of
woman. Genital union consists of intermis- the conditions which include lack of s.exual
sion of the erected penis inside the female interest, inability to experience pleasure dur-
vagina and its rhythmic manipulation till or- ing intercourse and inability to achieve or-
gasm and ejacuJation occur. In orgasm in gasm terminally. Dictionary meaning of fri-
male, there is spasmodic contraction of pe- gidity is, abnormal aversion to sexual inter-
nis, seminal vesicles with contraction of the course. Steri~ity means inability to procre-
allied structures with ejaculation and cOntrac- ate, which for women means inability to con-
tion of all the body muscles in general. In· ceive during child bearing age and for men
female org~sm, there is contraction of the means inability to make a woman of child
fallopian tubes, uterus, vagina, clitoris and bearing age, to conceive.
the neighbouring structures and also the A sterile person may or may not be impo- ·
whole body musculature, with secretion from tent or friiid and simila~ly an impotent or
the paraurethra,l glands. Resolution consists frigid person may or may not be sterile.
of a calmness and relaxation following orgasm
with flaccidity of penis and clitoris, followed Permanent impotence or frigidity is a
by lethargy and sleep in suitable circum- ground for nullity of marriage or divorce. But
stance. However, some may contmue ·in the sterility is not a ground for the same. This is
active phase during the period ~fter orgasm. so because, legally the purpose of marriage
Some women may have repeated orgasm is consuiruition· of the same by sexual inter-
before resolution. course but not 'e ssentially to beget a child.
Potency, impotence. and frigidity are de- Legal issues involved with sterility, im-
fined, described and explained on the back- potence anf!,/r:igidity-
ground of the above -chain of phenomena in- Civil issues :'-· Nallity of marriage; Di-
volved in eoitus. But sterility is totally a dif- vorce; Legitimacy; disputed paternity, com-

chapter 22: IMPOTENCE, FRIGIDITY, STERILITY, ARTI FICIAL INSEMINATIO N, IVF AND CLONING I 627
pensation cases due to loss of sexual func- before puberty. In old ages the virility of
tion. a man decreases but he is not essentially
Criminal issues - Rape , other sex of- either impotent or sterile.
fences, adultery, blackmailing, breach of 2. Local Developmental anomalies - Ab-
promise of marriage, criminal slander and sence of penis, infantile and non-erect-
defamation cases. able penis, intersexuality and adherence
In relation to the above cases, often a .of penis with the scrotum cause impo-
male and sometimes a female is sent to the tence. Absence or abnormality of both
doctor to ascertain sterility, impotence and testicles or cryptorchidism from child-
frigidity. This is not an easy job in most of hood (i.e., before puberty) may result in
the cases. In males , all cases of impotence impotence. These conditions may also
are conditionally sterile as they cannot pour lead to sterility. Temporary sterility may
semen in the vagina, except in cases of pre- also occur in case ofhypospadias and epis-
mature ejaculation when seminal fluid may padias, as in these conditions the male
be discharged inside the vagina or over the cannot pour the semen inside the va~na.
clift of vulva without erection of the penis However, these are correctable. Simi-
being maintained till the female gets orgasm. larly, phimosis and paraphimosis may be
Even in the latter case the spermatozoa may the cause of temporary impotence and
pass through the vagina and so, to the uterus 'hence temporary sterility, so. long the
and fertilize the ovum, which is termed as condition ,is not surgically corrected.
fecunda-ab-extra . In addition to the other con- 3. Local acquired abnormalities - Ampu-
ditions of impotence, ·a male may be sterile tation of the penis may cause impotence
due to some other pathology in him. In such depending on the extent of amputation,
cases, for this reason, where the male .can but not sterility. Castration before pu-
deposit semen in the vagina, the same should berty will cause both impotence and ste-
· be' subjected 'to lahoratory investigation for rility. Castration·of both ·sides ·after pu-
knowing the perce.n tage of motile normal berty will cause..stenlity but not i~po
spermatozoa in the semen and period of their tence. Vasectomy operation will cause
motility. Some other investigations are also sterility but not impotence.
recommended in specific cases. In any case, 4. Local abnormalities due to diseases -
the students should be well conversed with Elephantiasis and, hydrdcele may cause
the causes of sterility and impotence and fri- impotence but not sterility. Syphilitic
gidity in males and females . chancre or sore may also cause impo-
Causes of impotence and sterility in males
tence but not sterility. However,
gonorrhoea! infection or syphilis of tes-
1. Age - Before puberty a boy is usually tes and epididymis may cause sterility but
impotent and sterile. But in many cases, not impotence. Similar is the case with
erection of penis occurs with discharge new grow th (tumor) of these organs .
of semen with presence of spermatozoa, Mumps may cause sterility but not im-
much before usual pubertal age is at- potence. In the same way other infective
tained and other signs of puberty appear. conditions like tuberculosis of testes and
Such boys may be both potent and fertile epididymis may have similar effect. Ra-

628 I PRINCIPLES OF FORENSIC MEDICI NE
diation exposure or repeated exposure of dulgence to sex or even excessive sexual

the gonads to X-ray may also cause ste- ~esire or passion A man may be particu-
rility. larly averse to a particular woman and
5. General diseases - may find himself impotent with her but
(a) General infective conditions - Tuber- not with others (impotence quode hanc).
A man may be potent only in some spe-
culosis, nephritis or other chronic
cific environmental conditions or personal
infective conditions may cause tem-
effects of the woman and in other circum-
porary impotence and also sterility.
stances he may find himself impotent.
(b) Metabolicdisorderlike diabetes may Psychological causes outnumber all other
also be the cause ofboth impotence causes, but the effects are mostly tempo-
and sterility. rary and are overcome with adjustment
(c) Honnonal disorders particularly with and time. Psychological factors are not
sex linked hormones may lead to usually expected to cause sterility in male.
azospermia, leading to sterility and
may also reduce virility leading to Causes of impotence and sterility in
impotence. females
(d) Neurogenic causes - GPI, tabes dor- 1. As women are passive partners in sexual
salis, paraplegia, hemiplegia, syrin- intercourse, so far impotence is con-
gomyelia, injury to the spinal cord, cerned, theoretically no age in a wom-
all may lead to impotence and con- an's life is a bar for sexual intercourse.
sequential effective sterility. However, full penetration is not possible
6. Indulgence to drugs - Indulgence topsy- in very young girls, in whom the vagina
chotropic or psychodelic drugs like alco- is not well developed and capacious and
hol, morphine, heroin and cannabis or in whom the introitus is very narrow. A
hormonal preparation over a prolong pe- woman is of course sterile in the extremes
riod may cause impotence and sometime of her ages (beyond child bearing age i.e.,
sterility. before attainment of puberty and after
7. Chronic exposure to certain poisons like, menopause). It is however not always
lead, arsenic or prolonged use of so called true. A woman may be pregnant even
aphrodisiac agents may also lead to both before the age of usual attainment of
impotence and/or sterility. puberty and after the attainment of
8. Psychological causes - These causes are menopause.
most frequent, though mostly transient 2. Local developmental anomalies - Ab-
in nature. Worry and mental depression sence of vagina, narrow infantile vagina
is the most common cause of impotence and tough and imperforated hymen cause
for the period of worry or depression. Fear proper intercourse impossible. Absence
of inability to complete the act of inter- of vagina, imperforated hjrnen, absence
course may actually lead to such condi- or otherwise congenital defects of uterus
tion like non-erection, early flaccidity of (septate, infantile) and fallopian tube (lack
the erected penis and premature ejacu- of patency) and ovary (cystic or fibrous
lation. Similar outcome may be there due with absence of primordial follicles) are
to shyness, timidity, guilt sense, overin- the causes of sterility.

chapter 22: IMPOTENCE, FRIGIDtTY. STE[(ILITY, ARTIFICIAL INSEMINATION, IVF AND CLONING I 629
3. Acquired defects or abnonnalities -Injury ger is aimed towards the eye of a person.
or operation ofvagina or the introitus may In addition to the above factors , a woman
lead to inability to sexual intercourse . may be cold, disinterested or repulsive
Hysterectomy, tubectomy and ovariec- towards sexual intercourse, which is de-
tomy leads to sterility but not impotence. scribed below under the heading frigid-
4. Local diseases -Bartholin cyst, gross ul- ity.
ceration or chancre of vulva, stricture due
to perineal tear during previous preg- Frigidity in women and its causes
nancy, prolapse of uterus or urinary blad- 1. Sedatives or depressant drugs are said
der, kraurosis vulva with constriction of to lower sexual drive and response in fe-
vagina and dyspareunia of any other ori- males, as they do so in males.
gin cause impotence but not sterility.
2. Due to local conditions -Conditions which
Tumor of the uterus, endometritis, block- give rise to dyspareunia may ultimately
age offallopian tube due to any infective cause loss of sexual interest in a woman.
condition wil! cause sterility but not im-
3. Systemic diseases -Acute or chronic sys-
potence.
temic diseases inhibit the sexual desire
5. General diseased conditions -general in- and drive. In females, hypothyroidism is
fective, metabolic, and hormonal condi- particularly thought to be a cause of fri-
tions may cause sterility but not impo- gidity.
tence.
4. Neurological factor - It possibly does not
6. Drug indul~nce may or may not cause have anything much to do with frigidity
sterility but does not cause impotence. of a woman. However, sexual drive origi-
7. Chronic poisoning with lead, arsenic or nated in a female from higher centre or
some other agents may also cause steril- by local ne:fVous stimuli like, touch or
ity but not impotence. manipulation of the private parts may be
8. Psychological cause -Fear of pain or ap- grossly interfered with, due to neurologi-
prehension for sexual intercourSe (usu- cal causes. Such a woman may even-
'
- tually suffer from sexual inhibitio_n or
ally from the experience of a previous
painful seXI:lal intercourse) may, during repression.
an attempt of sexual intercourse give rise 5. Menopause - Contrary to causing frigid-
to a condition known as vaginismus with ity, menopause may increase sexual de-
sev~re contvaction of paravaginal mus- sire and drive in a woman due to being
cles including levator ani and adductor free from fear of gettil!g pre'gnant.
femoris muscles leading .to a state when 6,, Psychological causes - .Psychological
widening of the thighs and approach to causes outnumber other cause's of frigid-
the vagina and intercourse become im- ity in women. However women being
possible. It is more a psychological prob- passive partner, it may be difficult to as- .
lem. Vaginismus has been campared with sess by the male partner, the lack of de-
such mental apprehensions on the part sire for sex act by the woman partner.
ofthe woman as is seen in forceful blink- Unsuccessful intercourse where the
ing of the eyelids in a person when a fin- woman never gets orgasm may be an

important cause of sexual avulsion. Apart the primary intention but a person be-
from that, a woman may have repulsion comes sterile as a result of some medical
to a particular man for whom she may (ex. due to use of radiotherapy), surgical
be totally cold, but she may have desire (following some therapeutic surgery) or
or even nore than normal sexual drive therapeutic removal oftesticles.
and response for another man. Here, the 3. Accidental - Accidental injury to both the
behaviour, appearance, personality, psy- testes, or sterility due to some poison or
cho-socio-economic and educational sta- drug.
tus of the male may play important role.
Intentional sterilisation may again be of
Vaginismus is a condition which lead to
the following categories.
sexual avulsion in a few women. Homo-
sexuals (lesbian girls) may have general 1. Voluntary - Sterilisation may be per-
apathy towards th~ opposite sex. formed with free , voluntary consent of
the husband or the wife on the following
In assessing the degree of frigidity, the
grounds-
following factors should be given due con-
sideration. Time required for the woman (a) As a contraceptive step to keep the
for optimum arousal, period of genital size of the family limited (as a fam-
union (to give consideration on the point ily planning measure).
whether the woman gets orgasm or not), (b) For therapeutic purpose - Sterilisa-
whether she is selectively frigid , to some tion may be performed, particularly
particular man or she is absolutely frigid on a wife, when it is feared that fur-
under all circumstances to any male part- ther pregnancy may involve risk to
ner and whether the condition is appar- her life or health. This condition
ently temporary or permanent. It is to should not be confused with thera-
be kept in mind that, as partner, a woman peutic sterilisation mentioned above
can successfully suppress frigidity even where primary object is not sterili-
up to the extent of pretending of having sation but treatment of some other
orgasm. ailment.
(c) When there-is risk that, the offspring
may be physically or mentally a de-
SOCIO-FAMJLlAL AND LEGAL ASPECTS fective one, then sterilisation may
OF STERILISATION be performed on either partner with
consent from both.
Sterilisation is the process to cause a person
2. Compulsory sterilisation - This is effec-
sterile without affecting his or her potency
tive in some countries where a mentally
or sexual functions.
or physically defective person who is li-
Types
able to transmit a disease to his offspring
or a person who has committed some
1. Intentional - when a person is rendered specific type of offence (say sex offence)
sterile purposefully with some positive may be sterilised even without his or her
steps. consent . This provision has no approval
2. Therapeutic - When sterilisation is not oflndian legislation.

chapter 22: IMPOTENCE, FRIGIDITY, STERILITY, ARTIFICIAL INSEMINATION, IVF AND CLONING I 631
Methods other man which may initiate litigacies

Permanent like- divorce, legitimacy, disputed pater-
nity.
1. In males - ,
2. The doctor may be implicated if he per-
(a) Vasectomy - The vas is cut and the forms sterilisation without consent and
cut ends are tied. Though a perma- proper indication.
nent method, future surgery can
3. Healthy unmarried persons or healthy
offer fertility to a certain percent-
age ofvasectomised subjects. married persons without any issue should
not be permanently sterilised, even if
(b) Deep X-ray exposure of the testi-
they volunteer for the same.
cles - The person cannot be made
fertile in future even ifit is required.
This method is not recommended. ARTIFICIAL INSEMINATION
2. In females -
(a) Tubectqmy -Repair is possible in a When the husband is sterile or cannot pour
good percentage of cases in future. semen in the vagina, when living motile nor-
(b) Deep X-ray method - As in deep mal spermatozoa cannot enter the uterus,
X-ray procedure followed in cases of when a widow or unmarried woman wants
males, here the ovaries are given to have a child, pregnancy may be attempted
the exposure. by introducing semen, from a healthy selec-
tive male, inside the uterus or near the os
Temporary methods with the help of a syringe. There is no spe-
cific provision for or against artificial insemi-
1. Observation of safe period - Intercourse
nation in Indian law.
is avoided around the period of expected
ovulation.
Types
2. Coitus interruptus -Ejaculation is done
after withdrawing the penis from the va- 1. AIH or artificial insemination homologus
gina. -When the husband's semen is biologi-
cally normal but he either cannot pour
3. Prevention of the spermatozoa entering
the same in the wife's vagina by way of
the uterus by use of diaphragm in female,
intercourse or due to some defect with
outside the os and use of condom by
the cervical opening of the wife or condi-
males (most popular).
tion in the vagina, living sperms cannot
4. Use of spermicidal jellies or foam tablets. enter inside the uterus, semen from the
5. Use ofintra-uterine contraceptive devices husband is collected byway of masturba-
Goop)- also quite popular. tion and pushed inside the uterus.
6. · Use of hormonal contraceptive. 2. AID or artificial insemination donor -
When the defect is in the seminal fluid of
Medicolegal aspects
the husband then, semen from another
1. Failure of contraceptive measure adapted healthy suitable male is used and intro-
by males may be a cau8e to suspect the duced inside the vagina or the uterus of
wife to have sexual relationship·with any the wife.
632 j PRINCIPLES OF FORENSIC MEDICINE
3. A. mixture ofhusband's semen as well as the doctor also gets implicated with legal
that of a donor is used in cases where complexities.
the motile spermatozoa count in the hus- 2. In case of widow or unmarried woman
band's semen is poor though present in and in case of a married woman when
the semen. The advantage of this method the husband does not adapt the child, the
is that both the husband and the wife child remains illegitimate.
may like to believe that, the husband's
3. Artificial insemination inherits a remote
spermatozoa which being less in count
chance of incestual relationship between
could not by themselves fertilize the
the offsprings of the donor from his wife's
ovum but might have so done, being as-
side and the recipient's side , as the iden-
sisted by the spermatozoa of the donor tity of the donor being the father of the
and the child thus might have been the offspring of the recipient, remains secret.
product of the husband.
4. Family problem including mental trauma
of the husband of the recipient wife is
Indications of artificial insemination
possible, even though he gives consent
1. When the husband is sterile . - for artificial insemination of his wife.
2. When the husband cannot discharge the
semen in the vagina. It may be remem- Recommended guidelines for artificial
bered here that, in such circumstances insemination
when the semen is discharged at the As has already been mentioned that, there is
vulval zone, pregnancy has occurred in no specific law ip Ind,ia regarding artificiaJ
some cases due to the passage of the insemination, legal problems may arise 9n
motile sperms through the length of the the· allied aspects of the procedure adapted
vagina, to the.uterus, a condition known for the purpose . To avoid the possible prob-
as fe~dation ab extra . However it can-
not be taken as a common event.
, pro,cedurfll precautions are reo-
lems, certain
onvnended. a •
3. When t}le husband is impotent in other

senses.. • •
1. The dortor shoUld not ha;e any phy_sical
.
or mental d.isease whiCh may be. trans~.
. 4. When some di~:ase is likely to be trav.s- • • mitted to the child . '
• •
"
.
mitted from th~ fl}ther to the off!lJ>ring. 2. Consent ~f both the recipient 'wife and
5. Widows and unmarried 'Yomen de(:liring_ her husband iS necessary .
for children. 3. • Sirn1larly, consent of the donor and his
6. In special ci~umstances , Rh fncompa- ~~fe•is also necess~ry . · ·
. . tibility may l:_?e Considered as an indication_.
.,
··4. The donor . . should
"
have his own child .
5. • There should be paritY of rae~ , religi~n
Possible legal and s~cial compli~ations of
and.as much as possible , the morph~logi
artificial insemination
cal appearance between t~e donor and ·
· 1. Artificial insemination is as such not a the husband of the recipient woman.
ground for nullity of marriage, but it is a 6. The donor must not be a relative of ei-
ground for divorce if it was done without ther the recipient or her husband (diffi-
the consent of the husband. In such a case cult to know).
chapter 22: IMPOTENCE. FRIGIDITY, STERILITY, ARTIFICIAL INSEMINATION, IVF AND CLONING / 633
7. The donor should not know the identity II'- VITRO FERTILISATION
of the recipient and the recipient also
should not know the identity of the do-
nor. In vitro term is used for any biological proc-
ess or activity performed outside the body of
8. The donor should not know the outcome
a human being or animal. In vitro fertilisa-
of donation of semen.
tion means fertilisation of ova by sperms out-
9. The donor should give a written decla-
side the mother's womb. Now this is an ap-
ration that he will not prefer parenthood
proved treatment of infertility where fertili-
claim for any child on the ground of do-
zation of ova or continuation is not possible
nation of semen .
in the mother's womb. To make it a success
10. A female attendant must be present dur- ovulatory process is brought under control
ing the process of insemination. by hormonal therapy. More than one suit-
11. Maintenance of strict confidentiality of all able ova is extracted from the ovary through
the records is a must. transvaginal route under USG scanning, by
12. In suitable ·cases the sterile husband's aspiration, the extracted eggs are stripped of
semen and the fertile donor's semen the surrounding cells. On the other side the
should be mixed before insemination (e.g. semen is made ready by removing inactive
when the semen of the husband contains or defective sperms, other cells and undesir-
insufficient amount of motile sperm). able fluid. Iffrozen-preserved healthy semen
13. Rh. compatibility between the recipient is used then thawing is necessary. Sperm
and the donor should be tested. made ready in this way is mixed with ex-
Both donor and recipient should be tracted ova in the ratio of95,000:1 :: sperm :
healthy and free from certain diseases. ova. This is then inC\lbated in suitable cul-
ture media, at body temperature for 18 hrs.
Where sperm count is less, 1 healthy sperm
is directly injected in a ovum. When fertili-
.SURROGATE MOTH
zation occurs, the fertilized ovum shows 2 pro-
nuclei. When one sperm has to be injected in
A surro~ate mother is a woman who accepts
the ovum, it is so done by ICSI (Intra cyto-
pregnancy and bears child either by way of
plasmic sperm injection). The fertilized sperm
artificial insemination or by way of implan-
is then placed in a special growth medium
tation afm-vitro fertilized ova at the blasto-
where it is left for about 48 hours until it
cyte stage, till normal delivery ("test tube
turns to 8 cells stage and can be graded as
baby") for another woman who is incapable
embryo . Embryos showing satisfactory
tp carry child . The surrogate mother carries
changes during this period are .chosen and
the child whenthe husband and wife for whom
transfe~ in the uterus through a thin plas-
she carries child, both desires and give con-
tic catheter. To assure the chance of impreg-
sent for the same. According to the contract,
nation more than one fertilized ova is in-
a surrogate mQther cannot place future claim
serted.
on the guardianship of the child. But the fac-
tual position is that, her relationship with the IVF (In vitro fertilisation) has revolution-
child cannot be totally deni~d. ised the problem which used to arise due to
psychological and other impacts of infertil- 2. The peculiar relationship between the
ity. However, being a complex process and baby and his surrogate mother cannot be
probable rmknown biological factors, success ignored.
rate of pregnancy has been estimated to 43% 3. Ethically, the procedure bypasses the
and successful life birth to 36% , in healthy natural method.
yormg women.
4. Creation of life in the laboratory cannot
fu vitro fertilisation is practised in the be considered as a natural event i.e., it is
following circumstances : against nature's law.
1. When ovulation does not occur or is de- 5. Embryo is used as a commodity.
fective in a women , healthy ovum is
6. Long term effect of frozen embryo is yet
taken from another woman is a hormone
to be fully assessed.
controlled process and fertilisation is done
in vitro. 7. Birth of a life in rmnatural environment.
2. In case ofblockage of Fallopian tubes . 8. It inherits a danger to create embryo for
medical research purpose .
3. When the uterus cannot impregnate the
fertilized ova or 9. There may be change in the concept of
4. Or when the womb (uterus of a woman) parent-children relation and also of fa-
is not fit for continuation ofpregnancy . ther-mother relationship.
fu case of no. 3 and no. 4 another con- 10. Structural shape of the family being in-
senting women's help is taken for the pur- tact, there may be emotional imbalance.
poses. 11. Fertilisation of excess ova has already
Other methods followed are : attracted attention.
1. Zygote futra Fallopian Transfer CZIFT), 12. An effect on family rmderstanding and on
2. Gamet futra Fallopian Transfer (GIFT) family psychology may affect family en-
- actually in vivo fertilisation. vironment and family relationship in the
long run.
3. Cryopreservation of embryos in frozen
state in liquid nitrogen is also in prac-
tice .
4. Oocyte cryopreservation (ofrmfertilised ) CLONING
egg is done in case offemale patients who
may be subjected to chemotherapy. Cloning is the method of producing identical
5. Ovarian healthy tissue cryopreservation replica by asexual laboratory process .
may be considered in women suffering 1. Molecular cloning - It is the process to
from ovarian cancer - It is still being in create replica of DNA fragments.
research stage to get (healthy ova) from
2. fu cellular cloning multiple cells are pro-
the healthy preserved ovarian tissue.
duced from one cell. Cloning ofrmicellu-
Socio-religious ethical and legal issues lar organism i.s easier than cloning of a
linked with IVF . cell from a multicellular organism. Clon-
1. Some religion, including catholics are ing of cell of a multicellular organism is
against IVF. a strenuous job.._It does not grow easily

chapter 22: IMPOTENCE. FRIGIDI1Y. STERILI1Y, ARTIFICIAL INSEMINATION. IVF AND CLONING I 635
in standard media. However, adapting so- had to be destroyed on consideration oflegal

matic cell nuclear transfer, human and ethical ground. Legal issues are involved.
blastocytes could be created, but stem cell Not only that, a cloned individual may in fu-
lines could not be isolated. ture have personal, familial and social prob-
3. Organism cloning - It involves the proc- lem also. The society by itself may face many
ess of creating new multicellular organ- problems, related to the above issues. It can-
ism which are genetically identical with not be forgotten that it will also be an asexual
the source organism. The procedure can replica production.
produce most plants and some insects.
Parthenogenesis in some animal crea-
tures like, ant is essentially natural clonal References
derivation.
• E. Bergle - Premature ejaculation - in International
4. Reproductive cloning - In this, nucleus journal of sexology, Vol. 4, 1950.
from an adult cell (e.g. somatic cell) is
placed insi~e an egg i.e. an egg is ferti- • E. G. Daniel and E. S. Tauber- Replacement therapy
in castrates- in American journal of Psychiatry, Vol.
lised by transferring a nucleus from an
adult cell. When the egg starts to divide, 97, 1941.
it is transferred to the womb of a surro- .· • • Katherine B. Davis- Periodicity in sexual desire : Part
gate mother. II, married woman- in American journal of Obstetrics
First clonal creation of a mammal is and Gynaecology, Vol. 14, 1927.
"Dolly the ship", in Scotland. • A. L. Finkle, T. G. Moyers. M. I. Tobenkn and S. J.
Presently, by nuclear transfer method of · Rang- Sexual potency in aged males- in Journal of
cloning, new "ones" have been produced in a American Medical Association. Vol. 170, 1959.
wide range of species namely, mouse, sheep, • C. S. Ford and F A. Beach - Pattern of sexual behav-
rhesus monkey etc. Human hybrid embryo iour in New Yo(k, Harper, 1951 .
produced by injecting human stem cell nu- • L. J. Friedman- Virgin wives. 1962.
cleus from leg in cow egg in 1998 was not
• Ruth D. Hart - Monthly rhythm of libido in married
allowed to be implanted in the womb on ethi-
women- in British Medical Journal, Vol. 1, 1960.
cal ground. It had to be destroyed. Human
cloning is creation of genetically identical • W. S. Kroger a~d S. C. Freed - Psychosomatic as-
replica of an existing or of a person since dead pects of fridigity- in Journal of American Medical
but from whose body healthy somatic cell Association. Vol. 143, 1950.
nucleus can be made available. This has 2 • Joan Malleson- Vaginismus; Its management and
(two) uses. Firstly, therapeutic, e.g. tissue Pathogenesis- in British Medical Journal, Vol. 2, 1942.
transfer. In this field research work is con-
• L. S. Simpson -Impotence- in British Medical Jour-
tinuing officially. But the 2nd purpose i.e. re-
nal. Vol. 1, 1950.
production of a new replica is prohibited world
wide, though secret (illegal} research work • W. Stekel-lmpotence in male; by Bani and Liveright,
in this field cannot be said to have stopped. New York, 1927.
Human cloning attempted an.d progressed by •· Richard Shephard - Simpsons Forensic Medicine -
using adult skin cell m!cle-a~ and human egg, 2003.


-2008.
• Michael J Skrun and Davidson A Ramsay- Pathol- What do you understand by
ogy of Trauma - 2006. 1. Impotence, sterility and frigidity?
2. What are the medicolegal importances of impotence
and sterility ?
3. Is nullity of marriage or divorce allowed in impotence,
Long, theoretical questions frigidity and sterility?
1. What are the causes of impotence and sterility in 4. What is artificial insemination ?What are the types?
males/females ? What legal questions are involved in the practice of
2. What is IVF ? What is the basic principles of IVF ? artificial insemination? What precautions are recom-
What are the problems ? mended?
3. What is cloning ? What are the types? What are the 5. What is sterilisation? What are the methods adapted
problems of producing human replica by cloning ? by males and females ? What legal problems are
What therapeutic use of cloning may be allowed ? involved in it?
NOTES

Virginity means inexperience of sexual inter- Signa of virginity in a fomalo
course on the part of a woman Defloration
1. Genital findings
means loss of virginity, i.e. , experience of
sexual intercourse by a woman for once at (a) Hymen - A virgin girl is expected to have
least. an intact hymen. It is wall-like flap of thin
tissue placed anterior to the vaginal ori-
Virginity and defloration have legal fice or the outlet. It is about 1 mm thick
importances. Loss of virginity before mar- and may be of different shapes and ap-
riage is not a ground for nullity of marriage. pearances. It may be,
Virginity after marriage indicates 1. annular and situated centrally;
nonconsumation of marriage by sexual inter-
2. semilunar and placed anteriorly;
course and that is a ground for nullity of
marriage or divorce. This may be due to im- 3. septate with two openings separated
potence of the husband or the wife or frigid- by a septum of hymenal tissue;
ity of the wife. Defloration or loss of virginity 4. cribriform with multiple openings;
is related with rape committed on a virgin 5. hymen with elongated vertical open-
girl. Apart from this, false allegation of loss ing
of virginity of a female amounts to her defa- 6. Imperforate without any opening for
mation Hence, legal issues related with vir- the vagina;
ginity and defloration are - 7. Infantile, with very small opening.
1. Nullity of marriage or divorce, In deflorat:.ed woman the hymen is usu-
2. Rape. ally ruptured During the first act of in-
3. Defamation. tercourse the rupture usually occurs
posteriorly at 5, 7, or 6 '0 clock position.
4. Fabricated charge of rape.
In a woman who is habituated to sexual
A virgin woman has certain features in intercourse, there will be multiple rup-
her private parts, some of which are lost dur- tures of the hymen with presence of tags
ing the first act of intercourse (defloration) of the hymenal tissue on the margin giv-
and some others are lost due to repeated acts ing the hymen an appearance known as
of intercourse. carunculae hymenalis. After pregnancy
5 6
8
[!] riJ. 9
B
10 11 •
Fig. 23.1A: Rupture of hymen after ~exual int~rcourse

FIQ. 23.18: Different types of hymen
• 1 &2. Annular shaped hymen, 3. Semilunar hymen, 4. Vertical hymen , 5. Cribriform hymen , 6. Septate
hymen , 7. Imperforate hymen, Fr. Hymenal tear after 1st act of intercourse , 9. Multiple tears of hymen ,
10. Carunculae hymenalis ,. 11. Carunculae myrtiformis
..
and delivery the hymen is almost absent injuries. Masturbation should not cause
with presence only of its remnant near . rutpure of the hynie~, as the manipula-
the marginal attachment, as an irregu- tion , involves 'm ainly tlie superficial or
lar thick area. Such a state of hymen is • outer aspects and when it involves -i ntra-
known as caronculae myrtiformis . • vaginal manipulation , it is so done not to
In a deflorated woman, the hymen may cause rupture· of the hymen and pain.
be intact (1) when the subject is a young An unruptured hymen in a young woman
child , as the marginal tissue prevents in- should not allow entrance of any finger,
trusion of the penis in the vagina, and other than the little finger. Fimbriated
(2) when the hymen is thick , fleshy , elas- hymen with marginal irregularity should
tic and loose . not be confused with ruptured hymen.
Similarly, in a virgin woman, the hymen (b) During the first act of coitus , the four-
.nay be ruptured or absent due to surgi- chette j"e~ , the lower meeting point of
cal interference, ulceration, scratching both labia..minoras may rupture , to heal
due to chronic itching, diseases like diph- in a thic~~gvlar
·. 1,1.•,.,,. ,.,
line. Changes in the
theria, regular use of sanitary napkin, de- fossa navielilaris , labia minora, labia
liberate rupture ,to ~~ a girl fit for il- majora~ t~girj:al wall, vestibule and clito-
legal intercourse ·for ·immoral purposes ris occm- o~ly .a ftet several frequent acts
like, prostitution and certain accidental of intercpu~e .

chapter 23: VIRGINITY AND DEFLORATION I 639
ence of intercourse, these are lax, not in

close apposition, have rather a gap in
between the two sides, through which the
labia minoras peep out.
(f) Vaginal walls in virgin women have ru-
gosity and the vagina is not capacious in
them. With frequent intercourse the ru-
gosity is minimised and the vagina be-
comes more spacious.
(g) The narrow vestibule, the whole space
between the labia minoras and above the
Fig. 23.2: Virgin breast (size of nipples contradictory) '"aginal opening, in a virgin becomes spa-
cious with appearance of folds due to fre-
quent intercourse .
. .(c) . Foss·anavicularis -: In women who are
habituated ;with frequent sexual inter- The posterior cornnlissure·i.e., the lower
course, fossa navicularis, the depression or posterior meeting point of the labia
between the fourchette and the vaginal majoras, does not usually change due to
opening, changes its appearance. intercourse.
(d) Labia minora - These are usually pink-
ish, smaller and mostly covered by labia
majora in virgins. But in women with fre-
quent experience of intercourse, these
are enlarged, partly darkly pigmented,
and project much outside the labia majora
(see Fig. 23.4 and 23.6).
(e) Labia majora - These are firm and fleshy
and both sides are ?n close apposition_in
virgins . Inwomen with .frequentexperi-
Sex organs in \'! fal~~· virgin with veneral

warts. Mark the pinkish, small labia minoras. Fig. 23:4: Note the enlarged labia minora in a woman
Hymenal opening not appreciable well in the expe.rienced and habituated to sexual
picture intercourse

640 I PRINCIPLES OF FORENSIC MEDICINE ·~
'1.
Fig . 23 .6: Multiple healed tears of hymen which is

almost absorbed in a woman habituated to
regular sexual intercourse. Note the
pigmented, enlarged labia minora
2 . Extra-genital signs of virginity
(a) Breasts are hemispherical, firm, with

smaller pinkish areola and small nipples.
With defloration due to a single act of
coitus these signs are not changed. But
in women habituated to frequent acts of
Fig. 23.5: Breasts of a woman habituated to
intercourse, the breasts are enlarged,
sexual intercourse. Note the slightly loses firnmess and may be slightly pen-
pendulous breasts, larger areola, dulous and the nipples will be large and
large and raised nipple with recent
marks of bruises caused during raised. TP.ese changes are not directly due
recent sexual assault to intercourse but are the result of the
process of acts accompanying intercourse
(see Fig. 23.5). -
Table. 23.1: Differences between virginity and defloration

Points of difference Virginity Defloration
1. Basic difference Condition in a woman having no experience Condition in a woman having experience of
of sexual intercourse sexual intercourse
2. Hymen Usually intact. Some may have ruptures Usually ruptured; exception- false virgin
due to some other reasons
3. Introitus Does not admit more than the tip of a finger. May admit 2 fingers, which is not painful
This is also painful
4. Vagina (a) Marked rugosity of the wall (a) Rugosity diminishes with frequency of
practice of sexual intercourse
(b) Full length of a finger cannot be (b) Full length of a finger can be admitted
admitted and the vagina appears capacious,
after repeated intercourse
Contd.
chapter 23: VIRGINITY AND DE FLORATION I 641
Table. 23.1 Dffferences between vi rg1ndy and defloration

Points ofd.ifference Virginity Defloration
5. Fossa navicularis less COnsptc.'JOUS Morn conspicuous after repeated intercourse

-6 Fourchette lntrt May show healed lear
7. Labia minora Smaller, pi ish, covered by labia majoras Enlarged, partly pigmented and partly
protn.Joo out throug lhe labia majoms,
after repeated intercou se
s Labta majora hick, fleshy: both side majoras are in close Less fleshy, slig tly absotbed; both sides are
~sition rot jn fUll a~ition, if experierloo of i terootJse
is for 01/Bf a long period
9. Breasts Size - Variac~e. firm, hemisoherical w·ith Size- Variable, may be Rabby slighUy or
pmkish smaller areola andsmall pples moderatety pencil1ous. wtij'J wider areola and
large and raised 'pples. Other changes may
be lhBre due to pregnancy
- - - ----
Table. 23,2: Differences between true virgin and false virgin

Paincs of difference True lfirgm False virgin
I
1. Basic diff00;1nce The woman has no experience of sexual The wotnan is e.xperiel1!Ged with sexual
intercourse intercourse
-
2. Hymen Not rup red. It ts a thm flap oftissue of Not ruptured It is thick, fleshy or fibrt:X.s
regular shape and appearance elas.ic with folds
3 ~ntroilus
4. Vagina
5. Fossa navicularis
6. Fourchette As in caseofvi rgmity noted in table 23.1 As in case of defloration noted in ta e 23 1
7, Labia minora
8. Lab;a majora
9 ~SI.s
(b) All signs of pregnancy, some of which are virginity. As ~he most countable sign of de-
permanent, are signs ofloss of virginity, floration or loss of virginity is the rupture of
·except when pregnancy is the result of hymen, its intactness may be taken to be the
artificial insenll,nation or in vitro fertili- infalliable proof of virginity. ~ut in a few per- j ·
sation. centage of women, the hymen may remain -
False virgin - False virgin is a woman intact even after multiple acts of coitus. This
who has lost virginity but does not show the may occur when the hymen is thick, tough,
signs of defloration i.e., retains the signs of fleshy, elastic and loose. In suc;h cases, other
rF M. - 4 11
642 I PRINCIPLI;S OF FORENSIC MEDICINE
signs of deflora:tion may be there depending • David Dolinak, Evan Matshep, Emma 0 Lew .-Foren-
on the length of the period of experience of sic Pathology: Principle and Prac6ce- 2005.
sexual intercourSe.
Questions
Short and oral .questions .

• Human Sexual behaviour and Sex education ~· w. R.
Johnson, [G. Belzer, edfte~ by R. Abernathy, 1973. 1. What are the types of hymen ?
. .
• Sexual Ass~ult of Children and Adol escent~. Ann 2. · What is virginity, deflon3ticm, true virgin, false virgin ?
Wolbert Burgers, A Nic~olas Groth, L. L. Holrns.trom, 3. Differentiate between virginity and defloration, true
S. M. Sgroi, 1978. virgin and false virgin.
• W Dog las Hemming- Forensic Medicine and Toxicol- 4. What is carunculae hymenalis, carunculae myrtiformis,
ogy- 2008. · · imperforate. hymen ?
• Stiffen Timmenmanas- Post-mortem: How Medi- · 5. What are the extrage·nital signs of defloration or false
cal Examiners Explain Suspjcious Death - 2007 ~ virgin?
NOTES
.'
nal case, the execution of the punishment
may be deferred until 6 months pass af-
ter the birth of the child of the pregnant
Pregnancy occurs in a woman due to
convicted and condemned woman, so that,
embeding or impregnation of a fertilised
she can rear the child till that period.
ovum or zygote , deep in the endometrium of
In some cases, the ' capital punishment
the uterus . The ovum is fertilised in the isth-
may be comm_uted to imprison-
mus of the fallopian tube within about 12 -
ment.
24 hours of ovulation and the fertilised ovum
2. When a woman due to advanced stage of
comes down in the uterine cavity by about
pregnancy expresses her inability to with-
the fourth day and its impregnation in the
stand the strain of trial in a criminal
uterine wall occurs, after about 7 days offer-
court, the trial of the case may be de-
tilisation. The fertilised ovum is known as
ferred to any future date as is felt rea-
zygote and after impregnation it is known as
sonable by the court.
embryo up to 8th week. After this period, it is
termed as foetus . Pregnancy continues nor- 3. When pregnancy is claimed to be the re-
mally for 10 lunar months or 40 weeks count- sult of rape, kidnapping and seduction.
'
ing from the date of last period (9 calendar 4. Pregnancy in an unmarried girl of 16 yrs.
months ± 7 days from the date of start of or less and in a married girl of 15 yrs. or
L.M.P.). less point towards commission of the of-
fence of rape.
Pregnancy may have extensive medico-
5. A pregnant woman (unmarried) may
legal implicatio~s. The medicolegal aspects
bring a charge of criminal breach .of trust
may be concerning criminal or civil cases.
against a man, who allegedly had intimate
Medicolegal aspeds of pregnancy relationship with her (resulting in preg-
nancy), with promise to marry her.
A. Relating criminal casas 6. When a woman claiming to 'be pregnant
1. Execution of death sentence - When a by a man, tries to blackmail him.
pregnant woman is awarded capital pun- 7. Pregnancy of a woman, who had no ac-
ishment after being convicted in a crimi- cess· to her -husband, within the reason-
644 I PRINCIPLES ·m FORENSIC MEDICINE
able period matching with the pregnancy, Diagnosis of Pregnancy

may be linked with a charge of adultery
Diagnosis of pregnancy is ordinarily not diffi-
against the man, who is responsible for
cult. But in medicolegal practices the diag-
the woman's pregnancy.
nosis has to be full-proof In contrast to the
8. Pregnancy may be the cause ofkilling of diagnosis for therapeutic purposes, where no
an unmarried woman or a widow (Homi- litigation is involved and clinical steps can be
cide). taken according to the available signs and
9. Pregnant unmarried woman or widow symptoms, the position of a medicolegist is
may also commit suicide. somewhat different where assertion of preg-
10. Question of pregnancy is intimately re- nancy or its absence is expected to solve cer-
lated with abortion or concealment of tain litigation and the opinion of the medical
birth cases. man in such a case has to be helpful for clear
conception of the court oflaw. Accordingly, a
B. Relating civil cQses man of Forensic Medicine prefers to catego-
rise different signs as presumptive, probable
11. Nullity of marriage - If at the time ·of
and positive signs of pregnancy, so that he
marriage a woman is pregnant, then the
knows and can impress the court with due
marriage may be declared null and void.
weightage about the chance of pregnancy in
12. If a woman had no access to her hus- a woman.
band within the reasonable period match-
ingwith the duration ofpregnancy then
A. Presumptive signs of pregnancy
a decree of divorce may be allowed to the
husband. Certain changes appear in the woman with
13. Inheritance of property - When preg- pregnancy or within a short period after im-
nancy is followed by the death of the hus- pregnation of the fertilized ovum in the uterus
band, the widow may claim a greater and with progress of its growth. These are
share of the ancestral property of the mostly due to actions of certain hormones
husband. exerting effects on different organs, and meta-
14. In divorce cases pregnant women are al- bolic activities of the body as well as due to
lowed higher maintenance allowance. mechanical causes.
15. Compensation cases - Death of the hus- 1. Amenorrhoea - After ovulation, there is
band of a pregnant woman may allow her formation of corpus luteum at the site of
a higher compensation. the ruptured graffian follicle of the ovary
concerned. Ordinarily, this corpus lu-
16. Pregnancy beyond the scope of lawful
teum regresses after subsequent men-
wedlock makes the future baby illegiti-
struation and if pregnancy does not oc~
mate.
cur. The function of the corpus luteum is
17. Working pregnant women are allowed to liberate certain hormones, which pre-
additional leave facility. pares the endometrium for impregnation
18. A civil compensation case can be all~wed of the fertilized ovum, which when oc-
for slanderous allegation of pregnancy curs, keeps the functioning of the corpus
a gainst an unmarried woman or a luteum in increasing degree for some
widow. months and in presence of active corpus

chapter 24: PREGNANCY. DELIVERY AND LEGITIMACY ETC. I 645
luteum, due to the hormones liberated 4. Vomiting - Mild degree vomiting and
from it , further ovulation and menstrua- nausea is a conunon phenomenon in all
tion are prevented- Thus, amenorrhoea cases of pregnancy, particularly during
is one of the early signs of pregnancy. In the early morning hours. In some preg-
most circumstances, a woman first pre- nant women, however, there may be ex-
sumes conception with the missing of one cessive vomiting, a condition known as
period. But amenorrhoea is not the result hyperemesis gravidarum .
of pregnancy alone . In circumstances of 5. Pigmentation of selective parts of the skin
hormonal imbalance, some pathology in -The eyelids, the axilla and the areola of
the ovary and the uterus, chronic debili- the breast darken during pregnancy.
tated conditions like tuberculosis, carci-
6. Appearance of linea nigra - A vertical
noma and psychological imbalance, men-
pigmented line appears over the midline
struation may cease temporarily and with
of the abdomen, from umbilicus to sym-
menopause permanently. There are sev-
physis pubis.
eral reasons for menstrual irregularities
when one or.two periods may be missed. 7. Striae gravidarum - Multiple transverse
Conversely, even after pregnancy a woman or oblique stripes appear over abdomen,
may bleed for up to 2 - 3 occasions, at in- including the flanks which are the result
tervals of her usual cyclic periods. of fibrous change in the tissue, which
2. occurs due to over-stretching of the ab-
Changes in Breasts - In pregnancy
breasts enlarge . In the early period there dominal wall. These may however, be
present in any case, where the abdomen
are tingling and tense feeling. On palpa-
tion, the hypertrophied alveolar ducts bulges out as in ascitis, abdominal par-
give a nodular feeling. The shape is pen- ticularly pelvic tumours and may even
dulous. Surface veins are prominent. Sil- be seen in extremely obese women.
very striae may appear later. Areola is 8. Increase in the frequency of micturition -
enlarged, darkly pigmented with Mont - This occurs in 2 phases of pregnancy.
gomery's tubercles (enlarged sebaceous During the first trimester, when the
glands ). Nipples are enlarged and on 3rd uterus enlarges in size, it exerts pressure
month onwards yields secretion of co los- · over the urinary bladder and there is in-
trum on squeezing of breast and nipple. crease in the frequency of micturition.
Colostrum is a pale yellow secretion As the uterus enlarges further and rises
which contains free fat globules and large up to be accommodated in the abdomen,
phagocytes containing fat globules. Some this symptom passes off temporarily for
of the changes in breasts may occur in some months. But during the last months
conditions other than pregnancy, like of pregnancy, when the uterus drops
ovarian tumour. down, it again exerts pressure on the
3. Morning sickness - A general feeling of pelvic contents, including the urinary
indisposition, during the early hours of bladder, causing recurrence of increase
the morning is a common occurrence af- in urinary'frequency.
terpregnancy. This constitute oflethargy, 9. E asy fatigueability and irritable tempe-
weakness sometime with feeling ofheavi- rament are some of the additional non-
ness in hands and legs . specific symptoms ofpregnancy.

10. Perverted desire for spicy food may be height. Enlargement of abdomen, is an
noticed from very early period. important and essential change due to
11. Quickening - Foetal movement inside the pregnancy but it is not specific of preg-
uterus starts and is appreciated between nancy. It may also occur due to ascitis,
16th and 18th week in multigravida and due to any tumour in any organ inside
between 18th and 20th week in primi- the abdomen, or may be even due to rapid
gravida. This is known as quickening and obesity.
the women, during this period is desig- 2. Height of Uterus - The increase in the
nated as "Quick with child". It is appre- size of the uterus follows more or less a
ciated earlier in multi, in comparison definite rule during the period of preg-
with primi due to the former's previous nancy. Up to the 12th week of pregnancy,
experience, whereas , the latter takes it is not palpable per abdomen. At the end
some more time to appreciate this feel- of the 12th week however it may be just
ing as foetal movement. Peristaltic move- palpable above the symphysis pubis. Af-
ment occasionally may be confused with ter 16th week, it is 2" above the symphy-
movement of the foetus . Quickening has sis pubis. At the end of the 20th week, it
special medicolegal importance in that, is 2" below the umbilicus. At the end of
if criminal abortion is caused in a woman, 24th week, it is at the level of the umbili-
who is quick with child then the dura- cus . At the end of•2.8th week, it is 2" be-
tion of punishment of imprisonment is
low the xiphisternum. At the end of 36th
increased and may extend up to 7 yrs.
week it is at the level of xiphisternum.
12. Jackquemier's Sign -This is a change in At full term, it is again 2" below xiphister-
the vagina, the mucous membrane of num.
which alters from pink colour to violet
3. Hegar's Sign -During the 2nd month of
or bluish, which occurs due to venous
obstruction. There is also simultaneous pregnancy, the body of the uterus be-
softening of the vagin al wall with in- comes soft. The cervix remains compara-
crease<! secretion. These changes are tively firm. He gar's sign is elicited by bi-
noticeable after 4th week of pregnancy. manual examination. 2 fingers of one
hand is placed at the posterior fornix and
B. Probable signs of Pregnancy fmgers of the other hand is placed over
midline, just above the symphysis pubis .
1. Enlargement of the abdomen - With in-
Fingers of both the hands are brought
crease in the size of the foetus and the
closer, when the isthumus, part of the
uterus, the abdomen enlarges. But this
uterus is appreciated as soft compress-
does not occur until the duration of preg-
nancy is for 12 weeks. Because, till this ible zone in between the very soft uter-
period, uterus remains in the pelvis be- ine body and firm and tough cervix be-
low the level of the symphysis pubis. low. He gar's sign becomes positive by the
Then gradually the abdomen enlarges as end of 6th week ofpregnancy.
the height of the uterus increases. The 4. Anteroversion of Uterus - Uterus is usu-
enlargement of the abdomen occurs for ·ally anteroverted and this anteroversion
the .rest of the · period of pregnancy, .. increases during .the first few months of
though during the last month the l.lterus p~gnancy.- Th~ de~e.of anterior incli-
drops to some extent With lowering of th~ nation decreases during the ~ater phase.

chapter 24: PREGNANCY. DELIVERY AND LEGITIMACY ETC. / 647
7. Ballo'tment - Internal and ·External

. ballotments are objective signs of preg-
Xiphoid process ~· ~....-- nancy, which can be elicited during the
36thwk ~
32nd and 40th wk - - -
4th or 5th month of pregnancy .
28th wk - - - -- - ·Ballotment tests may be performed by
·24th wk (umbilicus) --~ external . means as well as internal
20th wk - - - -- : - -
16th wk ~----'=- means. Accordingly, the tests are termed
12th wk - - - - - - - '' - - ---.- as internal ballotment test and external
(Symphysis pubis) -------
ballotment test. In ballotment test, actu-
Fig. 24.1 : Height of fundus of the uterus at different ally the foetus is tossed in the amniotic
periods of pregnancy fluid . In external ballotment test, grip of
2 fingers.is applied over the lower part of
uterus , the woman being in semi-inclined
position. As the foetus takes lowest posi-
5. Goodell's sign - By the 4th month after tion inside the uterus, in this posture of
pregnancy, the certix is reasonably soft . women, it is closer 'to the fingers. By ex-
This change starts occurring from the erting thrust with the help of the fingers,
later part of the 2nd month and reach its . . the foetus can be made to move up in the
optimum by the 4th month. By this time amniotic fluid, just as a ball can be tossed
the external os is slightly enlarged in di- up. After a while the foetus resettles again
ameter. The change may occur in inflam- in the lower part of the uterus. In inter-
matory condition of uterus and in case of nal ballotment, the test is performed by
new growth in the uterus. pressing 2 fingers on 2 sides of the fornix
6. Uterine . Souffle - With increase in the and imparting a force for the upward
size of uterus and the foetus inside, the movement of the foetus , which also re-
circulation of blood in uterus is also in- settles at the lower part of the uterus
creased. This increase in circulation after a while. This te!st gives satisfactory
causes flow of more amount of blood in- positive result by 4th or 5th month of
side the uterus through the uterine ves- pregnancy when the quantity of amniotic
sels and thus, when the lateral aspects fluid is comparatively more and in the
of fundus is auscultated, murmur is amniotic fluid the foetus can thus be made
heard, which synchronises with the to move freely. After 5th/6th month,
mother's pulse beat. these tests cannot be elicited in a good
It be~mes appreciable from the end of number of cases due to proportionate de-
4th month . This type of sound may also crease in the quantity of the amniotic
be heard with the help :of a stethoscope, fluid, in comparison with the size of the
when there is increased blood supply in foetus. The test will give a negative re-
the uterus due to any reason , like a new sult, if the quantity of amniotic fluid is
growth inside the uterus. less .
Uterine souffle must not be confused 8. Braxton-Hick's sign -After 15-16weeks
with foetal heart sound, which is more of pregnancy, there is.intermittent con-
rapid in its rate and•does not synchro- traction and. relaxation of uterine mus-
nise with the mother's pulse . cles. The duration of each contraction is

•.
for about a minute and the duration of Disadvantage of the test

relaxation is for about 5 minutes- The 1. It takes about 5 days for completing
contraction is not a forceful one and is the test,
painless. Intermittent contraction may
2. In each case, one animal has to be
also occur due to other reasons of en-
sacrificed.
largement of uterus, including soft new
(b) Rapid rat test - 2 ml of the filtered morn-
growth.
ingurine ofthe woman is injected intra-
9. Test for human chorionic gonadotropin
peritoneally in immature female albino
in the urine- In case of pregnancy, there
rats. The rat is killed sometime after 4-
is secretion of HCG, at placental level
5 hrs. Extreme congestion of the ovaries
Thus, HCG can be detected in the preg-
indicates presence ofHCG in the urine.
nant woman's serum and urine. It be-
comes detectable by the 2nd week of preg- Disadvantage
nancy and its concentration increases 1. Sacrifice of the animal is a disadvan-
gradually with progress of gestation. The tage for this test also.
test for chorionic gonadotropin may be (c) Friedman test or Female rabbit test -An
positive even up to 1 week after termi- immature female rabbit of about 3 months
nation of pregnancy. old is selected and 5 ml of filtered morn-
ing urine of the woman is injected in the
Methods of the Test vein of its ear for 2 consecutive days and
(Biological tests for H.C.G.) on the 3rd day the rabbit is killed and the
ovaries are searched for presence of
Human chorionic gonadotropin stimulates hemorrhage or ruptured gra:ffi.an follicle,
ovulation and spermatogenesis. This action which indicates pregnancy in the woman.
ofHCG is utilised for testing presence of preg-
.....
Disadvantage
nancy and the tests are known as biological
tests for pregnancy. 1. Here also the test takes 3 days time
for completion and one animal has
(a) Aschheim-Zondek Test - This is the clas- to be killed for each test.
sical biological test, which has been sub-
stituted by other biological tests for preg- (d) Hogben test or Female toad test - Ma-
tured female xenopas toad lay eggs
nancy. In Aschheim Zondek test, imma-
anytime when stimulated for the same
ture female albino mouse of about 3 - 4
and if it gets a moist place for laying eggs,
weeks old are used. About 3 - 4 ml of
HCG acts as the alternative of mating as
filtered morning urine (morning urine is
a stimulus. About 5 ml of the morning
most concentrated in all its constituents)
urine of the woman is injected in the dor-
of the woman said to be pregnant is in-
sal lymph sac of the toad and it is kept
jected subcutaneously, in the mouse,
confined with a bell-zar or some such
twice daily for 3 days. After lapse of an-
thing, on a moist place. If the urine of
other day, the mouse is sacrificed and the
the woman contains HCG, then the toad
ovaries are searched for a haemorrhagic
ovulates within 8- 10 hours.
graffian follicle or corpus luteum, the
presence of which is strongly indicative Advantage
of pregnancy in the woman. 1. This test has an advantage over the

chapter 24: PREGNANCY, DELIVERY AND LEGITIMACY ETC. I 649
3 tests described above. Here the Advantages

animal is not to be sacrificed on com- 1. Time necessary for completion of the
pletion of the test. The toad can be test is reasonably short.
used for several tests, each time af- 2. The same animal is ready for the
ter effect of HCG is over. next test again just after about 24
2. It takes moderate time for comple- hours.
tion of test of pregnancy. Disadvantages - To be precise, the posi-
(e) Galli mainini test or Male toad test - It is · tive result of the test is only strongly in-
the most popular one of the biological tests dicative of presence ofHCG in the urine
for pregnancy. Rana tigrina and Rana and is not confirmatory of pregnancy. In
hexadactyli are the two varieties of male addition to pregnancy, like all other bio-
toads, which are most suitable for the logical tests this test is also positive in
test. case of hydatidiform mole and chorion
epithelioma. To exclude these two possi-
Recognition of the male toad - The male
toads of these varieties have a yellowish bilities, instead of concentrated urine,
brown band. on the ventral aspect of their dilute urine in different gradations of ti-
tration may be used, when we get posi-
necks. During mating, these toads can
tive result with high dilution of urine
puff up the air sac at the posterior part of
then, that is suggestive of hydatidiform
the fauces to produce attracting sound for
mole or chorion epithelioma.
the female .
Serological tests for pregnancy
Preparatory testing of the toads
(a) Haemagglutination inhibition test -
The above two described features also speak
for the maturity of the toad. In addition, be- Materials required - (i) RBC, sensitized
fore subjecting these toads for HCG tests to antibody of HCG hormone, (ii) Anti
HCGfactor (Antibody), (iii) Morning urine
their cloacal urine is examined under micro-
scope. If the cloacal urine contains sperma- sample of the supposedly pregnant
tozoa then, the toad is unsuitable for the test woman.
and is rejected. If the cloacal urine is free The test is performed in a tube. (i) and
from spermatozoa then the toad is injected (ii) are mixed in a test tube of 5 mm di-
ameter (often an ampule containing
with 5 ml of filtrated morning urine of the
(i) and (ii) in dried states is used, which
woman in its dorsal sacs. After an hour or
has a circular ridge at the bottom). If the
two, another sample of cloacal urine is taken
woman is pregnant and her urine con-
and is subjected to microscopical examina-
tains HCG then, on addition of urine
tion. If the urine which was free from sper-
in the tube the antibody i.e. anti HCG
matozoa before injection, shows presence of factor will be neutralised and the cells
spermatozoa after 1 to 2 hours of injection, (RBC) v.:ill then, gradually settle at the
the presence of HCG in the urine of the bottom around the ridge making a red-
woman is indicated and pregnancy is strongly dish circle. If there is no HCG in the
suspected. To infer a result, another sample urine then the anti HCG factor will not
of cloacal urine after another 2 hours should be neutralised and it will cause clumping
be examined. · or agglutination of the RBCs, which are
sensitised against anti-HCG honnone and accuracy (but chance of error cannot be
~here will be no red ring formation at the . eradicated completely). ·
· bottom.
(b) Direct agglutination test for presence of C . Positive signs of Pregnancy
HCG in urine with latex particle:; - Latex 1. Auscultation of foetal heart sound - Foe-
particles are coated with anti HCG anti- tal heart sounds are detectable after 18 -
.body . This is taken on a glass slide . Then 20 weeks of pregnancy. The rate of foe:
1 drop ofinomingurine of the woman is tal heart beat is about 160/mt at the early
added to it . fu cas~ ofpregnancy , the urine phase and about 120/mt !?-ear the termi-
containing HCG hormone will react with nal phase of pregnancy. Their location on
the anti HCG antibody on the surface of the mother's abdomen varies according
the latex particles and there will be clump- to the intrauterine position of the foetus.
i~
nf the particles . · FHS is not synchronous with mother's
(c) Ind rect agglutination inhibition test -In pulsatimi. So the two can easily be diff~r
thi test, the latex particles' are coated entiated.
with HCG . The morning urine is first Even when there is pregnancy , foetal
.treated with anti HCG antibody. To this heart sound will be absent - (a) before 18
mixture above mentioned latex particles weeks of pregnancy, (b) when the-foetus
coated with HCG hormo.ne is added. If dies inside the uterus ; and It may not be
the urine of the woman contains HCG audible in , (c) very obese women and in
due to pregnancy, then that will neutral- (d) hydramnios cases where there is ex-
ise the anti HCG antibody after initial cess of liqp._or amnii.
mixing of the two. If the urine does not 2. Palpation of foetal parts per abdomen is
contain HCG, then anti HCG antibody a positive sign of pregnancy from 4th
remains active and when the latex parti- month onwards.
cles coated with HCG hormone are added · 3. Perception of foetal ~movement is possible
at the 2nd stage of the test, then due to from 5th mdnth onwords of pregnancy.
presence of the active antibody, there will
4. Shadows of foetal bones by X-ray exami-
be agglutination of the latex particles.
nation are available after 3rd month ,
The serological tests are easy to perform when in X-ray plates skull shadow ap-
and are more reliable than biological tests pears crescentic. Similarly, beaded ap-
because the chance of error due to bio- pearance ofvertebral column and ladder
iogical variability in animals are not there like arrangement of ribs and shadows of
in serological tests. These tests are also limb bones are also diagnostic. X-ray ex-
positive in hydatidiform mole or chorion aminatidn for diagnosis of pregnancy is
epithelioma cases . In these conditions , not recommended, which can be done by
the amount of HCG hormone excreted U$Gtesf
through urine is very high. Hence, the 5. Ultrasonography -This can diagnose preg-
tests become positive with highly diluted nancy of 6th week duration and more.
urine which does-not occur in case of (Though determination of sex of an eld-
urine of pregnant women . erly foetus inside the uterus is possible it
(d) Radio immunoassay and ELISA test can ml,lSt be remembered that intrauterine
~ ~so detect pregnane~ ~th high degree determination of sex is against law ).

chapter 24: PREGNANCY, DELIVfRY AND LEGITIMACY ETC. I 651
Signs of pregnancy in dead subjeds Medicolegal aspects of superfoetation and

superfecundation - These conditions are es-
In dead subjects, in addition to external
sentially twin pregnancies and being essen-
physical changes, internal examination
tially the product of two separate sexual con-
shows: (i) An enlarged uterus, (ii) A corpus
tacts, gross variations between the complex-
luteum in an ovary in its progressive or re-
ion and other features in the appearance of
gressive phase, (iii) Product of conception, ei-
the two babies after birth gives rise to the
ther in the form of an embryo with decidual doubt of adultery and infidelity and the pa-
changes in the endometrium or, in the fonn ternity of either or both the babies may be
a foetus, placenta, etc. disputed. Blood group test and DNA test may
. Superfoetation - This is a type of twin be needed in case of controversy.
( egnancy where, during the continuation
Foetus papyraseous or compressus - In
ofpregnancy an ovum is liberated in a sub- twin pregnancy, one foetus may grow and
sequent cycle which gets fertilj.sed followed develop more at the cost of the other. The
by progressive developmen t of both the fer- latter may eventually die and get compressed
tilised ova. In such a condition one foetus and flattened gradually. Such a foetus is
always remains more matured and developed termed as foetus papyraseous or foetus
than the other. Delivery of both foetuses may compressus.
occur in a single labour when one baby is
PSEUDOCYESIS - This means false or
perceivably larger and more developed than
spurious pregnancy, when the woman believes
the other, or very rarely delivery of the
that she is pregnant. She presents all or many
younger foetus occurs at a later period after subjective signs (symptoms) of pregnancy
being fully matured. Some do not agree with
which are often accompanied by enlargement
the existence of the condition ofsuperfoeta-
of abdomen due to disposition of fat or some
tion. According to them, what happens in pathological condition, e.g. an ovarian twnour.
reality is that in twin pregnancy when one The woman may have imaginary or false feel-
foetus gets more blood supply and more nuing of movement of the "foetus" inside. If not
trition, it develops more rapidly and grows diagnosed earlier, the condition may continue
larger in comparison to the other. Possibil- for about the full period of a pregnancy and
ity of superfoetation is more in septate or the woman may even have false labour pain.
double uterus cases. The period of gap be- All the symptoms vanish once the woman is
tween the fertilisations varies between 1 - info~ed that she is not pregnant. Pseu-
3 months. docyesis is seen in women who strongly de-
Superfecundation - In cases, where two sire for a child or who are afraid ofbeingpreg-
ova are discharged at a time in one ovula- nant. Hence, it may occur both in young
tion period, the two ova may be fertilised women or women who are close to or have
by sperms of two different acts of coitus, just achieved their menopause.
occurring within a short period. The two Pregnancy without knowledge of the
fertilised ova grow simultaneously, though pregnant woman - Just in contrast with the
one may grow larger at the. cost of the condition of pseudocyesis, a pregnant woman
other: There being two placentas1·c ircula- may be ignorant of her pregnancy and may
tion through one placenta 'may be better even go to labour without clear ofknowledge
than the other. of the same beforehand.
652 / PRINCIPLES OF FO REN SIC MEDICINE
Maximum and Minimum duration of 7. Deferring trial of a case in a court oflaw

pregnancy - Though normal period of gesta- as in case of pregnancy
tion is about 280 days, a woman may over- 8. Delivery after being pregnant as a result
carry the foetus to postmaturity up to the of rape, kidnapping, seduction
extent of a total period of gestation of more
9. Delivery of child below 16 years of age is
than 320 days and ~bout 350 definitely the result of rape
days, with the foetus being alive and a live-
birth being possible up to that extent. 10. Criminal breach of trust in case of prior
promise of marriage
Expulsion of pre matured foetus may oc-
11. Blackmailing of a male being pointed as
cur at any period before full term. But to have
father
a live-birth of a viable foe.t us, delivery should
occur after 210 days of pregnancy. Foetuses 12. Other cases of disputed paternity of the
born alive, after 180 days of pregnancy may child delivered
survive if proper care can be taken. Below 13. Legitimacy (see MLI of pregnancy)
. this period of gestation also , foetuses born 14. Inheritance of property
alive have survived but the chance for tlie 15. Homicide and suicide (see MLI of preg-
same remains remote . nancy)
Viability of a child means capability of a 16. Higher maintenance allowance in divorce
foetus to lead a separate life after birth Or- cases
dinarily, a foetus becomes viable afcer 210
17. Higher compensation claim in case of
days of pregnancy but foetus born alive ear-
death of husband on duty
lier can also be mad~ to survive with proper
care. 18. Legal provision of leave, for delivery for
working women.
In relation to any of the above cases, a
DEliVERY medical man may have to examine a woman
to ascertain if she has delivered recently or
Delivery means birth of a child with or within the past. Some of the signs of delivery are
out external help . permanent signs of pregnancy. Some remain
as permanent specific signs of delivery and
The legal issues linked with delivery are :
others pass off in course of days or weeks .
1. Infanticide (unwanted birth)
2. Concealment of birth (is a criminal of- Signs of recent delivery in the living
fence)
1. General signs - Up to 3 - 4 days or a
3. Abortion (when criminal)
week after delivery, the woman is sickly,
4. Nullity of marriage (when delivery occurs indisposed, weak, and exhausted in ap-
shortly after marriage) pearance. For a day or two, there is slight
5. Divorce (when delivery occurs, with the rise of temperature.
wife during calculated period of concep- 2. Signs in the abdomen - The abdomen is
tion being apart from the husband) lax with presence of linea nigra on the
6. Execution of judicial death sentence may midline and striae gravidarum (pinkish
be delayed up to 6 months after delivery white linear scar like m arks) on the

chapter 24: PREGNANCY, DELIVERY AND LEGITIMACY ETC. I 653 .
flanks. The presence of striae gravidarum admits 1 finger after 1 week and returns
indicates stretching, due to enlargement to its permanent size after 2 weeks.
of the abdomen, due to any reason in- 9. Lochial discharge - For 2 - 3 weeks af-
eluding pregnancy. ter delivery there is discharge of lochia
On palpation, the uterus appears like a from the uterus which has a sour disa-
firm tennis ball on the 1st day after de- greeable odour and which gradually
livery, at a level 4- 5 ems below the urn- changes its colour and consistency. For
bilicus. Involution of the uterus occurs the first 4 - 5 days, there is discharge of
at the rate of 1.5 em per day at the initial lochia rubra which is red in colour and
phase and by the 6th day, it is midway contains blood and blood clot. For the
between umbilicus and pubis. The rate next 4 - 5 days the discharge is thin ·and
of involution then decreases and the pale and is termed lochia serosa. After
uterus comes to its permanent parous this, discharge of whitish or greyish yel-
size after about 6 - 8 weeks. There is in- low, lochia alba continues for some more
termittent contraction of the uterus for days which is thick and turbid in appear-
3- 4 days after delivery. ance.
3. Signs in the breasts - The breasts are 10. Laboratory fmdings - For about 2 weeks
voluminous and pendulous with engorged after delivery, the morning urine of the
surface vessels. The areola is large with woman shows presence of HCG hormone
prominent Montgomery's tubercles. The by biological or serological tests.
nipples are large . On palpation, breasts
are rather tender and are nodular in feel- Signs of recent delivery in dead subjects
ing. On squeezing, the nipples yield milk The external and genital signs of recent de-
or colostrum. livery as are available in living subjects, will
4. Labia majora are swollen, congested and also be present in dead subjects. In addi-
tender. tion to these, additional internal findings
5. Labia minora is congested, swollen, ten- will be present in uterus and its append-
der, often bruised. ages. The uterus is soft, flabby and enlarged
in size which, gradually becomes firm and
6. Fossa navicularis and posterior commis-
returns to a permanent reduced size (see
sure may show tear, which may extend
measurements of uterus at different times
up to perineum. •
after delivery in table 24.1). The site of pla-
7. The vagina is spacious with loss of ru- cental attachment is raw and uneven for
gosity, the walls of which are relaxed. some days to keep later a permanent small
The walls are congested and may show scar like mark. Up to a few days after de-
presence of abrasions and tears. The ru- livery, there will be evidence of discharge
gosity of the· wall returns gradually in a from this site. The ceni'ix and the os will
few weeks. be as discussed in cases of living subjects.
8. The cervix is soft, swollen and congested. The fallopian tube, the ovaries, urinary
The os shows transverse tear. Immedi- bladder and lower part of (pelvic intestine
ately after delivery, the external os ad- are congested for a day or inore. 1: ~gres'sed ·
mits 2 fingers. The internal os reduces corpus luteum wiil still be detectable in one
much in size after a day. The external os ovary.

Table. 24.1 : Different measurements of Uterus after delivery

Different Immediately After 3days After a week After 2 weeks After 6 weeks
measurements after delivery ofdelivery of delivery ofdeHv~ry· of delivery
, Outer length 20cm 17cm 14cm 12cm jOcm
Outer breadth 13-14 em 10cm Scm ?em 6cm
Thickness 5cm 4- 5cm 4cm 3cm 2.5cm
Inner length 15cm 12cm 10cm Scm ?em
Weight of uterus 1 kg 700gm 500gm 300gm S0-100 gm
Diameter of site af
placental attachment 10cm ?em 4cm 2.5cm 1.5cm
Table. 24.2: Differences between Nulliparous and Parous uterus

Points of difference Nulliparous uterus Parous uterus
1. Size Smaller (7 em x 5 em x 2 em) Larger (10 em x 6 em x 2.5 em)

2. Warjtt 40gm approx A0-100gm
-
3. Ratio between body and cervix Lengths of body and cervix almost Body length is almost twice the length
equal of cervix
4. Upper surface of fundus Less convex and is in the same line More convex and is at a higher level
of broad ligament than the line of broad ligament
5. Uterine cavity The inner walls are convex and that The inner walls are concave and that
makes a triangular cavity with less ma~es a comparatively large and
space spacious cavity
6. Scarfor placental attachment No such thing It is present. May be very faint and not
prominent in very old pregnancies
7. External os Small roundish dimple like, depressed Transverse slit like opening
S. lntemalos Circular, well defined Ill defined, margin wrinkled
Signs of past (remota) delivery in the and lower aspects of abdomen respec-
living tively.
Sore'1 of these signs are permanent signs of 2. Signs on breasts -Breasts are ·lax and
pregnancy and others· are penhanent signs pendulous with dark big are?.la with
of delivery. Montgomery's tubercles. The nipples are
1. Signs on abaomen'..:.•WaH ·is lax, the ex- la:r;ger, dark and raised. ·In some multi~
tent oflaxity depends- dn number.of preg- para there may be stria presep.t on :the
nancy. Linea nigra llll.d striae: gr.avidarum surfflye of ·~}:le breasts; on Ji~lpation,
will be--present <on:·the:rn1d·Iine and flanks breasts, give nodular feeling.

.··
chapter·-24: PREGNANCY, DELIVERY AND LEGITIMACY ETC . I 655
The uterus will be comparatively enlSrged

in siZe (lOcm x 6cm x 2.5 cm)with convexity
for·the outer surface of the fundus and con-
cavity of the inner surfaces of the walls.
Weight is . about 80 gm. The body is about
twice the length of the ce:rv.ix and the inter-
(a) nal os may show marginal wrinklings.
. Concealment ofbirth - Intentional con-
cealment of birth is a punishable criminal
offence in India. Sec. 318 ofthe Indian Penal
Code states that, "Whoever, by secretly bury-
. 1 !~.,. "r otheiWise disposing of ~he dead body
of Xi child, whether such a child die before or

after or during its birth, intentionally con-
ceals or ~ndeavours to conceal the. birth of
(b)
such· child, shall be punished with impri-
Fig. 24.2: (a) ·shape of uterine .cavity in· case of sonment of either description for a term,
nulliparous woman , (b) Shape of the cavity in which may extend to. two years or with fine
case of par-ous woman
' - - - - - - - - ' - - - - - - - - - - _ _ _ j or with both".
· Posthumous child - It is a child who is
3.· EXternal genitalia- Labia IIU:\iorais dark born after the death of its father. Legal is- .
and the two sides are not in close apposi- sues involved are:
tion. Labia minoras are pigmented dark ·
1. Legitimacy ·
and protrude out through the gap i~ be-
tween the majora of two sides. 2. Inl).eritance of property
4. Hymen - Hymen is absent and i~ repre- 3. Increased compensation from the father's
sented by caruneulae myritiformis"(thick, emplo~e~
uneven knob like circular marginal line 4. Compensation cases against slanders
at the vaginal outlet). · ·against the mother.
5. Perineum including posterior commis- Sup}i)ositious child- It is a child presented
sure may show old healed scar represent- by a woman to have been delivered by her,
ing tear during past delivery. though she has not delivered the child Some-
6. Vagina is comparatively capacious with times child of one sex, delivered by a woman,
some degree loss of rugosity. · is substituted by the child of. another sex.
Legal issues involved are:
7. External os - It is represented by trans-
verse slit like opening. 1. Inheritance of property
.
2. Blfickmailing a male
Signs of past (remote) d~livery in dead
3. When a widow claims higher compensa-
In a dead subject, .i n addition to the signs tion from the husband's employer
. available in living subj~ctS' for reniote.. deliv~ 4~ Bringing a charge of breach. of promise
.ery, .there
. . will also be some 'findings
. ' .
in the of ~arriage, aiainst a man who, alleg-
·uterus. edly is the·father of ~e presented child.
Legitimacy and Disputed Paternity leged (putative ) father during the prob-
able time of conception
Legitimacy - It means positive legal status
2. Morphological akinness of the child with
of a child who is born out oflawful wedlock.
Any child born within 280 days after legal the father, in respect of complexion and
other features.
separation or divorce or death of the husband
is presumed to be a legitimate child , unless 3. Atavism - Sometimes the child may not
the contrary is proved. have morphological similarity with the
father but, may have the same with the
Question of legitimacy of a child arises
grand-parents or, great grand-parents in
in connection with :
the paternal side. This is Atavism.
1. Inheritance ofproperty ~ 4. Matching of blood group and type fac-
2. Use of title of the husband of the mother tors -A blood group genotype factor ab-
by the child sent in mother and father, cannot be
3. In nullity of marriage and divorce cases present in the child. That way
4. In posthumous child cases and in fathership of a person can be excluded
in over 80% cases of false allegations of
5. Affiliation or adoption cases.
paternity, by testing the blood of the
A child is presumed to be illegitimate child, mother and the putative father,
when: for different group factors. Where there
1. It is not born out of lawful wedlock as is no disparity in the blood group test
described in the first para, or of the three, the paternity is only sug-
2. When the husband is sterile gestive and not confirmatory because,
3. When the wife had no access to her hus- many persons have similar group fac-
band during her probable period of con- tors. On the other hand, exclusion is
without ambiguity, if we ignore the
ception.
chance of mutation of blood group fac-
Paternity of a child is disputed in all these
tors in the child, which is presumed to
cases and also in posthumous child cases or
occur in 1 in 50,000 cases.
alleged suppositious child cases or when the
Giving due consideration to all the fac-
alleged father is sterile by virtue of being
tors discussed above and carrying out ex-
under-aged or even for a married woman ,
haustive blood group tests, reasonably sat-
other conditions remaining satisfactory , the
isfactory opinion can be given in this re-
child bears some biological characteristics dif-
gard (See chapter 5, pages 213, 214).
ferent from the husband of the mother and
also on the basis of some doubtful circum- 5. DNA test may be confirffiative.
stantial reasons . (See also chapter 5, pages 213, 214)
Fixation of paternity in disputed cases - Disputed Maternity Cases
In these cases, paternity may be fixed basing
on the following factors: Maternity may be disputed in :
1. Accessibility of the mother, with the al- 1. Hospital birth cases, where many new-

chapter 24: PREGNANCY. DELIVERY AND LEG ITIMACY ETC . I 657
born children are kept side by side, which Questions

may cause mixing up of children,
2. In alleged suppositious child case. Long theoretical questions
Disputed maternity cases are settled in 1. What are the medicolegal importances of, and how
the line of settlement of disputed paternity do you diagnose pregnancy ?
cases with addition of one more factor, i.e. 2. What are the signs of recent delivery? How delivery
matching the age of the child with the find- is important medicolegally? What are the postmor-
ings of the disputed mother's body related to tem findings in the body of a woman who has re-
her time of delivery, if at all there was any cently delivered ?
delivery. Here also DNA test will be confirma-
tive. (See Chap. 5, pages 213, 214). Short notes/Difference
Medicolegal importances of delivery, quickening,

Cloning Hegar's sign, Uterine souffle, Ballotment, Braxton-
(See Chapter 22, Impotence Frigidity, Steri- Hick's sign, Biological tests for pregnancy, Immuno-
lity, etc. pages 634, 635). logical tests for pregnancy, Rapid toad test, positive
signs of pregnancy, superfoetation, superfecundation,
pseudocyesis, Differences between parous and nul-
References liparous uterus, Concealment of birth, Posthumous
child, Suppositious child, Legitimacy and disputed
• Novak's text book of Gynaecology, 11th Edn., 1985.
paternity, Disputed maternity
• C. R. Whitefield- Dewhurst's text book of Obstetrics
and Gynaecology for Post graduates, 4th Edn. 1988. Oral questions
• Cunningham, MacDonald, Gant- Williams' Obstet-
Questions from long and short questions as above
rics, 18th Edn. 1989.
and presumptive signs of pregnancy, Hyperemesis
• Shirish N. Daftary, Sudip Chakrabarty- Holland Brews gravidarum, Striae gravidarum, Jackquemier's sign,
Manual of Obstetrics, 15th Edn. 1991 . Goodell's sign, Height of uterus at different period of
• D. C. Dutta- Text Book of Obstetrics, 3rd Edn. 1992. gestation, Aschheim-Zondek test, Rapid rat test,
• D. C Dutta - Text Book of Gynaecology, 2nd Edn. Friedman test, Hogben test, Male toad test, Hae-
1994. magglutination and agglutination tests for pregnancy,
when are pregnancy tests, ultrasonography test for
• Werner U, Spitz David J, Spitz Ramsay Clark, Russel
pregnancy, positive? What are normal, maximum and
S Fisher- Spitz and Fishers Medico/ega/Investigation
minimum period of pregnancy? What is foetus
of Death - 2006.
papyraseous or compressus, viability of a foetus, Lo-
• WB Woodman and Charles M Tidy- Forensic Medi- chia, Uterus after delivery, Carunculae myritiformis,
cine and Toxicology- 2007. Role of blood group test in disputed paternity or ma-
• D. C. Dutta - Text Book of Obstetrics, 6th Edn. 2004. ternity cases.

NOTES
·,I ,(
_I •,:' , ,1,1._'
,,,
.J,_f\ ''· • I 't ,.-
'- J..'.
J~
~. 1 I • • '• • ' ' I r-:> I.- 'I~

Legally , miscarriage or abortion means ter- Natural abortion - Natural abortion oc-
mination of pr~gnancy by premature expul- curs mostly during the 2nd and 3rd month of
sion of the foetus , from the uterus , at any pregnancy.
time of pregnancy.
Causes of natural abortion
1. Defect in the ova, including chromosomal
Types of Abortion defect (this often leads to fonn hydatidi-
form mole)
A Spontaneous - this may be : 2. Developmental defect of the foetus
1. Natural 3. Low implantation of zygote
2. Accidental 4. Diseased condition of decidua or placenta
B. Induced - This may be 5. Rh incompatibility
1. Legal or Justifiable 6. Retroverted uterus
2. Criminal 7. Submucous uterine fibroid
8. Malformed uterus
Spontaneous abortion
9. Uterine hypoplasia
About 10% of all pregnancies end in spontane- 10. Hyperpyrexia of mother
ous abortion and much more than that, per- 11. Hypertension
centage counts for induced abortion, greater
12. Diabetes mellitus
number of which, now are non-criminal, be-
ing induced under the provisions of Medical 13. Hormonal deficiency (progesterone)
Termination of Pregnancy Act of 1971. Those 14. Fatigue and general ill health
cases where termination of pregnancy is in- 15. Sudden shock, emotional disturbance
duced beyond the scope ofMTPA are criminal 16. Syphilis
in nature and are punishable by law. Number
17. Nephritis
of such cases are proportionately much re-
18. Arsenic or lead toxicity, etc.
duced due to extensive provisions of the MTP
Act and the bulk of criminal abortions now 19. Drug toxicity
appears to be limited ·to -iuial"areas: 20. ·some vegetable poisoning.
Accidental abortion may occur due to Explanation - II: Where any pregnancy
(i) Trauma, (ii) Accidental poisoning (see no. occurs as a result of failure of any device or
18, 19 and 20, above). method, used by any married woman or her
husband, for the purpose of limiting the
Induced abortion number of children, the anguish caused by
such unwanted pregnancy may be presumed
Legal or Justifiable - Medical Termination
to constitute a grave injury to the mental
of Pregnancy (MTP). MTP is guided by MTP
health ofthe pregnant woman (Social ground).
Act 34 of 1971 which came into force from 1.
4. 1972. This Act imposes certain restrictions Length ofPregnancy - All the indications
while liberalising termination of pregnancy. ofMTP are applicable only up to 20 weeks, of
pregnancy. Up to 12 weeks of pregnancy, one
Qualification and experience of the doc-
doctor alone may form opinion about the ap-
tor - Under this act, a medical man with MD
plicability of an indication for abortion. Above
in Gynaecology and Obstetrics or a DGO or a ·
12 weeks of pregnancy and up to 20 weeks,
registered practitioner who has assisted MTP
the decision about the applicability of the in-
in at least 25 cases in a recognised centre, is
considered eligible to perform MTP. · dications should be taken jointly by 2 doc-
tors. Above 20 weeks of pregnancy it can be
Recognised Centre - The centre should terminated only on therapeutic consideration
be well equipped with facilities for operation for the mother, when continuation of preg-
and administration of anaesthesia and should nancy will involve a risk to the mother's life.
procure a license, for the purpose of perform- In such cases, decision can be taken by a sin-
ing MTP, from the Chief Medical Officer of gle doctor and termination can be performed
the district or the Director of Health Serv- even in an unrecognised centre.
ices of the State.
Consent - Consent of the woman is nec-
Indications of MTP - As per this Act, a
essary, if she is not a minor or not a lunatic,
. / pregnancy may be terminated by a Registered in which case consent of the guardian will be
. _ ____/ Medical Practitioner, if such practitioner is
required. Consent of the husband of a mar-
of the opinion, formed in good faith that -
ried woman is not necessary.
1. Continuance of the pregnancy would in-
Contravention of the rules by the doctor -
volve a risk to the life of the pregnant
This, in any form may make the doctor li-
woman or of grave injury to her physical
able to be punished with fine up toRs. 1,000
or mental health, (therapeutic, humani-
and if he is a government servant then, he
tarian and social grounds) or
will be liable to be dismissed from the serv-
2. There is substantial risk that, if the child ice.
was born, it would suffer from such physi-
cal or mental abnormalities, as to be se- Criminal abortion - Any abortion induced
riously handicapped (Eugenic ground). in defiance of one or more of the provisions
will amount to criminal abortion.
Explanation- 1: Where any pregnancy is
alleged by the woman to have been caused Punishment for inducing criminal abor-
by rape, the anguish caused by such preg- tion -As described under sections 312 to 316
nancy shall be presumed to constitute a grave oflndian Penal Code which are as follows.
injury to mental health of the pregnant Sec. 312. Causing miscarriage- Whoever
woman (Humanitarian ground). voluntarily causes a woman with child to

chapter 25: ABORTION I 661
miscarry shall, if such miscarriage be not Explanation - It is not essential to this

caused in good faith for the purpose of saving offence that the offender shall know that the
the life of the women, be punished with im- act is likely to cause death.
prisonment of either description, for a term Sec. 315. Act done with intent to prevent
which may extend to three years ,orwith fine , child being born alive or to cause it to die
or with both ; and, if the woman is quick with after birth - Whoever, before the birth of any
child, shall be punished with imprisonment
child does any act, with the intention of
of either description for a term which may
thereby preventing that child from being born
extend to seven years , and shall also be li-
alive, or causing it to die after its birth, and
able to be fined.
does by such act, prevent that child from be-
Explanation -A woman who causes her- ing born alive, or causes it to die after its
self to miscarry , is within the meaning of this birth, shall, if such act be not caused in good
section . faith for the purpose of saving the life of the
mother, be pm1ished with imprisonment of
Notes: A registered medical practitioner
either description for a term which may ex-
shall not be guilty, if any pregnancy
tend to ten years, or with fine, or with both .
is terminated by him, in accordance
with the provisions of the Medical Sec. 316. Causing death of quick unborn
Termination of Pregnancy Act, 34 child by act amounting to culpable homicide
of1971. - Whoever does any act under such circum-
stances, that if he thereby causes death, he
Sec. 313. Causing miscarriage without would be guilty of culpable homicide ; and
woman's consent - Whoever commits the does by such act cause the death of a quick
offence, defined in the preceding section with- unborn child, shall be punished with impris-
out the consent of the woman, whether the onment of either description for a term, which
woman is quick with child or not, shall be may extend to ten years, and shall also be
punished with imprisonment for life , or with liable to fine .
imprisonment of either description for a term,
which may extend to ten years , and shall also Methods adopted for inducing criminal
be liable to fine . abortion
Sec. 314. Death caused by act done with 1. Abortifacient drugs -Preferred in the 2nd
intent to cause miscarriage -Whoever, with month of pregnancy.
intent to cause the miscarriage of a woman 2. Use of general violence -up to the end
quick with child, does any act which causes of 1st month.
the death of such woman, shall be punished 3. Use of local violence - During 3rd and
with imprisonment of either description for 4th month of pregnancy.
a term which may extend to ten years , and
shall also be liable to fine : A. Abortifacient Drugs
If act done without woman's consent - 1. Ecbolics - These are the drugs , which con-
and if the act is done without the consent of tract the pregnant uterus , e.g. (a) Ergot
the woman, shall be punished either, with preparations, (b) Quinine, (c) Strychnine,
imprisonment for life , or with the punishment (d) Synthetic oestrogens, (e) Pituitary
above mentioned . extract. These are not always successful

in low doses and in high doses they may

cause danger.
2. Drugs initiating menstrual flow -
(emenagogues) e.g. oestrogen, borax,
savin, sanguinarin.
3. Drugs which irritate genito-urinary tract
cantharides, oil of turpentine, oil of tansy.
4. Drugs which primarily irritate GI tract
3
and reflexly stimulates uterine contrac- 4 5
6
~
tion - e.g. drastic purgatives like Julap,
Castor oil, Croton oil, Calomel, Senna,
Rhubarb, Phenophthalein, Podophylum,
Saline purgatives like Magnesium sul-
phate.
;, 7
5. Drugs which are primarily toxic to other

Fig. 25.1: Materials used for causing criminal abortion
systems - e.g. inorganic irritants like - 1. Hair pin, 2. Syringe, 3. Nail, 4 & 5. Abortion
lead, arsenic, phosphorous, copper, mer- stick, 6. Root of abortifacient plant, 7. Douche,
8. Part of Higginson's syringe
cury, antimony; organic irritants like,
abrus precatorius, calotropis, plumbago,
unripe fruit of pappaya, methi, used in forward which sometimes causes separa-
ABORTION STICK tion of placenta and abortion, more com-
6. Patent preparations - Abortion pills made monly in advanced stage of pregnancy.
oflead, diphenylephylene. 5. Introduction of utus paste (containing
mercury, thymol, iodine and some other
B. General Violence, local Violence agents) inside the uterus leads to abor-
These are not always successful. tion. Systemic abortifacient agents are
also in use.
1. Application of severe pressure or force
on the wall of the abdomen - kneeling, 6. Pushing laminaria tent and abortion
stick inside uterus.
jumping, application of tight bandage,
forceful massage, kicking, fist blow, etc.
2. Heavy (violent) exercise - e.g. jumping,
jolting, riding, running.
3. Alternate hot and cold bath of lower ab-
domen.
4. Cupping - A flaming light is placed on
abdominal wall, which is covered by a pot
or bowl. Air expands due to heat andes-
capes. On cooling, the air contracts and
the pot sets tightly on the abdominal wall. Fig. 25.2: X - clMitte d uterus (at 2nd month of
When the pot is pulled, the abdominal · ' Pregn,<;~ncy)' 'curetted after attempted
instrumentation
wall with anterior uterine wall comes

Fig. 25.3: Tear in the cervix in an attempt of instrumen- Fig . 25.4: Injury caused due to attempted criminal
tation abortion
7. Rupture of membrane by hair-pin, nail. Causes of death and dangers of criminal

8. Syringing - Higginson's syringe type ap- abortion
paratus is used. Abortifacient fluid like I. Causes of rapid death -
soap water, solution of potassium perman-
1. Haemorrhage - common due to in-
ganate, cresol or lysol or tincture iodine
is pushed inside the uterus. complete abortion
9. Dilatation and curettage . 2. Perforation - when instrument is
used (it causes haemorrhage, shock
The above methods being used for induc-
& peritonitis)
ing criminal abortion.
3. Vagal shock
Method adapted in therapeutic processes
for legal or justifiable abortions are 4. Fat embolism - due to syringing with
fat containing solution
1. Dilatation and curettage - Suitable at
early phase 5. Air embolism - syringing with soap
2. Vacuum aspiration - This is also suitable solution which creates air bubbles.
at the early phase . The cervix is dilated IT. Causes of delayed death - Death may
and the product of conception is extracted occur within some days due to local or
out by a tube attached to a suction pump general infective conditions like -
3. Low rupture of membrane 1. Peritonitis - in case of perforation
4. Dilatation and oxytocin infusion 2. Local infection getting complicated
5. Use ofutus paste 3. Tetanus
6. Amniotic fluid replacement by hypertonic 4. Septicaemia, Pyaemia.
glucose or saline solution
Ill. Remote causes where death occurs due
7. Abdominal hysteretomy - Recommended to complications of abortion -
only in complicated or problematic cases
1. Ren~l failure
8. Some prostaglandin preparations and
some other drugs are used E!ij;her locally 2. Mep.~J}gitis , Endocarditis, Pneumoni-
or through oral or N routcr to Induce
abortion. · ,·,. '),, ., 3. Hepatitis. ,

664 I PRINCIPLES OF FORENSIC M EDI C INE
Fig . 25 .5: Death due to criminal abortion Fig . 25.6: Death due to criminal abortion
Fig. 25.7: Incomplete

abortion by
mechanical
interference -
see clot
inside uterus
Fig . 25.8: Incomplete

abortion , clot
inside uterus
(same as in
Fig . 25.7
above)

chapter 25: A BORTIO N I 665
N . Toxic effect of abortifacient drugs, may While performing local examination, the
cause death during any period depend- undergarments may show some staining with
ing on the nature of the drug. blood and occasionally, with liquid abortifa-
cient agent, used locally.
Medical findings of criminal abortion
Labia majora and minora will be con-
These are available from the examination of gested and depending on the size of the foe-
(i) woman concerned, (ii) the product of con- tus expelled, some injuries may be present
ception, if available. in the form of abrasion, contusion or tear lac-
1. Examination of the woman who has al- eration, over these areas, the post. commis-
legedly aborted- In connection with an sure, fourchette and the vaginal wall which
alleged case of criminal abortion, the doc- is also congested with some degree decrease
tor may have to examine a : (a) living in rugosity, in case of abortion of advanced
subject, (b) the dead body of the woman pregnancy. The vagina may show presence
may be sent to him for postmortem ex- of small blood clots and all these organs may
amination. show chemical staining, if any chemical had
been used. The cervix is congested and the
(a) Findings related to abortion which os remains dilated for a few days. The extent
may be present in a living woman of dilatation and the period of its stay also
depends on the size of the foetus expelled.
The signs are akin to those found in delivery
The os may also show tear and abrasion due
cases, but these may not be always well
to instrumentation.
marked due to premature expulsion of the
foetus. In addition, some evidence about the The woman remains indisposed for 1 - 2
method used may be present in the body of days with slight rise of temperature. The se-
the woman. rum and urine of the woman, gives positive
result for tests for HCG up to about 7 - 10
As in case of delivery, in case of abortion
days.
also, some of the findings are related to preg-
nancy and others related to expulsion of prod- (b) Postmortem findings in a case of death
uct of conception. In case of abortion, many due to abortion
of the signs of pregnancy may not be present
at all, depending on the duration of pregnancy External findings - The undergarments may
when the woman aborts. The doctor will ex- show blood· stain, clots and staining due to
amine the breasts, pigmentation of different abortifacient agents used. Occasionally parts
places and the abdominal wall, which are of products of conception may be present with
particularly important if this was the 1st preg- the.blood clot.
nancy of the woman. In many cases, death being due to haem-
Apart from the permanent changes occur- orrhage, the body may look extremely pale.
ring in these body parts, in case of recent abor- In such cases, PM staining, is not prominent.
tion, there may be discharge of milk or colos- Depending on the duration of pregnancy, the
trum on squeezing of the breast and there may distribution of pigmentation may be present
be tenderness of the abdominal wall. The in axilla, around the eyes, etc.
uterus may not be palpable per abdomen, if it Breasts may be enlarged with dark are-
was not a case of advanced pregnancy. ola, presence ofMontgomery's tubercles and

raised, large nipples. Abdominal wall may be dinal dissection of the uterus, the wall is thick-
lax with presence oflinea nigra and occasion- ened. The cavity may show presence of the
ally striae gravidarum. In case of cupping, a product of conception in full or in parts.
circular mark, may be noticed on the wall of There may be presence ofblood clot , and
the lower abdomen. parts of product of conception should be
Labia majoras are laxed, labia minoras searched in the clot. In some cases, there may
are pigmented, they may be stained with blood be presence ofhair pin , nail or root of a plant,
and may bear some injury apart from being if any of these elements was used. The en-
congested and stained with locally used abor- dometrium may show evidence of scooping,
tifacient agent , when any such agent is used. if evacuation was done by curetting. If the
As in case of living, there may be injury of evacuation was incomplete, the placenta may
fourchette and posterior commissure . Exami- still be there . Otherwise the site of placental
nation of vagina is performed along with attachment may be seen as a raw and slightly
uterus, during internal examination. depressed area. In case of use of any chemi-
If the abortifacient agent was injected cal , the inner surface of the uterine wall may
parenterally, then the injection mark or be stained . There may be smell of the agent
marks will be detectable overdeltoid/gluteal used. If soap water was used, then froth may
region , cubital fold or dorsum of hands . be present in the cavity. Both internal and
external os may be congested and may be
Internal Examination - Injury to intra- distorted with presence of injury due to use
abdominal organs due to instrumentation and of instrument.
perforation of uterus and vagina may occur.
Vagina - The vaginal wall near the for-
After opening the abdominal cavity , it nix, may show perforation , if an instrument
may be seen to be full of liquid and clotted was pushed wrongly through the fornix. The
blood , ifthere is perforation of the uterus due vaginal sac will show presence ofblood clots ,
to instrumentation. In such cases, injury to occasionally with presence of parts of prod-
neighbouring organs like intestine or blad- uct of conception, including pieces of mem-
der , in the fonn of perforation, laceration or brane . If a chemical was used, the wall will
contusion, may be present. Sometimes the be stained accordingly, with suggestive smell
material used may be present in situ . Some- and excoriation of the epithelium. The wall
times injury to the pelvic organs may occur , will be congested and be abraded or even lac-
without perforation of uterus but due to per- erated with excoriation of epithelium, if a
foration of vagina by the instrument at the corrosive or irritant agent was used.
level of fornix .
Lungs -In case of death, due to air or fat
The uterus, ovaries and the vagina are embolism, there will be evidences for the
dissected out enmasse for detail examination. same . In such a case lungs will also be con-
Findings in the Uterus - Apart from per- gested . If general anaesthetic agent, like
foration and presence of instrument in the ether was used, then on exposure of the
injury which may be a sharpened root of some lungs, smell of the same will be appreciated.
plant, a nail or a hairpin, there may be the If death was due to excessive haemorrhage,
following findings in the uterus - then lungs wi11 be pale .
. f.( t •
The uterus is enlarged, soft an~ cq:pgested Heart .,- GJ"l:.alllbert? may be empty or blood
with prominent surface vessels. On longitu- may be present. rin cas_e of air embolism froth

chapter 25: ABO RTION I 667
may be detected, if dissection of the heart is When available in pieces, it is strongly

undertaken properly with full care. In case suggestive that, it was a case of instrumen-
of death due to septicaemia or bacteraemia, tal abortion. When the product of concep-
subendocardial haemorrhages may be seen. tion is available in ful~ presence of me-
chanical injury, will be suggestive of use of
Ovaries - Either of the ovaries will show
instrument. When some chemical was used
presence of an active corpus luteum Any of
locally, chemical injury with stain and smell
the ovaries may show injury due to use of will be present In case, the abortion was
instrument, when there should also be rup- procured by use of methods like use of sys-
ture of uterus or vaginal wall. temic drugs or rupture of membrane, then
Meninges are congested and inflamed no signs as described above, will be pre-
. when death occurs due to meningitis. sent
In case of air embolism, air bubbles may In abortion cases, either , the placenta
be present in the blood vessels. and the foetus will be found, connected with
an intact umbilical cord or when the umbili-
Both kidneys may be congested In per-
cal cord will be cut, the cut ends, particu-
foration cases ei.t her kidney may show con-
larly of that part which is attached with the
tusion. Liver is congested, particularly in foetus will not show any evidence of tying
some cases of drug induced abortions.
The product of conception available and
If death occurred due to use of some drug examined should be preserved in formalin for
by mouth, then part of the agent may still be future examination if necessary. Parts of the
present in the stomach with corresponding organs of the product of conception should
changes in the stomach and other organs, be preserved in S. S. of common salt
depending on the type of drug used
While examining such an aborted foetus,
In case of death due to excessive haem- it is important that the age of the foetus is
orrhage, other organs will be pale. In case of determined as the same has importance in
death due to effects of drugs, the organs may connection with abortion, (see below and also
be congested pages 138- 143) still- birth, infanticide and
Materials to be preserved - Uterus, ova- viability.
ries and vagina are preserved in formol sa-
Age of foetus
line for histological examination, with a part
of contents of uterus and a part of vagina, in Hasse's ·rule - The length of the foetus gives
saturated solution of common salt for chemi- an idea about the I. U. age of the foetus. It is
cal examination. Other usual and special vis- calculated as follows :
cera (chosen, depending on probable nature For the first 5 months of the foetus -
of abortifacient drug used) are preserved in Square root of the length of the foetus in ems
S. S. of common salt. Blood and urine should gives its age in lunar months.
be preserved without use of any preservative.
After 5 months - tth of the length offoe-
Examination ofthe product ofconception - tus in ems is the age of the foetus in lunar
The product of conception may be present in months. Thus, when the foetus measures 16
the uterus or may be presented to the medi- ems, its age is ...f16 = 4lunar months. When
cal man separately, either i:h.'full'or in parts the foettiE(measures 35 ems, its age is 35 x t
with tags of clothes mixed with blood clot. = 7 lunar months.

Appearance of foetus at different periods most reach the tip of the fingers. Left testi-
of their intra uterine life having legal cle is in the scrotum, right near the external
significances ring in male foetus . Ossification centres for
all sacral vertebrae present. Placenta is about
12th week (Up to this age of the foetus, one
400 gms in weight.
doctor alone can fonn opinion about the appli-
cability of indications ofMTP) - Length of the 40th week or full tenn (MLI = infanti-
foetus - 9 ems, weight - 30 gm. Mouth , nose cide) Body length - about 50 em. Body weight
and neck are distinct. Pupillary membrane is about 3 kgs. Umbilicus is midway between
present in the eye. Scalp hair and lanugo hair tip of xiphoid and pubis. Nails progress be-
are absent. Sex is not distinguishable, nails yond tips of fingers. Scalp hair is about 4 ems
are membranous, meconium is absent, ossifi- long. Lanugo hair is absent except over shoul-
cation centres for clavicle, mandible, ribs and ders. Meconium is in the rectum. Ossifica-
vertebrae are present, placenta is fanned. tion centres for upper end of tibia and cuboid
will be present.
20th week (Up to this age, all indications
ofMTP are applicable but the opinion ha.s to
MLI of Placenta
be fanned by 2 doctors). The foetus is 25 ems
long , 400 gms in weight. Umbilicus is slightly 1. From its weight and to some extent its
above the pubis . Body is covered with vernix size , the period of conception can be said.
caseosa . Scalp hair and lanugo hair have ap- 2. Its mere presence even in pieces, along
peared. Sex can be differentiated. Gall blad- with blood clots is confirmatory of abor-
der is present. Meconium is present at the tion or delivery .
beginning of ascending colon. Ossification
3. Its chemical examination may detect type
centres for manubrium, 1st segment of ster-
of systemic abortifacient agent used .
num and calcaneum may appear. Placenta is
Hence in all cases, placenta should be pre-
larger and weighs about 200 gms .
served for chemical examination.
28th week (Still-born- above this age).
Body length of foetus is about 35 ems , body Medicolegal aspects of abortion
weight around 1 kg. Scalp hair - more than 1
1. Abortions may be induced without proper
em long, nails are thick and proximal to tips
indication or in contravention to the pro-
of fingers. Left testicle is at the external ring
visions of MTP Act, when it amounts to
in male foetus. Gall bladder contains bile. Os-
a cnme .
sification centre for talus has appeared. Meco-
nium is present up to the distal end of large 2. When a doctor violates the provisions of
intestine. Placenta is about350 gm in weight. MTP Act, he is liable to be punished .
Pupillary membranes vanish, eyelids can be 3. A pregnant or even non-pregnant woman
opened. may malinger abortion, due to assault,
to bring a false charge against an enemy .
30th week or 210 days (Legally accepted
age of viability; MLI - infanticide) - Body 4. Abortion may be feigned to bring a charge
length is about 37 ems, body weight - about of rape or intercourse by a man , for
1,500 gms. Scalp hair about 2.5 em . Umbili- blackmailing the man .
cus is at the midpart of the body . Nails al- 5. Abortion may be feigned to claim com-

Fig . 25 .9: Emaciated body with intra-abdominal Fig. 25.10:Meconium in the transverse colon of a
haemorrhage (cause of death), due to foetus
rupture of ectopic pregnancy
pensation by a. working woman, linking Rofor ncoo

the said abortion with her hazardous duty.
6. A woman may be falsely charged for in- • M. L. Calderone- Abortion in United States, 1958.
ducing criminal abortion • D. C. Dutta- Text Book of Obstetrics, 1992.
7. A woman who has aborted, may be falsely • C. J. Polson, D. J. Gee, Bernard Knight- Essentials of
charged for infanticide. Forensic Medicine, 1985.
8. A woman who has aborted, may bring a • F. E. Camps, Recent advances in Forensic Pathology,
charge of negligence against the doctor 1963.
who was treating her.
Dutie of a medieal man d aling with a S Fisher- Spitz and Fishers Medicolegal lnvesdgation
ca e of criminal abortion of Death- 2006.
• WB Woodman and Charles M Tidy- Forensic Medi-
1. The doctor should consult a professional
colleague.
• D. C Dutta- Text Book of Obstetrics, 6th Edn. 2004.
2. He should render proper treatment to
the patient.
3. Law demands that, the police authority Question•
should be informed about the crime. The
doctor should otherwise maintain profes- Long theoretical questions
sional secrecy about the case. 1. What are the provisions of MTP Act ?
4. If there is a chance that, the woman may 2. How criminal abortions are induced in our country?
die, then the doctor should arrange for 3. What are the postmortem findings in a case of crimi-
recording her dying declaration nal abortion ?
5. If the woman dies, then the doctor should
Short questions
inform the police for arranging for post -
mortem examination and other investi- Indications of MTP, Abortifacient drugs, Duties of a
gations. doctor in dealing a case of criminal abortion.

Oral questions general violence adapted for abortion, local violence,

syringing, vacuum aspiration, causes of death in crimi-
Causes of natural abortion, who can perform MTP. nal abortions, Hasse's rule, materials to be preserved
where MTP can be performed ? Indications of MTP. in postmortem cases, importances of 12 wks, and 20
Liability of a doctor concerning MTP. Provisions of Sec. wks of pregnancy in relation to MTP Foetuses of
312 IPC and Sec. 314 IPC, Ecbolics, emenagogues, 12th, 20th and 28th wks.
NOTES
··.'
•''
,_, f
··l1 _._ '

Infanticide means killing of an infant, within born alive or was capable for a separate ex-
1 year of its live ~irth. istence or did not die due to natural or acci-
In India, infanticide is homicide, which dental causes and that, death was actually
may amount to murder, if ingredients of caused by the mother with some acts of com-
murder are there. In many countries includ- mission or omission. Even when killing of the
ing England and Scotland, infanticide com- baby by the mother is established, she may
mitted by mother has been given a different be taken as insane or mentally unsound, or
status. Giving consideration to the mental insane at the material time, due to peurperal
state of the mother after child birth and even and/or lactation causes.
during lactation period, if the mother kills In India, so much latitude is not ex-
her baby, then she will be charged for com- tended to the mother, even though she might
mitting felony which will amount to man- be suffering from some peurperal mental
slaughter (culpable homicide not amounting agony after child birth. However, the other
to murder being the equivalent in our coun- parts of the issue remain existent. It is diffi-
try). Th e English law further states that, all cult to prove that it was a case of live-birth,
such dead babies will be viewed by law as still that the born foetus was viable, that the
born foetuses until the contrary is proved.
death was not due to any natural or acci-
Any benefit of doubt should go in favour of
dental cause and that the death was due to
the mother. Fillicide is the term used when
some deliberate act of commission by the
either of the parents kills the infant. Killing
mother or somebody else. Hence in India
of a newborn within 24 hours of birth is
termed neonatocide. All such cases of infan- also, punishment for infanticide is not an
ticide, however, ends with secret disposal of easy outcome. Here lies the importance of
the body of the foetus and hence the mother provision of punishment for concealment of
can ultimately be punished for concealment birth (see page 655).
of birth and concealment of birth alone . For Hence, it is obvious that in a case of in-
this part of the offence, her accomplices also fanticide the matters to be proved are:
being equally responsible, all are charged as
primary accused. For the other part of the 1. Whether the foetus was viable when
offence , i.e. killing of the baby, it becomes born.
often impossible to prove that; the baby was 2. Whether it was born alive.
Parvej Dr. Md. Ahsan

671Uddin (Nayan) CoMC-24
3. Whether it had separate existence for after 28 weeks of pregnancy and does not
sometime. show any sign of life after complete birth.
4. That, the cause of death was neither natu- According to the definitions of still birth and
ral nor accidental. live birth, as defined in India (see below), the
5. That death was due to some deliberate position of those foetuses which are alive
act of commission or omission. during birth, with some part of the body be-
ing out of the moth er's body and their death
6. That, the dead infant examined belonged
to the woman charged for commission of occurring before full birth, become confus-
the offence of infanticide . ing as because they can be included in both
groups.
Hence, it is also seen that in a case of
infanticide the medical man is the primary Giving due consideration to the definition
and the most important witness. of dead born foetuses, it is very likely that
foetuses dying inside the uterus are not des-
1 . Whether the foetus born was viable ignated as still born and still birth thus es-
This is not an easy question to answer. VI- sentially includes birth where death occurs
ABILITY or capacity to lead a separate life during the passage of the foetus from moth-
outside the body of the mother, depends on er's womb to outside.
many a biological and physiological factors as In contrast to general conception, some
also on the extrinsic factors. However, the still born foetuses may show signs of respira-
acceptable age of viability of a foetus has been tion , as the same may occur in the vagina
fixed to 210 days and the appearance of a foe- (see vagitus vaginalis below) without any part
tus of this age has been described on pages of the body of the foetus being outside the
142, 652, 668 and 673. These features how- body of the mother. In such cases, putrefac-
ever are not totally dependable as to the age tion of the body of the foetus m ay start from
of the foetus except of course the length of inside as it had inhaled contamin ated air, a
the foetus , the exact measurement, of which part of which might also had been swallowed,
is again not easy. Some errors may make the
though generally speaking, in still born foe-
legal position totally different. Further, it has
tuses, putrefaction starts from outside as they
been seen that, foetuses born much earlier
usually do not breathe at all.
can be made to survive whereas more elderly
normal foetuses die after birth, even after all
precautionary life supporting steps are taken.
2 . Whether the child was born alive

In this connection two other conditions ofthe
newly born foetuses are recognised, when
they are not born alive. These are:
1. Still born foetus ,
2. Dead born foetus .
Fig. 26.1: Newborn infant (9th day EU) see the

changes in the umbilicus
A still born foetus is a foetus , which is born

chapter 26: INFANTICI DE I 673
To be declared as a still born foetus, the

birth of the foetus should occur after 28 weeks
of pregnancy which includes foetuses of vi-
able age who are born dead, as legally ac-
cepted age of viability of foetus is 210 days or
30 weeks.
The frequency of still birth rate is calcu-
lated as 1 in 18 births.
Medicolegal aspects
Charge of infanticide will not stand if it is seen
that the baby was a still born one and was not
alive when fully born . But due to the
confusional definition, problem may arise
when a foetus which was alive, when its head
and neck comes ·outside and then strangled
to death before completely born. In India, it is Fig . 26.2: Child killed second day after birth , see the
to be considered as killing after live-birth, nails for age
which may be sensed as same as to be consid-

lytic decomposition of the dead foetus in
ered under section 302 IPC. But it may also
the aseptic environment in the uterus,
be considered under section 315 IPC for pre-
when the dead foetus remains inside the
venting live birth or causing its death after it
uterus for at least 2 - 3 days after death.
was born alive. The punishments described in
these two sections ofiPC are different. Signs of intrauterine maceration - After
birth the dead foetus lie flat and flaccid
on the tray. There is emission of sweet-
ish disagreeable smell. The colour of the
skin is reddish or reddish purple. There
This means death of a foetus inside the uterus may be P .M. blisters on the skin contain-
without specific mention of its intrauterine ing fluid with reddish tinge. The cuticle
age, and the foetus after birth should show is removed easily. The internal organs
any of the signs described below, as a proof show signs of autolytic decomposition.
of death inside the uterus. The brain is pulpy. The skull vault bones
may partly overlap each other, a condi-
Signs of intrauterine death
tion known as "Spalding sign", which is
1. Presence of rigor mortis in the muscles also detectable by X-ray examination be-
of the foetus born. This indicates that fore the birth of the dead foetus.
death of the foetus must have occurred 3. Intra uterine mummification - This con-
at least about 2 - 3 hrs. before birth and dition occurs in the dead foetus inside the
hence, most probably inside the uterus. uterus due to scarcity or absence of am-
2. Intrauterine maceration (some like to niotic fluid for a reasonable period. Nor-
term birth with this sign as macerated mal delivery may not occur and the foe-
still birth). This is a condition of auto- tus may have to be extracted after diag-
rF M- <1..~ 1

674 I PRINCIPLES OF FOI(ENSIC MEDICINE
nosis by X-ray, sonography and physical (b) Movement of the limbs or any mem-
examination. Intra uterine mummifica- ber of the body of the foetus , is an-
tion indicates death of the foetus long other strong evidence of live birth.
back, inside the uterus. (c) There may also be sneezing and
yawning by the newbom
2. Physical examination of the child by a
doctor after birth - This includes: (a) See-
This, in India means that, the foetus is alive, ing and palpating the respiratory move-
after complete birth or when at least one part ment or heart beat of the child and hear-
of its body comes out of the mother's body. ing of the respiratory sound and heart beat
This makes a difference with the term live sounds by auscultation. Doctor's tests also
birth, as defined by the law of England and include those. (b) Pain sensation by pinch-
some other countries, where live birth means ing skin of any part of the body or by test-
the baby should be alive after complete birth. ing (c) Muscular tone and activity (by try-
ing to move a limb or finger) .
In India, live birth does not nec~ssarily
mean separate existence of the foetus as its
B. Signs of live birth and separate
death might have occurred during the course
existence in dead infants
of delivery after expulsion of one body part of
the foetus. However, to prove live birth, we A number of tests may be performed du ring
have to depend on signs which are actually postmortem examination, to decide whether
signs of separate existence. the child was born alive or not.
Signs of live birth External signs

A. Signs during lifetime of the new born 1. Shape of the chest and its measure-
ments - Chest is more flat anteropos-
1. Layman's perception oflive birth
teriorly in foetuses born dead It is less
(a) A baby cries after birth which is a flat with increase in the anteroposterior
strong evidence in favour oflive birth. diameter after respiration. The circum-
People outside the labour-room may ference of the chest is also increased af-
hear the cry. Cry of a healthy new-
ter respiration In a foetus born dead, the
born foetus is almost a certain phe-
circumference of the chest is about 2-3
nomenon after respiration has taken
ems less than that ofthe abdomen at the
place. Crying by newborn foetus,
level of the umbilicus. In a live-born foe -
helps expansion of lung alveoli. But
tus which has respired, the circumference
then, there are a few fallacies. A foe-
of the chest is 2 - 3 em more than that of
tus may inhale air and cry, :when the
the abdomen at the said level
head is inside the vagina, a condition
termed as vagitus vaginalis orit may 2. Changes on the body surface
even cry inside the uterus (vagitus (a) Vernix caseosa is present on the body
uterinus) when after the rupture of surface of a new born child. It is ei-
the membrane, air enters the uter- ther cleaned or gets removed by it-
ine cavity which the foetus may in- self within a day or two in live birth
hale and cry. cases .

chapter 26: INFANTICIDE I 675
Fig. 26 .3: Obliteration of

pupillary
membrane in a
7th month I.U.
aged foetus
Fig. 26.4: Ossification

centre for lower
end of femur
(age- 9m I.U. +)
Fig. 26 .5: Infanticide by inflicting burning Fig . 26.6: Still birth - ossification centre of sternum

(b) Immediately after live birth, the col- Internal examination

our of the skin is rather bright red,
1. The position of the highest point of dia-
which darkens after 2-3 days. The
phragm goes down after respiration to
permanent complexion of the skin
the level of 6th/7th ribs from 3rdl4th be-
comes by seven days after birth.
fore respiration. This occurs due to ex-
3. Caput succedaneum - Compression pansion of lungs after respiration. It is
around the presenting part during deliv- not a very clear and dependable sign of
ery causes some extravasation and diffu- live birth or respiration, as the lower-
sion ofblood and accumulation of fluid in ing of the position is the result only of
the subcutaneous tissue of the present- full expansion of lungs which occurs af-
ing part which swells up. This is caput a
ter considerable period. There are
succedaneum. It resolves within a few other causes including decomposition, to
days after live birth. Hence, presence of alter the position of the dome of the dia-
caput succedaneum is a definite evidence phragm.
in support of the foetus being alive dur- 2. Examination oflungs
ing delivery. But in prolonged labour
(a) Naked eye examination of the lungs
though this will be present, the foetus
may die before birth. (i) General appearance - Unrespired lungs
as seen in still born foetuses are smaller
4. Cephalhaematoma - Here there is gross
in size, placed at the uppermost part of
extravasation and collection of blood in the chest cavity, dark red or brown in
the head which occurs usually due to use colour, tough in consistency, and on dis-
of instrument (forceps delivery). It takes section, show frank bleeding from the cut
longer time to resolve. Its presence also surfaces, having similarity with liver in
suggests life of the foetus during birth appearance. Margins are sharp. The
and its regression process may help to lungs are non-crepitant on pressure.
conclude about the separate existence of But respired lungs oflive born infants are
the child and for how many days the child larger in size having bright red, mottled
survived after birth. or marbled appearance of the surface, due
5. Changes in the umbilical cord - In case to the expanded alveolar sacs, soft and
oflive birth, free end ofthe umbilical cord spongy in consistency, cut surface exudes
attached with the body of the child shows frothy blood and the margins are
clean cut margins with presence of a liga- roundish. The lungs are crepitant on
ture. However, in unwanted live birth pressure.
cases, cut margin of the umbilicus may In decomposition or in attempt for mouth
show ragging but there will not be any to mouth artificial respiration, there may
ligature. The cut margin dries up by about be accumulation of gas or air in local-
2 hrs. The cord dries up by about 24 hrs. ised areas, with emphysematous change
A red ring appears around the umbilicus in those parts. Surface bullae may appear
on the second day. The shrivelled, dried under the pleura, in case of decomposi-
cord falls offby 4th-5th day and complete tion which may contain some amount of
healing of the surface of the umbilicus reddish fluid which shift position on pres-
occurs by about 7 days. sure. Presence of gas due to putrefaction

or air due to attempt of artificial respira- other hand, a respired lung may sink in some
tion, does not give the unrespired lungs cases (see below). So to give value to the hy-
uniform typical changes all around, as is drostatic test, it should be performed me-
found in case of respired lungs. thodically.
(ii) Weight of the lungs - Weight of the two The vessels and bronchus should be tied
lungs after respiration is almost double at the hilar region and the two lungs should
of what their weight was before respira- be placed in water separately. In case of com-
tion. From 30 - 40 gm in unrespired state, plete expansion ofboth lungs due to respira-
it rises to 60 - 70 gms after respiration tion, both will float on water. In case of par-
(static test ). This increase in the weight tial expansion due to any reason, any of them
of the lungs is due to increase in the blood may or may not float.
flow through the lungs, after respiration.
Hence , irrespective of the lungs float-
Considering this change in relation to the ing or sinking, the next phase of the test
body weight of the newborn (Ploucquet's must be undertaken. This phase of the test
test ), the weight of the unrespired lungs is really important. The lungs are to be cut
is about 1/70th ofthe weight of the whole into small pieces and then squeezed or com-
foetus . But the weight of the respired lung
pressed with pressure. In case of inflation
is about 1135th of the weight of the whole of any part of the lung due to artificial respi-
body of the newborn infant.
ration or due to decomposition gas, squeez-
The weight of the lungs may however be ing or compression will expel the air or gas
increased in still born foetuses due to : completely and the lung which floated ear-
1. Inhalation of amniotic fluid lier, sinks now, and that excludes respira-
2. Oedema of the lungs before birth and tion. In case of inflation of some pieces of
3. Congenital pneumonitis. the lung due to respiration, residual air will
remain in the alveolar sacs, and these pieces
(iii) Contusion over the surface of the lungs -
will float now also, though the whole lung
Due to vigorous attempt of artificial res-
sank earlier due to non-inflation of other
piration, there may be contusion on the
parts of the lung or due to any other rea-
surface of the lungs in the lines of the
son. This will establish respiration.
ribs , if done in living newborns. Contu-
sions are not possible in dead newborns.
Fallacies of Hydrostatic test
(b) Hydrostatic test
As indicated already, if the hydrostatic test
This is a time-old important test for respira-
is not properly performed till the final stage,
tion of lungs. But often it is given more
it may give wrong information.
weightage than it demands.
The unrespired lungs may float in the
The w1respired lung being solid, has a
following circun1Stances:
specific gravity more than that of water.
Hence , it sinks in water. A respired lung on 1. Due to accumulation of decomposition
the other hand, being inflated with air, has a gases
lower specific gravity, acquires buoyancy and 2. Due to inflation of the lungs by air, due
floats on water. An unrespired lung may in to forceful attempt of mouth to mouth
some circumstances float on water, on the respiration.

The respired lung as a whole may sink migh~ have been formed by fatty substance
under water due to : derived from vernix caseosa.
1. Very feeble respiration for a very short In case of microscopic evidence of phago-
period involving only a very small area cytosis of meconium by the cells of the alveo-
ofthe lungs lar wall, it can be rightly concluded as due to
2. Due to atelectasis inhalation of ammotic fluid which indicates
intrauterine death.
3. Due to oedema of lungs
In case of intrauterine maceration, there
4. Due to congenital pneumonitis of infec-
will be sign of desquamation of surface of the
tive origin.
bronchus and bronchioles .
(c) Histological examination of the lungs Often the students are asked as to when
To get proper findings and information from hydrostatic test need not be performed. The
histological examination, it should be per- answer is:
formed very carefully. Both the lungs are (a) When the foetus has gross congenital
taken out en masse along with heart and tra- anomaly, incompatible with life e.g. anen-
chea. The lungs are then processed very care- cephaly.
fully. Sections from different parts of the lungs (b) When the foetus is below 28 weeks of age .
are to be examined. (c) When the stomach contains food sub-
The unrespired lung tissue will show less stance.
vascularisation, no air sacs. In exchange there (d) When the foetus shows signs of intra-uter-
will be glandular structures lined with cuboi- ine maceration or mummification.
dal or columnar epithelium. (e) When the umbilical cord shows
In case of respiration , the lung tissue cicatrisation.
shows increased vascularisation and ex- (f) When there are bruises on lung surfaces,
panded air sacs , which are lined with flat sq- indicating efforts to respirate the child.
uamous epithelium. In case a foetus inhales 3. Findings in the stoma~h and intestine -
amniotic fluid inside the uterus and did not In still born foetuses , the stomach will
respire after birth, the alveolar sacs will be not show presence of food (e.g. milk), sa-
expanded and will appear hyalinised and will liva or air. However, gas may be present
not be empty, as in case of respiration . But in the stomach after decomposition .
due to faulty histological technique if the Thus, presence of milk and saliva or sa-
amniotic fluid comes out of the sacs then they liva alone or air in non-decomposed new-
will appear empty as in case of respired lung. born (which a live born foetus swallows
during inspiration) are definite signs of
In some cases of unrespired lungs,
live birth. These substances , if present
oedema due to asphyxia before birth and evi-
in the small intestine , further confirms
dence of pneumonitis due to congenital in-
live birth and separate existence. In a live
fective causes may be there.
born child, the stomach may contain an
Hyaline membrane disease or alveolar amount of engulfed air which may cause
duct membrane may be seen in a few cases, it to float when placed in water. Applying
where the bronchiolar margins are seen to double ligatures , at the cardiac end of
be lined with a membranous coat , which oesophagus and below the pyloric end of

I Table. 26.1: Differences between Respired and Unrespired lungs i

I
1 Points of difference I Respired Lung Unrespired Lung
1. Volume larger Smaller

2. Consistency Soft, spongy, crepitant, elastic Firm, non-crepitant, non-elastic
3. Weight More than 60 gms in full term after full Around 30 gms in full term
respiration
4. Ratio of the weight with 1/35th of the body weight 1/?0th of the body weight
body weight
5. Margins Roundish Sharp
6. Appearance Mottled or marbled appearance Uniform reddish brown in appearance
7. Vessels Prominent with increased circulation Not prominent to the extent of respired
lungs
8. Alveoli Expanded and rises above the surface Not so
9. Anatomical position in the Occupies almost the whole of the cavity Not up to that extent in comparison with
thoracic cavity in comparison with other thoracic organs; other thoracic structures; position is at the
extend much in all directions after upper pa11 of posterior wall near the
respiration vertebral column
10. Hydrostatic test Squeezed pieces of lungs float on water Squeezed pieces of lungs sink in water
due to increased buoyancy and lower due to higher specific gravity and lack
specific gravity of buoyancy
" Microscopically Alveolar sacs are dilated and lined with Alveolar sacs are closed and lined with
flat cells. Vascula1ity prominent cuboidal or columnar cells. Vascularity
!ess prominent
12. Mll Significant of life-birth Indicates still-birth or dead birth
the stomach, give incisions in between the In case of breech presentation and hy-
double ligatures at both ends . (Breaslau's poxia, however, meconium may be com-
second life test ). If it is a case oflive birth pletely expelled out of the intestine be-
then if the stomach is dissected under fore birth and thus may be absent even
water . air bubbles will come out from such in still born foetuses .
a stomach . 5. Changes in blood vessels - Vessels, which
-r ::\Ieconium in the intestine - Meconium were useful during intrauterine life but
is constituted of inspissated bile and mu- have no use in the post-natal life, oblit-
cus secreted from the intestinal wall. In erate rather rapidly after birth, in a foe-
case of live birth, the large intestine is tus born alive.
completely free of meconium within 24 Thus, umbilical arteries are almost ob-
hrs after birth . In case of still birth, it literated within 12 hrs. after birth, which
will be present in the intestine. is complete in 3 days . By that time oblit-

eration of umbilical vein and ductus veno- whether the child was live born or not be-
sus has progressed which is complete cause, by the time these changes occur, other
within another day. The process of oblit- developmental changes in the child includ-
eration needs about 10 days for ductus ing the change at umbilicus, are so promi-
arteriosus . Though the anatomical oblit- nent that, there is no scope of confusion about
eration of these vessels occur at differ- live birth and separate existence. Presence
ent times after birth, their function or absence of these changes are however
ceases simultaneously after birth. helpful to assess the age of the child and say
6. Change in the heart - Closure offoramen whether he/she was within the age of infancy
ovale occurs within 3 months after birth. or crossed that age.
In a few cases the foramen may not com-
pletely close.
7. Incremental line in the enamel of the INFANT DEATHS
teeth -Neonatal incremental line in the
enamel of the teeth is considered to be While examining a case of suspected infanti-
one of the surest sign of live birth. cide, the natural and accidental causes of in-
8. Air in the middle ear - The gelatinous fant deaths must be excluded and the method
substance present in the middle ear dur- adapted to kill the child, should be searched
ing foetal life is gradually replaced by air, out.
within some days after birth.
Natural causes of death in a newborn/
9. Presence of some ossification centres, e.g. infant
at the lower end of radius, heads of hu-
1. Prematurity
merus and femur and capitulum of hu-
merus are also signs of separate exist- 2. Asphyxia due to central and local causes
ence for a few months. including atelectasis, hyaline membrane
10. Changes in the blood - Nucleated R.B .C. diseases
is absent in peripheral circulation within 3. Birth trauma
24 hrs. after live birth. Foetal haemo- 4. Congenital malformation
globin may be present in the blood up to 5. Haemolytic diseases including Rh-incom-
6 months or more . At birth the R.B.C. patibility
count is more than 5 million/cu mm. WBC
6. Neonatal infection
count is about 20,000, reticulocyte count
5-6% and haemoglobin is about 20 gm%. 7. Early separation of placenta
These values gradually fall in course of a 8. Pre-eclamptic toxaemia in mother
few days . 9. Infective conditions during infancy
11. Closure offontanelle - Closure of differ- 10. Sudden infant death syndrome (crib or
ent fontanelle occurs at different periods cot death).
after birth (see page 136).
Accidental causes of death of newborn/
The closure of foramen ovale, appearance
infant
of post-natal ossification centres, closure of
fontanelle or absence of foetal haemoglobin 1. Injury to mother on her abdomen, may
have no practical role in determining, cause premature separation of placenta

or injury to the foetus and lead to deliv- Precipitated labour usually occurs dur-
ery. Death of the baby may occur soon ing clearing of bowel, preceded by an "urge"
after birth. for the same . It is also claimed to have oc-
2. Prolapse of the cord may cause stoppage curred during sleep, in intoxicated state, dur-
offoetal circulation during birth and death ing a convulsive phase. In case the baby is
of the newborn may occur during or just born in a lavatory pan, then death may occur
after birth. due to inhalation of dirty water of the pan.
3. Prolonged labour- This may cause death Death of newborn may occur due to fall
of the foetus due to injury to brain, due on the ground and head injury with fissured
to compression effect on head or due to fracture of parietal and occasionally of fron-
asphyxia. tal and temporal bones with intracranial
4. Twisting of the cord around the neck - haemorrhage and injury. If delivery occurs
This may cause death of the foetus dur- in st anding position such head injury may not
ing birth or occasionally, immediately be expected. Length of the umbilical cord is
after birth, fr9m asphyxia due to stran- 50 ems only and a part of it remaining inside
gulation. the uterus, the head of the foetus may not
touch the ground. With separation of the pla-
Accidental death of the newborn may also centa, the head of the foetus may strike the
occur for purely post-natal causes ground. But then the length offall will be far
too short a distance as to cause serious head
1. Due to non-availability of nursing care,
injury. However, this may occur with the
the neonate may die due to smother-
woman being in stooping position. It is some-
ing, or choking due to inhalation of am-
times claimed that the newborn may fall due
niotic fluid or blood from the spot of de-
to tear of the cord due to weight of the foe-
livery.
tus. The cord is usually strong enough to bear
2. Non-rupture of membrane, even after the weight of the foetus. However, if occurs,
delivery may cause death of the newborn tear of the cord is more possible near its at-
due to asphyxia. tachments at both ends. In precipitated la-
3. Precipitated labour may cause death of bour, there should not be any caput succeda-
the newborn due to head injury, suffoca- neum formation. Cephalhaematoma or other
tion or drowning or occasionally due to injuries over head should not be confused as
bleeding from tom end of attached um- head injury due to precipitated labour. The
bilical cord. site and nature of the injuries in these cases,
should help to come to the right conclusion
Precipitated Labour by the autopsy surgeon.
In this condition, all the 3 stages or the first Medicolegal aspects of precipitated labour
two stages of labour occur in very quick suc-
cession so that delivery occurs suddenly and 1. A case of death of the newborn due to
very rapidly, without any warning to the actual precipitated labour may be taken
mother. This occurs due to hyperactivity of as a case of deliberate infanticide.
the uterus, lack of tone of cervix and a suit- 2. A case of infanticide may be claimed by
able position of the foetus. It is much more the mother, as a case of death of the new-
common in multiparae than in primiparae. born due to precipitated labour.

Methods of deliberate killing of an infant (c) Poisoning - Previously opium was the
common poison used for the purpose.
These may be divided into two groups - Now a days its use has decreased and
1. Acts of omission any available poison may be used in
\ 2. Acts of commission its place including acids, insect poi-
1. Acts of omission or deliberate neglect - sons. Use ofpoison to kill an infant
After birth, a human newborn needs indicates planned killing.
some care and attention for its survival. (d) Head injury - The head of the foetus
Intentional failure to extend those cares may be struck against a wall or the
to the newborn, may lead to its death and floor, by holding it with its legs which
may amount to infanticide. may leave an impression on the legs
also. The head may be simply com-
Examples
pressed and crushed in between two
(a) Failure to tie the cord after it is cut, hands or some other hard objects.
may cause death of the new born due Some blunt weapon may also be used
to haemorrhage. to strike the head.
(b) Failure to protect the child from be- (e) Concealed punctured wound - This
ing suffocated by linens or in birth may be caused by a nail or a needle
fluid . through the fontanelle, the nape of
(c) Failure to nourish the child with food the neck, or the inner canthus of one
and water. eye etc.
(d) Failure to protect it from exposure (f) By cut-throat injury -comparatively
to cold and other adversities . rare .
2. Acts of commission to cause infant death - (g) By burying the newborn alive .
(Arranged according to frequency)- (h) By drowning - This method also ser-
(a) Smothering the baby to death with the ves the purpose of disposal ofthe un-
help ofhand or clothes, which may not wanted child in a river, lake or pond.
.keep any local sign around the mouth (i) By burning -by disposing the living
and the nose as no great force need to new born inside an oven.
be used. But, as usually a greater force (j) By twisting the neck - Death occurs
is applied than required, local marks due to fracture-dislocation of the cer-
may be available in many cases. vical vertebrae and injury to medulla.
(b) Strangulation -Caused by a separate In case of examination of a dead new
ligature material or the umbilical born child in connection with an infanticide
cord (to simulate natural twisting of case, the suspected mother also should be
cord round the neck) or by throttling examined to see if the woman has actually
or manual strangulation. In case of delivered in the recent period and if so ,
natural twisting of the cord around whether the extra-uterine age of the new-
the neck. Wharton's jelly on the sur- born tallies with the period lapsed after the
face of the cord, will not be disturbed. delivery of the woman . Blood group and DNA
But in case of deliberate twisting, the tests for both the woman and the child are
jelly will be displaced. also recommended .

Abandoning of a child not find any alarming signs in the babies

when they were last seen alive.
The offence of abandoning a living child un-
der 12 yrs of age, is triable under sectio~ 317 The most vulnerable age range of the
IPC and is punishable with imprisonme~t up infants are within 3 - 4 months of age, flanked
to 7 yrs and if such abandoned child actually by infants in ages within 2 - 6 months, the
dies, then the offender may be punishable for accepted range for the condition being 2
causing homicide, amounting or not amount- weeks after birth to 2 yrs of age. Different
ing to murder. But usually, abandoning of an statistical studies place the incidence ofSIDS
infant is committed by either or both parents from 0.2 - 0.4% of all live births.
.in such a way and with such a desire that,
Causes of SIDS
somebody else will see the baby and will take
care of it. In such cases, the baby is left well No definite single cause or combination of
protected with clothes and unp.er a shelter in causes, could yet be made responsible. This
a fairly common place. has resulted in postulating various predispos-
Sec. 317 I.P.C. Exposure and abandon - ing and precipitating causes.
ment of child under 12 yrs by parent or per-
son having care of it. Whoever being the fa- Predisposing causes
ther or mother of a child under the age of 1. Season - In most occasions, such deaths
twelve years or having the care of such a are seen to occur commonly in rainy and
child, shall expose or leave such child in any winter seasons.
place with the intention of wholly abandon- 2. Premature birth.
ing such child, shall be punished with impris-
3. Sex - Male infants have a proportionately
onment of either description for a term, which
higher death rate on this account than
may extend to seven years; or with fine ·or
fernales, with a higher proportionate rate
with both.
of 3 : 2.
Explanation -The section is not intended
4. Age - Mid infancy is the most vulnerable
to prevent the trial of the offender for mur-
age.
der or culpable homicide, as the case may
be, if the child dies in consequence of the 5. Social status - Low and middle class fam-
exposure. ily with their housing condition, size of
the family and lack ofhealth conscious-
Concealment of birth- See page 655 ness, may have something to do with it.
Sudden infant death Syndro me (SJDS) 6. Time of death - In most cases, the infant
is discovered dead either in the early
(COT death or Crib death) morning (death possibly occurring at late
Infants particularly in some specific age night) or after sometime of 1st feeding of
range, may carry a danger, to die without the infant in the morning.
presenting any apparent signs of any disease
or cause . The unfortunate parents of these PRECIPITATING CAUSES
infants discover their babies lying dead in 1. Prolonged sleep apnoea is presently ac-
their crib or cot, though the parents could cepted as the most countable of the sug-

~ I PRINCIPLES OF FORENSIC MEDICINE
gested causes. This condition leads the linked for having criminal involvement
infant to hypoxia . Hypoxic state may be or negligence .
promoted by many allied factors , e.g. 2. Some criminal infant-death cases may be
some infective condition of the respira- presented as natural cot death cases .
tory tract . A flaccid pharynx and fixed
position of the neck during sleep , may
decrease the air movement. Further, the
NON--ACCIDENTAL tNJtJRY OF
hypoxia , may cause oedema of the respi-
CHILDHOOD
ratory tract lumen which worsens the
condition . (Ba1tered Baby Syndrome I Caffey 's
2. Local hypersensitivity of the respiratory Syndrome I Maltreatment Syndrome/
tract lumen to bovine milk which , often Cruelty on Children)
leaks into the lumen during feeding , was
for sometime, considered responsible, (See page 569-576)
which by way of sensitizing the larynx
against bovine milk, was thought to cause
laryngeal spasm with further inhalation
of minute amount of such milk leaked
into the lumen.
• A M. Barrett- Recent advances in Paediatrics, 1954.
3. Viral infection of the respiratory tract .
• K. Simpson- Forensic Medicine, 1957.
4. Bed clothes and pillow falling accidentally
• C J. Polson, D. J. Gee, Bernard Knight- Essentials of
over the mouth and nose by the move-
Forensic Medicine, 1985.
ment of the child .
5. Accidental prone position of the child fa- • F E. Camps, Recent advances in Forensic Pathology,
vouring it to be smothered. 1969.
6. Overlying of the baby, by a sleeping or • J M. John Stone and H. S. Lowy "Role of infection in
intoxicated mother or smothering by cot deaths" British Med. Journal- Vol. 1 (1966).
mother, when in course of breast-feed- • J. L Lake, et al, "Paediatric Forensic Pathology -
ing the mother falls asleep, in real sense Death by Homicide", Journal Forensic Science, Vol.
is not crib death as the death does n ot 12 (1967)
occur on the crib.
7. Criminal involvement of either or both
parents
Qu®tions
Of all the precipitating causes, prolonged
sleep apnoea aided by other factors , particu-
Long theoretical questions
larly the resultant oedema of the respiratory
organs, is the most acceptable one at present. 1. What is infanticide 7 What are the signs of live-birth?
2. What are the acts of omission and acts of commis-
Medicolegallmportances sian in relation to infanticide?
1. Cot death is essentially a natural death , 3. What is Battered child syndrome? Describe the medi-
in which the parents may be wrongfully cal, medicolegal and social aspects.

Short notes/ Differences of infanticide, What is intra-uterine maceration,

Spalding's sign, I. U mummification, Definition of sti ll-
Still-birth, Dead -birth, Signs of intra-uterine macera-
birth, Dead-birth, Vagitus vaginalis, Vagitus uterinus,
tion, Hydrostatic test, Acts of omission and commis-
Caput succedaneum and Cephalhaematoma,
sion related to infanticide, Precipitated labour, Aban-
Changes in umbilicus and Umbilical cord after birth,
doning of a child, Cot or crib death, Difference be-
Macroscopic and microscopic changes in the lungs
tween respired and unrespired lungs.
after respiration, Changes in blood, in middle ear af-
Oral questions
ter live birth, Breslau's second life test, M.L.I. of pre-
Questions from long and short questions as above cipitated labour, Questions from cot death, Aban-
and, What are the questions related with allegation doning of child.

~RINCIPLES OF FORENSIC MEDICINE
NOTES
''

SEXUAL OFFENCES 5. Intercourse by any member of the
management staff of a hospital with
any woman in that hospita~ not
Sexual offence can be defined as sexual in- amounting to rape.
tercourse or sex-related acts performed in a
6. Adultery
way which is against the provision of the law
7. Cohabitation by a man deceitfullyin-
ofthe land
ducing a belief of future marriage.
Sexual offences are categorised into three 8. Incest- This in particular and as such
types is not an offence according to Indian
1. Natural sex offence law, but is so in many countries.
2. Unnatural sex offences N.B. : It should be noted that conditions de-
3. Some sex linked offences. scribed between No. 2 and No. 8
without any specific ingradient does
1. Natural sex offences include those sexual not amount to the offence of rape.
offences which are performed in the or-
2. Unnatural sex offences- These are sexual
der of nature i.e. by penetration of the
offences where intercourse is performed
female organ (vulva) by the male organ against the order of nature i.e. when the
(penis). act does not involve penetration of a wom-
Examples of natural sex offences: an's vagina by the penis of a man.
1. Rape
Types of unnatural sex offences
2. Intercourse by a man with his wife
during separation 1. Sodomy or anal coitus
3. Intercourse by a public servant with 2. Buccal or oral coitus
a woman in his custody, not amount- 3. Lesbianismor tribadism
ing to rape. 4. Bestiality
4. Intercourse by the superintendent of 3. Sex linked offences:
a jail, remand home etc., with a fe- (a) Indecent assault
male inmate of the same place, not (b) Some unlawful perversive acts (see
amounting to rape. sexual perversions on page 714-719)
(c) Offences under obscene and public and then commit rape on her. In USA it now
nuisance Acts not related with medi- amounts to an additional serious offence apart
colegal service from rape).
(d) Offences under immoral traffic Acts , Sixth - With or without her consent,
e.g. k idnapping of a woman, unlaw- when she is under sixteen years of age.
ful prostitution etc.
Explanation - Any degree penetration
is sufficient t o constitute the sexual inter-
course necessary to the offence of rape .
(As is provided in some countries there
has been some thinking in our country also
Definition of rape that sexual intercourse with one's own wife
without her will and consent should also
Rape has been defined legally in our country
amount to rape. But incorporation of such a
uls 375 IPC .
provision at this stage, needs consideration
A man is said to commit "rape " who , (ex- of the matter in issue, on the background of
cept in the case hereinafter excepted), h as socio-familial culture of a country). Th e
sexual intercourse with a woman under cir- bracketed parts are not part of the concerned
cumstan ces falling under any of the six fol- section ofiPC.
lowing descriptions:
Exception - Sexual intercourse by a man
First- Against her will . with his own wife , the wife not being under
Second- Without her consen t . fifteen years of age , is not rape .
Third- With her consent, when her eon-
sent has been obtained by putting her or any Punishmentfar rape (Section 3761.P.C.)
person in whom she is interested, in fear of Punishment for rape - Subsection (1)- who-
death or of hurt . ever, except in the cases provided for by sub-
Fourth - With her consent, when the section (2) below commits rape shall be pun-
man knows that he is not her husband, and ished with imprisonment of either descrip-
her consent is given because she believes that tion for a term which shall not be less than
he is another man to whom she is or believes seven years but which may be for life or for a
herself to be lawfully married . term which may extend to ten years and shall
Fifth- With her consent , when, at the also be liable to fine unless the woman raped
time of giving such consent, by reason of is his own wife and is not under twelve years
unsoundness of mind or intoxication or the of age , in which case , he shall be punished
administration by him personally or through with imprisonment of either description for
another, of any stupefying or unwholesome a term which may extend to two years or with
substance , she is unable to understand the fine or with both:
nature and consequences of that to which she Provided that the court may, for adequate
gives consent . ("Da t e-rape-drugs " like and special reasons to be mentioned in judg-
rohyprol are popular in USA for stupifYing a ment, impose a sentence of imprisonment for
girl friend by mixing such a drug in her drink a term of less than seven years.

chapter 27: SEXUAL OFFE NCES AND SEX PERVERS IO NS I 689
Subsection (2), provides that whoever judgment, impose a sentence of imprison-

(a) being a police officer cmmnits rape ment of either description for a term of less
than ten years .
(i) within the limits of the police sta-
tion to which he is appointed; or Explanation 1. Where a woman is raped
(ii) in the premises of any station house by one or more in a group of persons acting
whether or not situated in the po- in furtherance of their common intention,
lice station to which he is appointed; each of the persons shall be deemed to have
or committed gang rape within the meaning of
(iii) on a woman in his custody or in the this sub-section.
custody of a police officer subordi- Explanation 2. "Women's or children's
nate to him; or Institution" means an institution, whether
(b) being a public servant, takes advantage called an orphanage or a home for neglected
ofhis official position and commits rape women or children or a widow's home or by
on a woman in his custody as such public any other name, which is established and
servant or in the custody of a public serv- maintained for the reception and care of
ant subordinate to him: or women or children.
(c) being on the management or on the staff Explanation 3. "Hospital" means the pre-
of a jail, remand home or other place of cincts of the hospital and includes the pre-
custody e ~tablished by or under any law cincts of any institution for the reception and
for the time being in force or of a wom- treatment of persons during convalescence
an's or ch~s institution, takes ad- or of persons requiring medical attention or
vantage ofhis official position and com-
rehabilitation.
mits rape on any inmate of such jail, re-
mand home , place or institution; or Important - section 228A -
(d) being on the management or on the staff Whoever prints or publishes the name
of a hospital, takes advantage of his offi- or any matter which may make known the
cial position and commits rape on a identity of any person against whom an of-
woman in that hospital; or fence under section 376, 376A, 376B, 376C or
(e) commits rape on a woman knowing her section 376D (see page 704) is alleged or
to be pregnant; or found to have been committed (hereafter in
(f) commits rape on a woman when she is this section referred to as the victim) shall
under twelve years of age; or be punished with imprisonment of either de-
scription for a term which may extend to 2
(g) Commits gang rape, when rape is com-
mitted on a woman by a gang (more than years and shall also be liable to fine .
one person), shall be punished with rig- Subsection (2) of section 228(A) mentions
orous imprisonment for a term which about certain establishments who are author-
shall not be less than ten years but which ised to give permission for such printing and
may be for life and shall also be liable to publications and the related conditions with
fine ; proper "explanation"- (N ot directly concerns
Provided that the court may, for adequate a medical man ordinarily-except in question
and special reasons to be mentioned in the of publication in a scientific journal).
rF. M. - 441
Subsection (3) of section 228(A) provides cance . Will and consent does not mean the
that- whoever prints or publishes any mat- same thing, though consent is generally de-
ter in relation to any proceeding before a court pendant on will. A woman may have will for
with respect to an offence referred to in sub- sexual intercourse, but she may not give con-
section (1) without previous permission of such sent for shyness, for fear of detection and
court shall be punished with imprisonment of social stigma or for fear of becoming preg-
either description for a term which may ex- nant. On the other hand, a woman may give
tend to two years and shall also be liable to consent suppressing her unwillingness due
fine. to some other factor e.g. for some otherwise
Exception - The printing or publication benefit or fear.
of the judgment of any High Court or the It may be possible to prove her expressed
Supreme Court does not amount to an offence unwillingness and also absence ofher consent
within the meaning of this section. from the marks of resistance offered by her,
which may leave some injury on her body e.g.
General consideration on the back, inner aspects of thigh or on anns.
There is no age limit' either for the victim of But, if a woman subjects herselfto sexual in-
rape or for the accused. However, when the tercourse for fear of death, injury, blackmail-
vietiin\ not being the wife, is below 16 years ing or some other reasons then, marks of re-
of age ,\ sexual intercourse in any case, sistance may not be there to substantiate ab-
amounts to rape. Some authors describe, this sence of will and consent. Similarly, when un-
as STATUTARY RAPE. Rape can of course willingness is suppressed, there will not be
be committed with elderly women. Similarly anything to prove unwillingness except by oth-
in case of the accused male, law does not spe- erwise close investigation of the case. Further,
cifically exclude any age group, higher or no signs of unwillingness or absence of con-
lower, when a person cannot be charged for sent should be expected, when, at the time of
commission of rape . However it is obvious rape, the girl was intoxicated or stupified.
that a child of8 yrs age physiologically should These are to be remembered apart from inva-
not have desire or feeling and erection for lidity of consent in different circumstances,
sexual intercourse in ordinary circumstances like insanity, impersonation, being younger
but a child of 11 years may not have defi- than 16 yrs of age etc.
ciency of these factors in him. Hence, it is It should be remembered that, even a
the court which in all individual cases will professional prostitute cannot be subjected
take appropriate decision as to whether a to intercourse against her will and without
young accused can be considered as sexually her consent.
potent or capable, or not. However, for the Ordinarily>, the burden to prove unwill-
purpose of committing rape one need not be ingness and absence of consent lies with the
potent in the scientific sense, because to com- prosecution.,But in rape cases as described
mit the offence of rape sligh~ penetration of under sec. 37,6,;'subsection 2, a, b, c, d, e and
vulva by the penis .is suffici13nt. H~nce , full g, if the victim'States in the court of trial that,
erection,. intermission and
~ ' ejaculation
.
are not
' she did not give consent, the court will pre-
essential Old age is n<;>t a bar for a man to be sume that she did not give consent, (vide sec.
capable to perfonn. ~eitial intercourse. 114A oflndian Evidence Act). It then lies with
Use of the two phrases "against her will" the accused to show that, she consented for
and "without her consent" both have signifi- the intercourse. Clause 'f of subsection 2 of

chapter 27: SEXUAL OFFENCES AND SEX PERVERSIONS I 691
section 376 being regarding rape of a girl using the above means - irrespective of
under 12 yrs of age , question of giving a valid whether the perpetrator is male or female .
consent does not arise in any way. Thus if perpetrator of such an offence is a
If a husband performs sexual intercourse female then she will be liable for the act. In
forcefully on his wife above the age of 15 yrs, India, a woman may be charged to have com-
it will not amount to the offence of rape, be- mitted indecent assault on a man. Another
cause law states that to be valid, marriage is point to be noted here is that in many coun-
to be consumated by sexual intercourse. How- tries "sexual penetration" has not been lim-
ever, that does not mean that, the husband, ited to vaginal penetration. It may as well
for the purpose of sexual intercourse should include anal or oral penetration or a combi-
use unusual force causing pain or injury to nation of more than one or all of the varie-
· the woman without considering personal tem- ties of penetrations.
porary difficulties of the wife. In this type of
a case, though the husband will not be
Expmination of the Vidi~ _pf an Alleged
charged for commission of rape, he may be
Case of Rape ··
charged for cruelty and assault on wife. On
the other hand if the wife, continuously and
--------
unreasonably refuses sexual intercourse with (Examination should be undertaken without
the husband due to frigidity or some other unnecessary delay, so that, the findings do
reason, the husband instead of performing not obliterate, e.g. spermatozoa, if present
forceful intercourse may pray for a decree of in the vagina, should not disintegrate. A sec-
nullity of marriage or divorce . ond day for examination should be suitably
chosen for further examination of the woman,
Like Rape, charges of adultery (sec- 497
if she was in her period during first examina-
IPC), cohabitation by deceitfully inducing to
tion and if there is possibility of gonorrhoea!
a belief oflawful marriage (sec 493 IPC) and
infection due to rape ).
charges as described under sec. 376A, 376B,
376C and 376D (see page 704), cannot be Procedure for examination
brought against a woman for commission of
the same offence on a man in reverse but A The prerequisites for examination:
otherwise identical circumstances. 1. A requisition for examination of the
victim in connection with the alleged
Rape by a woman on a man incident of rape should come from an
According to Indian Law a woman cannot authorised person, either a Magis-
commit the offence of rape on a man. This is trate or from the officer in charge of
the provision in most countries of the world a police station.
except in France and some other countries 2. An authorised person should be there
including erstwhile French Colonies, where to identify the victim before the medi-
like a man a woman niay be charged for com- cal officer, about whom there should
mission of sex offence on a man. The law in be mention in the requisition.
some countries including France states that 3. The victim woman should give con-
"All acts of sexual penetration made against sent for examination if she is 12 yrs
a person by the use of violence , constraints, or above 12 yrs of age . If she is below
threat or surprise makes the perpetrator re- 12 yrs of age or if mentally unsound
sponsible for commission of the offence by or intoxicated then, consent for ex-

amination should be given by her le- C. Minimum two identification marks, pref-
gal guardian about whom there erably from exposed parts of the body
should be mention in the requisition. should be noted.
Consent for examination is a must D. General Examination - Height, Weight,
or else criminal charge of indecent General built and configuration should be
assault may be brought against the recorded which will give idea about her
doctor subsequently. age and capacity to resist the offender.
4. There should be an adult mentally Teeth erupted, with pattern of position-
sound female attendant, present during of teeth may be noted. Any develop-
ing examination. mental anomaly and any disease should
B. History of the case should be taken from also be recorded. Examination of teeth
the victim and recorded in brief. History helps in 2 ways, e.g. helping to estimate
should constitute about the date, hour the age, and if, the accused has any teeth
bite mark on his body, then this can be
and place of alleged occurrence of the
compared with the pattern of positioning
rape. Whether she knows the accused,
of teeth of the victim girl which will help
whether she resisted and shoute·d for
to establish that she resisted the act.
help, whether she was given any food or
drink prior to the act which subsequently E. Examination of Mental Status - If men-
affected her consciousness, desire and tal unsoundness is doubted then, she
capacity to resist. Whether she was put should subsequently be referred to a psy-
chiatrist. If she is thought to be intoxi-
under any threat. Whether there was
cated, arrangement for preservation of
palpable penetration followed by act of
her blood and urine should be made af-
coitus and ejaculation, or there was pre-
ter relevant physical examinations. ,
mature ejaculation before penetration.
Whether she experienced pain and bled F. Examinatibn of Developmental State of
during the act. It should also be ascer- Secondary Sex Features - Growth and
tained from her if she was wearing the appearance of breasts, axillary and pubic
same dress during the incident as during hair should be noted. For this purpose,
the examination. required removal of dress should be done
by the victim herself or by the female at-
Her menstrual history should be taken tendant and not by the male doctor him-
including the date oflast period. Her mari- self.
tal status should be asked and noted. It
The breast give information about the
should also be enquired from her, if she
sexual habit of the woman. The breasts
had any previous experience of sexual
of a woman not accustomed to sexual
intercourse, whether she was habituated
practices will be hemispherical, firm,
to frequent intercourse, or habitually
spongy with smaller nipples and pinkish
practices masturbation manually or with
areola. In women habituated with sexual
some aid.
practices, the breasts will be larger, lax,
She may be asked if she noted any puru- slightly pendulous with larger raised nip-
lent discharge from or ulcer on the penis ples. These changes do not appear with-
of the stated offender. out habitual sexual acts. The colour of
Her occupation and educational status the areola may not change before preg-
should also be recorded. nancy.

G. To note the marks of injuries present, if should be scrapped out by a blunt

any, on the body other than on sex or- blade and preserved.
gans. Some of these injuries are due to Vulva: Labia majora may show con-
resistance offered by her and some are gestion, bruise , scratches , seminal
due to excessive passion by the offender. and blood stain and foreign pubic hair.
Injuries due to offer of resistance may be For blood and seminal stain, swab
present in the forms of abrasions and should be taken and this along with
bruises on the back of chest, buttock, foreign pubic hair, if present, should
forearms , face (nail scratches) inner as- be preserved. In woman who had no
pects oflips (due to friction with teeth in previous habitual experience of
an attempt by the offender to stop her sexual intercourse , the labia majoras
from crying for help), at the inner aspects are roundish , fleshy and both side lie
ofthighs (in the form of nail scratch abra- in close apposition. In women habitu-
sion or bruise , in an attempt to forcefully ated to intercourse, these are lax and
push, the thighs wide apart), or abrasions not in apposition.
over the vulva· (caused while removing Labia minora may show stain, for-
the woman's hand covering her private eign pubic hair and injury as in case
part). oflabia majora. Here also same pro-
Injuries due to excessive passion of the cedure should be followed. In women
offender may be presented in the form of habituated with sexual intercourse
labia minoras are slightly projected
bruise , nail scratch abrasions , teeth bite
out, pigmented and enlarged. In oth-
injury over face , breasts , mons veneris .
ers , these are pinkish , smaller and
THESE INJURIES ON BREASTS AND covered by majoras .
PRIVATE PARTS SHOULD BE EXAM-
The parts deeper to labias may show
INED WHILE EXAMINING THESE
seminal and blood stain which should
PARTS FOR OTHER PURPOSES.
be preserved in swabs . These parts
H. Examination of the private parts - The may show congestion, bruise and of-
woman should be laid in lithotomy posi- ten tear or laceration over the poste-
tion. Undressing of the private parts rior commissure , in case the girl was
should be done only by the victim herself a virgin before being raped.
or the female attendant and not by the Clitoris is slightly enlarged in women
doctor. The attendant should not apply habituated to intercourse and mas-
any force to undress her. turbation.
The pubic hair should be examined. Hymen: In case of rape of a virgin ,
Any matting due to semen should be there will be one or many tears usu-
noted and the matted hair should be ally on the posterior aspect at 5, 7 or
cut by a scissor and preserved. Any 6 O'clock positions . If very fresh , then
foreign pubic hair should be identi- the margins of the tears will be red-
fied and preserved. dish, swollen, and may still show ooz-
The inner aspects of thighs may show ing of blood which usually stops
presence ofdried seminal stain, blood within a few hours . But swelling and
stain and injuries . Dried stains redness persist for 2-3 days.

In a previously de flo rated woman, recent Vaginal swab and cervical smear should
tears may not be there. Instead, there be taken. Vaginal swab should give posi-
may be old tears at places. In a woman tive tests for semen and spermatozoa, if
habituated to sexual intercourse, carun- present and if of recent occurrence. The
culae hymenalis appearance will be there, group factor may also be detected if the
with tags ofhymenal tissue at the periph- Offender is a "secretor''. Presence ofblood
ery. of the victim and the offender may be
detected from the swab. The cervical
Hymen may not rupture after rape, in the smear may show evidence of gonococcal
following circumstances infection with demonstration of gram
negative intracellular concavo-convex
1. If the penetration was not full.
diplococci as mirror image pairs in plenty,
2. If the hymen is tough, fleshy and elastic. in gram stain. DNA tests if can be under-
Then there may be congestion or bruise taken may be of immense help.
of course. Gait - Gait may be altered and painful
3. If hymenal opening is large due to prac- (Gait should not be tested making the
tice of masturbation. women naked).
4. In very young children, due to deeper I. Examination of clothings - If the clothes
placement of the hymen and less capac- were not changed then, their examina-
ity of the vagina, full penetration with tion may be very useful. They may show
rupture ofhymen may not occur. Instead, recent tear (mark of resistance), mud or
there may be congestion, bruise or even soil stain (a corroborative sign; the mud
tear laceration of the structures of pos- or soil should be matched with the same
terior wall of introitus and vagina which of the alleged place of occurrence), semi-
may extend upto perineum. nal stain (starchy in appearance), blood
stain and foreign pubic hair. The clothes
5. In deflorated woman no fresh rupture of
should be preserved for further exami-
hymen may occur. nation at Forensic Science laboratory.
Any vaginal discharge should be
noted and preserved. The discharge
may contain semen, blood, purulent
discharge due to gonococcal infection
contaminated from the offender (may
be present after 2 days of the inci-
dent), or due to ordinary leucorrhoea
of the woman.
Vaginal wall congested, may even
show contusion and may be tender.
In sexually habituated (both inter-
course and masturbation), it will eas-
ily permit 2 fingers. In virgins, intro-
Fig . 27.1 : (a) Human spermatozoa, (b) Enlarged view
duction of more than 1 finger is pain- showing C!ifferent parts.
ful. Vaginal rugosity is partially lost (1) A.nt. ·2/3rd of head (nucleus), (2) Post
after repeated acts of intercourse. 1/3rd of head, (3) Neck, (4) Tail

cryapfer 27: SEXUAL OFFENCES AND SEX PERVERSIONS I 695
J. Other materials to be preserved -Apart 7. Swab from teeth bite marks - For group
from the materials to be preserved as factors from saliva.
mentioned above, preservation of some 8. Wearing dress with under garments .
other materials is recommended e.g.,
9. Scrapping from nail beds for blood and
( 1) Scrapping from the nail beds of the
cuticle, if she scratched him.
woman , which may contain cuticle of the
offender, if the victim girl scratched him. 10. Blood and urine - For grouping, DNA test
(2) Swab from the teeth bite marks for and in suspected case of intoxication.
detection of saliva and group factor of the
offender from the saliva. Preparation of report
K Further recommended investigations : While preparing the repo1t, name , address ,

1. X-ray of ossification centres for assess- age of the victim, case reference , date, time
ment of age, if the victim is around and place of examination should be recorded.
16 yrs of age. Briefhistory of the case may be noted. Iden-
2. Urine test after 15 days for Human tification marks and other findings of exami-
chorionic gon'adotrophin if the alleged nation should be properly incorporated. The
rape was committed during the 'dan- opinion ordinarily should be regarding sexual
ger' period. intercourse forceful or otherwise and not re-
L. Treatment and further action : garding rape, which will be finally decided in
the Court. Though by implication forceful
1. Treatment for injury, mental shock
intercourse amounts to rape.
should be provided.
2. If pregnancy occurs and abortion de- In all alleged rape cases certain questions
sired , then it should be induced. need to be answered. The most vital of these
questions is - whether rape was committed
Summary of materials preserved from the or not. It is the question which is most diffi-
victim cult for the medical man to answer. An af-
firmative answer can be given only in a very
1. Vaginal swab and Cervical smear - For
limited number of cases, when the vaginal
Seminal fluid , Blood (helpful for group
fluid of the alleged victim ofless than 16 years
test and DNA profile study), Gonococcus .
2. Foreign pubic hair - To compare with the
pubic hair of the accused.
3. Matted pubic hair -· For presence of Se-
men and Blood.
4. Her own pubic hair _:_ To compare with
the foreign pubic hair available on the
body of the accused.
5. Scrapping of suspected stain mark on the
body surface - For test for Semen and
Blood.
6. Scalp hair - For compai;i.~qn with foreign
scalp hair available froin the body of the Fig. 27.2; Arrortnalfemale org an in a woman habituated
accused or his dress:··_;· r• ' · ., , , , to intercourse

Fig. 27 .3: Different sites of healed rupture of hymen in Fig. 27.4: Smothered to death after rape
a girl with experience of sexual intercourse
for some times
Rape on virgin and deflorated women -

of age (or 15 yrs in case of wife) or of .an in- Genital findings are more in the former (with
sane shows presence of spermatozoa under recent rupture of hymen) than in the latter
microscope with tear of hymen at the ex- (vide page 693-694). In both cases positive
pected sites with or without marks of resist- genital findings are supportive of sexual in-
ance over other expected parts of the body. tercourse and marks of resistance including
From medical points of view, findings present bodily injuries and tears of clothes in pres-
in the private organs including spermatozoa ence genital findings are strong corrobora-
in vaginal fluid and tear of hymen are only tive signs of rape. However marks of resist-
supportive of sexual intercourse and not rape. ance may not be present in many cases as
Marks of resistance in addition, of course acts stated earlier.
as strong corroborative evidence in support Rape on very young children - There may
of rape having been committed. Hence it is not be penetration and rupture ofhymen (see
rightly commented that "Medical evidence of page 694) but there may be other local inju-
sexual intercourse is not necessarily the le- ries, simple or serious. Seminal stain may
gal evidence of rape". Because, sexual inter- be present near the vulva.
course with valid consent from an woman Rape on sleeping woman - Theoretically,
above 16 years is not rape. Here lies the im- slight penetration is possible without the
portance of marks of resistance (vide page knowledge of the sleeping woman. But full
690) which indicates lack of willingness and intercourse with full penetration during her
consent. This way all findings available on sleep is impossible.
the body and dress of the victim may be cor- Intercourse, intoxication and consent -
roborative to the commission of rape or just generally speaking, consent given for sexual
corroborative (not definite) of sexual inter- intercourse in a state of intoxication is invalid.
course only. But marks of resistance may not Intercourse during intoxicated state of the
be there when the offence is committed un- woman amounts to rape as such and includ-
der threat, by impersonation or after stupe- ing when the intoxicating agent has been
faction. In any case, the final opinion rests given by the man to perform intercourse
on all evidences available and produced in the without her understanding the matter and
court. without offering any resistance by her. But if

Amputation of penis as a punishment for sex

offence Fig. 27.6: Punishment for rape
the woman wilfully took the intoxicating agent Example of rape by misrepresentation of
to enjoy sex act, commission of the same by fact - when it is done pretext of therapy for
the desired man wili not amount to rape. some disease.
Offering of resistance during rape - A Rape and venereal disease - When the
smart, working and educated woman is more accused has son'le venereal disease and the
likely to offer reasonable resistance when she victim shows signs of same venereal disease
is free from fear or is not intoxicated or when after some d ays of alleged rape, the period
it is not a case of impersonation of the ac- matching with the incubation period of the
cused pretending as her husband or when it
is not committed by misrepresentation of any
fact. A timid, weak and shy or a very young
girl or an intoxicated woman is not expected
to offer much resistance.
Rape by impersonation as husband is pos-
sible in dark, during night or with a moder-
ately intoxicated woman.
Fig. 27.7 : Scene of crime of rape and murder Fig . 27.8: Murder after rape

5. It may cause psychological trauma to the

victim (Rape Trauma Syndrome ) charac-
terised by emotional imbalance , depres-
sion , feeling of guilt during the first phase
(phase of disorganisation) and followed by
gradual adjustment with occasional pho-
bia and fear state during the second phase
(phase of reorganisation, see pages 702-
704).
6. Pregnancy due to rape causes additional
mental trauma .
Fig . 27.9: Injury to clitoris .by a iron rod before murder
EXAMINATION OF THE ACCUSED
disease, it becomes a strong corroborative
The procedure of examination of the accused
evidence of rape, if the man denies sexual
is more or less same as in case of examina-
intercourse with the woman.
tion of the victim. Here also the same pre-
Complications of rape requisites are necessary. The same fonnali-
ties should be observed and the same line of
1. Rape may be followed by murder (for fear examination should be followed, except that:
of disclosure of the offence ofrape). 1. Consent from accused for his examina-
2. Death may also occur due to suffocation tion is not a must . Consent should be
due to closure of the mouth and nose of
the victim by the accused or due to gag-
ging to stop her cry.
3. Vaginal stricture or Recto-vaginal fistula ,
due to gross injury of the vagina.
4. It may cause a social stigma for the vic-
tim and affect her future.
Fig. 27.10 : Old healed tears on hymen of a woman

accustomed to sexual intercourse and Fig. 27.11 : Sex assault on private parts by hard blunt
sodomy (also note the dilated and sphincter) weapon

chapter 27: SEXUAL OFFENC~S AND SEX PERVERSIONS I 699
asked for. But if refused then, the accused

can be examined with application of rea-
sonable force as is n~cessary. (Sec. 53
CrPC)
2. Presence of a female or a male attend-
ant is not necessary.
3. History taking part may be omitted or Fig. 27 .13: Sexual intercourse on a minor
his own version of the case may be re-

corded. 2. The penis, particularly the glans and the
Marks of identification should be noted prepuce may appear moist due to vagi-
General examination should be performed as nal fluid and seminal fluid A swab should
in the case of the victim. Marks of injury on be taken and preserved Presence of vagi-
the body should be noted. These have impor- nal fluid can be known by testing for vagi-
tance as because they may be the result of nal epithelium and monilia
resistance offered by the girl. Development
of secondary sexual features should be noted.
Lastly, examination of private parts should
be undertaken.
Examination of Private Parts

Fig . 27.14: A
1. Whether there is any morphological de-
very minor
fect or disease on or around the private prostitute
parts, should be noted. Pubic hair should (sexual
abuse of
be searched for any foreign pubic hair, child)
which if present should be preserved. His
own pubic hair should also be preserved
Matted pubic hair should be preserved for
detection of semem and for detection of
foreign blood with its group.

Fig. 27 .15:
Injury (bruises
on breast)
during forceful
intercourse
(a) The glans 1s soaked with a moist blot-

ting paper which is then expos d to
iodine vapour . Brown discolouration
of the soaked part of blotting paper Fig 27.1 6 Note the pigmented enlarged
indicates presence of vaginal epithe- labi a minors in a woman
lium , as these cells contain glycogen experienced and habituated
to sexual intercourse
which turns brown in presence of io-
dine vapour. 6. Uret hral swab should be t aken after
(b) A drop of wash of glans is placed un- prost atic massage to test for presence of
der high power observation of micro- gonococcus .
scope . Vaginal epithelium and mon- 7. Blood should be collected for testing for
ilia can be detected. The fom1er stains blood group , DNA study and compare
brown if a drop of lut. ol's iodine is
with DNA pattern of blood or sperms
added , as the same contain glycogen .
present in the vagina or body surface and
3. Tear of the frenulum may be noticed . cloths of victim.
4. If the prepuce is present and is not re- 8. s,, ab k::>'ll1.·om any bite m ark inflicted
tracted, then presence of smegma goes by the victim any where may help to link
against full penetration and intercourse the offender.
within the last 24 h ours . This is because
full penetration and intercourse re- 9. In some cases, when the accused is very
moves smegma which takes 24 hours for young , his age may be ascertained from
re-deposition. Absence of smegma to an physical findings, teeth and X-ray find-
extent, goes in su pport of sexual inter- ings.
course within the last 24 hours (except 10. If required and requested, his potency
in a person with habit of cleaning this may be tested when possible . If the find-
part daily). ings in the accused corroborates with
5. In addition to these findings nail scra- those in the victim, then sexual inter-
tches may be presenton the penis , caused course is established. In such a case, de-
by the victim. n 1al of sexual i1 tercOl... rse between him

Fig. 27.17: Secondary syphilitic eruption on chest and Fig . 27.18: Contusion on dissection over breast -
mouth in a minor girl indicating relation with sex offence
and the said girl is strongly suggestive of 7. Swab from teeth bite mark if any
rape but not confi,.,natory of the same 8. Blood.
because, he may deny consented inter-
course for fear of conviction for rape or Establishment of co-relationship between
the victim may deny her consent for many the accused, the offence and the victim
a reasons.
1. DNA profile and blood group factor de-
Materials preserved during exarnination tected from the blood, seminal stain, sa-
of the accused liva stain and tissue debris from the nails
of the victim matches with the DNA pro-
1. His clothings
file and blood group of the accused.
2. Foreign pubic ha'
2. Group factor detected from the saliva
3. His own pubic ha including matted pu-
from the bite mark on the body of the
bic hair
accused if tallies with blood group ofthe
4. Scalp hmr
victim or group of the blood stain avail-
5. Swab from glans
able on the undergarments of the ac-
6. Urethral s a') cused, suspected to be due to injury of
Fig . 27 .19 : Sex assault and murder. Forceful sexual

intercourse with ecchymosis in the private
parts Fig . 27 .20· Rape and murder

the victim, if tallies with the blood group 2. There may be total loss of memory of the
of the victim. event.
3. Foreign pubic hair available on the body 3. Recapitulation of the event with night-
of the victim if matches with the pubic marish feeling .
hair of the accused and vice versa. 4. She may be totally dissociated from her
4. Presence of gonorrhoea in the accused , surrounding.
with the victim suffering from the same 5. There may be communication aversion
after 2 - 3 days . and she may be totally dumb for a pe-
5. Presence of seminal fluid in the vagina riod.
of the victim and presence ofvaginal cells 6. She may avoid social life .
and absence of smegn1a on the glans of 7. She will avoid to go to the area of place
the accused. of occurrence even in case of necessity.
6. Rupture of hymen in the victim and rup- 8. She may avoid things or discussion about
ture of frenulum in the accused. anything which reminds her about the
7. Marks of struggle , on the body of the vic- rapist, her feeling and the place and cir-
tim as well as the accused . cumstance of her rape.
8. Teeth bite mark pattern on the body of 9. She may suffer from acute post-trau-
one , matching with the teeth pattern of matic-stress-disorder syndrome . Their
the other. form an,l legree is variable from victim
to victim, from no external reaction in
9. Garments of both the accused and the
some to extensive rape-traumatic syn-
victim stained with soil and mud of the drome in others.
complained place of occurrence.
Rape traumatic syndrome has an acute
OVERALL CONSIDERATION OF THE phase followed by reorganisation phase .
IMPACT OF RAPE - ON THE VICTIM AND
During the acute phase of the rape-
VARIOUS ALLIED ASPECTS OF PROB- trauma syndrome , the victim is in a state of
LEMS OF RAPE ON THE SOCIETY. shock , non-responsive or non-reactive, con-
fused and unmindful of personal habits like ,
(a) Elaboration of impact of rape on the cleanliness food habit , normal activities and
victim (vide page 698) sleep . She is ashamed with a feeling of guilt
(finds herself faulty ), suffers from extreme
The victim of rape may suffer from various
anxiety, nightmare , frequent flash back of the
damaging effects from the sexual assault i.e.,
event . Overall·picture is that she appears to
rape on her, originates unpredictable emo-
be disconnecte'd from the surroundings . Emo-
tions with adverse effects on her, even loss
tionally she may-be agitated , tense , may cry;
of memory of the event, lack of concentra-
there may be rage , restlessness ; there may
tion, disturbance of personal habits like sleep,
be painful laughter:· With suppressing her
nourishment, personal social behaviour etc. feelings she may be peaceful , behave nor-
along with effect of mental. trau~a, giving mally , though ili.ternal turmoil continues . All
rise to auto-stress-di~>order~.,, ,_ these may lead < l rer even to commit suicide .
1. She is overwhelmed with the assault and During reorganisation phase there may be
shock . self-attempt by ·the victim to recreate , which

is not unusual. However, a feeling of guilt, and other opportunities, this is the next fa-
fear, shame, anxiety and sometime emotions vourable place for the rapist where also the
of anger, negativism, feeling of insecurity, chance of resistance and interference will be
helplessness, lack of interest in normal events minimum at the chosen time, if the situa-
and intimate relation, with generalised mis- tion is not unfavourable for the offender. Its
trust and suspicion may prevail in her even occurrence is minimum even in bars where
during the reorganisation phase, which takes it cannot be easily performed and comple-
time to go. But for the whole life she may ted.
continue with internal unexpressed turmoil
Coming to the other aspects, commission
in her mind. On the other hand, she may be
of rape is less relied upon, when the report-
critical on her own behaviour for which she
ing or complaint is lodged late. But it must
· may like to suffer and may make her own
·· .- t ~,e forgotten that delayed complaint may
plan for future security.
have various reasons. Fi.r stly, for a reason-
The stress disorders, emotional upset ~nd able and variable period the victim may be
other mental distresses, affecting her beha- mentally shattered and may be in a state of
vioural pattern and her future social ;md mental shock and traumatic stress. So, re-
healthy sexual life should be properly ad- porting after being partly recovered from such
dressed to by psycho-therapy. This need coun- a mental state reasonably takes some time.
selling for cognitive reprocessing and behav- Secondly in the first occasion of sexual as-
ioural therapy. sault the victim may like to keep silent to
avoid social stigma It is only after repeated
Social Considerations rape continuing for some period, finding no
Human life and behavioural pattern is differ- respite or no other way to bring an end to
ent from that of animals. In animals forceful the occurrences, she may prefer to report the
intercourse is an instinctual behaviour re- matter to the police, when she tries to give
lated with reproduction to a great extent. But some vague reasons for delay in complaining
the process of development of human society about the first incidence. Thirdly, even after
has provided for a peaceful existence amongst complaining, the victim faces many other dif-
members. With imposition of restrictive or ficulties to ~et justice. During investigative
restrain on violent behaviour in all aspects, phase the investigating agency desires some
where necessary, use of force or deception corroborative evidences on the body or cloth-
on anybody for the purpose of fulfilment of ing of the victim, namely, seminal stain, for-
desire, is not approved or allowed. Otherwise eign hair on the body or cloth, some injury
rape would have not caused any stress- etc. on the body of the victim. But, it is often
trauma and would have not been considered not considered that no woman would like to
a stigma for the rape victim. In such a sce- kept the stains, hair etc. on her body or dress
nario, if we look to the environmental condi- which she rightly feels filthy for her; and pres-
tion of commission of rape then, we see that ence of injury is also not a must as mentioned
most of this offence occurs at home; in the in the previous pages.
home of the perpetrator- where the perpe- But it must be made clear to the assail-
trator feels more safe, stre:ngthy·and secured ants that by invading forcefully the privacy
for him to commit the offence: ·~ext to this is of a woman he strikes the fundamental con-
the home of the victim Finding suitable time ception of a peaceful social structure.

704 I PRINCIPLES OF FORENS IC MEDICINE
- -
Various remedial thoughts and steps are shall be punished with imprisonment of ei-
already existing which have also been dis- ther description for a term which may ex-
cussed in the previous pages. But going back tend to five years and shall also be liable to
to re-read the definition of rape a feeling arises fine (Sec. 376B. IPC).
that it is expected that the victim of rape Sec. 376C. IPC. Intercourse by superin-
should have exerted resistance. But such tenden t of jail, remand home ,' etc. - Who-
expectation is apparently not very much ra- ever, being the superintendent or manager
tional. A woman who is going to face one type of a Jail , remand home or other place of cus-
of assault and violence should not be expected tody established by or under any law for the
much to invite some other physical violence
time being in force or of a women's orchil-
which may be of any extent and may result dren's Institution takes advantage ofhis offi-
"ultimate all round harm". This point needs
cial position and induces or seduces any fe-
consideration.
male inmate of such Jail, remand home, place
To conclude, it can be said open- or institution to have sexual intercourse with
heartedly that our society should have proper him, such sexual intercourse not amounting
feeling and understanding of the plight of a to the offence of rape , shall be punished with
poor rape victim and the state should take imprisonment of either description for a term
the responsibility of her mental , social and which may extend to five years and shall also
otherwise rehabilitation very seriously in as be liable to fine (Sec. 376C. IPC).
much acceptable manner and steps as possi-
Explanation 1. -"Superintendent" in re-
ble.
lation to a jail, remand home or other place
OTHER NATURAL SEX OFFENCES NOT of custody or a women's or children's institu-
AMOUNTING TO RAPE (Sec 376-A, B, tion includes a person holding any other of-
C, D of IPC) fice in suchjail, remand home, place or insti-
tution by virtue of which he can exercise any
Sec. 376A. IPC . Intercourse by a man with authority or control over its inmates.
his wife dming separation - Whoever, has
Explanation 2. - The expression ''wom-
sexual intercourse with his own wife, who is
living separately from him under a decree of en's or children's institution" shall have the
separation or under any custom or us age same meaning as in Explanation 2 to subsec-
without her consent shall be punished with tion (2) of section 376 (Vide page 689).
imprisonment of either description for a term 376D. IPC. Intercourse by any member
which may extend to two years and shall also of the management or staff of a hospital with
be liable to fine (Sec. 376A. IPC). any woman in that hospital - Whoever, be-
Sec. 376B. IPC . Intercourse by public ing on the management of a hospital or be-
servant with women in his custody - Who- ing on the staff of a hospital takes advantage
ever, being a public servant, takes advantage of his position and has sexual intercourse
ofhis official position and induces or seduces , with any woman in that hospital, such sexual
any woman , who is in his custody as such intercourse not amounting to the offence of
public servant or in the custody of a public rape , shall be punished with imprisonment
servant subordinate to him, to have sexual of either description for a term which may
intercourse with him, such sexual inter- extend to five years and shall also be liable
course not amounting to the offence of rape , to fine (Sec. 376D. IPC).

Adultay - Whoever has sexual inter- subjects with psychological aberrations .

course with a person who is and whom he Though not common in our country, there is
knows or has reason to believe to be the wife no legislation to debar such prohibitory sexual
of another man , without the consent or con- relationship specifically. It is mostly consid-
nivance of that man , such sexual intercourse ered as a social and familial offence. Covert
not amounting to the offence of rape, is guilty incest is a term used, where there is no bod-
of the offence of adultery , and shall be pun- ily contact or intercourse but one enjoys
ished with imprisonment of either descrip- sexual pleasure by having discussion about
tion for a term which may extend to five sexual matters with a close relative of oppo-
years , or with fine or with both . In such case site sex.
the wife shall not be punishable as an abet- As in covert incest, without any physical
tor (Sec. 497 IPC). contact, a brother may have a secret desire
Cohabitation caused by a man deceitfully to have sexual intercourse with his sister
inducing a belief of lawful marriage - Every termed as pharoan complex. Similarly when
man who by deceit causes any woman who is the son has sexual inclination towards his
not lawfully married to him, to believe that mother it is termed oedepus complex and
she is lawfully married to him and to cohabit when a daughter has a desire for sexual in-
or have sexual intercourse with him in that tercourse it is called electra complex. These
belief, shall be punished with imprisonment in a way can be called perversion with some
of either description for a term which may mental aberration. In psychiatric patients
extend to ten years , and shall also be liable such types of abnormal desires are seen more
to fine (Sec. 493 IPC). often.
INCEST UNNATURAl SEX OFFENCES
It is not an infrequent sexual behaviour, in Definition

which the sexual partners are close blood
These are sexual acts (penetration/gratifica-
relations, often belonging to the category of
tion) against the order of nature and against
prohibitory relationship e.g., between father
the provision of Law.
and daughter, mother and son, brother and
sister, with nephew or neice, cousins etc. Sodomy or anal coitus is the most com-
Incestual practice is legally prohibited in many mon. It may be homosexual or heterosexual.
countries but not in India. In India, though it Lesbianism is the female homosexuality.
is not a generally accepted practice all over Bestiality is the sex act performed with an
the country, in some parts, it is not only al- animal. Buccal coitus may involve partners
lowed but also promoted by compulsive mar- of opposite sex or same sex.
riage between relatives. In some circum- Punishment for unnatural sex offences
stances, incestual practice is seen in subjects has been described under section 377 IPC
of otherwise timid personality, having no ap- which states that, whoever voluntarily has
preciable exposure to outer world, in subjects carnal intercourse against the order of na-
with low mental development, among persons ture with a man, woman or animal shall be
having organic psychiatric problems or in punished with imprisonment for life or with
rF M - 41'1
imprisonment of either description for a term World without any age limitation, involving
which may extend to ten years and shall also adults, children and old subjects. Old and
be liable to fine . children usually act as the passive agents.
Explanation - Penetration is sufficient to Sodomy is termed as paederasty with a child
J constitute the carnal intercourse necessary

to the offence described in this section (ex-
acting as passive agent who is termed as cat-
amite . With old people serving as passive
agent it has another terminology - Geron-
cept lesbianism and some buccal sex prac-
tices, see below). tophilia.
Though in many cases, Sodomy may be
the consequence of some degree of Psycho-
SODOMY logical aberration, in vast majority of cases,
possibly it is not so. Accordingly, Sodomy by
Sodomy or anal coitus is the commonest of itself should not be taken as presentation of
the unnatural sex offences which is popularly perversive mind
I
of its practitioners.
termed among the general population as bug- So far male homosexuality is concerned,
gery (which of course includes intercourse again sodomy is the most popular and widely
with animals also ). Sodomy may be homo- practiced method. Though in our country,
sexual or heterosexual in nature, involving both the passive and active agents, of sod-
two males (homosexual) or one male and one omy are punishable with exception to the
female (heterosexual). In any case, a male is passive agent when he or she is forced to act
the active agent (active sodomite) and either or participate as passive agent. Giving due
another male or a female acts as the passive consideration to the mental make up and
agent. Two males may mutually act as ac- harmless effect of sodomy in the society, it is
tive and passive agent. conditionally not considered an offence in
However it mostly involves two males. many countries. "Gay" is the popular term
According to the old testament, it used to be for a male homosexual, who primarily prefer
practised in the town of Sodom. Thus it ac- male homosexuality and a pair of such gay
quired the name Sodomy. This abnormal persons may even live together as sex part-
sexual practice is popular all around the
Fig. 27.22 : Murder after rape . Smothering marks of

(njuries over face and lower part of chin
against a hard platform and bleeding from
passive sodomite nose

Fig. 27 .23 : Scene of crime; rape followed by murder. Fig . 27 .24 : Rape and murder
Note the position of the undergarment on
the floor and haemorrhage caused due to
assault during killing
chological influence on them which may be
either unusual passion for the same sex or
ners like husband and wife . Gay people may
even just the reverse , a criptic hatred nur-
or may not be totally averse to heterosexual
tured by them against their own sex, which
vaginal penetration or intercourse . Such
is expressed through their such sexual activ-
Mental trend of sodomites may have same
ity. In heterosexual sodomy, sometimes the
genetic or hormonal or behavioural factors
female accepts it and also partly enjoys it,
originated during childhood environmental
feeling it as an way of outlet of male arousal.
conditions. Playful homosexual practice dur-
It is also not unlikely that, such abnormal
ing childhood is not very uncommon which
behaviour is a reflection of rejection of their
is rather childish sexual adventurist act with-
own sex. The whole thing might have some
out any real sexual relationship and this nor-
bearing of childhood environment and expe-
mally does not continue in adulthood. In our
riences.
country, there are professional passive
sodomities , the so called male prostitutes who Generally a medical man has to often
move on and try to allure vulnerable active examine both active and passive agents of
agents. It is taken as bread earning profes- sodomy in course ofhis medicolegal practice.
sion by the castrated eunuchs and the so Some of the subjects of both the groups turn
called •Zenana' males. It is hard to ascertain out to be habitual active or passive agents,
and there is no authentic study also, to say while some others do not show any such evi-
whether in these people there are any trace dence.
offemale psychological trait. However, some It has to be accepted that, in many cir-
physiological change is observed in castrated cumstances there is no reason why this
eunuchs due to the influence of changed hor- should be taken as an abnormal sexual prac-
monal pattern after castration. As such, the tice. For hostel inmates or inmates of a bar-
possibilities offemale psychological trait may rack, this is a preferred sexual behaviour to
not be ruled out in these people . As for all be gratified, in the compulsive segregated life
active agents and those passive agents who having no preferred alternative for gratifica-
enjoy their participation as -passive agents tion available to them. In these circumstances
there might be some background having psy- it is quite often noticed that, two partners

act alternately as active and passive agent (d) Presence of a female attendant while
which indicates, that, it is adapted by them examining a female passive agent.
as a just suitable and available outlet of
In case of examination of a habitual sodo-
sexual arousal. Allmost all of these subjects mite, history taking is irrelevant. But in those
usually change to normal sexual practice, cases where a child is forcefully subjected to
once released from the compulsive environ- act as a passive agent, a briefhistory may be
ment. taken, as in the case of examination of a vic-
All the while some women may enjoy tim of an alleged case of rape.
even anal coitus as a supplementary to vagi-
nal coitus. Examination proper
Examination and findings of a non-habitual Examination of an occasional or accidental

sodomite (non-habitual) passive agent
Procedure of examination Examination should constitute

(a) brief general examination
The procedure of examination of both the
active and passive agents is same in all re- (b) examination of the anorectal region
spects except that, when the passive agent is (c) examination of wearing clothes, parti-
a female , a female attendant should be cularly the undergarments.
present during the examination of such a fe- In each case, some materials have to be
male passive agent. The prerequisite and the preserved during examination. Brief general
procedure as recorded in case of examination examination should include measurement of
of the victim of a case of rape, may be taken height, weight and note general configura-
as the standard for medicolegal examination tion of the subject. In case of a child, teeth
of sodomites also, except that, in sodomy and development of the secondary sexual
when both are adults , both stand on the ac- characters should be examined. In other
cused platform. And as such, to examine them cases, the signs of eunachoidism or signs of
their consent is desirable and should be any type of intersexuality or gonadal dysgen-
sought for but as per provision of the Sec. 53 esis may be seen. During general examina-
CrPC, their consent is not essential for their tion, the doctor should try to assess the men-
examination and it they refuse examination tal status of the subject and if he feels re-
then, reasonable necessary force can be ap- quired, may arrange for his subsequent ex-
plied to examine them. When the passive amination by a psychiatrist.
agent is a catamite and is a minor child his
Eunuchs after castration, develop some
examination needs consent from his legal
guardian, if he is 12 years or below in age. feminish features with slight enlargement
of breasts, absence of male distribution of
The pre-requisites are hair in the body and general increase in the
deposition of subcutaneous fat with change
(a) A requisition for examination of the sub-
in their gait and behaviour. The perineum
ject, from an authorised person.
also externally appears to a great extent like
(b) Identification of the person to the medical that of a female. These findings are more
officer, by a person authorised to do so. conspicuous, if castration is done before pu-
(c) Consent of the person to be examined. berty.

A passive agent presented as a non-ha- Examination of a non-habitual active

bitual one , may ultimately turn out after ex- agent
amination to be a habitual one .
A non-habitual active agent will have no per-
Examination of anorectal region: (to be manent sign ofbeing a sodomite . Hence very
performed in knee-elbow position) few or none of the evidences in support of
commission of the act may be observed, if
In a non-habitual passive agent, the anus may the examination is undertaken after gap of
appear to be swollen with temporary loss of sufficient period, which will allow the accused
tonicity of the anal sphincter. There may be time to clean his organ. However, when ex-
congestion of the cutaneo-mucous tissue with
amination is not delayed the evidences which
some contusion and sometimes a posteriorly
may be available are as follows:
placed tear laceration . The area may be
stained with mixture of semen , faeces and (a) Moist appearance of the glans and shaft
sometimes blood . Foreign pubic hair may be of the penis may be stained by mixture
present. When the passive agent is a young of semen, faecal matter and lubricant,
child and when the intromission is a forceful also, when used.
one , the tear may be more extensive with (b) The penis , the glans in particular, will
free bleeding and sometimes prolapse of a emit smell of faeces or that akin to the
portion of anal canal . If one finger, can be smell of secretion of anal glands
inserted without pain, then probably no anal (c) Tear of frenum in some cases.
intercourse occurred. If insertion of one or
(d) Absence of smegma in all cases examined
two fingers causes some pain , it is sugges-
tive of anal intercourse . Internal examina- within 24 hrs .
tion is performed in full aseptic conditions, (e) Presence of anal hair of the passive agent
with the help of a proctoscope of suitable size. on the glans or prepuce .
The mucosa of the anal canal and also the The above being the local findings, gen-
rectum is congested , may show recent tear eral examination should be carried on as in
and presence of seminal fluid . In occasions case of the passive agent in which case occa-
more conspicuous injuries in the forn1 of con- sionally marks ofresistance by the victim pas-
tusions , may be noticed particularly in the sive sodomite may be imprinted on the body
anal canal . In some cases, evidence of use of of the active agent in the form of nail
lubricants may be there.
scratches or teeth bite marks. The penis is
After a few days of the incident, evidence not excluded from bearing such injury marks.
of gonococcal infection may be noticed, if a
second examination is undertaken, if the ac- Materials to be preserved
tive agent is having the disease .
Swab from the glans and prepuce , urethral
Materials to be preserved: swab after prostatic massage , wearing
(a) Swab from around the anus . apparels , particularly the undergarments ,
(b) Swab from the anal canal. handkerchief, which might have been soiled
(c) Any foreign pubic hair. due to cleaning of the penis are to be pre-
served.
(d) Undergarments of the passive agent, if
not changed after the act and before ex- Further evidence are as will be available
amination. from examination of materials preserved

during examination of the victim and the ac- eases, will further establish link between
cused and the inter-relationship of the evi- the active agent and the passive agent,
dences thus made available: relating the act of sodomy.
(When both the active agent and passive Note : To come to a positive conclusion it
agent are sent to the medical man in connec- is necessary that, pubic hair of the
tion with the same single offence of anal coi- active agent and the anal hair of the
tus). passive agent are preserved. To im-
part any evidential value to the dis-
(a) Presence of seminal fluid mixed with fae-
eases noted above, it is imperative
cal matter and lubricant, in the swab col- that the passive agent should be
lected from the anal area of the passive examined twice more, once each af-
agent and detection of semen in the swab ter the incubation period of the two
collected from the anal canal will act as common venereal diseases as indi-
proof that, he participated or was made cated. Further evidence may be ob-
to participate as the passive sodomite. tained if either of the agents has any
Congestion or any injury over the area bleeding injury which will stain the
will be additional substantiating point. effective part of the other agent,
(b) Presence offaecal stain mixed with semen when by matching group factors of
and lubricant on the glans and penis of the blood from the stained area with
the alleged active agent will substantiate the group factors of blood of the
that he actually acted as an active sodo- other agent, it may be corroborative
mite. Presence of foreign anal hair will to the fact that, both of them par-
further substantiate this conclusion. ticipated in the same act of anal coi-
tus. The blood group factor of the
(c) Similar stains on the clothing (undergar-
active agent may also tally with the
ment) and the handkerchief of the alleged
blood group factor available from
active agent will lead to same conclusion
semen collected from the anal ca-
as in (a) and (b) above.
nal of the passive agent , if the ac-
(d) Matching offoreign pubic hair recovered t ive agent is a secretor. Study of
from the anal region of the passive agent DNA profile ofboth may also be done
with the pubic hair of the active agent as in case of rape.
and foreign anal hair recovered from the
penis of the active agent with the anal Examincmon of a Habitual Passive Agent
hair of the passive agent will establish The findings of general examination will be
link between the active agent and pas- same as in case of examination of the non-
sive agent regarding participation in anal habitual passive agent. The local examina-
coitus. tion will show presence of some permanent
(e) Evidences of venereal disease either in changes due to regular anal coitus.
the form of a chancre on the penis of the
active agent or presence of gonococcus local Findings
in his urethral smear and similar diseases (a) The area around the anus will take the
developing around the anal region of the shape of a funnel with its apex at anus
passive agent subsequently, after lapse due to loss oflocal subcutaneous fat due
of specific incubation periods for the dis- to frequent anal coitus.

(b) The anal sphincter is lax with loss of to- constitutes acts of sexual arousal and drive
nicity and constricting strength, and will like kissing, massaging the breasts and pri-
admit two fingers easily. There may be vate parts, mutual rubbing, caressing and lick-
haemorrhoids in a few subjects , particu- ing of private parts and use of artificial phal-
larly in elderly passive agents . lus or tongue or something similar, for inser-
(c) There may be healed or active anal fis- tion inside the vagina for gratification. One of
sure . the women acts as a more active partner. Such
(d) Venereal warts (syphilitic) may be present a lesbian girl has avulsion towards male sex
in the region around the anus . and she herself develops some masculine fea-
tures , particularly behavioural. A lesbian girl
(e) Anal hair is shaved . The skin is smooth
searches out a female partner who herself may
and thick.
be of lesbian category or may be one with es-
(f) By inserting a finger, elasticity and to- sentially of normal sexual inclination, in which
nicity of the sphincter can be tested. The case she acts rather as active partner to sat-
anus will appear lax and patulous . isfy the lesbian girl.
(g) Bimanual examination with sidewise trac- A lesbian woman who is accustomed to
tion of marginal skin of the anus will such homose}>.'Ual practice may, in addition
cause complete relaxation of the sphinc- to her masculine behaviour, have enlarged
ter and dilatation of the anus .
clitoris as the other physical sign . A lesbian
(h) Proctoscopic examination may show old girl usually has aversion for a male sexual
tear with tunnel formation . partner and it is not just due to deprivation
or non-availability of a partner of opposite
Examination of a habitual Active agent sex. In different parts of the world various
Local Findings in case of the habitual active colloquial terms are in use for them. While
Sodomite : sodomy may be homosexual or heterosexual
The penis appears partly twisted with a practice lesbianism is purely homosexual.
relative constriction at some part of its length. Practice of lesbianism is punishable un-
Presence of signs of recent anal coitus der Section 377 IPC . However, these cases do
not usually go to the court, because in most
may additionally be present, in the expected
parts both in passive habitual agent as well circumstances these cases are not reported,
as in active habitual agent , if they are appre- it is also not very easy to carry on full investi-
hended and examined soon after an act of anal gation successfully, due to lack of evidence.
coitus. Some endocrinal or psychological factor
is thought to have some role for such sexual
deviation in a woman.
lESBIANfSM OR TRIBADiSM
This is female homosexuality, in which two BUCCAl COITUS

women , by mutual acts of sex-passion achieve {Orot coitus or sin ctf Gomorroh)
gratification . The term Lesbianism has come
from the name of an island, the Isle of Lesbos , This offence has mention in Bible as to be prac-
mentioned in Greek mythology, where the tised in the town of Gomorrah. Hence the
women used to practice homosexuality. This name Sin of Gomorrah is attributed to this

) practice. Oral coitus may be practiced by both

sexes. When the male organ is sucked by a
A male accused, on examination may
show his penis stained with a mixture of his
female or another male, it is termed fellatio · semen and the animal dung. Animal hair may
When female sex organs including clitoris is be seen adhered. In some cases, due to being
sucked by a male or another female , it is called kicked by the animal bruises may be sus-
cunnilingus. Thus, it may be a heterosexual tained on the lower limb.
or homosexual practice. In any case it is pun-
On examination of the animal. human
ishable by law under section 377 IPC. A case
was dealt by the author where a middle aged semen may be seen present in the vagina or
person confined a boy of 17 years age and anus of the animal Cor the cloaca as in case of
forced him to suck his penis till ejaculation. a hen). There may be tear of the organ. Hu-
The case was booked under sec. 377 IPC. There man pubic hair may be present near the peri-
anal zone. The act ofbestiality is punishable
may not be any sign in the face or mouth of
the passive agent due to washing but signs of under sec. 377 IPC.
resistance in the form of minor injuries may
be present on the face and elsewhere on the
body. The penis of the accused may 'show abra- fNOECt:Nt ASSAULT
sions, caused by the teeth and may have stain
of saliva. In the practice offellatio , there is a Indecent assault generally means sex linked
little danger to be gagged for the passive agent misbehaviour towards a person of opposite
who suck the erected penis . Some times the sex or same sex. It is unwanted sexual be-
act of fellatio or cunnilingus is forcefully im- haviour even just touching some specific
posed on the other partner to the extent that parts which is forced upon a person by an-
the erotic sexual practice amounts to sadism other against the former's desire- Simply an
(see below page 717). Both fellatio and cunni- act is indecent if a reasonable person believes
lingus have popular colloquial names e.g. glo- it indecent irrespective of the belief or say of
rified male uimpism for fellatio and for cunni- the alleged accused. When it is done on an
lingus, the names "muffdiving" or "giving lip" under-aged person, or by force or compulsion,
are used. In case of cunnilingus both clitoris threat, or on an intoxicated or mentally un-
and "G point" on the inner wall of the vagina sound person, the offence is viewed seriously.
and in case offellatio , the joining point of frenu- The offender may be a male or a female . The
lum and meatus are important spots to give desire may be to get sexual pleasure but not
optimum sex stimulation. necessarily aimed at intercourse and gratifi-
cation. Often the acts are aimed to insult a
, person or just to have a fun or to enjoy the
embarrassment of the victim.
Some examples of indecent assault are,
In bestiality or zoophilia , lower animal is cho- to squeeze the breast of a woman, to kiss a
sen for sexual inter.course . Though it may be woman forcefully , to touch or press the pri-
seen in both sexes, it is more common in vate parts of a female or a male , to force-
males . Cattle e.g. a she-goat, or a hen may fully embrace a woman , to try to undress a
be chosen by a male , and a pet dog by a person (male or female ). These cases are
woman. Cases involving females do not come punishable by law under section 354 and 355
to light usually. IPC.

chapter 27: SEXUAL OFFENCES A ND SEX PERVERSIONS I 713
Fig . 27.25: Indecent assault at a fam ous holy place

ment and different NGOs are acting against

this social evil. But this clandestine process
to earn money could not be eradicated.
Pornography
The word pornography has come from Greek
words 'porne ' meaning "prostitute " and
"grapho " meaning to "to write ". In totality it
means a place to write about prostitutes . In
printing literatures , photography , electronic
media, pornography has made a firm place ,
where starting from details of sex organs,
sexual intercourse, perversive sexual activ-
ity, manipulative sexual activities, created
and animated sexual activities are presented.
Fig. 27.26 : Indecent assault on road.
This comes under the purview of Sec. 292
IPC .
Sexual abuse of a child
It is indulging in sexual activity by an elderly

person with a minor . Child sexual abuse is Sexual perversions are different from sexual
illegal worldwide . Apart from paederasty , it offences. Some of the perversive acts may
may be incestual practice , oral coitus , prompt- be punishable on some account. But perver-
ing a child to indulge in sexual acts , forcing sions are altogether a different entity.
or alluring a child in sexual acts of any kind .
Making a child to witness sexual activities, Sexual Perversion
desiring sex from a child , inducing female
children in prostitution , inducing a child to Definition
touch and manipulate the perpetrators sex It is defined as "sexual activity or fantasy di-
organs . To talk about sexually implicit mat- rected towards orgasm, other than genital
ters to a child , to touch and fondle the sex intercourse with a willing partner of oppo-
organ of a child . To demonstrate porno- site sex and (mostly ) of similar sexual matu-
graphic matters to a child etc . rity , persistently recurrent , not merely a
substitute for preferred behaviour made dif-
Immoral trafficking ficult by the immediate environment and con-
In the darker side of our society this is one of trary to the generally accepted norm of sexual
the way to earn money easily by inducing behaviour in the community".
women , often minor girls , pushing them to This is the most satisfactory comprehen-
"red light area" or for prostitution . Often a sive definition of sexual perversions. To sim-
woman or a girl is allured with promise of plifY, sexual perversion can be defined as re-
service or marriage , taken to a distant place current abnormal sexual activity offantasy,
and then subjected to prostitution . Govern- directed towards orgasm, when normal sexual

chapter 27: SEXUAL OFFENCES AND S::: X PERVERSIONS I 715
activity, as approved by the society is possi- (a) Anal or oral intercourse , mutual
ble. On the basis of this definition an act of masturbation, i.e. , orgasm obtained
sodomy by two males or the act of masturba- without genital intercourse.
tion may amount to perversion in some oc- (b) Requiring unusual condition for
casions but may not be so in other occasions. gratification:
Indulgence to sodomy once in a while, may
(i) Sadism
be viewed as to be not very unusual a phe-
nomenon, when in a barrack or a hostel, male (ii) Bobbit Syndrome (partner can't
inmates are made to maintain strict discipline have willingness for the
and they may have no scope or approach to trauma).
any female and may not have a substitute (iii) Masochism
for preferred sexual behaviour i.e., vaginal (iv) Lust Murder (partner has no
intercourse. But when it is regularly prac- desire to be killed)
tised by a married man though living with
(v) Requiring special type of part-
his wife or even when a man has approach to
ner as in ease of incest, inter-
other women for natural sexual intercourse,
practice of sodoiny may be viewed as a per- course with child, prostitute,
version. Similarly, masturbation is nothing intoxicated partner etc.
unusual in young unmarried persons. But if (vi) Unusually excessive sexual
a married man living with wife, indulges to arousal and drive e.g., (i) Sa-
masturbation regularly, instead of natural tyriasis in males (ii) Nympho-
sexual intercourse with his cooperative wife , mania in females.
then the act of masturbation must be viewed 2. Perversions - Not requiring a willing
as perversion. partner
Some of the perversions amotmt to sex (a) Troilism,
offences or some other offences linked with (b) Voye-urism or Scopophilia or Scopto-
sex. Natural sex offences may also be consid- philia, Peeping Tom
ered sometimes as perversions, if the alleged
(c) Exhibitionism
circumstances of the sex act are against the
social nonns and if other avenues of lawful (d) Frotteurism
natural sexual practice are open to the per- (e) ·Necrophilia
son. For example, if a healthy, young, re- (f) Necrophagia
cently married man who lives with his sexu-
3. Perversion - Where no human partner
ally warm, cooperative and willing wife, in-
is necessary.
dulges to forceful intercourse with an unwill-
ing woman, then that may be,considered as (a) Fetichism or Fetishism- when some
act of perversion on the part of the young object is the substitute for a partner
husband in addition to commission of offence. (b) Transvestism
(c) Bestiality- where an animal is the
Clossificotion of Sexual Perversions substitute for a human partner (an
1. Perversions -Requiring a wming (?) part- offence in any case).
ner (may be both homosexual or hetero- (d) Masturbation (in specific circum-
sexual) stances).

4. The term paraphilia is used by some for ure by making himself ready for his own sex)
many of the sexual perversions out of or in some cases simply direct to abnormal
those named above and it is defined as fascination for the opposite sex . It is also
any of the group of psychosexual disor- more common in males. Hizras or Zenanas
ders having features of feeling or activi- who dress themselves in female attire may
ties of sexual origin involving a non-hu- not be true transverstites. In them, a homo-
man object or a non-consenting human sexual psychology acts to facilitate homo-
partner e.g. a child (no consent or invalid sexual practices . They dress like females to
consent) or causing pain or humiliation attract male active sodomites which, for some
of the active partner or passive partner. of them is also the source of earning. Some
Example - fetichism , lack of modesty con- males who dress themselves as females to
cerning sexual feeling and action , exhi- attract males to act as a passive sodomite are
bitionism , voyeurism , zoophilia or besti- often called male prostitutes .
ality , paedophilia or paederasty and some
other conditions. Peeping Tom or Mixoscopia
A peeping tom gets sexual gratification by

Fetichism or Fetishism
secretly observing the sex performance of oth-
This condition is mostly seen in males . Here ers . Orgasm is usually preceded by mastur-
the pervert gets sexual gratification by see- bation . Commonly , such persons are also
ing or touching female body parts , dress , par- called voyeurists Csee below ). The "Peeping
ticularly the under garments or some article Tom" term has a background . In the lOth!
of feminine use . Though to a small extent, 11th century A.D. one Lady Godiva (also
this tendency is not altogether unusual, yet named as Godjifu or Godgyfu- which means
to achieve gratification from these articles "Gift of God" was a widow who remarried the
and to indulge with the same regularly is Earl of Mercia Leofric. According to ancient
considered as perversion. There may have story the beautiful lady Godiva who was very
some compulsive phenomenon related with sympathetic towards poor people, was men-
this condition as is noticed in some fetichist tally distressed as her husband used to tax
who cannot suppress their desire to steal his people highly and beyond their capacity.
small articles used by females . Gratification He was not agreeable to reduce the tolls of
is obtained sometime by just seeing or touch- his tenants. On repeated persuasion by Lady
Godiva he agreed to reduce the toll tax on
ing the articles or sometime with subsequent
condition that for getting the toll reduced,
masturbation and ejaculation . Pigmalionsion
is a condition where the sufferer loves some lady Godiva would ride naked through the
objects which he has made with sexual ob- streets of the town. Lady Godiva agreed and
before starting her ride nakedly, issued a
jective.
proclamation for the public that during the
Transvestism : (Eonism) period of her ride all the people of the town
would stay inside their houses with doors and
Here sexual gratification is obtained by wear- windows closed. One Tom, a tailor failing to
ing attire of opposite sex . This represents a restrain his curiosity made a hole in the shut-
psychological aberration with secret reverse ter of the door of his room to look at the na-
passion for the same sex (so as to get pleas- . ked Lady Godiva riding the horse on the

chapter 2J! SsXUAL OFFENCES AND SEX PERVERSIONS I 717
street. It is said that Tom got blind for look- A sadist is a mentally aberrated person.
ing at Godiva through the hole of the shut- The sadistic act might be the reflection of a
ter. However, as promised, Godiva's husband desire for revenge, jealousy due to the influ-
reduced the toll tax on his people after this. ence of some adverse experience of childhood
From there the term "Peeping Tom" has of being tortured or hu~liated.
come into use for secretly seeing others sex
organ or activity. Bobbit syndrome
Troilism A recently used term for a type of perverted

sex offence in which the female partner
In troilism, the pervert gets sexual gratifica- amputes the penis of her male partner with
tion by inducing his wife to sexual intercourse a sharp cutting weapon, say a blade. The rea-
with another person and observing the same. son may be of sexual or asexual origin. How-
ever, it amounts to grievous hurt.
Scopophilia or scoptophilia
It means gettin pleasure by seeing a nude Lust murder
woman in her privacy, in bathroom, while
It is the consequence of extreme sadist prac-
bathing, dressing or undressing. This condi- tice. With t orturing the partner, sexual
tion is also very close to "voyeu rism'' or arousal st art and with death of the partner
"peeping tom''.
full gratification is obtained. Often the body
In voyeurism, the scopophilic desire takes of the victim partner is mutilated. In some
more perversive shape, in which the feeling cases after full arousal in this way, the per-
of pleasure is not limited to only looking for vert performs sexual act with the dead body
the genital organ. It takes a bad shape as the of the victim. There are countless examples
voyeurist gets gratification by seeing a woman of lust murder. The perpetrators executed
micturating (a condition specially termed as their goal killing scores of female victims
un dinism) or by seeing defecation by an adapting various ways - often by deceitful
woman. Some such thing is necessary for his means to allure the victims silently, in most
sexual gratification. However, urolagnia and circumstances, remaining undetected in their
caprolagnia are different conditions where the area of operation but smelling the possibility
perverts get sexual excitement from urine of detection often changed the area of opera-
and faeces respectively. tion to another area. The name of"Jack the
Ripper' became famous as a serial killer of
Sadism (Algolagnia) prostitutes in London's White Chapel district.
He created a panic in 1888, was never identi-
In sadism, the person gets sexual gratifica-
fied. He and his activities created a history
tion by torturing and humiliating the sex
in the world of crime.
p artner by beating, biting, whipping etc. The
cruel sexual behaviour has been named sad- Though the perpetrators of lust murder
ism in the name of Marquis de Sade, who in are almost always males, name of a few fe-
h is stories and novels presented practice of males are also on record.
such cruel sexual behaviour. Without these Naturist or nudist organisations activi- •
activities sexual arousal is not achieved by ties - so long these do not contravene the
some. provisions of law of a country and so long
there is no indecent exposure or lewd or often there is a hidden expectation of similar

sexualised item, programme or content and exposure by the woman or it may be a reflec-
so long these do not contravene obscene Act, tion of a hidden desire to observe the private
these are tolerated in many countries and parts of the woman . This act amounts to an
culture. offence and is punishable under section 290
and291IPC
Necrophagia
It is another extreme form of sadism, where

the pervert who is a male , mutilates the body
of the female and after the death of the vic- Hypersexuality is an abnormal (often com-
tim , even eats the body parts (which are of- pulsive ) sexual desire which is definitely more
ten sex organs ) to achieve sexual gratifica- than the upper sexual behaviour seen in any
tion . It occurs in males. individual . It is seen in both males (Satyria-
sis ) and in females (nymphomania or furore
Masochism (Passive Algolagnia) uterinus ). The threshold of sexual desire or
hypersexual activities are not easy to define
It is the opposite ofSadism. Here the person or fixed at a level. But generally it can be
gets sexual gratification or peak arousal by opined that these two conditions can be con-
being bodily tortured or abused . The term is sidered as some sort of mental disorder when
derived from Leopold Von Sacher Masoch . He the concemE < Lerson causes distress and dis-
was a novelist and as a stimulus to write , he turb social function (both) for self in one side
liked to be whipped by his wife . Male maso- and the society/relatives/acquaintances on
chists are more common than female maso- the other side. The difficulty for fixing an up-
chists . Masochistic asphyxial death occurs per limit of sexual behaviour is due to vari-
when a pervert creates a state of hypoxia in able physiological sexual need.
him to get orgasm, either by hanging or by
strangulation. After experiencing orgasm the (a) Satyriasis
constricting force around the neck is released.
It is excessive sexual desire, arousal and drive
In course of such practice, once the release
in case of males . These subjects are liable to
may not be possible which causes death of
commit sex offences or perversive acts . There
the person (see also page 528)
is an obsession with sex, which may be em-
This also is an example of mental aber- barrassing for the person inheriting the un-
ration and possibly the same components of desirable obsession and for others, and his
childhood experience of cruelty and adversity act may make him liable to be charged for
gets reflected in the masochistic self-tortur- commission of a sex offence
ing.
(b) Nymphomania
Exhibitionism
It means excessive sexual desire in a woman .
This condition is just the opposite of sco- Some ofsuch women may tum lesbians . The
pophilia . The exhibitionist gets sexU.al pleas- nymphomanic·suffers from an obsession with
ure by exposing.private parts in -public or in sex, and she caimot restrain herself from the
vision of a woman, sometime with demon- abnormally excessive sexual act. However, as
stration of masturbation . When the -exposure females, they are less expected to be exposed
is aimed to attract a particular w0man then, of their such aets and suffer the consequences.

Frofteurism Lubricant may be used by both sexes. Mas-

turbation has long been discouraged for be-
It is a mischievous act usually practised by a ing a cause of losing physical and mental
male sex-pervert in a crowded place to de- health, memory and intelligence. But these
rive sexual gratification, even orgasm by rub- are baseless. So far morality is concerned, it
bing his private part against a female's body.
cannot be considered immoral unless it
This is also an offence and is punishable un- amounts to exhibitionism or cannot be con-
der section 290 and 291 IPC. sidered obscene (if not practiced publicly or
aims other's attraction). Masturbation in fe-
Necrophilia male may help to elect their sensitive spots
. It is a desire for sexual intercourse with a for successful intercourse after marriage. In
dead body. Males are the sufferer from such males it acts as an way to avoid exposure to
a desire. The sufferer is psychosexually in- i::ivme hazards including sexually transmitted
competent. He finds this as most suitable a diseases.
process, as there is no resistance or rejec- Narcism though indicates love for one
tion and which will not be known to anybody self, there is no much sexual ingredient in it.
else. Often he visits a prostitute for fear of It also cannot be equated with masturbation.
social stigma and for fear of exposure of his
sexual incompetence. This condition is are-
sult of mental aberration accompanied by per- TESTS FOR PRESENCE OF SEMEN OR
sonality defect. OJHERMATERIALS PRESERVED
Masturbation See pages 115, 116, 173, 174, 195, 196,

Masturbation is a device adopted by a male 197, 199,204-209,211-216,218-221.
or a female to practice sexual acts to achieve
sexual ejaculation and orgasm. Arousal may References
occur on thinking about some past event or
about person of opposite sex or visualising • Sex crimes, John Drzazga, VA. Leonard, 1960.
some sexually explicit matters of some indi-
• Human sexual behavior and sex education, W.R.
viduals, some pornography or due to physi-
Johnson & E. G. Belzer, R. Abernathy, 1973.
ological urge for orgasm or ejaculation. To
complete the drive man may (usually) use • Homosexuality in Perspective, W. N. Masters &V E.
hand to move the skin of the phallus to and Johnson, 1979.
fro , may fondle the glans, the rim of the glans, • Sex and its problems, W. A. R. Thomson, 1968.
the delta where frenulum meets the urethral • Sexual crime today, Paper written by Max Grunhurt,
meatus (these being the most sensitive points Rudolf Scinerts and Jacob M. V Bemmele, 1960.
in male). Females may fondle the clitoris,
• Sexual assault, Marcia J Walker and Stanley L.
their breasts and nipples and may insert a
Brodsky, 1976.
finger into the vagina to stimulate the 'G' spot
on the anterior vaginal wall. Alternatively • Sexual function and Dysfunction, Paul Jay Fink and
males may use artificial aids like, pillow, ar- Van Buren 0. Hammelt, 1969.
tificial vagina type object, and females may • Understanding Homosexuality - its biological and
use artificial phallus or such suitable objects. psychological bases, J. A. Loraine, 1974.

• Sexual Assault of Children and Adolescents, Ann (habitual and non-habitual), in an alleged case of
Wolbert Burgen, A. Nicholas Groth, L L Holmstrom sodomy?
and S. M. Sgrior, 1978. 3. What are sex perversions? Describe each of them.
• An Analysis of Human sexual response, Ruth and Discuss the mental trauma suffered by the victim of
Edward Brecher, 1966. rape.
• Sexual behaviour and the Law, Ralph Slonenko, 1965. Short questions
• Sexual behaviour - Psycho-legal aspects, Frank S Bestiality, Incest, Adultery, Habitual passive sodomite,
Capsio and Donald R. Brenner, 1961. Sadism, Masochism, Voyeurism, Peeping Tom, Lesbia-
• Sexual Hygiene and Pathology, John F. Oliven, 1965. nism or tribadism, Fetichism, Transvestism, Lust mur-
• Pathology and treatment of sexual deviation, Edited der, Exhibitionism, Necrophilia.
by lsmond Rosen, 1964. Oral questions
• WB Woodman and Charles M Tidy- Forensic Medi- In addition to questions from long and short ques-
cine and Toxicology- 2007. tions described above,
• Richard Shephard - Simpsons Forensic Medicine - What is rape, gang rape, natural sex offence, un-
2003. natural sex offence, sex-perversion, incest, bestiality,
adultery, indecent assault, catamite, paedarasty, sad-
ism, masochism, voyeurism, scopophilia, peeping tom,
lesbianism, tribadism, fetichism, transvestism, lust
• Werner U, Spitz David J, Spitz Ramsay Clark, Russel murder, necrophilia, necrophagia, nymphomania, sa-
S Fisher- Spitz and Fishers Medico/ega/Investigation tyriasis, exhibitionism, sin of gomorrah, xerontophilia,
of Death - 2006. paraphilia, furore uterinus undisim, capra lognia,
• Gundes Gray- The Hidden Holocast- Gay and Les- urolognia, pigmalionsion, "G" point, pharoan com-
bian Persecution- 1945. plex, oedepus complex, electra complex.
• Tristan Torsmins- The Ultimate Guide to Anal Sex for What are the different types of natural and unnatural
Women - 2006. sex offences?
• Tristan Farmin and Joan Larkin - The Lesbia Eratica- What are the punishments described under section
2008. 376 IPC?
• V. Bullough- Sexual Variance in Society and History- Which sections of IPC deal with definition of rape,
1980. punishment for rape, punishment for unnatural sex
offences?
What materials are preserved from a victim/accused
Questions
of a case of rape, sodomy, bestiality?
Long questions Can a woman in sleep be raped? Legal position of

intercourse with an intoxicated person. Can a prosti-
1. How do you classify sex offences? Define rape. De- tute be subjected to intercourse against her will?
scribe the procedure of examination of a victim and How do you establish relationship between a sex
an accused of rape and the findings available in them. offence, offender and victim? Can a healthy conscious
What laboratory investigations may be necessary in woman be raped by a single person? What is the
an alleged case of rape? most common site of rupture of hymen during first
2. Classify unnatural sex offences. What findings are act of intercourse? Can a woman rape a man? Who
available on examination of active and passive agents are punishable in cases of sodomy and who are not?

Diagnosis and treatment of poisoning cases if acts chemically and pathologically, causing
is at present essenti.ally in the domain of eli- disturbance ofbody functions and leads to dis-
nicians. But as the clinicians, are reluctant ease or death, is a POISON.
to deal with the legal aspects of poisoning DRUGS are natural or synthetic sub-
cases and as they actually may not do so sat- stances which are used to exert physiologi-
isfactorily, like all other medicolegal cases, cal or psychological effects in the user. Drugs
poisoning cases having legal implications are may be used to sustain and prolong life, to
in part dealt by specialists in forensic medi- get relief from the stress and strain oflife, to
cine. Many of the unnatural death cases, get some 'additional pleasure', or to end one's
where postmortem examination of the dead life.
body is performed, are cases of death due to
A man of forensic medicine requires to
poisoning or where some poisoning is an as-
study all aspects of the commonly available
sociated factor in the process or the circum-
poisons, so as to give opinion about the cir-
stance of death. Hence, to deal these cases cumstance, cause of death, nature, criminal
successfully, a medicolegist has to be well intent and involvement, responsibility of the
conversant with the different aspects of dif- treating physician on the outcome of the poi-
ferent poisons prevalent in his locality and soning and treatment, the type of poison and
their poisoning effects on human beings. whether the poison used in the dose can or-
FORENSIC TOXICOLOGY deals with the dinarily cause death.
source, physical and chemical properties ,
Relevant Acts
absorption, fate , pharmacological and toxic
actions, signs-symptoms in human being, fa- Dealing of poisons and drugs are governed
tal dose, fatal period of different poisons, labo- by certain Acts. The important Acts in our
ratory investigations, diagnosis, treatment, country are:
circumstances and other medicolegal aspects 1. The Opium Act of 1857 - This Act em-
of different poisoning cases. powers only the Central Government to
There is no legal definition of poison. cultivate poppy plants and manufacture
Anything which when used internally or on opium with the help of farms authorised
the body surface, once or in repeated doses, by the Government.

2. The OpiumActof1878 -ThisActAmends visions of the Act, all over the Country.
the Act of 1857 and prohibits import, ex- The Central Drug Laboratory analyses
port, transportation, possession and sale imported and manufactured drugs to
of opium. This Act was further ammended know their constituents, purity and po-
in 1957. tency. This Act also provides that the for-
3. The Poisons' Act of 1919 - This Act pro- mula of a patent or proprietary drug must
vides for the regulation of import of poi- be shown on a label on the container of
sons and grant oflicense for dealing poi- the medicine.
sons. This Act also provides the Central For the purpose of sample analysis of a
or the State Governments power for con- drug, the drug inspector should procure the
trol on the possession and sale of poisons. drug on payment of proper price. The pro-
4. The Dangerous Drug Act of 1930 - This cured drug should be divided into four parts,
act regulates the import, export, cultiva- one part of which should be sent to the drug
tion, manufacture, possession, sale and analyser for testing, the second part should
use of dangerous drugs (dmgs of abuse) be retained by him, the third part should be
e.g. opium, cannabis and cacaine or drugs left to the seller and the fourth part should
derived from these agents. This Act was be sent to the place from where the seller of
further ammended in 1933 and 1938. the drug has purchased the same. All the four
5. The drugs Act of 1940 - This Act regu- samples should be proper~y sealed by him,
lates the import, manufacture, distribu- with his signature and signature of the seller
tion and sale of drugs in whole oflndia. with other particulars being mentioned on
This Act was ammended in 1962 to in- the cover of the packets.
clude cosmetics under the purview of the Under the provisions of the drugs and
Act and is now known as "Drugs and Cos- Cosmetics At of 1940 (forn1er drugs Act of
metics Act of 1940". There was further 1940), a rule came into effect in 1945, known
ammendment of the Act to include as Drugs and Cosmetics Rule of 1945. This
Ayurvedic and Unani drugs under its rule regulates the import, manufacture, dis-
purview. The Drugs Act provide for the tribution and sale of drugs in India. This rule
constitution of Drugs Technical Advisory dictates the procedure of sale of medicine by
Board, Ayurvedic and Unani Drugs Tech- the retailer. The retailer should maintain a
nical Advisory Board, and Drugs Con- register which should contain the following
sultative Committee. The different Drugs information with the serial number and date
Technical Advisory Boards advise the ofthe sale.
Central and the State Governments on (a) The name and address of the patient.
different technical matters related to the
(b) The name and address of the prescrib-
administration of the Act. The Drugs
ing doctor.
Consultative Committee is formed with
representatives of the Central and differ- (c) The name of the drug or name of the
ent State Governments. This committee ingredients used in a mixture etc.
advises the Central and the State Gov- with quantity of each.
ernments and the drug Technical Advi- (d) While selling drugs enlisted in cer-
sory Boards for enforcing uniformity in . tain s.Gh~dlJ.les of this rule (Schedule
the implementation of the different pro- - C, H ·{Uld L), the name ofmanufac-

chapter 28: FORENSIC TOXICOLOGY I 723
turer, the batch numberof the prod- tions to deal offences related to drugs and
uct and the expiry date of the potency poisons.
of the drug should be recorded. Different sections of the Indian Penal
(e) The signature of the person under Code specifically related to the use ·of poison :
whose supervision the medicine is
Sec. 272 IPC - Punishment for adulter-
compounded and sold should be
ating food or drink intended for sale, so as to
there.
make the same noxious, may extend upto 6
(Schedule C contains the list of bio- months imprisonment of either term and/or
logical and special products; schedule fine upto one thousand rupees.
H contains the list of poisonous drugs
Sec. 273 IPC - Punishment for selling
which cannot be sold without a pre-
noxious food or drink may be imprisonment
scription; schedule L contains the list
of either description for a period of 6 months
of antibiotics , antihistaminics and
and or fine up to one thousand rupees.
other chemotherapeutic agents).
Sec. 27.4 IPC - Punishment for adultera-
6. . The Drugs Co.ntrol Act of 1950 - The spe-
tion of drugs in any form with any change in,
cial feature of this Act is that it fixes up
its effect knowing that it will be sold and used
th e maximum price of a drug and the
as unadulterated drug, may be imprisonment
maximum quantity of retail sale of a
of either description for a period of 6 months
drug.
and or fine.
7. Drugs and Magic Remedies (Objection-
able Advertisements) Act of 1954 - Sub- Sec. 275 IPC - Punishment for knowingly.
selling adulterated drugs with less efficacy
jected to other provisions, this Act pro-
hibits advertisement for- or altered action serving it for use as unadul-
terated may be imprisonment of either de-
( 1) abortion, (2) prevention of conception,
scription for 6 months and or fine.
(3) maintenance and improvement of ca-
pacity to indulge in sexual pleasure, Sec. 276 IPC - Punishment for selling a
(4) treatment for menstrual disorders, drug as a different drug or preparation, may
(5) diagnosis, treatment and cure of ve- be imprisonment of either description which
nereal diseases, (6) false or misleading may extend upto 6 months and or fine.
information about a drug as to its nature Not e: In the State of West Bengal, the
and function. punishment for these offences de-
8. Medicinal and Toilet Preparation Act of scribed under sections 272 to 276
1955 - This Act provides for payment of may be upto imprisonment for life
levy and excise duty for medicinal and with or without fine.
t oilet preparations containing alcohol, Sec. 277 IPC - Punishment for fouling
cannabis, opium and other similar drugs. water of public spring or reservoir may be
imprisonment of either description which may
extend upto a period of 3 months and or fine.
Sec. 278 IPC - Punishment for voh~ntar
ily niaking atmosphere noxious to health is
Apa~ from different Actsrelated to drugs and fine which may extend upto five hundred ru-
poisons, Indian Penal Code has certain Sec- pees.

Sec. 284 IPC - Punishment for negligent 7. ! Tiscellaneous sources - Snake bite poi-
conduct with respect to poisonous substance soning, city smokt, sewer gas poisoning
may be imprisonment of either description etc.
which may extend upto 6 months and or fine
which may extend upto one thousand rupees.
NATURE OF POISONING
Sec. 328 IPC - Punishment for causing
hurt by means of p01son or any stupefying,
intoxicating or unwholesome drug or any Consumption of poison may have, (a) crimi-
nal intent or it may be (b) accidental.
other thing with the intent to commit an of-
fence shall be imprisonment of either descrip- (a) Examples of use of poisons with
tion for a term which may extend to ten years
criminal intent
with or without fine.
1. Homicidal.
2. Suicidal.
SOURCES Of POISON (circumstances of
3. To cause injury or annoyance to a per-
poisoning)
son.
Poisoning may occur in various circum- 4. Stupefaction with intent to commit some
stances or from various sources - crime .
1. Domestic or household source -In domes- 5. To cause abortion.
tic environments poisoning may more 6. To kill cattle to procure hide.
commonly occur from detergents, disin- 7. Adulteration of food and drink.
fectants , cleaning agents, antiseptics,
cooking gas, insecticides, rodenticides and (b) Examples of accidental circumstances
some common drugs available at home. of poisoning
2. Agricultural and horticultural sources - 1. Food!dnnk - poisoning due to contami-
Different insecticides , pesticides, nation.
fungicides and weed killers . 2. Consuming a poison for a medicine by
3. Industrial sources - In factories , where mistake.
poisons are manufactured or poisons are 3. Wrong medication.
produced as by-products.
4. Overdose of medicine or drug.
4. Commercial sources - From store- 5. Snake bite , scorpion stinging etc.
houses, distribution centres and selling
6. Cooking gas poisoning.
shops.
7. Poisoning at industrial and commercial
5. From use as drugs and medicines - Due
places.
to wrong medication, overmedication and
abuse of drugs . 8. Agricultural fields.
9. Use of cosmetics.
6. Food and drink - Contamination in way
of use of preservatives of food grains or
ROUTES OF ADMINISTRATION OF
·other food materials, additives like col-
POISONS
ouring and odouring agents or other ways
of accidental contamination of food and Oral (commonest), inhalation, parenteral (in-
drink. tra-muscular, intra-venous, subcutaneous

and intra-dermal), natural orifices other than sorbed pmson is resecreted in the intestine
mouth (e.g , nasal, rectal, vaginal and ure- either through bile or through the intestinal
thral), ulcers , wounds and intact skin. mucosa and is excreted through the faeces .
RATE OF ABSORPTION of poisons Apart from these routes of elimination, small
through various routes - Sublingual, mhala- amount of poison may be excreted through
tion and intrwenous routes allow most rapid saliva, milk, swGat, tear, hair and nails .
absorption of poisons. Poison is also quite
rap1dly absorbed through intra-muscular ,
subcutaneous , nasal, rectal, urethral and ACTIONS OF POISONS
vaginal routes . Injured or ulcerated skin ab-
sorbs poisons quicker than intact skin. When Poisons may have local effect at the site of
taken by mouth various factors influence the contact with the body, may act remotely af-
absorption of poison. These are quantity and ter absorption or may have both local and
quality of food present in the stomach, dis- remote effects .
ease of the stomach including pyloric steno- 1. Poisons acting purely locally - Mineral
sis, gastro-jejunostomy, condition of the body, acids and alkalies .
sleep , intoxication, tmconsciousness etc.
2. Poisons having primarily remote action
FATE OF POISONS in the body - A part - Opium, barbiturates, tranquilizers, digi-
of the poison taken orally gets eliminated talis , CO , C02 .
unabsorbed by means of defecation and vom-
3. Poisons having both local and remote
iting. Before absorption, the poison may ex-
actions - White arsenic, mercuric chlo-
ert its effects in the GI tract and get neutral-
Iide , phosphorus , chlorinated hydrocar-
ised or inactivated . When absorbed, the poi-
bons , organophosphorus compounds ,
son reaches different parts of the body and
snake venom.
organs through circulation. Some poisons
reach some tissue easily. Others may not
cross some tissue barrier. Cumulative poi-
sons get accumulated in some organs or tis-
sues. A part of the poison is eliminated as
such through different routes of elimination. 1. Quantity - A high dose of a poison acts
But the major part of a poison is detoxified quickly and more severely, often result-
or metabolised in the body and then excreted ing in fatal fulminating type of poisoning
after exerting its toxic effects on the body. A moderate dose causes acute poisoning
Liver is the organ to detoxifY or metabolize which also may be fatal. A low dose may
most of the poisons in maximum amount. have sub-clinical effects , but if introduced
Some poisons may be metabolised in part or repeatedly at intervals, it may have su-
whole in other tissues or organs, particularly bacute or chronic effects , particularly if
at the site of their action. the poison is cumulative in nature . Regu-
ELIMINATION OF POISONS - Poisons lar intake of some drugs in low dose may
which are not absorbed are excreted through cause dependence on the drug.
faeces and vomitus . Absorbed poisons are 2. Physical form - Gaseous or volatile poi-
excreted mostly through urine . A part of vola- sons are very quickly absorbed and are
tile poisons is exhaled out . A part of the ab- thus most rapidly effective . The rate of

absorption and the effect is quicker when gastro-jejunostomy operation was

a poison is taken in liquid form than when performed on the person, poisons
taken in solid form. In case of solid poi- which are absorbed from the intes-
sons when the same is taken in powder tine are absorbed late due to "delayed
fonn the absorption and action is quicker emptying of the stomach in case of
than when taken as a lump . Some poi- pyloric stenosis and due to repeated
sonous vegetable seeds may pass through backward flow ofthe stomach content .
the intestinal canal ineffective when from the jejunum to the stomach
taken intact due to the impermeable through the anastomosis.
testa. But when taken crushed, they may (c)" In case of achlorohydric subjects,
be rapidly fatal. KCN and N aCN is ineffective (rather
3. Chemical fonn - Chemically pure metal- takes more time to exert effect) due
lic arsenic and mercury are not poison- to lack of hydrochloric acid in the
ous because these are insoluble and are stomach, which is required for con-
not absorbed. But white arsenic (arseni- version of KCN and N aCN to HCN
ous oxide ) and mercuric chloride are before absorption (see page 892).
deadly poisonous . Barium sulphide is (d) Empty stomach absorbs poison most
deadly toxic but barium sulphate is non- rapidly.
toxic.
6. Route of administration - Through some
4. Concentration (or dilution) - Generally
routes poisons are absorbed very rapidly
speaking, in concentrated fon11 poisons and exerts their actions equally rapidly.
are absorbed more rapidly and are also (See page 725).
fatal more rapidly. But this is not true
with some poisons. A dilute solution of 7. Age - Some poisons are tolerated better
oxalic acid is less corrosive but is more in s01i.1e ages and badly in some other
rapidly absorbed and hence may be more ages. Opium and its alkaloids are toler-
rapidly fatal. ated better by elderly subjects but badly
by children and infants. Belladona group
5. Condition of the stomach -
of drugs on the other hand, are better
(a) Food content - Presence offood-stuff tolerated by children than by adults.
in the stomach acts as diluent of the
8. State of body and health - A well built
poison and hence protects the stom-
person with good physique and health will
ach wall from the corrosive and irri-
tolerate the action of a poison better than
tating action of the poison. Dilution
a weak subject.
of poison also delays its absorption
and systemic action. Some specific 9. Presence of any disease - In certain dis-
type of food has specific action on eased conditions some drugs are tolerated
absorption of the poison. Fatty food exceptionally well, e.g., sedatives and
usually delays the process of absorp- tranquilizers are tolerated in very high
tion. But, for phosphorus, presence doses by maniac and deliriant patients.
of fatty food accelerates the process 10. Intoxication and poisoning states - In
ofits absorption. certain poisoning cases some drugs are
(b) Abnormal condition of the stomach - well tolerated, like, in case of strychnine
in case of pyloric stenosis and where poisoning, barbiturates and sedatives are

better tolerated . Whereas in case of bar-

biturate poisoning any sedative or
tranquilizer will accentuate the process Proper diagnosis of the poisonous substance
of death . consumed by a person may not be always
11. Sleep - Due to slow metabolic process and posible due to various reasons. But in cases
depression of other body functions dur- of living subjects , who come to the hospital
ing sleep , usually the absorption and ac- in time, diagnosis of the poison is compara-
tion of the poison is also slow . But de- tively easy. In living victims, the doctor has
pressant drugs may cause more harm the opportunity to study the course of the
during the state of sleep . clinical features . The autopsy surgeon does
12. Exercise - Action of alcohol on CNS is not have this advantage. However, the au-
slowed during exercise because more topsy surgeon has the scope to inspect the
blood is drawn to the muscles during ex- internal organs and subject different body tis-
ercise . sues to laboratory testing. Hence, the proc-
13. Cumulative action of a poison - Prepara- ess of diagnosis of poisoning cases varies ac-
tions of cumuiative poisons (poisons cording to whether the victims are examined
which are not readily excreted from the by doctors during life or after death.
body and are retained in different organs Diagnosis in LNING SUBJECTS - The
of the body for a long time) like, lead may diagnosis depends on the following:
not cause any toxic effect when enters 1. History of the case as stated by the pa-
the body for once in a low dose. But when tient himself or his relatives or friends.
such poisons enter the body over a long History should be taken on the following
period even in low dose , may ultimately lines -
cause harm when their concentration in
(a) Time of onset of the present illness .
different tissues reaches high level due
to their cumulative property. (b) Initial symptoms.
14. Idiosyncracy - Some persons are idiosyn- (c) Progress

cratic to some drugs and react most ad- (d) Whether the symptoms are related
versely though the general population tol- with intake of any food or drink.
erates the drug well. Examples - Some (e) Condition of others who took the
serum preparations, aspirin . same food or drink.
15. Tolerance - Due to prolonged use, per- (f) Possible source of the poison.
sons may develop tolerance to certain
(g) Any history of previous poisoning.
drugs and may not show any alarming sign
even when they consume a high dose of (h) Did the victim have any depression
drugs. A person addicted to opium may or had he any quarrel with anybody
tolerate such a dose of the drug which can or was there anything for him to be
cause death to even two or more persons. frustrated?
16. Mental alertness and make up - Some (i) To note, if the victim or his friends
drugs when consumed inadvertently may can narrate about the colour, smell,
lead to alarming signs and symptoms consistency, taste and quantity of the
though, if taken knowingly, they may not possible poisonous substance.
do so. Example - LSD (see pages 873-874). 2. Signs and symptoms .

3. Detail physical examination. red or cherry red - In case of CO and

4. Preservation and laboratory investiga- HCN poisoning.
tion of vomitus, excreta, stomach wash, 2. Deep cyanosis - With opium and cardiac
scraps from any stained area on the body, poisons.
blood, stained part of the dress, content 3. Early rigor mortis - With strychnine .
of a doubtful container, left over any part
4. Early appearance of the sign of decompo-
of food or drink.
sition -With H 2 S gas.
Diagnosis in DEAD SUBJECTS - The 5. Detectable smell - In case of volatile poi-
diagnosis depends on the followings : sons, opium and HCN, KCN or NaCN.
1. History of the case as provided by the 6. Haemorrhagic spots under the skin and
police or the relatives. The history should mucus membrane - Phosphorus.
be taken in the line as in case of living
7. Ulceration on lips and near the angles of
victims. In addition to those points, the
mouth - Corrosive poisons.
history should also contain two more vi-
tal points - 8. Stain near mouth and on hands - Nitric
acid and copper sulphate.
(a) For how long th~ victim survived af-
ter the start of the' initial signs, symp- 9. White froth from mouth and nose -
toms of poisoning. Opium and its alkaloids.
10. Blood tinged froth from mouth and nose
(b) Whether he was giv~n any treatment.
-Organophosphorus compounds.
If so, the details of the treatment
given . 11. Alopecia, hyperpigmentation and hyper-
keratosis -Arsenic poisoning over a long
2. Postmortem examination of the body
period.
(a) External findings
12. Staining, erosion and ulceration near the
Cb) Internal findings female external genitalia - Use of abor-
3. Preservation of viscera and other mate- tifacient agents or torturing agents.
rials for laboratory examination. 13. Injection marks - Injection of poisons
To come to the diagnosis in a case of (snake bite or othmwise), sign of treat-
death due to poisoning, the autopsy surgeon ment.
should give due importance to the available
history, should perform a detailed postmor- Internal postmortem findings
tem examination and should also give due 1. Corrosion, ulceration and desquamation
importance to the findings of the laboratory of inner aspects oflips, mucus membrane
investigations on the materials he preserved. of mouth and tongue - Corrosive agents
2. Soft, swollen, sodden, transluscent,
bleached tongue and mucus membrane
POSTMORTEM FINDINGS fN A CASE OF
DEATH DUE TO SUSPECTED POtSONlNG of mouth - Corrosive alkali
3. Hardening of mucus membrane - Phe-
External postmortem findings nol
1. Postmortem staining: Deep blue -In case 4. Yellowish discolouration- Nitric acid
of asphyxiant poisons and aniline. Bright 5. Bluish discolouration- Copper sulphate

chapter 28: FO RENS IC TO XIC O LO G Y I 729
6. Carbonisation and charring- Cone. Sul- rus compounds, chlorinated hydrocar-

phuric acid bons, opium, cyanogen, formalde-
7. Chalky appearance and consistency of hyde, phosphorus; Detectable liquid
teeth - Sulphuric acid -kerosene.
8. Blue lining in the gum - Chronic lead 15. Small intestine - May show irritation,
poisoning sometimes may show presence of poison-
ous remains.
9. Swollen gum, loose teeth, foetid smell·-
Acute mercuric chloride poisoning; 16. Large intestine - May show ulcerations,
chronic phosphorus poisoning as in case of HgCl.l' similar in appearance
10. Corrosion, irritation, desquamation and of uclers of bacillary dysentery. It par-
haemorrhage in _the inner wall of the ticularly involves the ascending and
oesophagus- Corrosive and irritant poi- transverse colons.
sons 17. Liver - Different degenerative changes
11. Hardening and whitish discolouration- occur in cases of poisoning with poisons
In case of Carbolic.acid poisoning like phosphorus, carbon tetra-chloride,
12. Discolouration and staining of inner as-
chlorofonn, tetrachlorethylene and many
other poisons. The type and extent of the
pects of mouth - With coloured poisons
degenerative changes occur depending on
13. Oesophageal stricture - A complication
the type of the poison, dose, duration of
of sulphuric acid ingestion
the exposure and the physical condition
14. Stomach- of the patient.
(a) Thickening and softening of the wall 18. Kidneys - Swollen, reddish, soft, some-
- Corrosive and irritant poisons times greasy in touch with haemorrhage
(b) Hard wall- Carbolic acid in the calyces and other degenerative
(c) Hard and leathery wall - Formalde- changes in cases of poisoning with mer-
hyde cury, oxalic acid, carbolic acid, phospho-
(d) Hyperaemia, haemorrhage and desq- rus, cantherides, viper snake venom and
uamation of mucus membrane - Ir- many others. In case of oxalic acid poi-
ritant poison soning, white powder of oxalate crystals
(e) lnceration and sloughing- Corrosive are present in the tubules and the caly-
poison ces.
(f) Perforation- H 2 S0 4 and HN0 3 19. Urinary bladder - Haemorrhage in cases
of abrus precatorius, viper snake bite and
(g) Yellowish discolouration of mucus
cantheride poisoning.
membrane - HN03 ; Bluish - Cu2 SO 1;
Slaty grey - HgC1 3 20. Larynx and trachea - Hyperaemic, in-
flamed - In case of inhalation of irritat-
(h) Stomach content - Blood - Corrosive
and irritant; Yellowish - HN0 3 ; Blu- ing gases, leaking of corrosive agents
ish - CnzS04 ; Lumin ous in dark - while ingestion or vomiting; froth in the
Phosphorus; Detectable tablet - lumen of trachea and larynx; in case of
soneryl; Powder - oxalic acid, white opium and oro-~1 o 1)hosphu:'lls poisoning.
arsenic; Detectable smell - kerosene, 21. Chest cavity - S' ell of volatile poisons,
alcohol, chloroform, organophospho- cyanogen , opium etc. can be detected.

·'JJa I PRINCIPLES OF FORENSIC MEDICINE
22. Lungs - Voluminous, congested, pres- fore death , preservation of that part
ence of Tardieu's spots - In case of as- alone may be useless for the purpose
phyxiants and inhaled poisons . Cut sec- of detection of poison. If identical lon-
tion gives blood stained frothy fluid in gitudinal halves of each kidney is pre-
case ofopium and other asphyxiants . served then that risk is to a great
23. Heart - Presence of subendocardial extent avoided.
haemorrhagic spots in cases of arsenic , 5. Some recommend preservation of
phosphorus , mercuric chloride etc. spleen as a routine measure . But
24. Brain and spinal cord - Congestion and from practical point of view, when
oedema of brain and spinal cord in cases other organs mentioned above are
ofcerebra] and spinal poison (e.g. strych- preserved, preservation of the spleen
nine ), respectively . Brain may be con- does not add much to the advantage.
gested, oedematous with occasional B. In some particular types of poisoning ,
haemorrhagic points at places in cases of apart from the usual viscera noted above,
asphyxiant poisons. some specific organ, tissue or material
25. Uterus and vagina - Staining, conges- may be required to be preserved , e.g.
tion, haemorrhage, ulceration in cases of 1. Blood should be preserved in all cases
attempted abortion by use of local abor- where poisons act after being ab-
tifacient agents . sorbed in the system. Quantity of
blood required to be preserved - 100
ml . It should be preserved from the
chamber of the heart or the inferior
vena cava .
2. Urine should be preserved in all cases
Materials preserved for chemical analysis :
where blood is required to be pre-
A Usual viscera to be preserved in all cases served, if urine is available in the
of death due to poisoning or suspected bladder . While collecting urine it
poisoning - should be seen that, it is not contami-
1. Stomach with its full content . nated with blood: F'or collection, the
2. Half of liver or 500 gms of liver , urine can either be syringed out or
whichever is more . When the weight can be spooned out after dissecting
of the liveris less than 500 gms then , the anterior wall of the bladder.
the whole of the liver has to be pre- Quantity of the urine to be collected
served. - 100 ml or the whole amount of the
3. A loop (about 1' ) of the small intes- urine present in the bladder.
tine, from the upper part . 3. Parts ofboth the lungs should be pre-
4. Half of each kidney . Identical longi- served ·in all cases of poisoning with
tudinal half of each kidney should be volatile. I?oisons or poisons which are
preserved instead of preserving one partly excreted with the expired air.
kidney or transverse section of the 4. The whole of the heart should be pre-
kidneys, because if one kidney or a served in case of suspected poison-
part of one kidney was nonf'uQ.ct being with cardiac poisons .
____ _____._ _
' TOXICOLOGY I 731

chapter 28: FO RENSIC
5. The whole of the brain should be pre- is an important test for its detection. Satu-
served in case of suspected poison- rated solution of common salt is a more com-
ing with cerebral poisons. no.
monly used preserv~tive ..be.C1i1J..Se, it has
6. Spinal cord should be preserved in contraindication. ·
case of use of spinal poison like Tissue preserved for histological exami-
strychnine. nation, should be cut into small pieces,
7. In suspected heavy metal poisoning washed with tap-water and preserved in 10%
cases, particularly in case of arsenic formol saline solution.
or lead poisoning, bone should be pre- Organs to be preserved for museum, ~.
served. should be so done in fonnaline solution. LateF
8. Hair should be preserved in case of it is further treated with suitable chemicals.
poisoning with arsenic or copper. Blood should be preserved in fluorid~ ,
9. Nails should be preserved in case of oxalate, EDTA, gold chlorid~,~ercuric chlo-
poisoning with arsenic. ride or citrate tube.-: The.,chojce of the pre-...
10. Uterus and vagina should be preservative depends on the type of test neces- -
served in case of use of abortifacient sary and the type of poiso~_suspected.
drugs either locally or systemically, Urine may be preserved in a sterile glass
when the drug h as direct action on container without use of ab.Y.preservative.
the uterus. Stained clothes should be=S1lll-dried arid
11. Skin-scrap - From an area stained preserved as such.
· ·~
~- ':.o ·
with a suspected poison.
12. Skin, subcutaneous tissue and mus- Mode of preservatlon-.ofvi~er'd
cle - from the site of injection of a For preservation, the visc~ra~should be sub-
suspected poision. merged in the preservative inside a clean·
13. Suspected stained area of the dress, glass container with-a glass--mr.-One third of-
suspected packet of poison, strips of the container should i5e keptempty to accorlf-"'
tablet recovered from the pocket of modate the· gas which may e~olve du_e to par-[. -
the dress of the deceased. tial decomposition of the -¥iscera. The con: ·
tainer should be made airtight with the help
Preservatives used of paraffin w~ used to close the mouth with
For preservation of viscera, organs or tissues, the lid. It~h_guld then be properly labellea
the best preservative is absolute alcohol or and properly sealed wit~ing wax. Th~
rectified spirit. But alcohol cannot be used if label should contain: the rrame; age, sex and-..
the suspected poison is alcohol, chloroform, address of the deceasfcl; tk .name of the po"-
chloral hydrate, fonnaldehyde, ether etc. lice station, the case reference; name of the
because, if alcohol is used in these cases then, station (mortuary), sl. nur~ber of the post-
after chemical test of the material the na- mortem exaniliiation, date.-~f-PM examina~
ture of poisoning in these cases cannot be tion; preservative u~ed ~d-the-signature an~ .
inferred, due to similarity of the observation. designation of the autops¥;:surgeon. ·· P- •
Alcohol also cannot be used in case of phos- IN ALL CASES THE;:SAMPlE OF THif -
phorus poisoning, because alcohol prevents PRESERVATIVE USED SHOULD BE PRE-
the luminosity of phosphorus in dark, which SERVED lN A SEPARATE CLEAN CON-
TAINER. This is necessary to avoid the ar- Laboratory tests for qualitative and
gument that, the poison detected in the vis- quantitative analysis of poisons
cera, was due to contamination by the poi-
1 Chemical Tests - The preserved viscera
son present in the preservative used. is treated with some solvent to extract
It is recommended that, stomach and the the poison from them, because the poi-
small intestine should be preserved in one son may not be detected if the stomach
container and liver and kidney in another con- content and the viscera are directly sub-
tainer. Other viscera should be preserved in a jected to chemical test, due to low con-
separate container. This will help to infer that centration of the poison in them. Further,
the poison was not only ingested but was also substances other than the poison may in-
absorbed in the system and exerted its action terfere with the chemical test. The sol-
on the organs, if the poison is detected from vent to be used is chosen on the basis of
the contents ofboth the containers. the poison suspected to be present in the
viscera. Alcohol is a good solvent for most
Blood, urine and skin tissue etc. should of the poisons. For separation of the veg-
be preserved in glass containers and "bone , etable alkaloids , chloroform is a more
hair or nails and clothes (afterdrying )in poly- suitable agent . Mter separation of the
thene packets . All should be properly labelled poison, the solvent is evaporated out and
and sealed . the remaining part is subjected to chemi-
THE PRESERVED MATERIALS cal test for detection of the poison.
SHOULDBESENTTOTHECONCERNED 2. Physico-chemical tests - By use of chro-
FORENSIC SCIENCE LABORATORY, matography and spectroscope (For detail
THROUGH THE CONCERNED POLICE see Forensic Science Laboratory chapter).
STATION AS QUICKLY AS POSSIBLE , 3. Histological examination of organs or tis-
OTHERWISE, THEPOISONMAYNOTBE sues - Poisons have adverse effects on
DETECTED DURING ANALYSIS OF THE different organs causing degenerative
VISCERA, EVEN THOUGH THEY MAY and necrotic changes in them. As such,
CONTAIN SOME POISON. in various suspected cases of poisoning,
Reasons for non-detection of poison in the various degree of pathological changes
viscera though death was due to some poi- occur in those organs . Some of these
soning- changes are detectable in macroscopic
examination of the organs . For more de-
1. Delay in the examination of the viscera.
tailed study of the pathological changes ,
2. Improper preservation of the viscera. tissue from different organs should be sub-
3. Use ofwrong analytical technique . jected to histopathological examination ,
4. Early disintegration of the poison. irrespective of whether any macroscopic
change was noticeable or not.
5. Complete metabolisation of the poison in
the body. For preservation of tissue for histologi-
cal examination, 10% formol saline solu-
6. The amount of poison in the preserved
tion should be used as preservative . HE
viscera being negligible .
stain of the tissue section Sf' :VPR ~ .e pur-
7. Lack of suitable chemical t ests for cer- pose in most cases . But, for some spe-
tain poisons. cific pathological changes, special sta!lls
8. Tampering of the preserved viscera. may be required .

! CHROMATOGRAPHY i
t
Column Chromatography Paper Chromatography Thin layer Chromatography
t
Gas Chromatography by
(for direct detection or (after absorption of the (after absorption of the 1. Flame ionisation
separation for further poison in chromatogra- agent in the absorbing detector
test by feeding into a phic paper the poison media or layer, the poison 2. Electron capture
spectroscope) is made visible by is detected by detector
spraying suitable 1. Spraying colouring 3. Electric signal amplifier
colouring agent) agent, or recorder
2. Using UV light, or
3. By electron separation
and spectroscopy)
4. MLcrobiological tests - To know the in- guarding respiration and maintenance of

volvement of bacterial toxins and to ex- circulation.
clude bacterial infection causing ill
1. Removal of the patient from the
health, when the features of a poisoning
source of exposure
is similar to those of a bacterial infection,
microbiological tests are required to be In case of exposure to volatile or gaseous poi-
performed, to detect the micro-organism son, it is important to remove the patient from
by microscopic test, or by culture test or the poisonous environment, without any loss
by testing for their toxins. of time. For these types of patients and also
for others, transfer to a hospital may be re-
quired according to the need and merit of the
TREATMENT OF POISONING CASES individual case and condition of the patient.
(From applied point of view treatment men-
2. Removal of the unabsorbed poison
tioned anywhere in the book will depend on
the doctor consulted) In case of contact of the poison with the exter-
nal body surface as in cases with corrosive
General principle of treatment of any
agents and organophosphorus compounds,
poisoning case -
removal of th e clothes may be necessary.
For the best interest of the patient, cer- Washing of the affected area with lukewarm
tain methodical steps should be taken while soap water with gentle rubbing will be help-
treating a case of poisoning. These are ful. Involvement of the eye needs special care
1. Removal of the patient from the source to wash out the poison, which should be done
of exposure. gently and properly with patience. Use oflo-
2. Removal of the unabsorbed poison. cal anaesthetic agent may be of special help.
An ophthalmologist should be consulted.
3. Diluting the poison and delaying its ab-
sorption. When the poison has been ingested (taken
by mouth), the mouth should be washed and·
4. Elimination of the absorbed poison.
the unabsorbed part of the poison should be
5. Use of specific antidote. removed from the stomach by emesis or by
6. Symptomatic treatment including safe- use of stomach tube or ryle's tll,be ..

734 I PRINCIPLES O f FORENSIC MEDICINE
Emesis - At-very early stage , emesis is d1,1lla. It can be given to a non-coopera-

better than sto-mach wash. Emesis can be
l ,., _ ~· ~ ·--
tive patient who is not willing to take
caused by - medicine by mouth. It should not be used
(a) Stimulating the posterior wall of the in very young and old. Some are of the
fauces bY'fi. r ,-ii'!reflexes are not lost. opinion that it causes more harm than
' · ~, benefit to the patient.
,.__,(b) Giving on~-table sp~onful of common salt
~ -
Contraindication of emetics -In cases of

.,., in a tum~l of l~e-warrn water (6%
soln. approx+ corrosive , convulsive and volatile poisons
emetic should not be used as it may irritiate
(c) Giving good amount of plain luke-warm
stomach, cause convulsion and cause aspira-
water.
tion inhalation of the vomitus , respectively.
·,,...(d) Giving one table spoonful of m1lstard pow- It should also not be used in commatosed
. ~ der in a glass-Gt\vater.lt is comparatively patient, again due to the chance of aspira-
-- more eff~e an emetic. But it causes tion inhalation. It should not also be used in
irritation to the mucosa of the oesopha- case of heart disease of the patient (due to
....--
gus and thestomach.
(e) Ipecacuanna - 1 - 2 Gm acts as an emetic.
the chance of heart failure due to strain of
vomiting) and to a pregnant woman (due to
But 1t is slow in action and do~s not serve the chance of abortion).
·· ~· ~ --
the emergel!CY
-~
purpose.
(f) Zinc sulfate - 1 - 2 Gm is given in a glass Stomach wash by use of stomach tube
of water. It should be repeated every 15 (Boa's or Ewald's tube) or Ryle's tube or
minutes till required. Male urinary rubber catheter
-~ ,
• _<-(g) Ammonium carbonate ,- (NH 4 ) 2 C0 3 , When emesis cannot be effective or is not

'"~ · given in the d~se of.:-1 - 2 Gm in water.
indicated or when quick removal of the
-Ql) Tartar e;;€fic - given in the dose of 0.1 unabsorbed poison is necessary or when a
Gm. reasonable time has passed after ingestion
(i) Apomorphine hydrochloride - 1 - 2 ml of of the poison, stomach wash is indicated. For
3 mgm per mt· concentration, given by this purpose, Indian rubber made stomach
intramuscular injection. V9miting starts tube (Boa's or Ewald's tube ) is available, for
within a.ie.w minut es and continues for use in adult patients. It is 1.5 metre long and
about 15 minutes after a single injection 1.5 em in outer diameter. At one end of the
of the said dose. Intermittent vomiting tube there is a rubber or glass funnel. The
may continue for an undesirable longer other end is smooth with one central open-
· · period . Tl'iis causes additiopal strain to ing at the end and more than one lateral open-
the. patle-n:~:ri~(is preceded by .
ings . the inner channel of the tube. 50 em
for
:rytchiilg apa saliv~tion . It maY also calise· away from this end there is a mark. At about .
sweating, pallor, tremor, fall of blood the midpart of the tube there may be a suc-
pressure , collapse , shock and uncon- tion bulb, used to pump out the stomach con-
sciol,lsn~ss ..Hence, its need and.disadvan- tent. This suction bulb is not present in all
- tages should be well-j1,1d,ged -before ·11Se . the tubes . An wooden mouth g~g with a hole
- · T It acts at--fu~~itffig centre in the meat its midpart to allow. the passage of the tube
"•
...
Fig . 28.2: Different parts

of a stomach
tube
(1) Funnel,
(2) Tube ,
(3) Mouth gag ,
(4) Openings
Fig. 28.1 : Stomach tube

3
through it, is an esse11tial appliance of the

tube. One end of gag is pointed so that it ~an
be forcefully inserted by the side of the mouth the sound of the air movement. Once it is
in non-cooperative patients. evident that the tube-end is inside the stom-
Use of the stomach tube - The wooden ach, 300 ml of luke-warm water is poured
mouth gag is first placed in right position in through the funnel end of the tube and the
between the teeth of the two jaws, with the stomach content and the water is pumped
patient either being on his left lateral posi- out, if there is a suction pump in the tube. If
tion or in prone position with the head being there is no suction pump in the tube then,
at a lower level than the trunk, so that any the washing is done by syphonic action While
fluid which may leak out through the sides the tube remains full with water, the funnel
of the tube, will not trickle down inside the end of the tube is pressed air-tight by the fin-
larynx and trachea. The · smooth end of the gers and the funnel end is brought down at a
tube is lubricated with bland oil like olive oil level below the stomach, with the funnel fac-
or glycerine or liquid paraffin. This end is ing downward The content of the stomach
then slowly pushed inside the mouth through comes out automatically by syphonic action
the hole in the gag It should be pushed up to This first wash with plain luke-warm water
the 50 em mark so as to be sure that the end is preserved for chemical analysis. The sub-
of the tube has passed the cardiac end and sequent washes are made with suitable anti-
has entered the stomach cavity. To be sure dote or neutralizing agent. The volume of
that the tube has entered the digestive tract each wash should not be more than 300-350
and not the respiratory tract, the funnel end ml. The wash is continued till the doctor is
of the stomach tube may be placed under wa- · satisfied about the complete removal of the
ter in a bucket. In case it has entered the unabsorbed poison from the stomach. In most
respiratory tract then air bubbles will come cases, about 200-300 ml of the washing fluid
out from the funnel end with''B"Xpiration. Fur- is left inside the stomach so as to neutralize
ther, if air is pushed through :the stomach . the unremoved part of the poison, if any. In
tube and the stomach area is auscultated for case of opium or morphine, the washing agent

(e.g. some KMn01 soln ) is left inside the Removal of the unabsorbed poison from
stomach after the last wash, because a part the intestine
of the absorbed morphine is resecreted in the
This can be promoted by use of purgative or
stomach , which needs neutralization after by high colonic lavage when the lower part of
washing of the stomach is over. the intestine is to be cleared off the poison.
Large amount of fluid should not be
pushed at a time , as that may exert pressure Removal of the unabsorbed poison from
on the diaphragm and cause respiratory and the site of injection, e .g. snake bite
cardiac embarrassment . Mter placing ligature , proximal to the site of
Dangers of use of stomach tube - Vagal injection , multiple punctures or incisions are
shock , aspiration inhalation into the larynx given at and around the site of the injection.
and trachea , perforation of the stomach, The poison is then squeezed out or sucked
haemorrhage in gastric ulcer patients , heart out.
failure in cardiac patients . When the use is intra-vaginal, vaginal
Contraindications - douching with plain water is recommended.
1. Very old subjects - due to possible 3. Diluting the poison and delaying its
rupture of delicate oesophageal vari- absorption
cose veins. If it is essential to wash
the stomach of these subjects then, The poison in the stomach can be diluted by
that has to be done very cautiously. giving water to drink. It helps in two ways. It
reduces the local damaging action of the poi-
2. In corrosive poisoning, because of
son on the stomach, and it delays the rate of
the danger of perforation of the stom-
absorption . Bulky bland food also acts in the
ach being very high.
same way. F at delays the process of absorp-
3. For poisons which cause convulsion, tion and also protects the stomach wall from
because the attempt to use the tube the corrosive action of the poison on the stom-
may initiate severe convulsion. ach. But sometimes dilution and fatty food
4. In unconscious or semiconscious pa- speeds up the process of absorption. In case
tients , because in them washing may of oxalic acid poisoning, dilution of the poi-
lead to aspiration inhalation of the son decreases the corrosive action of the poi-
stomach content into the larynx and son but that increases rate of absorption of
trachea. the poison. In case of white phosphorus poi-
5. In infants and children - it should not soning, fatty food promotes the process of
be used due to its thickness, In in- absorption.
fants , Ryle's tube may be used in-
4 . Elimination of the absorbed poison
stead. In young children male uri-
nary rubber catheter (No. 10/12) may To promote elimination of the absorbed poi-
be used. In case of infants , the vol- son four means are available. (a)'by increased
ume of each wash should not be more urination (diuresis ), (b) by increased perspi-
· than 100 ml. In case of young chil- ration (diaphoresis) (c) dialysis, and (d) by use
dren the volume should be 150-200 of chelating agents for heavy metals (see
ml. pages 737 -739).

(a) Diuresis - Kidney being the main organ soothing action and form a protective layer
for elimination of the poisons which are on the mucous membrane of the stomach
absorbed in the system, forced diuresis wall to protect it from the action of corrosive
is a good method to enhance the process or irritant poison.
of elimination of the absorbed poison Adsorbents - Ex. activated animal char-
when the kidneys are in well functioning coal. This has the capacity to adsorb poisons
condition and can take additional load.
(e.g. alkaloids) in the pores so that the poi-
For this, measured amount of fluid and
son cannot come in contact with the wall of
diuretic are given.
the stomach and is thus prevented from be-
(b) Diaphoresis - When the kidneys are not ing absorbed or acted upon the wall of the
. functioning well, they should not be given stomach.
additional load. In such cases, if the poi-
son is known to be excreted through Diluents - Water or milk or similar drinks
sweat and if dialysis is not available, dia- dilute the poison and in that way delay ab-
phoresis can be tried with the help of sorption.
neostigmine or p "locarpine. Bulky food - Like, boiled rice or boiled
(c) Dialysis - Haemodialysis and peritoneal vegetables. They act by getting admixed with
dialysis are very effective methods to the poison and thereby allow only very little
eliminate the absorbed poison when kid- amount of the poison to be available to the
neys are not functioning efficiently. stomach wall for absorption. Thus the rate
(d) Cholating agents - (See pages 738-739). of absorption of the poison is much decreased.
(b) Chemical Antidote - These are substan-
5. Use of specific antidote of the poison ces which disintegrate and inactivate poi-
sons by undergoing chemical reaction
ANTIDOTES are substances which prevent
with them.
the action of the poison or neutralize the
poison or produce signs and symptoms op- Examples
posite to those produced by the poison. Ac- Weak non-carbonate alkalies, for acids.
cording to their modes of action these are In case of poisoning with corrosive acids, al-
known as kalies act as neutralizers. But strong alka-
(a) Physical or mechanical antidote, lies should not be used as they can damage
(b) Chemical antidote, the stomach further. Carbonate-alkalies are
(c) Physiological or phannacological an- also avoided because, these when react with
tidote, acids, produce C02 gas which inflates the
stomach and the stomach, which is already
(d) Chelating agents and
soft and partly damaged due to the action of
(e) Serological antidote. the poison may get ruptured if inflated much
(a) Physical or Mechanical Antidote - They with gas.
prevent the action of the poison mechani-
Weak vegetable acids, for alkalies - In
cally, without destroying or inactivating
case ofpoisoningwith strong corrosive alka-
the damaging actions of the poisons.
lies weak vegetable acids like citric acid, ace-
Examples tic acid (vinegar) etc. are used because, by
Demulcents - Ex. egg albumin, starch themselves, they are least damaging but the_y
or barley water or even milk. They have a successfully neutralize the alkalies.

Common salt - Its use in case of poison- if the poison is an acid. Tannic acid precipi-
ing with silver nitrate , silver nitrate converts tates most of the alkaloid poisons. Dose is
to silver chloride which should be taken out one table-spoon full (about 15 gms) in a glass
from the stomach. of water. The dose may be repeated once or
Egg albumin - It forms innocuous mer- twice .
curic albuminate with the poison mercuric (d) Chelating Agents - These are the sub-
chloride . This also should not be allowed to stances which act on the absorbed me-
stay in the stomach for a long period, because tallic poisons. They form chelate with
by the action of the HCl in the stomach, mer- metallic poisons those are freely avail-
curic chloride may again be formed from able in the circulation and help their early
mercuric albuminate. excretion from the body through the kid-
Freshly prepared ferric oxide in case of ney. Certain chelating agents have spe-
arsenic poisoning. With arsenic it forms fer- cial affinity for some metals. They are
ric arsenate which is not absorbed. not physiological antidotes. They do not
produce signs and symptoms opposite to
KMN0 4 - It is used to inactivate opium
those produced by the metallic poisons.
and other alkaloids chemically by oxidation . However, they have their own harmful
(c) Physiological or Pharmacological Anti- actions on the body when used injudi-
dote - These are the substances which ciously. The chelating agents in use are
have their own action on different sys- 1. Dimercaprol (2 - 3 - Dimercaptopro-
tems of the body, producing signs and panol), commonly known as British
symptoms opposite to the signs and
Anti-Lewisite or BAL. Some metals
symptoms (or actions ) produced by the
enter into chemical combination with
poisons .
SH radicals of tissue respiratory en-
Examples zyme and make them useless . BAL
Naloxone - for morphine has 2 unsaturated SH radicals in it,
which combine with the metal in cir-
Neostigmine - for Datura or hyoscin
culation, thus the tissue enzymes are
group of poison
spared . With dimercaprol, metals
Barbiturate - for strychnine . form a stable compound which is ex-
UNIVERSAL ANTIDOTE - Universal creted through urine via plasma.
antidote is actually a combination of physical Dimercaprol is useful against many
and chemical antidotes . When the exact na- . metallic poisons like, arsenic, mer-
ture of the poison consumed is not known , cury, copper, bismuth, gold etc.
then the universal antidote is used which acts Dose - 3 - 4 mgrn/Kg body weight, as
against a wide range of poisons . a preparation of 10% BAL with 20%
Constituents of universal antidote Benzyl Benzoate in arachis (ground
nut) oil, given deep intra-muscularly,
Activated charcoal 2 parts
4 hourly for the first 2 days, followed
Magnesium oxide 1part
by twice daily for 10 days or until re-
Tannic acid 1part covery. If sufficient dose is not given
. ,Actiyate4 charcoal acts as adsorbent for then, BAL' ,and ·t he metal complex
many poisQI)S'. Magnesium oxide ne-qtralizes , m.ay not be a stable one.

Side effects - It causes nausea , vom- 3. Penicillamine (Cuprimine) -It is a

iting , lachrimation , tingling of ex- degraded product of penicillin and has
tremities . To avoid these side effects, a stable SH radical in it , which helps
the patient may be premedicated with it to combine with the free metal in
25 mgm of ephedrine sulphate , 1/2 the circulation . It is a very good
hr. before the injection . Premedica- chelating agent .
tion may also be done with adrena- Dose -- 30 mgmik.g body weight per
line or barbiturate . BAL inhibits car- day , given orally in 4 divided doses
bonic anhydrase and insulin and also for 7 days or 1-3 gm in slow normal
causes tachycardia , raised BP and saline drip for 2 - 4 days .
burning sensation in the mouth .
4. Desferrioxamine - It is a specific an-
2. Ethylenediamine tetra-acetic acid or tidote for iron . It is used both for
EDTA -It is a cyclic organic acid and unabsorbed iron in the stomach and
combines with sodium to form its the intestine as well as for the ab-
sodium salF . When this salt combines sorbed iron .
with calcium, it forms a stable chelate Dose - In acute toxicity , for the
known as disodium calcium edetate unabsorbed part of the metal, it is
or disodium calcium versenate . given orally , daily 8 - 12 gm in di-
When this preparation is introduced vided doses . For absorbed part of the
into the circulation it does not drag poison , 2 gm dose is given intrave-
blood calcium (because it is a calcium nously with 50% laevulose solution.
compound), but combines with other (e) Serological Antidote - Anti-snake venom
freely available metal . It gets firmly serum is available for snake bite poison-
bound with the metal and inactivates ing of both cobra and viper types.
it biologically and the product is ex-
creted in urine as harmless com- 6. Symptomatic Treatment
pound. It is the best chelating agent A Safeguarding respiration -It may require
for lead . It removes blood lead and
the following steps:
thus helps mobilization oflead from
(a) Clearing the airways - When some
tissue and helps to get relief from the
obstruction is present in the airway
signs , symptoms of colic , encepha-
then, the patient struggles to breath
lopathy , palsy etc. Given by mouth it
with signs like, heavy breathing,
is not absorbed well. Hence it is given
choking, stertorous breathing with
by IV drip .
cyanosis and sometime convulsion. In
Dose _ For adults , 1 gm twice a day such circumstances, the patient is
at 12 hours' interval , given by slow rolled on to one side, his tongue is
IV drip , each time for over a period pulled in front and then gross ob-
of 1 hour mixed with 5% glucose sa- struction is removed from the back
line, in a ' concentration of not more of his throat, by finger or swab or by
than 3% , for 5 days . If necessary , the suction.
therapy can be ,r~peated after an in- · · (b) Endotracheal intubation may be help-
terval of 1 wee¥.. ·, . ful where there is fear that,· the: air-

740 I PRI NC IPLES OF FORENSIC M EDICI NE
passage may be obstructed again due C. In case of cardiac arre:-t - cardia,, mas·
to constant secretion or otheiWise. sage, caffeine, d1gital.s, epinephr: 'le etc.
(c) ,..._,nc'1eotomy - May be necessary D. In case of vagal mhibitw _- Atropine.
where the obstruction cannot be eas- E. In case of abdominal colic - Atropine.
ily cleared out but the patient needs F . In case of nausea and vomiting - Short
quick relief. acting ba·b1turate or Na-amytal.
(d) 0 ygc. .nhalahon - 6 htl' mt. M11sk G. In case of electrolytic imbalance - NaCl,
IS prefen-ed to tube or catheter. R, Ca etc. Ifnecessry, :r~aHC0 3 withNaCl
(e) A.Jtificial respiration - Artificial res- when alkaline resen e diminishes.
piration is necessary when respira- H. In case of oedema glottis - epinephrine -
tion ceases. Holger Nielson method 1: 1,000, cortisone, atropine, ephedrine.
is continued for 112 to 1 hour, in case I. In case of cough - antitussive or expecto-
of a 'nlt patien ,s. l\1 outh to mouth rant, according to the need.
breathing is better in some cases. In J . In case of pulm, nary oedema - Oxygen
children mouth to mouth r spirahon inhalation, epinephrine, aminophylline.
rnust not be very v ·gorous, as that
K In case of respiratory infection - antibi-
may injure the lungs or inflate the
otics.
stomach and intestine, which may
L . In case of convulsion - barbiturate, par-
subsequently emban-ass normal and
aldehyde, chloral hydrate.
spontaneous breathing. It does not
provide oxygen but establishes tidal M. In case of con1a - Analeptics.
flow. Further, C02 of the pushed ex- N. In case of oedema of brain - '9'-l)ertonic
pired air helps to boost the mecha- urea, sorb tol, glucose, .a1 t x, "'ffeine.
nism of breathing. 0 . In case of hyperthennia - Co~·l sponging
Uae of Ambu bag - By this method, con- of the body, antipyretics.
trolled amount of air can be pushed with P . In case of hypothermia - wann covering,
controlled pressure. It is very easy to use. hot drink, hot water bag.
Both air and oxygen can be given at a Q. In case of kidney failure - see page 737.
time. Drawback of mouth to mouth R. In case of liver damag• - \> 1t B complex,
breathing can be overcome by the use of gl 1cose, Calcium Sl LE, r ethionine.
ambu bag. But ambu bag may not be al-
ways available at hand.
ed Medi~ol Pra<=tmO'rtef'
Mechanical ventilator- It is an automatic
oi$oniAS Case
instrument. Its use needs the service of
an anaesthetis See Chapter 3, Page 5b (Legal and Ethical
B. Ha.nter.ance of circulation - For main- Aspects of Practice ofMedicine) .
tenance of circulation vasoconstrictor,
c rculatory stimula~'l transfusion or in-
fusion of saline, glucose saline, plasma,
noi c.drenaline drir , IllPthyl amphetanune 1. According to the site and mode of action
etc. may be necessary according to the 2. According to tpe nature or motive of use
condition of the patient. 3. According to the source of poisoning.

chapter 28: FO RENSIC TO XICOLO GY I 741
1. Classification according to the site and 2. Cardmc p01::;ons - HCN, KCN, NaCN;
mode of action Digitalis; Aconite; Nicotine; Quinine; Ole-
ander (Yellow and white)
A Local Acting Poisons -
3. Asphyxiants - C0 2 ; CO; H 2 S
1. Co -rosives -
4. Nephrotoxic agents - Oxalic acid, mer-
(a) - trong acids (i) Mineral acids cury, cantherides
(ii) Organic acids 5. Hepatotoxic age:tts - Phosphorus, Car-
(b) ..::trong < ' e bon tetrachloride, chloroform
(c) \tetalli< - Mercuric chloride 6. Miscellaneous - Food poisons
2. Ir. t. nts - 2 . Classification of poisons according to
(a) Mechanical - Class powder etc . motive or natu re of use
(b) ...:hemical (i) Inorgani - In this consideration, poisons may be -
Weak acids 1. Homicidal poisons - Arsenic, Aconite,
Weak alkalies Digitalis, Abrus precatorius, Strych-
Inorganic non-metals nos nux vomica.
Inorganic metals 2. Suicidal p01sonr -Opium, Barbitu-
rate, Organophosphorus compounds,
(ii) Organic -
Carbolic acid, Copper sulphate.
Chemical preparations 3. Accidental poisons -Aspirin, organo-
Veget.....ble origin phosphorus compounds, Copper sul-
Animal origin phate, snake bite poisoning, Ergot,
B. e otr. Act· n!! or Systemic Poisons CO, C02 , H 2 S.
(Which act on different systems after ab- 4. Abortifacient agents - Ergot, Qui-
sorption.)- nine, Calotropis, Plumbago.
1. Neurotics - 5. Stupefying agen~s - Datura , Canna-
bis, Chloral hydrate.
(a) ~ _iso ••£ (i) Somniferous
6. Agents , used to cause bodily injury -
(ii) Inebriants
Corrosive acids and alkalies.
(iii) Stimulants
7. Catt.le po .::.o :s -Abrus precatorius,
(iv) Deliriants Calotropis, Plumbago.
(v) Stupefaciants 8. Used for malingering purposes -
(vi) Hallucinogens Semicarpus anacardium.
(vii) Convulsants
3 . Classification of poison according to
(b) Spinal (convulsant ) - Ex. Strychnos the source of poison or circumstances
Nux Vomica (strychnine) of poi soning
(c) Penpheral nerve poisons -
See page 724. Source of poisons (circum-
(i) Local anaesthetics stances of poisoning).
· (cocaine, procaine) Ideal Suicidal poisons -An ideal suicidal
(ii) · Relaxants (curar~ ) poison should be , easily ava1lable , ch ,.

should have no bad taste, should not cause • Treatment of common acute poisonings - Henry
much pain, fatality should be certain, death Matthew, A.A. H. Lawson, Third Edn. 1975.
should be rapid without much suffering. In • Poisoning Emergencies - PA. Czajka, J P Duffy, 1980.
all these considerations opium and its alka- • Dewar's Text book of Forensic Pharmacy, 6th Edn.
loids and some other cerebral depressants Revised by D.H.O. Gemmell, 1964.
like barbiturates are preferred to commit
• The Pharmacological basis of Therapeutics- Edited
suicide.
by L. S. Goodman and A. Gilman, 4th Edn. 1970.
Ideal homicidal poisons - An ideal homi- • Some aspects of Toxicology - Edited by Ranjit
cidal poison should be, easily available, cheap, Roychowdhury, 1969.
should have no .detectable smell, colour or
• Drugs and Drug dependence- Edited by G. Edwards,
taste, should be certain in its action, should M.A.H Russell, D. Hawks, M. Mallafferty, 1976.
have no suitable antidote, actions should
• Drug dependence - Current problems and Issues,
simulate some natural diseased conditions,
Edited by M. M. Gealt, 1977.
should not be detectable by labor tory tests.
• Methods in Toxicology- Edited by G. E. Paget, 1970.
In these considerations, arsenic and aco-
• Modern trends in Drug dependence and alcoholism,
nite were used to be considered as ideal homi-
Edited by R. V Phillipson, 1970.
cidal poisons. ArseniG possesses all the crite-
• Alcoholism and Drug dependence - Edited by L. G.
ria mentioned above except that after death
Kiloh and D. S. Bell, 1971.
it can be detected from viscera or tissues in-
cluding bones, hair, nails years after death • Insecticides- Action and metabolism- O'Brien R. D.
1974.
and even from the soil of the burial place or
soil and ash from the cremation ground. • Alcoholism - Progress in Research and Treatment,
Edited by P G. Bomne, Ruth Fox, 1973.
• Selective Toxicity (Fourth Edn.) - Adrient Albert, 1968.
• Principles of Drug action - The basis of Pharmacol-
ogy, A. Goldstein, L. Aronow, S. M. Kalman, 1969.
• All India Major Criminal Acts- Central Law Agency, • Poisoning Misadventures- L. B. Jensen, 1970.
1989. • WG Aitchison Robertson- Aids to Forensic Medicine
• Toxicology of Drugs and Chemicals, William B. -2008.
Deichmann and Horace, 0. Gerarde- 1972. • David Dolinak, Evan Matshep, Emma 0 Lew -Foren-
• Clinical Toxicology - 5th Edn. Clinton H. Thienes W. sic Pathology· Principle and Practjce- 2005.
Thomas J Haley, 1972. • Michael J Skrun and Davidson A Ramsay - Pathol-
• Poison detection in human organs, 2nd Edn. A. Curry, ogy of Trauma - 2006.
K. Simpson, 1969. • Werner U, Spitz David J, Spitz Ramsay Clark, Russel
• Modern trends in Toxicology, E. Boyland, R. Goulding, S Fisher- Spitz and Fishers Medicolegallnvestjgatjon
1968. of Death- 2006.
• Criminalistics- An introduction to Forensic science, • W Dog las Hemming -Forensic Medicine and Toxicol-
2nd Edn. Richard Saberstein, 1981. ogy- 2008.
• The diagnosis and treatment of Acute poisoning- J. • Michel Dahi and Barbara B. Rollins- Poison Evidence
D. P Graham, 1962." - 2004.

Sites of action, Factors influencing action of poison,

Cumulative action of poison, To lerance and
idiosyncracy, Changes in the stomach in poisoning
Long questions
cases, Hepatotoxic and nephrotoxic poisons, Poisons
1. What are the different actions of poisons? What are
which cause subendocardial haemorrhage, Poisons
the factors influencing the actions of poisons?
which cause dilatation and constriction of pupils (an-
2. How do you diagnose poisoning in living and in dead swer not available in this chapter), Poisons causing
bodies? What are the viscera preserved in death due alopecia, Usual viscera to be preserved, Special vis-
to poisoning cases? cera preserved in specific cases, different preserva-
3. What is the general line of treatment of poisoning tives, Circumstances when poison may not be de-
cases? What are antidotes and chelating agents? tected in viscera, Line of treatment of poisoning
How do you classify poisons? cases, Different emetics, Advantages and disadvan-
tages of apomorphine as an emetic, Description of
Short notes stomach tube, Use of stomach tube, Contraindications
Preservation of yiscera, Stomach tube, Antidote, of emesis and stomach wash, Elimination of absorbed
Chelating agents, BAL. EDTA, Penicillamine, poisons, Diaphoresis, "Antidotes - Types, Physical,
Desferrioxamine, Duties of a medical officer in dealing Chemical physiological and universal antidotes,
with poisoning cases, Different uses of poisons, Ideal Chelating ag ents, EDTA and BAL - doses, dangers,
suicidal and homicidal poisons. mode of use, Penicillamine, Desferrioxamine, Sero-
logical antidote, Methods of artificial respiration, Du-
Oral questions
ties of a doctor in dealing a poisonous case, Cerebral
What are : toxicology, Drug, Poison, Dangerous Drug poisons, Hallucinogens, Stupefacients, lnebriants,
Act, Drug and Magic Remedies Act, Provisions of Drug Cardiac poisons, Spinal poisons, Classification of poi-
and Cosmetics Act, Sources of poison, Uses of poisons according to nature of use, Ideal suicidal poison,
sons, Routes of poisoning, Routes of Elimination, Ideal homicidal poisons, Abortifacient poisons.

NOTES

CORROSIVE AGENTS are chemically highly terns. But organic corrosive agents have di-
reactive. Due to their chemical action, locally rect, local and remote action both, as they
they corrode and destroy the tissue with are absorbed and reach different systems.
which they come in contact. They coagulate Corrosive mineral (inorganic) acids -
the tissue protems, fix the tissue, extract tis- Mineral or inorganic acids are corrosive
sue fluid and if the patient survives for a rea- agents in their concentrate forms. When
sonable period then, there is ulcer formation , diluted, they act as irritants and when very
sloughing of the necrosed tissue and there is much diluted and taken by mouth some of
scar formation with contracture. Mineral cor- them may act as stimulants to the diges-
rosive agents (mineral acids and alkalies) have tive process . Of the many mineral corro-
only direct local action as they are not ab- sive acids, under graduate students need
sorbed , but may have action on the systems to read sulphuric, nitric and hydrochloric
indirectly viz ., circulatory and respiratory sys- acids only.
Features Sulphuric acid Nitric acid Hydrochloric acid
Physical and chemical Colourless, oily, heavy, non- When pure, colourless, fum- Colourless, volatile, odourless
properties fuming, odourless, hygros- ing liquid with a pungent liquid, has a burning sour
copic liquid, having a pain- odour and painful burning taste
ful burning taste. It carbonises taste. With organic substan-
organic substances. ces it causes yellowish dis-
colouration due to xantho-
proteic reaction
Sources Industries, commerce, Industries, commerce, Industries, commerce, labo-
chemical laboratories chemical laboratories ratories. A normal digestive
fluid of stomach
Action Locally- corrosive (directly), Locally - corrosive, respira- Locally- corrosive, inflamation
Indirectly - shock, asphyxia tory distress (when fumes of resp. tract due to inhalation
-when the acid or the vomi- are inhaled), indirectly circu- of fumes, indirectly, shock due
tus trickles down the resp. latory failure due to pain to severe pain
Contd.
745 CoMC-24
J' Features Sulphuric acid Nitric acid Hydrochloric acid ~

tract, chemial peritonitis due
to perforation of stomach,
malnutrition due to resultant
stricture of oesophagus.
Fatal dose 5-10 mi. (cone.) 10-15 (cone.) 15-20 mi. (cone.)
Fatal period 12-18 hrs. or more 12-24 hrs. or more 18-30 hrs. or more
Clinical features
Burning pain in throat Present Present Present
followed by, over epi-
gastrium, then whole
abdomen
Difficulty in speech Present Present Present
and swallowing
Difficulty in respiration Present due to swelling and Present due to local damage, Presentduetolocaldamage,
local damage of the tissue trickling down of acid and trickling down of acid and
near the larynx and trickling vomitus through laynx and vomitus through larynx and
down of acid and vomitus inhalation of vapour of the inhalation of the vapour of
through the larynx acid the acid
Eructation Present Present Present
Vomiting Present Present Present
Thirst Present, drinking causes Present, drinking causes Present, drinking causes
more vomiting more vomiting more vomiting
Vomitus
Reaction Strongly acid Strongly acid Strongly acid
Altered blood Present Present Present
Mucus and mucus Present Present Present
shreds
Constipation Usual, occasional loose Usually constipation Usually constipation
motion
Urination Suppressed Supressed Supressed
Tenesmus Present Present May be present
Nature of stool Mucus with altered blood Mucus with altered blood Mucus with altered blood
present present may be present
Tenderness over Present Present Present
abdomen
Stiffness of abdomen May be due to peritonitis due May be due to distension or May be due to distension of
to perforation of the stomach less commonly due to rupture the stomach
of the stomach
Cantd.
chapter 29: CORROSIVE AGENTS I 747
-----------------------------------------------------
Features Sulphuric acid Nitric acid Hydrochloric acid

---------------+----- - - - - - - -
· ---:------------- - - - -
Abdominal distension Not usual Present due to gas in Present due to gas 1n stomach
stomach
Erosion of the skin, its Over angles of mouth, lips, Over angles of mouth, lips, Usually no erosion. Epider-
type/appearance fingers with blackening and fingers with yellowish mis may fall off after a few
excoriation colouration due to xantho- days
proteic reaction
Erosion of mucus mem- Similar as in case of skin Similar as in case of skin Erosion with brownish
brane of mouth and discolouration
tongue
Floor of the eroded area Reddish, haemorrhagic and
1
Reddish, haemorrhagic and Reddish, haemorrhagic and
when destroyed and co- sometime ulcerated sometime ulcerated sometime ulcerated
vering tissue is removed
Teeth Chalky-white, brittle Yellowish surface coating, No significant change
not brittle
Perforation or rupture Common Less common Uncommon
of stomach
Shock Present Present Present
-
Cause of Death Shock, perforation of stom- Shock, perforation of stom- Shock, Laryngeal spasm,
ach, peritonitis, laryngeal ach, peritonitis, laryngeal pulmonary oedema due to
spasm due to trickling of acid spasm due to trickling of acid inhalation of vapour of the
or vomitus or malnutrition or vomitus or inhalation of acid
due to stricture of the oeso- vapour
_____________,________________ phagus
~--------------------- -------------
Treatment Treatment in al! ti1ese three cases are same Emesis is not attempted for fear of rupture of the
stomach. Stomach wash with use of stomach tube is also contra-indicated However, in this
regard some prefer to take decision on the merit of the individual case. If much time has not
lapsed by the time the treatment starts, stomach wash is indicated by some, with caution. This
is more applicable in case of poisoning with hydrochloric acid and to a reasonable extent nitric
acid. However, the essential aspects of treatment consist of- 1. Drinking of plenty of plain wate
to dilute the acid (of course not to overdistend the stomach or else it may rupture; it is also to be
remembered that drinking initiates vomiting ~'hich also may cause rupture of the stomach and
also inhalation of the acidulated vomitus may cause suffocation). 2. Use of weak solutions of
non-carbonate alkalies like CaO, MgO or calcined magnesia is recommended. Strong solution
of alkalies should not be used because they may further damage the stomach- Carbonate
alkalies should also not be used because they produce gas which distends the stomach and
ihat may rupture the stom~ch! 3. Non-flatulent antacids do good work. 4. If none of these are
available at hand then wall scrapJ)ing whic~ have calcium alkaline ingredients, mixed with
, water or soap solutiOIJ W~I.Gh )S mi!~ly alkaline 1n react1on. can be given. 5. Demulcent dnnks
like ba~ey or starch water (partly bojled and cooled), ffesh, unboiled egg albumin or milk
should be given to protect.the wall of the stomach. as they form an inert viscous coating over
------------~~--~~~--~-~~~~~~- ~-~--~~---------------------
Cnnfd.
748 I PRINCIPLES OF FO RENSIC MEDICIN E
Features Su/phuricacid Nitdcapi~ ~ Hytlr&hforfcafifd

the mucus membrane of the stomach. Milk acts in r1ore than one ways . It not only acts as a
demulcent agent , it also dilutes the acid and being mildly alkaline in reaction it alsochem1callv
neutralises the acid. 6. In case of respiratory distress , due to inhalation of the vomitus or
leaking of the poison in the respiratory tract ,tracheotomy may be necessary . 7. In case of the
~ontact of the acid with eye ,irrigation of the eye with plain water or normal saline is recom-
mended. 8. In case of contact with skin anywhere,washing of the area with soap and then
treating the area with bland or antibiotic ointment are necessary. Apart from these, when
collapse or any other untoward symptoms arise then,matching treatrl8nt should be given to
combat those symptoms.
Postmortem findings With sulphuric acid there is With nitric acid there is ./TO Here, there may 10t be mucr
gross corrosion of skin with sion wir y..._' ::;h diS' ~- ~ '" Jn of the skin. There
blackish or chemical chamng ration 01 the s~1n of tnese may be damage of the skin
of the affected area. Lips ,an- areas due toxanthoprotP.ic over these areas with brow-
gles of mouth o fingers of reaction . Similar changes are nishparchmentization . The
the hand sometimes thechin , noticed on themucus mem- mucus membranes of the
front of abdomen andchest brane of mouth ,tongue , mouth and the tongue show
show such corrosion due to oesophagus . Thestomach reddish brown corrosion with
trickling of the acidulated wall is swollen, soft with des- desquamation and haemorr-
saliva . The mucus membra- quamation, haemorrhage hagic points and swelling.
ne of mouth and tongue andulceration .Perforation is Similar changes are seen in
showblackish corrosion . not as common as in case of the inner surface of the oeso-
Teeth are chalky white and sulphuric acid .Xanthoproteic phagus . Thestomach is soft ,
brittle . Corrosion with mild to reaction is not much promi- swollen with congestion, des-
moderate degree ofcharring nent due to altered blood quamation, haemorrhagic
is present in the mucous which causes dark-brown points and ulceration of the
membrane of theoesopha- discolouration of the mucus inner surface .Stomach con-
gus . Depending on the membrane of thestomach . tains altered blood with mucus
amount and concentration Upper part of thesmall in- shreds . The upper part of the
of the acid, the wall of the testine shows signs ofirri- small intestine shows some
stomach is soft , swollen with tation . In case the vapour is degree ofirritation . If the
blackish corrosion ,desqua- inhaled , then there is extreme vapour is inhaled then, the
mation ,haemorrhage ,ulce- congestion of the respiratory respiratory tract shows
ration andperforation with tract with congestion and extreme congestion .Similar
occasionally the whole sto- oedema of the lungs.If the changes are seen inlungs .
mach changing to blackish acid or the vomitus is inhaled Other organs may show
disintegrated mass . When the then there is desquamation congestion.
overall structure of the sto- and haemorrhage in the tract.
mach is maintained, the con- Other organs are congested. Forfurther external changes
tent show presence of altered see ''Jitriolaqe "
r ighly acidic )blood mixed For further external changes
with charred mucus shreds. in the skin and eyes see
When there isperforation of ' itriolage "
the stomach with leakage of
Contd.
chapter 29: CORROSIVE AGE NTS I 749
FfJ1.liares SUlphuric acid Nitric acid Hydrochloric acid

the acid, extensive corrosion
of the nearing organs with
development of chemical
peritonitis occurs. Upper part
of the small1ntestineshows
mild corrosion or severe irri-
tation. If the vomitus is 1nhalec
then, mild to moderate corro-
sion of the respiratory tract
with congestion and oedema
of the lungs are noticed.
For further external changes
see" Vitriol age'
Materials to be preser- In all these cases- Stomachwith full content a loop of the upper part of the small intestine,
ved from the dead body half of liver, half of each kidneyare preserved in one container. corroded areas of the skin
are preserved in another container and acid stained clothes are preserved separately
Preservative used Viscera and skin are preserved in absolute alcohol or rectified spirit and the clothes are
presArved without any preservative
Chemical tests With barium chloride or nitra- If nitric acid is added by the With silver nitrate it produces
te it produces white precipi- side of a test tube containing curdy white precipitate of
tate of barium sulphate a mixture of ferrous sulphate silver chloride
and sulphuric acid then a
brown ring is formed at the
interface
Medicolegal aspects and 1. These poisons are taken mostly to commit suicide
circumstances of 2. Accidental poisoning may occur when any of these agents are taken by mistake for some
poisoning other substance e.g., a purgative like, liq. paraffin
3. Homicidal poisoning is as a rule very very rare because a person with sense will not or
cannot be made to swallow any of these due to the burning taste. Homicide victims are
usually incapable infants or intoxicated persons. These agents, if given mixed with food or
dri'l will loose their corrosive property
4. These agents are used for vitriol age, to cause injuf)( annoyance or physical debility o
disfiguration of an enemy (See vitriolage below)
5. They are occasiona11y used inside vagina of a woman as a punishment for adultery o
infidelity
6. They are occasionally used locally to cause abortion
7. Prolonged exposure to the vapoursof these agents in industries may lead to respiratory
complications
8. Acute exposure to the vapours in the industries may lead to death due to respiratory
distress

Chronic exposure to the vapours of

mineral a cids in the industries
In industries , where mineral acids are used,
the workers remain vulnerable to the va-
pours. This may lead to chronic irritation of
the respiratory tract , including lungs as also
the eyes . As a result, the victims may suffer
from chronic inflammation (catarrh ) of the
respiratory tract , with sneezing , coughing ,
leading to chronic bronchitis and respiratory
insufficiency . In the eyes, there may be
chronic conjunctivitis , keratitis and early
development ofcataract .
Fig. 29 .1: Vitriolage -eyes
were main target
VITRlOLAGE
the contaminated area of the body. Due to
The term vitriolage literally means throw- damage of the nerve endings , these are com-
ing of the oil of vitriol (cone. sulphuric acid) paratively painless lesions. Wide area of the
on the body of a person with the intention to body may be i r Tulved with evidence of spill-
cause bodily injury .But for practical purposes ing or splashing or pouring of the acid . These
this term is used in all cases of throwing of injuries heal with scar formation and thus
any corrosive agent on the body of a person. cause permanent dis figuration , loss of eye-
The usual target is the face of the victim with sight , or contracture , which if is near a joint
the idea to cause disfiguration of the face. may restrict the functions ofthejoint grossly.
This may lead to the destruction of the eyes Thus , if the victim sur.rives with any of such
with permanent loss of the eyesight . There outcomes, the act ofvitriolage may amount
is ulceration and resultant scar formation of to the causation of grievous hurt . (See Figs.
Vitriolage- eyes were the Vitriol~ge -eyes were the ~ig : 29.4: · )Jitriolage- eyes were the
target main target . _' • tf.lrget

chapter 29: CORROSIVE AG ENTS I 751
Fig. 29.5: Death due to

sulphuric acid
poisoning with
sulphuric acid
corrosion a t
different parts
of the bod y in
addition to lips
and face
Fig. 29.6: Vitriolage - on face and eyes with

fracture deformity at right elbow due
to mechanical force Fig. 29.7: Vitriolage- on left shoulder

752 I PRINCI PLES O F FORENSIC MEDICINE
Fig. 29.8: Vitriolage- eyes were the Fig. 29.9: Vitriolage-eyes and head Fig. 29.10 : Vitriolage - eyes
main target were the main target were the target
29.1 to 29.11) . But when the area of involve- oxalates . The different sources of the agents
ment is extensive , then death may occur, are
when the offence will amount to homicide . 1. Household - Metal cleaning agent and
To treat such a case, the area of contact stain remover containing
should be washed with soap water or plain oxalic acid or oxalates.
water as quickly and as thoroughly but softly 2. Industrial - Leather industry, dye in-
as possible. Bland and antiseptic ointment dustry, book binding fac-
should be applied to prevent infection. Care tory, hat factory.
should be taken to prevent contracture. Spe- 3. Vegetable - Rhubarb (particularly
cial care should be taken to preserve the leaves), spinach, lichen,
eyesight when eyes are involved. onion, cabbage.
Physical properties
ORGANIC CORROSIVE ACIDS/AGENTS
Oxalic acid is colourless, transparent, pris-
Organic corrosive agents have both local cor- matic crystals, soluble in water, has a burn-
rosive action and action on diff. remote or- ing sour taste. It vapourises on heating and
gans or systems of the body as they are ab- sublimates on cooling of the vapour.
sorbed in the body systems. Among the or-
ganic corrosive acid or agents the students Action
need to read oxalic acid , phenol or carbolic (a) Local - Corrosion and irritation of the
acid, acetic acid and acetyl salicylic acid. skin and mucus membrane in particular.
(b) Systemic - Hypocalcaemia, nephrotoxic-
OXALIC ACID ity.
Fatal dose
Sources of poisoning
5 - 15 gms cause death after absorption. 15 -
Poisoning may occur from oxalic acid or 20 gms . causes fulminating poisoning.

chapter 29: CO RROS IVE AGE NTS I 753
Fatal period 5. Enema may be useful to remove the

unabsorbed poison from the gut.
In case offulminatingpoisoning death occurs
within 2 hours . In case of hypocalcaemia , 6. 10% solution ofCa-gluconate can be given
death occurs within 12 hours . In case ofurae- by slow I.V. injection which will combine
mia or renal failure death may occur between with the oxalic acid in the circulation and
2 days to 2 weeks . will thus save the calcium of the blood .
This may prevent hypocalcaemia but the
Clinical features (signs and symptoms) danger of damage to the kidney remains
due to blocking of the tubules by Ca-
Locally oxalic acid does not cause much cor- oxalate crystals .
rosion of the skin . There may be some de-
7. As a rule, sodium and potassium salts by
gree of irritation and if the person survives
then the cuticle may fall off after a few days. mouth, should be restricted as they form·
But the mucus membrane is corroded . The soluble salts of oxalic acid which promotes
corrosive action and the pain may be shock- absorption of the poison.
ing enough to cause de~th . 8. Rest of the treatments are symptomatic.
After absorption there is hypocalcaemia, Postmortem appearance
as calcium of blood is used by oxalic acid to
form Ca-oxalate salt. Hypocalcaemia causes Externally, the skin and the lips are not much
tingling and numbness of fingers and limbs . corroded. But the mucus membrane of the
There is muscula-r tenderness , irritation and mouth and tongue are corroded, swollen, sod-
tetanic convulsion. Respiration is slow . There den, bleached or brownish with occasional
is bradycardia with weak, irregular pulse . desquamation and bleeding points .
Ventricular fibrillation may lead to death . Internally , the same picture as inside
If the patient survives hypocalcaemia, the mouth, is noticed inside the oesopha-
there may be toxic nephritis . In such cases, gus also . The stomach is swollen and soft.
there is uraemia with scanty urination, hae- The mucus membrane shows brownish or
maturia, albuminuria, oxaluria. In fatal cases blackish branching streaks . There are desq-
death occurs within 2 days to 2 wks. usually. uamation and haemorrhage . Perforation is
rare . The stomach contains glairy, brown-
Treatment ish, gelatinous mucus mixed with altered
blood . The upper part of the small intes-
1. Emetics may be useful to remove the
tine shows signs of irritation. Kidneys are
unabsorbed poison.
swollen . The tubules and the calyces show
2. Stomach wash can be done cautiously presence of calcium-oxalate crystals . There
with 2 t.s.f. ofCa-lactate in each wash. may be evidence of toxic nephritis , the de-
3. Calcium may be given in any form to form gree ofwhich depends on the period of suf-
Ca-oxalate in the stomach which is in- fering.
soluble and should be taken out by stom-
ach wash. Materials to be preserved during
postmortem examination
4. Demulcent drinks should be given to pro-
tect the mucus membrane of the stom- (a) Stomach with content and a loop of the
ach from the corrosive action of the acid. small intes,tine (from the upper part) in one
[F M.- 481
container. (b) Kidney and liver in a separate Sources

container. (c) Dress stained with vomitus, any
It is used as antiseptic, disinfectant, preserva-
doubtful container offood or drink from the
tive and in laboratories and industries, like
place of occurrence. (a) and (b) should be pre-
soap industry. Its coinmercial form contains
served in saturated solution of common salt
impurities like cresol.
for chemical examination. Part ofkidney may
be preserved in formol saline for histological Fatal dose
examination. For preservation of dress no
preservative is required. 3- 10 gm is the usual range of the fatal dose .
Chemical test - Barium chloride forms Fatal period
white crystals ofbarium-oxalate.
Death may occur within a few hours due to
Medicolegal aspects respiratory or circulatory failure or within
some days due to hepatic or renal failure.
Accidental poisoning - As it is available at
home, children may take it accidentally. Ac- Action
cidental poisoning may occur if it is taken by
mistake for epsom salt (mag-sulphate) as Locally it is corrosive agent. After absorption
purgative. Poisoning has also occurred from it first stimulates C.N.S. and then depresses
excess consumption of rhubarb. it (convulsion followed by narcosis). Later it
damages the kidney and the liver.
Suicidal - it is occasionally used.
Homicidal use - Not easy due to its de- Clinical features (signs and symptoms)
tectable taste, early onset of signs and easy
Poisoning with carbolic acid is known as
chemical detection in vomitus and body or-
Carbolism
gans.
Locally, in concentrated form, it causes
necrosis of the skin and the mucus membrane,
which at first appears whitish. There is numb-
PHENOL (CARBOLIC ACID)
ness of the affected area due to destruction
CAR:BOUSM (Carbolic Add Poisoning) of the nerve endings of the area. Within an
hour the area looks red, followed by necro-
Physical properties sis. In dilution, phenol d oes n ot destroy
healthy skin or the mucus membrane, but it
In pure form phenol is a colourless, needle- is absorbed through the tissue space.
shaped crystalline substance, having a detect-
After ingestjop. there is burning pain in
able "carbolic" smell and a burning sweet
mouth, throat, chest and abdomen. In many
taste. Its melting point is 38°C. Its solubility
cases there,. ~s yomiting. Vomiting may be
in water is about 7% - 8%, depending on the
there even hi' case of percutaneous absorp-
atmospheric temperature.· It is freely solu-
tion.
ble in alcohol, glycerol, vegetable oil and ani-
mal fats. On exposure to light and higher tem- Due. to absorption of the poison there are
perature and in mixture with 10% its volume dizziness, de~])ioom, convulsion, fall of tem-
of water, it liquefies to deep pjnk or brown- perature, CQlll;l!pW";.4yspnoea, coma. In caus-
ish pink liquid. ing circulatory collapse it has direct action

on heart musculature. It is also a nephro-

toxic agent and causes carboluria with oligu-
ria and albuminuria. There is also haemo-
globinuria. When fresh , the urine may not
have any change in colour or may be slightly
greenish. The urine contains trace of free
carbolic acid and the metabolic product of
phenol, namely hydroquinone and pyrocate-
chol - as etheral sulphates and glycuronates.
On keeping exposed to air the metabolic prod-
ucts undergo further oxidation and the col-
our of the urine changes to deep green. Fig . 29 .11 : Acid burn (carbolic acid} Mark the lips and
lower part of neck.
Trace of phenol is excreted through the Courtesy- Prof CB Tripathy (SHU)
expired air and thus the exhaled air gives the
smell of phenol. When ingested, 1. Stomach wash should
With phenol poisoning there is constric- be performed with 20% alcohol or glycerol or
tion of pupils . with some vegetable oil like groundnut oil or
castor oil. Sodium bicarbonate solution can
Absorption, fate and excretio n also be used as washing agent. In fact some
favours N aHC0 3 to alcohol etc. Alcohol has
Phenol is efficiently absorbed through all an advantage in that, it dissolves phenol from
mucus membrane, wounds , ulcers and un- the mucous membrane and submucous layer
broken skin. In preparation with camphor, of the stomach. But it makes the absorption
phenol is not absorbed through skin.
of the phenol easy and as such needs to be
After absorption phenol is found in blood excreted out quickly. 2. Demulcent drinks
in both free and combined form. It is detoxi- like milk, barley water or egg albumin should
fied in the liver and is mostly excreted be given. 3. For efficient excretion, I.V. infu-
through kidney as etheral sulphates and sion of fluid with sodium bicarbonate solu-
glycuronates (hydroquinone and pyrocate- tion may be given. 4. In case of respiratory
chol). A part is excreted through kidney un- distress, atropine sulphate and in case of cir-
changed and a part through the expired air, culatory collapse, I.V. fluid with vasoconstric-
also unchanged. tor are recommended.
Treatment Postmortem appearance
When spilled on the body surface, the area Externally, the contaminated areas of the skin
should be thoroughly washed with soap solu- may appear reddish (whitish discolouration
tion or with 25% alcoholic solU:tion. The area does not persist.for long), necrosed and some-
may then be treated with some vegetable oil time denuded and ulcerated. These changes
to wash the area again after some time with are note able at the expected sites like fingers ,
soap water. This way ~arbolic acid, from the angles of lllQ'\lth, lips, chin etc. The mucus
surface of the skin as well as the superficial membrane of mouth is,hyperaemic,.with desq-
layer of the tissue which has already absorbed uamation and haemorrhagic points. Though
it, can be removed. swollen, the surfaces are rather tough.

756 I PRINCIPLES O F FO RENS IC MEDICINE
Internally, the oesophagus in its whole Medicolegal aspects

length is reddish and is parchmentised, as if
Phenol was at a time a popular suicidal agent.
tanned. The stomach wall is tough and appears
Now-a-days also suicide with phenol is not
tanned. There is desquamation of the mucus
very rare.
membrane with presence of haemorrhagic
spots. The content is dark brown in colour and Accidental poisoning may occur -
smells like that of carbolic acid. There is pres- (a) when it is taken by mistake for some
ence of altered blood and necrosed mucus other liquid, e.g. a liquid purgative ; (b) when
membrane. Perforation does not occur due to taken by a child , as it is a common house-
the wall getting tough in consistency. Phenol hold disinfectant; (c) when absorbed through
passes through the wall of the stomach and skin from phenolic preparations for exter-
thus the surrounding structures may appear nal use ; (d) chronic intoxication may occur
necrosed with hardening and parchmenti- from inhalation of vapour from industrial
sation. Similar changes are noticed in the up- sources .
per part of the small intestine. There is cer- Homicidal use is not possible ordinarily
ebral oedema. The heart may appear flabby. due to its detectable smell. Unwanted new-
If death occurs after an hour or more then, born babies may be the homicidal victims.
degenerative changes become apparent in the
Phenol in dilution or mixed with some
liver and glomerulii and tubules of the kid-
other agent is pushed inside the uterus to
ney, in histological examination.
cause abortion.
Materials to be preserved during post-
mortem examination - Same as in case of
oxalic acid poisoning.
Preservative used - Saturated solution of
common salt . Alcohol or rectified spirit Physical properties
should not be used as they may mask the
Whitish, shining, scaly crystals, having bit-
detection of the poison. For histological ex-
ter-sour taste.
amination, liver and kidney tissue may be
preserved in formol saline solution. Source
Blood, when preserved, is so done with-
It is most frequently used, popular self-medi-
out use of any preservative.
cating agent.
Chemical test - With ferric chloride there
Available in house, chemists' shops and
is blue colouration of substance .
laboratories.
Chronic toxicity with phenol. This occurs
in industries where it is used or manufactured Absorption
and there is danger of it being inhaled by the
It is quickly absorbed through the mucus
workers for a prolonged period. There may be
respiratory trouble and in some, neurogenic membrane of the GI tract. Absorption is com-
signs-symptoms may develop. The permissi- plete by half an hour.
ble linlit of phenol in air in the industries is 5
Metabolism
ppm. Phenol in air can be recognised from its
smell at a concentration of0.05 ppm. In the body it is metabolised to salicylates.
Excretion In chronic users low fibrinogen level and

dilated vessels cause purpura like haemor-
Mostly through urine.
rhage.
Toxicity and toxic actions In sensitive (idiosyncratic) persons there
are vertigo, tinnitus, rashes, fever, blister
Aspirin or acetyl salicylic acid is twice as toxic
formation , angioneurotic oedema, urticaria.
as salicylates, thrice as toxic as methyl sali-
Very rarely there may be anaphylaxis-like
cylic acid but only half as toxic as salicyl sali-
reaction.
cylic acid.
Aspirin acts locally as an irritant. After Treatment
absorption it causes systemic acidosis . In 1. Stomach wash with magnesium oxide
chronic cases it causes haemorrhagic condi- solution
tions and toxic nephritis.
2. Increased fluid intake for rapid excretion
Fatal dose 3. Sodium bicarbonate by mouth or sodium
carbonate or lactate may be given intra-
5-15 gms. In persons idiosyncratic to aspirin,
venously
therapeutic dose has caused fatality.
4. Fruit juice by mouth helps to maintain
Fatal period potassium level
5. Pressure agents with I.V. fluid infusion
In case of idiosyncrasy, death may occur in
less than an hour period. In acute systemic 6. Stimulants like coffee drink or analeptic
poisoning the fatal period may extend up to a or oxygen inhalation may be necessary
few days. and helpful
7. Body heat is maintained by covering the
Clinical features body with blanket when temperature
falls
There are pain in the abdomen, nausea, vom-
iting, dinmess of vision, mental confusion, 8. Dialysis may be necessary when blood
tinitis. Respiration is first rapid (hyperpnoea), level of salicylate is 50 mgm% and above
then depressed. There is depression of CVS. 9. Cortisone lowers the blood level. It is
Temperature unaltered or raised due to in- specially helpful in case of idiosyncrasy.
creased metabolism, though it is antipyretic
when given in therapeutic dose in fever and Postmortem findings
though in some cases temperature may fall There is no mentionable external signs ex-
sharply. There is sweating. Urine is sup- cept some signs of asphyxia when death oc-
pressed with more uric acid excretion. Vita- curs due to that. But in case of idiosyncrasy,
min C and potassium excretion in urine is there may be signs of rash formation and blis-
also increased. There are haematuria and tering. In some, there may be signs of pur-
malena. There is fibrinogen depression to pura like haemorrhages. Internally, the stom-
50% of normal. ach mucus membrane is highly congested with
Respiratory depression starts at 50 presence of haemorrhagic points. Stomach
mgm% of blood level. ~0 mgm% blood level contains altered blood and is strongly acidic.
is lethal. The upper part of small intestine may be

slightly hyperaemic. There is parchmentized It has suicidal use, mostly in women, but
appearance of peritoneum. There is haemor- suicidal attempts with this mostly fails, due
rhage at the subserous levels of the organs. to excessive vomiting.
Kidneys are swollen, congested, haemor-
rhagic with nephrotic changes . There may
be haemorrhage in the substance of other ACETIC ACtO
organs too. When death occurs due to nar-
cotic effect then the organs are congested. Physical properties
Materials to be preserved during PM Colourless, volatile liquid having a peculiar

examination smell and burning sour taste.
Stomach with content and a loop of small Signs and Symptoms

intestine in one container; Liver and kidney
Concentrated (100%) acetic acid is known as
in another container and blood in a third one.
glacial acetic acid. It is extremely corrosive
Preservative used - Satvrated solution of to the mucus membrane and when taken by
common salt for preservation of organs. No mouth, there is corrosion of mucous mem-
preservative for preservation ofblood is used. brane of the mouth, tongue, oesophagus and
Chemical test - With aspirin ferric chlo- stomach. There is pain in the throat and ab-
ride turns deep purple in colour. domen. There is vomiting and the vomitus
contains blood and mucus shreds. Inhalation
Medicolegal aspects of the vomitus or leakage of the acid in the
larynx may cause respiratory distress and
Its use is mostly accidental, by way of- over-
there may be pulmonary oedema. There may
dose in children, poisoning in children when
be loose motion and malena.
they take it unknowingly, and therapeutic
dose causing sensitive reaction in both chil- Vinegar is 4 - 6% of acetic acid and is not
dren and adult. Prolonged therapeutic use corrosive in nature.
also causes toxicity. Acetic anhydride when mixed with wa-
ter forms acetic acid. Acetic anhydride as it-
self is highly corrosive.
Fatal dose and fatal period
Uncertain. Fatality is uncommon.
Treatment
1. Stomach wash
2. Demulcent drink
3. Safeguarding respiration, when neces-
sary by oxygen inhalation.
Postmortal!' findings
"') (
Fig . 29. 12: Submucosal haemor-rhage in a case of 1. Signs or~<i'~si6n inside the mouth and
death due to aspirin , ,
oesophagus.

2. Stomach wall - soft , MM - corroded with Physical properties

desquamation and haemorrhagic points,
Anhydrous ammonia is available as gas or
contains altered blood with mucus shreds.
liquid . Ammonium hydroxide is a liquid. Oth-
Smell of acetic acid detectable.
ers are available in solid form or as liquid in
3. Signs of irritation in the upper part of solution with water. They are hygroscopic .
small intestine . Anhydrous ammonia and ammonium hydrox-
4. Inflammation of the upper respiratory ide have a detectable ammoniacal smell, oth-
tract and congestion and oedema of the ers are odourless. They have burning irritat-
lungs if there is inhalation of the vomi- ing taste .
tus or leakage of the acid in the respira-
tory tract. Action
Medicolegal aspects They irritate the skin and corrodes the mu-
cus membrane . They liquefY the tissue and
Mostly accidental in children or in adults draw water from the tissue . Vapours of am-
when it is taken by mis~ake for some other monia when inhaled causes respiratory dis-
substance. tress .
Suicidal attempts occur. But death is not
Signs-symptoms (general and common to
certain.
all corrosive alkalies)
Homicidal use is difficult due to its de-
tectable smell. When ingested, they cause burning heat sen-
sation in mouth, throat, and abdomen. There
is vomiting and the vomitus contains altered
blood and gastric mucosa. The vomitus is al-
kaline in reaction. The mucus membrane of
the mouth and the tongue is soft, swollen ,
Strong alkalies are mild to moderately corro-
bleached , translucent, bogy in appearance ,
sive . Of the alkaline agents, the followings
but often it is reddish brown in appearance
have corrosive actions of medicolegal signifi-
due to haemorrhage. There is liquid motion
cance.
and the stool may contain blood and exces-
Anhydrous ammonia, aqueous ammonia sive mucus . Death may occur due to shock .
(ammonium hydroxide) , ammonium carbon- If there is inhalation of the vomitus , then
ate , sodium hydroxide , sodium carbonate , death may occur due to respiratory distress .
potassium hydroxide , potassium carbonate ,
With ANHYDROUS AMMONIA, there
calcium hydroxide .
may be irritation of the eye and with pro-
Sources longed exposure there may be permanent
damage of the eye . 5,000 ppm. in air may
Industries , laboratories . cause laryngeal oedema and spasm and rapid
death . Liquid ammonia causes chemical burn
Uses ofthe skin.
They are used as chemicals , as bleaching With ingestion of AMMONIUM HY-
agents , in medicine , and in different indus- DROXIDE , there are signs and symptoms of
tries . severe_irrit'ation of upper GI tract including

the stomach, as described in general signs Medicolegal aspects

and symptoms due to corrosive alkalies .
Death may occur, preceded by respiratory Mostly accidental, due tooccasional acciden-
distress, convulsion and shock. tal ingestion, mostly in children and by mis-
take for a medicine in adult. Leakage of am-
Ingestion of 3 - 5 ml. of concentrated so-
monia vapour in industries may cause fatal
lution of ammonium hydroxide may be fatal
accident due to inhalation.
and vapour in a concentration of 5,000 ppm.
may be fatal within a short period. Suicide is rare. Homicide is very very rare.
SODIUM HYDROXIDE solution causes May be used to cause injury by throwing on
extreme irritation of the skin with necrosis the body or eyes of an enemy, to. take re-
of the superficial layer. When ingested, same venge, to give "punishment".
painful signs of irritation will be there in the
mouth, oesophagus and stomach with vomit-
ing, followed by collapse, shock and death. In
some cases where the victim survives the G. I.
tract episode, he may die after lapse of some
For references, refer to Page 742.
days due to respiratory tract involvement due
to inhalation of vomitus. Death may occur • Michael J Skrun and Davidson A Ramsay- Pathol-
due to ingestion of 5-10 ml of concentrated ogy of Trauma- 2006.
solution of sodium hydroxide. • WG Aitchison Robertson -Aids to Forensic Medicine
-2008.
Treatment
Emesis is not recommended. Stomach wash

is also not done. Treatment should be given
in the following lines -
Long questions
1. Weak organic acid of vegetable origin
like weak solution of vinegar, citric acid Signs, Symptoms, Treatment, Postmortem changes
is given at short intervals, in dilute form and Medicolegal aspects of carbolic and oxalic acid
and in small doses in each time. poisoning.
2. Demulcent drinks to protect the stom- Short notes
ach wall.
Vitriolage, Carbolism, Carbolurea.
3. Sedation, if pain is unbearable and if
there is convulsion. Oral questions
4. Supportive treatment for respiration and Sources, Signs, Symptoms, Uses, Fatal dose and
to combat shock when these become nec- period, Cause of death, Treatment, PM findings, Cir-
essary. cumstances of poisoning in cases of H2S0 4, HCI, HN03,
Oxalic acid, Carbolic acid, Acetic acid, Aspirin.
Tests
Features and treatment of corrosive alkali poisoning .
Carbonate alkalies produce white precipitate Appearance of teeth in sulphuric acid poisoning.
with mineral acids. Appearance of stomach in H2S0 4, HN0 3, Oxalic acid,
Hydroxides produce yellow precipitate Carbolic acid poisoning, Pupils in case of carbolic acid
with silver nitrate. poisoning

! IRRITANTS I
t
t t t t
Mechanical Chemical Vegetable Animal
Glass powder, diamond Seeds of castor, croton, Venoms of snakes;
powder, fine stone chips, abrus, semicarpus, scorpion, bee, wasp;
chopped hair capsicum, ergot, different toxic fishes, cantharides,
parts of calotropis, caterpillars etc.
plumbago etc.
t
Inorganic non-metals,
weak acids and alkalies
•
Inorganic metals, salts of
mercury, arsenic, lead,
Synthetic organicc~emicals, weak
solutions of organic acids, halogenated
phosphorus, halogens copper, iron, zinc, barium hydrocarbons, organic polyphosphates,
thallium, potassium etc. D.N.C., Phenolic derivatives, organic
derivatives of arsenic etc.
IRRITANTS may have only local irritating powder and pointed metallic chips may be of
action on the tissue with which they come in real danger in most cases. (See next page).
contact or they may have both local irrita-
ting action and remote systemic toxic action GLASS POWDER OR BROKEN PIECES
after they are absorbed. The sh arp margins or the pointed ends of
broken pieces of glass may no doubt cause
MECHANICAL IRRITANTS injury of and haemorrhage in the GI tract ,
~
when swallowed. Butfortunately they do not
The efficacy of mechanical irritants as fatal usually get adhered at the wall of the GI tract,
agents are questionable though from ancient and rather pass out the whole length of the
period these have been incuse to terminate tract by perist altic movement , longitudinally
life of an enemy, a rival or a11- unwanted per- in relation to the length of the intestines.
son. Of all the mechanical irritants, diamond Their ingestion may cause psychological up-
'
. 761
762 I PRINCIPLES OF FORENSIC MEDIC INE
set but perforation , peritonitis or even seri- Medicolegal aspeds

ous injury to the intestinal tract is not usual .
Its use is rare and whenever used, it is used
They may of course cause some haemorrhage.
to cause ill-health to others.
If death occurs in any case, then it occurs
due to injury and internal haemorrhage . STONE PIECES
Treatment Minute stone pieces may cause GI tract dis-
Bulky food for easy passage of the glass turbances , only mildly and is not expected to
pieces. cause any alarming signs and symptoms. No
fatality is expected. May be given mixed with
PM findings food to cause ill-health to others.
Ifdeath occurs , the PM findings will depend DIAMOND DUST
on the extent of the injury and amount of
haemorrhage and the site of the GI tract af- Powdered diamond may be really hannful and
fected. Peritonitis is uncommon. Signs of may even be fatal. The minute spikes of the
anaemia , intestinal haemorrhage and inflam- powdered diamond may get stuck to the in-
mation are more common. testinal wall , get impregnated and then per-
forate through the wall leading to pain in
Medicolegal aspeds abdomen, haemorrhage, inflammation of the
Ingestion is usually accidental, either with intestine and peritonitis .
jam, jelly, butter or drinking beverages, the Treatment
contamination occurring from the broken
pieces of their glass containers . Show-men Within short period after ingestion bulky
after swallowing glass pieces occasionally face food , demulcent drinks and colonic lavage
trouble. may be useful. In long duration cases no defi-
nite treatment is recommended.
For homicidal purpose glass powder used
to be in frequent use, mixed with food or Postmortem findings
drink. Usually, though given for over a long
period for the expected "slow poisoning ef- Evidence of haemorrhage , inflammation of
fect ", the victims withstand the exposure, the intestine and peritonitis will be there
depending on the period of survival after in-
most of the time even without any alarming
gestion.
sign and many of such victims are killed sub-
sequently by some other means. Medicolegal Aspeds
CHOPPED HAIR Diamond is a wellknown mechanical irritant

which was in use more in ancient days . It
Pieces of chopped hair may be given mixed may be used for homicidal purposes either in
with food which when ingested may cause a single dose or repeatedly in minute doses
irritation of the stomach and the intestine. for causing slow poisoning. It can also be used
Chopped hair particles may get stuck on the with suicidal intent. But it does not cause rapid
wall of the stomach and the intestine and may death. Death occurs after a prolonged suffer-
continue to irritate . The walls may be in- ing . Occasional accidental sufferers are the
flamed with pain and gastro-intestinal distur- diamond cutters , who inspite of being cau-
bances. But chance of fatality is not there . tious may ingest invisible particles, unaware.

chapter 30: IRRITANTS: MECHANICAL & NON-METALLI C INORGANIC & SOME ORGANIC CHE MICAL I 763
SPIKY METALLIC PIECES White phosphorus is used in a good many

industries. It was previously used in the
Minute pieces do not pose much problem.
match stick heads, which is banned nowa-
Sharpness of the spikes reduce in the GI tract
days. It is also used in fireworks, as a rat-
often due to the action of the digestive chemi- killing agent. Due to its inflammability it is
cals. Bigger pieces like nails or open safety kept submerged under water.
pins may need surgical intervention.
Adion
Medicolegal Aspeds
It is chemically very active and destroys the
Mostly accidental. Children or "magicians" tissue with which it comes in contact. It is a
who publicly demonstrate chewing and swal- protoplasmic poison and causes fatty infiltra-
lowing of shaving blades etc. are the usual tion and necrosis of liver, kidney and other
victims. organs.
Fatal dose
50-100 mgm of white phosphorus may be fa-

CORROSIVE ACIDS AND ALKALIES, when tal. With higher dose rate of fatality increases.
taken in dilute form, act as irritating agents. With 0.5 gm dose, chance of fatality is 15%
Apart from these agents there are cer- and with 1.5 gm dose it is about 95%.
tain non-metallic and metallic inorganic and
Fatal period
organic irritants. These are not purely locally
acting agents. 'l'hey also have remote action With very high dose, death may occur in a
to distant organs or systems after absorption. few hours due to cardio-vascular failure. With
In this group, white phosphorus and halo- moderately high dose death may occur quite
gens have been considered in this chapter. early, i.e., by about 12 hours. But in acute
poisoning low fatal dose death occurs between
5th and 7th days.
Signs and symptoms
White phosphorus is available in the form of Necrosis of the epidermis may occur, after a
waxy cylinders, whitish or yellowish in col- day or two of its contact with the skin for a
our, has a garlic smell, ignites above 30°C while. When dry white phosphorus ignites in
when exposed to air, melts at 44oc, luminesce hand or in the pocket, the area is burned and
in dark, almost insoluble in water and 'Yhen ulcerates which heals slowly and is vety much
left in air at a low temperature it crumbles painful.
into pieces. It is absorbed from the intestine When taken by mouth, there is burning
and, for its absorption, fat or bile is neces- pain in' tlie mouth and throat. There is in-
sary. Absorption is slow but.~teaq.y. ,I t is highly tense thirst: Depending on the stomach con-
toxic. tent the gross signs and symptoms of irrita-
It has a red isotope. This variety is dark tion· stifri 'betWeen 1/2 to 6· hours.-There is
red in colour, odourless powder.,' insoluble in vomitingland -the vbmitus is dark red in col-
water, inert, non-toxic, non-fuming and non- outj' has · ~arliCJiike smell and luminesce in
luminous. .:: n ~·o'j~f·' dark. There is pain all · over the · abdomen.

Diarrhoea is more common. Stool is dark in Vitamins and intravenous glucose for
colour, has garlic-like smell and luminesce protection of liver.
in dark. These signs and symptoms persist Restriction offatty diet and provision of
for a day or two and then subsides for 2 or 3 carbohydrate and protein rich diet.
clays . After this period of apparent well-be-
ing, si111s ofliver and kidney damage appear Absolute rest and constant watch for some
alongwith increased GI tract disturbance . By days.
now jaundice appears. Urine is scanty, dark Symptomatic treatment as is required in
in colour, contains blood , albumin, bile salt the acute stage, like treatment for circula-
and sometimes, sugar. There is bleeding from tory collapse , convulsion or delirium.
the nose and in the skin, in the internal tis-
sue, ~ and .in all organs (actually in the Postmortem findings
under surface of all serous membranes). Externally, there is emaciated appearance of
There may be restlessness , delirium, convul- the body with presence of purpuric haemor-
sion and toxic psychosis. rhages in the skin. Mucus membrane of the
mouth is eroded. Gums are swollen with pres-
Absorption metabolism and elimination
1
ence of bleeding points.
Phosphorus is absorbed through mucus mem- Internally, the stomach wall is swollen
brane . It is absorbed quickly from the empty and soft. Mucus membrane is eroded, desq-
stomach and when the stomach contains fatty uamated with presence of haemorrhagic ar-
food . After absorption it is distributed to all eas. The con tent is dark brownish in colour.
organs where it is retained and metabolised, If death has occurred within 12 - 24 hours,
over a period of some days, to hypophosphate , then the stomach content will give a garlicky
which is excreted through urine . A small part smell and will be luminous in dark. The mu-
is excreted unchanged through faeces and cus membrane of the whole length may show
expired air. haemorrhagic patches with areas of desqua-
mation. The liver which was at first swollen
Treatment and soft, reduces in size , is soft, friable and
greasy. In the first phase there is cloudy
For external lesions , the part should be im- swelling change histologically. Then there is
mediately covered or wrapped with wet cloth fatty infiltration. This first occurs around the
to be followed by application ofbland or anti- centri-lobularveins and then extends towards
biotic ointment. the portal canal at the periphery. There is
For ingested poison , emetics or stomach tubular degeneration in the kidney. The or-
wash with 0.1% solution of copper sulphate gans show haemorrhages on their surface and
is useful which acts as chemical antidote by in the substances.
forming copper phosphide. Alternatively, the
stomach may be washed with 0.02% solution CHRONIC PHOSPHORUS POISONING
ofKMn0 4 which acts as an oxidising agent.
Chronic poisoning with phosphorus occurs
· Non-fatty purgatives should be used for due to inhalation of phosphorus vapour in
a few days for elimination of phosphorus from factories , those who in their profession h an -
the intestine which is excreted in the intes- dle preparations containing phosphorus and
tine up to a few days after poisoning. Milk of from consumption of sea-fish containing high
magnesia may be useful. quantity of phosphorus.

chapter 30: IRRITANTS : MECHANICAL & ['JON-METALLIC INORGANIC & SOME ORGAN IC CHEMICA_ 766
death occurs early and hence high dose

of white phosphorus may be taken with
suicidal intent.
3. It is also not a poison of choice to be used
with homicidal intent, due to its detect-
able smell, alarming and typical signs
and symptoms and detectability from ex-
creta and tissue . However, mixed with
food or drinks it has been used to kill
oth ers.
4. Accidental poisoning occurs due to con-
Fig . 30 .1: Bleeding from the mouth in a case of
phosphorous poisoning sumption of rat poison containing phos-
phorus, more commonly in children or
as contamination of food, in any. Chronic
Signs and symptoms .
poisoning may occur from industrial
There are GI tract disturbances, cirrhosis of sources. Accidental poisoning was more
liver with accompanying manifestations like common in children in the past due to its
jaundice, asci tis, spider varicosity of the abuse in the treatment of rickets and in the
domen and other varicosities, oedema of match-stick head; chewing the match-
limbs, muscular weakness and cramps, and stick head used to cause poisoning in chil-
necrosis of mandible with sequestration and dren. These uses of phosphorus are
discharge of foul smelling pus by sinus for- banned now-a -days.
mation. The necrotic change in the mandi- 5. It is used for creating smoke screen, par-
ble is observed in about 3% of industrial work- ticularly in warfield, which can cause poi-
ers who are exposed to vapours of phospho- soning.
rus for a long period. The condition is termed
6. Other criminal uses -
as PHOSSY JAW.
(a) For causing arson without being sus-
Treatment of chronic phosphorus poison- pected, it is used in wet cow-dung or
ing consists of (a) To avoid further exposure wrapped in wet cloth and placed the
or intake, (b) Maintenance of oral hygiene, same in the thatched roof of the
(c) Supportive treatment to protect liver and house in the village side. After the
prevent intercurrent infection by providing operation, the miscreant leaves the
nourishing food. village. When the dung or the cloth
dries, phosphorus ignites and causes
Medicolegal aspects
outbreak of fire. The miscreant be-
1. Red phosphorus is insoluble and non- ing absent in the village escapes ap-
toxic. prehension.
2. White phosphorus is not preferred by (b) To destroy undesired letters which
suicides because of the painful symptoms has been posted, white phosphorus
and comparatively prolonged suffering it may be used in the. same manner in-
causes. In fulminating dose however, side the letter box.
micidal. When comes in contact with mucous

membrane it causes irritation which liber-
ates water from membrane to form hydrochlo-
ric acid .
Chlorine , Fluorine , Bromine and Iodine are
very irritable to the GI tract and the respira- Chief uses
tory tract . With water from the mucus mem-
brane the halogens form acids or bases . (~0 2 As a disinfectant, cleaning and bleaching
and 0 3 also act locally by causing liberation agent. Has wide use in factories and in labo-
of nascent oxygen which is very much active ratories .
chemically- See page 770).
Signs and symptoms
With chlorine and other halogens thus,
the effect is same as to spraying the mucus Inhalation causes irritation to the respiratory
membrane with HCl or the respective acid . tract, serious coughing, respiratory distress,
The result is intense pain , coughing, capil- laryngeal spasm, bronchospasm, pulmonary
lary engorgement and congestive. oedema , oedema and secondary pneumonia. Fume or
and the danger is massive irreversible pul- vapour causes irritation to the eye. When
monary oedema when the gas is inhaled . In chlorinated water is swallowed it causes ab-
such a circumstance only a few whiffs may dominal pain, nausea, vomiting, purgation
cause cessation of breathing through reflex and circulat(•; ' collapse.
mechanism causing rapid suffocation and
none of the direct irritating changes may Fatal dose and fatal period
develop. Secondary oedema may develop in
some cases, if the patient survives the acute Exposure to 1 : 1,000 atmospheric concen-
tration will be fatal in 5 minutes .
episode.
It was used as first chemical warfare
agent during 1st World War.
Treatment
Elemental chlorine is not available in nature.
1. Removal from the vitiated atmosphere
Physical properties 2. Oxygen inhalation, if necessary under
pressure
A greenish-yellow irritating gas with a pun-
3. Hypertonic solution of glucose to reduce
gent odour can be liquefied under pressure
pulmonary oedema
at20°C .
4. Antibiotic cover to prevent pulmonary
Chemical property infection
5. Absolute rest to reduce oxygen necessity.
It is a chemically active . Chlorine and hydro-
gen do not react in dark and low tempera- PM findings
ture. But in presence of light there is explo-
sive reaction forming hydrochloride which is Signs of asphyxia, inflammation of the respi-
gas. Chlorine is not a self combustible gas, but ratory tract and pulmonary oedema when
it helps combustic;m,, In higla ·cone. in·w.ater- it inhaled. Inflammation ofupperGI tract when
is a bleaching agent .and in low _cop.c;·W:i.s_ger- : solution: i_s~~?Ug~e-.1 .

chapter 30: IRRITANTS: MECHANICAL & NON-METALLIC INORGANIC & SOME ORGANIC CHEMICAL I 767
occur due to respiratory failure or sometimes

circulatory collapse.
Fluorine in low concentration causes
Physical and Chemical Properties
chemical burn of the skin. Explosion ofhigh
Fluorine is pale yellow or greenish yellow concentration of fluorine causes deep ther-
irritating gas with sharp, penetrating, char- mal burn type of lesion on the skin.
acteristic diagreeable odour. Chemically, it
is the most reactive element among the non- Fatal dose and fatal period
metals. Its boiling temperature (i.e., temp. 150-800 ppm concentration in air may lead
ofliquefaction) is - 188.13°C and solidifies be- to death within some minutes .
low- 219°C. Combines with most compounds
to form stable fluorides. Treatment
Uses For respiratory irritation, the treatment

should be as in case of exposure to chlorine
In industries, laboratories. Na,fluoride is used gas.
as a rodenticidal agent.
For skin lesions
Signs and symptoms
The area is thoroughly washed with water
It is strong respiratory tract irritant and and then compressed with ice cold saturated
causes asphyxia by way of irritation, solution of magnesium sulphate or iced 70%
oversecretion, laryngeal and bronchial spasm alcohol or iced aqueous or alcoholic solution
and pulmonary oedema Inhalation also of hyamine to be followed by fresh prepara-
causes indirect GI tract symptoms like nau- tion of magnesium oxide and glycerine. For
sea and vomiting There are tetanic spasm, irritation of the eyes, they should be continu-
myocardial failure and collapse. Death may ously washed with water for 10-15 minutes.
Fig. 30 .2: Chronic fluoride poisoning in an endemic area. Whole family

involved-Look for the bony changes

Postmortem findings are same as in case of chlorine (Page 766).

Inhalation of vapour causes suffocation . Liq-
Rigor mortis comes early. The body is well- uid bromine when comes in contact with skin
preserved. Mucosal structure is well-pre-
may cause damage to the skin and ulcer.
served except at the places of contact . There Healing of ulcer caused by bromine is very
may be fatty changes in the liver and there slow .
may be single-fibre necrosis in the myocar-
dium . Chronic exposure causes bromoderma
(skin lesion ) and psychosis .
Chronic exposure to fluorine gas
(Fluorosis)
1 ml of the liquid may be fatal. Death may
In case of chronic or repeated exposure over
occur within some hours. 1,000 ppm. of the
a long period there is mottling of teeth , den-
vapour in air may be fatal within some min-
sity and weight of the bones increase ; there
utes.
is lipping of the bony margint> . Lipping of the
bony margins of the vertebral canal causes Treatment
pressure on the spinal cord with resultant
effect like,paraplegia . For inhalation, same as in case of chlorine
gas. For skin lesion , washing of the part with
weak solution of sodium bicarbonate salt and
BROMfNE use of antiseptic cream or ointment to avoid
infection in case of ulceration. When swal-
Bromine is widely distributed in nature. In lowed , washing of the stomach with weak non-
industries and in laboratories the vapour of carbonate alkaline solution and demulcent
bromine figures prominently. drinks.
Postmortem findings
Physical properties
It is dark reddish brown liquid . It solidifies Signs of asphyxia and irritation of respira-
below- 7.2°C and boils at 58.8°C. It vapor- tory tract and pulmonary oedema . When
ises at room temperature. It is slightly solu- swallowed , signs of irritation, desquamation,
haemorrhage of the mucus membrane of the
ble in water.
stomach with swelling and softening of the
Chemical properties thickness of the stomach wall.
Chemically it is very similar to chlorine . It

reacts with water forming hydrobromic acid. IODINE
Signs and symptoms

Physical properties
Vapour of bromine may be inhaled or the liq-
uid form may be swallowed. With water from Iodine is bluish black , soft, scaly crystals with
the mucus membrane bromine forms hydro- metallic lustre . It ha~ pungent odour and
bromic acid which irritates the mucus mem- taste . It gives brownish violet vapour at all
brane strongly. Irritating signs and symptoms temperatures .

chapter 30: IRRITANTS: MECHANICAL & NON-METALLIC INORGANIC & SOME ORGANIC CHEMICAL I 769
It has uses in laboratories , in photogra- PM findings

phy, in medicine (as a diagnostic agent or for
Mucosa is yellowish , brownish, leathery, con-
its antiseptic action).
gested, inflamed, and excoriated. Heart, liver
It is available as pure iodine ; iodide of and kidneys show fatty degeneration . Brain
potassium, mercury, iron and sodium and rais oedematous.
dioactive iodine (for diagnostic medical use).
Signs and symptoms

Poisoning in general causes intense pain and
swelling of the parotid glands . There is in-
tense gastritis, severe pain in abdomen and
collapse. There may be haemorrhagic nephri-
tis.
It is a colourless gas with slight pungent
IODISM odour which can be preserved as liquid un-
der pressure .
In chronic exposure , there is skin lesions ,
Phosgene is formed by oxidation of chlo-
either vesicular or fungal in appearance; io-
rinated carbons like chloroform, carbon tet-
dine asthma, iodine rhinitis , cachexia, ema-
rachloride or chlorinated hydrocarbons, by
ciation and mental depression. Organa-iodine
heating in air or exposing to sunlight. It is
derivatives are used in contrast radiography
also produced by combination of CO and chlo-
and their use may cause anaphylaxis , der-
rine in presence of a catalyst.
matitis, asthma, rhinitis, chill, fever and hemi-
plegia. Phosgene is not only respiratory tract
irritant, it also penetrates into the tissue
Radioactive iodine when used in the treat-
across the mucus membrane. WitlYwa~
ment of goitre may cause malignant change
from the tissue it produces HCl and C02 .
in the thyroid and leukaemia.
It was used as a gas poison in 1st World
Fatal dose War. Now its use is mostly in the labora-
tory or chemical industry for preparation of
2- 3 gms. when swallowed.
carbonic esters, poly urethane and isocya-
Fatal period nates.
Uncertain. Signs and symptoms

Sneezing, coughing, dyspnoea, suffocation,
Treatment
pain in the chest , cyanosis , pulmonary
In acute cases, the stomach is evacuated ei- oedema, lacrimation. The action is like that
ther by emetics or by wash with warm water ofHCl sprayed over the respiratory tract, as
containing starch, egg-albumin and 5% solu- phosgene is hydrolysed to HCl and C02 . The
tion of sodium thiosulphate , weak alkalies , onset of the acute symptoms may be delayed.
barley water. For allergic symptom - adrena- Death occurs early due to respiratory failure
line and antihistaminics. Rest of the treat- and later due to pulmonary oedema or pneu-
ment is symptomatic. monia.
fl= ~~ - L!Ql
\
Fatal dose and Fatal period ing with blood tinged frothy sputum, vomit-
ing, thirst, methaemoglobinemia, cyanosis,
More than 62 ppm in air may be fatal. With
pulmonary oedema and acidosis. On recov-
higher concentration death may occur within
ery there may be pneumonia.
a few minutes. In low concentration death
may occur within 48 hours. Complete recov- Fatal dose and fatal period
ery may take a few weeks to a few months.
At 1,000 to 1,200 ppm death may occur in a 250 - 500 ppm in air may cause death in a few
few minutes. minutes. Lower concentration may cause
death within several hours.
Cause of death
Treatment
Pulmonary oedema or subsequent pneumo-
nia. As in case of chlorine gas poisoning.
Treatment PM findings
1. Removal of the patient from the at:rpos- Congestion, desquamation and oedema of the
phere. mucosa of the respiratory tract. Lungs are
2. Oxygen inhalation. oedematous and haemorrhagic. Liver and
3. Artificial respiration. kidneys are congested and show cloudy swell-
ing. Blood is thick, acidic and fluid.
4. Antibiotic cover.
Postmortem findings
The mucus membrane of the respiratory tract

is congested, oedematous and desquamated. Ozone is naturally produced due to UV light
Lungs are oedematous . Signs of asphyxia acting on oxygen. Both 0 3 and H 2 0 2 liberate
signs of irritation and petechial haemorrhage free and nascent oxygen and cause irritation,
at the under-surface of pleura present. increased respiratory rate with decreased
tidal volume. There is sense of oppression in
chest, increased pulse rate, laboured respi-
ration, headache and drowsiness. There is
pulmonary oedema.
Treatment
Rest, 0 2 inhalation, symptomatic.

N02 or N2 0 4 is strong respiratory tract irri-
tant. Produced when nitric acid is used as an
oxidizing agent. Cigarette smoke contains 100
ppmofN02.
Hydrazine is irrit&nH o-the skin and mucus
Signs and symptoms
membrane and .caus;e.s:inflammation, vesicle
Inhalation of the gas causes dyspnoea, cough- foi-mation and necrosis of the tissue of con-

chapter 30: IRRITANTS : MECHANICAL & NON-METALLIC INO RGANIC & SOME ORGANIC CHEMICAL I 771
tact. On inhalation it causes pneumonitis. ated salicylanilide which may cause photo-
Chronic exposure causes anorexia, loss of sensitive dermatitis.
weight, weakness, tremor and convulsion.
There may be damage to the liver and kid- Treatment
neys. Hydrazine and its metabolic products
For ingestion, nothing more than demulcent
are excreted in urine.
drinks may be necessary. For photosensitive
Treatment - Pyridoxine hydrochloride is dermatitis, withdrawal of use of particular
considered helpful in the dose of 25 mgm per variety of soap is sufficient.
kg body weight. Other treatment consists of Detergents may contain alkyl sodium
use of demulcents, soothing agents and symp- sulphates, alkyl or aryl quaternary ammo-
tomatic treatment. nium compounds, alkyl or aryl polyether sul-
phates etc. These are mild to moderately
toxic. Detergent granules in addition contains
SULPHUR DIOXIDE
carbonates, silicates and polyphosphates.
These substances cause irritation of the skin.
Liquid sulphur dioxide is corrosive in nature.
VapourofS0 2 is strong irritant which when Treatment
inhaled causes pulmonary oedema and severe
dyspnoea. When swallowed, use of demulcent drink. For
skin irritation, use of bland ointment or oil.
Exposure to 400 ppm for a few minutes is

fatal. It has detectable smell.
Smoke may contain a wide range of irritat-
Treatment
ing gas including acids. These substances and
1. Removal of the patient to fresh air the heat in the smoke may cause irritation
2. Artificial respiration and oxygen inhala- to the respiratory tract and may also cause
systemic toxicity (e.g. due to CO and C02 ).
tion
3. Treatment for pulmonary oedema Treatment varies according to the nature
of the smoke and symptoms.
M.L.I. - Poisoning is accidental.
See also page 906, Chapter 40.
SOAPS AND DETERGENTS For references, refer to Page 742.

Soaps are sodium, potassium, magnesium or ogy of Trauma- 2006.
calcium salts of fatty acids. These are not very • Pekka Saukko and Bernard Knight- Knights Forensic
toxic. When large amount is ingested they Pathology- 2004.
may cause GI tract irritation and vomiting • En gene J. Olejos and Woodhall Stopford - Riod Con-
and diarrhoea. Some soaps contain halogen- trol Agents- 2004.

phorus, Liver and urine in case of phosphorus poison-

ing.
Long questions Oral questions

What are mechanical irritants? What do they cause?
Signs symptoms, Treatment, Postmortem appear-
How white phosphorus is used to cause arson? Fatal
ance in case of white phosphorus poisoning.
dose of white phosphorus, Urine in phosphorus poi-
Short notes soning, Criminal uses of white phosphorus. What is
Phossy Jaw, Difference between white and red phos- iodism ? What does chlorine cause ?
NOTES

Though metallic poisons have been classified formerly thought to be non-poisonous, as it
in this book as irritants, apart from irrita- is not soluble in the digestive juice. But pure
tion many metals have remote systemic tox- arsenic dust is now believed to have toxicity.
icity.
Toxic compounds of arsenic and their
sources and uses
ARSENIC Different compounds of arsenic have wide
range of uses. They are used as insecticide,
Many of the Arsenical compounds are highly weedkiller, rodenticide, in flypaper, for sheep
toxic substances . Pure metallic arsenic was dip, as fruit spray, in medicine, as depilatory,
colouring agent, and in industries. Apart from
these , its other sources are soil, water,
seafish, tobacco, beer etc.
White arsenic (commonly termed as ar-
senic) is chemically arsenious oxide or arsenic
trioxide - As 2 0 3 . It is highly toxic. This and
potassium arsenite were once used as medi-
cine for intermittent fever as liquor
arsenicalis or Fowler's solution. Later it was
used as a general "tonic". Its high degree of
toxicity and homicidal use have imposed re-
striction on its availability.
Fig. 31.1: From left to right Arsine (AsH 3 ) or arsenic hydride or
Top row: Aspirin , oxalic acid , mercuric chloride, lead arsenuretted hydrogen is a highly toxic gas .
carbonate
Middle row: White arsenic, KMn0 4 , yellow sulphide of It is an industrial poison.
arsenic, Lead monoxide
Scheele's green (copper arsenite ) and
Bottom row: 1st sample- Colour totally distorted. Other
copper sulphate crystal (partly Paris green (copper aceto-arsenite) were once
discoloured) , Lead tetraoxide , Mercuric used as colouring agent for various sub-
sulphide
stances including confectionery.
Parvej 773
Orpiment (arsenic trisulphide ) and real- dice develops. Haemolysis leads to anaemia.
gar (arsenic bisulphide ) were used as depila- Death may be preceded by anuria, uraemia
tory (hair remover), colouring pigment and and convulsion.
in flypaper.
Treatment
Organic compounds of arsenic like ar-
sphenamine, tryparsamide, acetarsone, car- Dimercaptopropyl ethyl ether is the antidote.
barsone, stoversol also had medicinal use . Other treatments consist ofblood transfusion
Among the natural sources of arsenic, in severe anaemia cases, and symptomatic
soil, water, some sea fish are mentionable. treatment.
High arsenic content of soil and subsoil wa-
P. M. findings
ter of some places are the cause of endemic
toxicity. Among the seafish, arsenic is present (1) Signs of anaemia (2) If death is delayed
in some fish, shellfish and crustaceans. Ar- for a few days then, signs of jaundice with
senic concentration of some oysters is about fatty degeneration and focal necrosis ofliver
3 -10 ppm. or even more. Arsenic content of tissue. Kidneys show tubular degeneration.
mussels and prawns may exceed 100 and 150 There ~ay be bronzed pigmentation of the
ppm., respectively. skin.
Tobacco smoke contains arsenic. Smoke
Medicolegal aspects
of cigars may contain arsenic up to 10 ppm.
and that of cigarette up to 50 ppm. A greater Accidental poisoning occurs from industrial
part of arsenic remains in the ash and butt. sources. Fatal exposure has been reported
Trace of arsenic may be found in beer as from inhalation of the gas produced inside
impurity from iron pyrites used in the com- the container of the stored sea fish scrap .
mercial preparation ofbeer.
WHITE ARSENIC, ARSENIOUS OXIDE OR
ARSENIC TRIOXIDE (As2 0 3 )
A colourless gas formed by the action of nas- Physical properties

cent hydrogen on arsenic emitting a garlic-
like smell. It is produced when an acid reacts Arsenious oxide is available as white amor-
with.an arsenical compound. It is highly toxic phous powder or white porcelain like mass .
(250 ppm. in air is toxic). White arsenic is odourless and tasteless. It
is only sparingly soluble in water. The pow-
Action and signs and symptoms - It der though 3t times heavier than water floats
causes haemolysis and damages liver and on the surface of the water. It is compara-
kidneys . It also depresses central nervous tively more soluble in hot water or drink. But
system. on cooling, the powder deposits at the bot-
Signs and symptoms do not appear im- tom of the fluid. Some have described it as
mediately after exposure and takes at least 6 having slight metallic taste.
hours or more to appear.
Absorption, distribution and elimination
There are nausea, vomiting, chill, fever,
backache , suppressed urination with presence All toxic compounds of arsenic including white
of red cells , free haemoglobin and casts . Jaun- arsenic are absorbed through the mucus

chapter 31: METALLIC CHEMICAL IRRITANTS I 175
membrane of the GI tract . Gaseous arsine in deglutination . Then comes severe abdomi-
and arsenical dust are absorbed through the nal pain and vomiting followed by severe di-
lungs . Mixed with suitable solvent , it may be arrhoea with tenesmus and rice water type
absorbed through the skin . Arsenic is depos- stool . Vomitus and stool may contain tinge
ited in liver, kidneys , bones , hair and nails . of blood. Abdomen is tender. Dehydration
In liver and kidneys the quantity deposited causes fall of blood pressure , oliguria and
is more marked after acute intoxication exhaustion . There is albuminuria. There is
which gradually diminishes, though trace pain in limbs and muscular weakness , signs
remains for a long period which is responsi- of collapse with cold extremities. There is
ble for sustained toxic action for some period. depression of myocardium with abnormal T
All arsenical compounds which are absorbed waves and prolonged Q- T interval . Uncon-
may be deposited in hair and nail . In bones , sciousness follows. With organic arsenical
it is mostly from arsphenamine . Excretion of compounds, degeneration of the optic nerve
arsenic is through urine , hair and nail . Due and focal degeneration of brain may occur.
to low amount of consumption of arsenic
The long standing effects of acute arsenic
through food contaminated by agricultural
poisoning are bone marrow aplasia with ba-
insecticides and due to natural content of
sophilic stippling ofRBC , presence of imma-
arsenic in some food , human urine , hair and
nails may contain some amount of arsenic ture red and white cells in the peripheral
circulation and development ofwhite streaks
e.g. 10 iJ.g%, 50 iJ.g% and 8 iJ.g%, respectively.
at the growing parts of the nails (Mee's
Fatal dose lines ).
More than 200 mgm for an average adult, Laboratory investigations

though much less dose has caused death and
recovery on the other hand has occurred af- Urine , stool, blood , hair and nail from living
ter consumption of a very high dose. subjects and in addition to these materials,
bone , liver and kidneys from dead bodies are
Fatal period subjected to test.
If a very high dose has been taken then death
Urine
may occur within half an hour. With usual
fatal dose death may occur within 24 hours Excretion of 100 mg or more per day is in-
but it usually takes 3 - 7 days for death to dicative of poisoning.
come. Urine test is positive within 6 hours of
poisoning and continues to be positive for
Acute Poisoning
about 2 weeks. Urine coproporphyrine test
Signs and symptoms is also positive.
With a very high dose; abdorriinal pain , vom-
Blood
iting and diarrhoea are followed by collapse
and rapid death. With average fatal dose, Apart from detection of arsenic in blood , pe-
symptoms start after about t hr. with a feel- ripheral blood picture will show presence of
ing of metallic taste , dryness and burning premature red and white cells and basophilic
sensation in mouth and throat and difficulty stippling ofRBCs.

Stool available then, dialysed iron should be

used alternatively. The iron preparations
When examined within some hours of poi- chemically inactivate arsenic, temporarily.
soning, faeces will show presence of arsenic Antidote for the absorbed arsenic is B.AL,
and blood. or dimercaprol. In acute poisoning cases
it is given in its usual doses, i.e., 3 mgm
Liver, kidneys and bones (in case of death)
per kg. ofbody weight in a 10% solution of
Show presence of arsenic. In bones, arsenic 20% benzyl benzoate in arachis oil, given
remains present for a very long period. deep intramuscularly, 4 hourly for the first
2 days, followed by the same dose twice a
Hair day for the next 7 days. For removal of
the unabsorbed poison from the intestine,
Arsenic is excreted through hair. More than
purgative like mag. sulphate may be given.
75 flg% is suggestive of poisoning. For test of
Electrolytes in ringer's solution should be
arsenic in hair, neutron activation analysis
given by IV drip to combat dehydration
is better. In acute poisoning cases, the con-
and loss of electrolytes. Liver should be
centration may be more than 3 mg%.
protected by giving carbohydrate, vita-
Nails mins, proteins and aminoacids. Adequate
rest is necessary for some days after the
Neutron activation analysis is also better for acute episode.
detection of arsenic from nails. More than
100 flgo/o of arsenic in nails is suggestive of Cause of death
poisoning.
1. Dehydration and circulatory collapse ,
In case of death, histological examination 2. Potassium and other electrolyte loss,
of myocardium shows round cell infiltration.
Cloudy swelling ofliver, kidney etc. may be 3. Hepatic failure ,
noticed. 4. Toxic encephalopathy.
Treatment of acute arsenic poisoning CHRONIC ARSENIC POISONING

1. Stomach wash with luke-warm water
Chronic arsenic poisoning may occur in in-
should be done at the initial phase. This
dustrial or agricultural exposures, due to use
is to be followed by emesis or if possible
of contaminated food or drink (e.g. sea food
substituted by stomach wash with freshly
or subsoil water in some area) or prolonged
prepared ferric oxide. Ferric oxide can be
use of an arsenical preparation as medicine.
prepared fresh by mixing ferric chloride
Chronic signs may also be apparent after
solution (45 ml), with magnesium oxide
some time of recovery from an acute poison-
(15 gm). If magnesium oxide is not avail-
ing episode.
able then milk of magnesia can be used
for it, for the preparation of ferric oxide. Signs and symptoms
15 gms of the precipitate of ferric oxide
used wit!l a glass-full of water, which is To start with, the symptoms are rather non-
the concentration to wash the stomach. specific like easy fatiguability, malaise, lack
It should not be left in the stomach for of interest and concentration, pain in joints,
long. If fresh ferric oxide cannot be made constipation or loose motion, loss of weight.

chapter 3 I: METALLIC CHEMICAL IRRITANTS I 777
Fig. 31.2: Hyperpigmentation skin lesion on palms in a

case of Chronic Exposure.
Courtesy- Sharmistha Bhattacharya, Cal.
Med. College
Then more specific signs arise with muscu- the tnmk and some other parts of the body.
lar weakness and change in keratin tissue. Then there is dark pigme11tation of the skin
There is abnormal pigmentation of the skin. of the palms and soles with thickening. Con-
In the initial phase, there is brownish pig- trary to Addison's disease there is no pigmen-
mentation (milk rose complexion as is de- tation of the mucus membrane inside the
scribed by many) of the skin is noticed around mouth. There is hyperkeratosis, particularly
the neck, over the shoulders, on the temples. of the skin of the palms and soles, which may
Pigmentation may virtually affect all around in occasions lead to epithelioma. Among the
Changes due to chronic arsenic poisoning Changes due to chronic arsenic poison ing
on back on sole

other features, there may be ulceration of ofblood - tinged vomitus and faecal matter
the nasal mucosa . There may be alopecia . may be there on the body or the clothes . The
'!'here may be liver damage with jaundice and mucus membrane of the mouth may or may
pruritis . Damage of the kidneys may give the not show signs of irritation . Internally , the
clinical feature of albuminuria . Neurogenic mucus membrane of the oesophagus is in-
involvement may cause cramping pain , weak- flamed. The stomach wall is swollen and soft.
ness and wasting of the muscles . Bone mar- The inner surface is inflamed, desquamated,
row aplasia with its effects and Mee's line are haemorrhagic and often ulcerated. The stom-
comparatively early features . ach contains blood, mucus shreds and thick
Death may occur due to damage of the mucus often mixed with arsenic powder . If
liver, kidneys, toxic encephalopathy or inter- orpiment , real gur , Scheel's green or Paris
current infection. green is taken then the colour may be appre -
ciated. The length of the intestinal mucosa
Laboratory investigations and their in- shows inflammation, swelling, desquamation
terpretation include those under acute poi- with occasional haemorrhagic points. In the
soning. In chronic cases, if pecessary, 24
heart , there may be subendocardial haemor-
hours' urine should be collected after one di-
rhage . Lungs are congested and oedematous .
agnostic dose ofB.A.L. Quantitative estima-
Liver and kidneys may show degenerative
tion of the arsenic excreted may not be pos-
changes according to the period of survival.
sible because in chronic cases there may not
In delayed cases of death there may be bone
be regular excretion of arsenic in the urine.
marrow aplasia . Mee's line on nails also takes
Examination ofhair, nails and, in death cases,
some weeks to appear. In decomposed dead
ofbones has definite value.
body yellowish discolouration occurs in stom-
ach and surrounding tissue as arsenic perco-
Treatment
lates through the tissue and combines with
1. The source of poisoning should be identi- the decomposition gas H 2 S to form arsenic
fied and further exposure should be sulphide .
avoided . In chronic cases , external findings con-
2. British antilewisite or penicillamine sist ofemaciation , pigmentation , keratosis or
should be administered in the recom- epithelioma , alopecia , white streaks on nails ,
mended dose. jaundice , wasting of muscles , ulceration of
3. Supportive treatment for protection of nasal septum.
liver, kidneys and neurogenic functions Varying degree degenerative changes
should be given. Nutrients like vitamins may be noticed in the liver , kidneys and
and minerals should be adequate in food. muscles .
Epithelioma will need special treatment.
In dead bodies recovered from graves ,
Postmortem findings
presence of arsenic should be interpreted very
carefully. Arsenic can be imbibed from the
In acute cases , the body appears emaciated . soil to the dead body or in the reverse way
Rigor mortis comes early. Decomposition sets arsenic from the dead body may contaminate
in late , due to some antibacterial action of the surrounding soil. To decide this problem
arsenic and partly due to dehydration. Stain it may be remembered that, arsenic absorbed

chapter31: METALLIC CHEMICAL IRRITANTS I 779
during life usually consists of soluble salt body is not burnt then, arsenic can be de-
forms. Arsenic present in the soil are usu- tected from the body remains (hair, nails,
ally of insoluble salt forms. Hence, if insolu- bone, teeth) years after death. If the body has
ble form of arsenic is present in the body then, been burnt then, the ash or even the soil from
it must have been imbibed from the soil; if the cremation ground may show arsenic long
soluble form of arsenic is present both in the after cremation. Further, there are chemi-
body as well as in the surrounding soil then, cal tests to detect arsenic in very trace
it could have percolated from the body to the amount. Thus, potential danger of detection
soil during the process of decomposition of of the crime exists even long after death.
the body or might have as well come from Suicidal uses - A suicide does not prefer
the soil to the body. In such a case, if the arsenic. This is mainly because arsenic
concentration of arsenic is more in the body causes a painful death. However suicidal uses
than in the soil, then it has gone from the are on record. But it is rather unusual.
body to the soil and viceversa. If arsenic has
gone from the body to the soil then not only Accidental poisoning - Accidental poison-
the concentration of arsenic will be more in ing may occur due to consumption of arsenic
the body, concentration in soil below the body with food (some sea food as named earlier) or
will be more than in the soil of both sides of drink (subsoil water containing arsenic in some
the body and over the top of the body. locality), when food substances get contami-
nated by arsenical preparations used for domes-
Medicolegal aspects of use of arsenic tic purposes, when seeds preserved with arsenic
for seedling purposes are consumed unknow-
Homicidal uses - Arsenic at a time was in ingly, in the agricultural fields (agricultural
use as a popular homicidal poison. In its homi- insecticides), in industries (arsine and ·other
cidal use, both acute and chronic poisonings preparations) and when used as a love filter to
are encountered. Arsenic has certain advan- increase the sexual desire and ability. Fatal
tages for use as a homicidal agent. Previously poisoning may occur when it is used as an abor-
arsenic trioxide was used to be available very tifacient agent, and to improve the complexion
easily. It has no taste and smell. Its white (dark to fair "milk-rose" complexion).
colour could be easily masked by food. A very
Arsenic preparation may be used to cause
low dose can cause death. Death is almost
criminal abortion.
certain if very active treatment cannot be
given timely. In acute poisoning cases the Some persons get used to the consump-
symptoms can easily be passed as those of tion of arsenic. They can tolerate W1believ-
cholera or gastro-enteritis, particularly if able amount of arsenic, without much harm
there is an outbreak of gastro-enteritis in the They are known as arsenophagists.
locality. In chronic homicidal uses there is
gradual devitalisation and death precipitate Chemical tests for arsenic
with some such symptoms which are not eas- 1. Marsh's test - Test material is placed in
ily lin~ed with chronic arsenic intake. It is a hydrogen generator. If the material con-
cheap too. tains arsenic then Arsine (arsenuretted
However, there is a great disadvantage .hydrogen) is formed, which mixed with
of using arsenic as homicidal poison. If the hydrogen is expelled out through the

I Table. 31 .1: Differences between Acute arsenic poisoning and Cholera/Gastro-enteritis .!
I Points Arsenic poisoning Cholera/Gastro-enteritis

-'
Vomiting and purging Purging follows vomiting Vomiting follows purging
Vomitus Contains mucus and blood No such thing
Stool Like rice water; may contain blood Like rice water; does not contain blood;
passed in a jet
Burning pain in throat Present Absent
Tenesmus and burning pain at anus Present, related with motion Absent
Motive and circumstance Homicidal, rarely accidental in nature No such things
Epidemiology Restricted to an individual or a family May occur in sporadic or epidemic form
or a group sharing same food
Laboratory investigation Detects arsenic Vibrio cholerae may be detected by
culture (difficult of course)
narrow mouth of a glass tube. This mix- trioxide which sublimates and is deposited
ture of gas burns with a blue or greenish as a white substance on the inner, upper,
flame and gives a garlicky smell. Grey- cooler surface of the test tube.
ish metallic arsenic is deposited on a
smooth porcelain plate placed atop of the
flame. The arsenic deposit is soluble in
hypochlorite solution .
Lead is not an essential constituent of our
2. Reinsch's test -The test material is mixed ~
body , but it is always present in our body due
with half of its volume ofcone. h~drochlo- to various factors, like its extensive use and
ric acid in a test tube in whic~ a clean easy absorption in the body in various forms.
copper foil is placed. The contem___of..the Contrary to many other pure metals, pure
tube is boiled for 5 minutes . If the mate- metallic lead is absorbed through the GI tract,
rial contains arsenic , mercury or anti- being soluble in the gastric juice .
mony, then there is greyish deposition on
the surface of the copper foil. Of the three Toxic compounds of lead
metals, arsenic trioxide sublimates . Lead acetate (sugar oflead or salt of Saturn)
Hence in the next stage of the test the - white crystalline salt; Lead subacetate -
copper foil is taken out and is washed with used in Goulard's solution; Lead carbonate -
water, alcohol and acetone , respectively, white fine, dusty powder used in painting;
to make it free from any other substance. Lead tetraoxide - scarlet crystalline powder
The copper foil is then placed inside a dry used as vermilion ; Tetra-ethyllead - used in
clean glass test tube and heated in a slant- petrol and gasolene; Lead monoxide - brick
ing position. If the deposition on the sur- red; Lead chromate - bright yellow powder.
face of the copper foil is of arsenic then, Other compounds are - lead sulphate , lead
on heating there is formation of arsenic sulphide , lead chloride , lead iodide etc.

chapter 31: METALLIC CHE MICAL IRRITANTS I 781
Lead has extensive uses in industries, a burning pain in the throat comes quickly
agricultural, commerce and for domestic pur- in case of ingestion of lead acetate. In any
poses. It was used in water pipes, it is used in case, there are abdominal pain and vomit-
tin food container, in batteries, paints, hair ing, the vomitus containing curdy white lead
dyes, cosmetics, as vermilion; in petrol, in glass chloride. There are cramps in the abdomen,
blowing, on the surface of ceramic articles. loose motion and the stool is dark due to lead-
sulphide. It causes thirst, dehydration, signs
Absorption, distribution and excretion of collapse and death may occur due to circu-
latory failure .
Most of the lead compounds are soluble in
gastric juice and are thus absorbed through Treatment
the GI tract. Lead dust and fume are well
In acute cases, the treatment consists of re-
absorbed through the respiratory tract. Lead
moval of unabsorbed poison from the GI tract,
tetraoxide (vermilion), some other dyes and
removal of the absorbed poison and sympto-
cosmetics and tetra-ethyle lead are absorbed
matic treatment. To remove the unabsorbed
through the skin. Lead acetate is soluble in
lead from the stomach, emesis may be tried
water and is easily al:isorbed when swallowed,
first, followed by washingofthe stomach with
though it is more injurious locally.
magnesium or sodium sulphate. These form
Lead is a cumulative poison. Its rate of highly insoluble lead sulphate preventing its
excretion being less than absorption, in absorption. For the same reason, for removal
chronic exposure, it deposits in tissues, of the poison from the intestine, sodium or
mostly in bones and also in liver and kidneys. magnesium salt is given in purgative dose,
If death does not occur after a large dose, which helps elimination of the poison through
then a good part of the absorbed lead is de-
purgation. Calcium gluconate - 2 gms IV, re-
posited in these tissues.
lieves abdominal colic and also helps deposi-
It is-Jil~stly excreted through urine tion of some lead in bones and combat the
though the rate of excretion rate is very low. acute crisis. Atropine may be necessary in
It is als~ slightly excreted through bile. To a case of acute abdominal colic.
small extent it is also excreted through n ails.
For elimination of the absorbed part of the
Acute poisoning lead, CaNaz EDTA is given by slow IV infu-
sion in a dose of 10 - 15 mgm per kg body
Fatal dose weight, twice in the first day. If the therapy is
tolerated well then, it is repeated in the same
20 gm of lead acetate and 30 gm of lead car-
bonate may be fatal for an average adult. dose for the next four days. If necessary, the
same regimen may be followed after a gap of
Fatal period five days. Peritoneal dialysis excretes lead
more effectively. For rapid effect, it is often
In severe cases death may occur within 24 given along with LV. EDTA therapy. Perito-
hours. Ordinarily fatal period may extend to neal dialysis is also recommended in patients
2-3days. with renal failure and in patients who are sen-
sitive to EDTA BAL can excrete, the circula-
Signs and symptoms
tory lead but it cannot excrete lead which is
An astringent metallic taste in the mouth and deposited in bones. Some prefer combined BAL

and EDTA. EDTA is not very useful if given container having lead lining, food contami-
subcutaneously or intramuscularly. Penicilla- nated with lead in course of preservatic.n or
mine is in a way better than EDTA in the sense use of insecticides. Poisoning may occur due
that, it is less toxic. It is given in its usual to prolonged use of vermilion, dye and cos-
doses (see page 739). metics made of lead. Percutaneous absorp-
tion oftetra-ethyle lead is common in people
Postmortem findings who handle petrol or gasolene.
Externally, the body appears emaciated. Rigor It is interesting to note that, it is recorded
mortis appears early . in history with sound reasons that, lead wa-
ter pipes and food containers (bowls etc.) were
Internally , nothing specific other than
popularly used by elites of the ancient Ro-
signs of irritation of the GI tract . The stom-
man Empire which is one of the causes for
ach wall is swollen, the mucus membrane is
the disintegration and destruction of the Ro-
extremely congested, often greyish in colour.
man culture . Members of the upper class of
The stomach may or may not sho~ presence
the Roman society suffered from various
of curdy whitish lead chloride . The length of
physical and mental disabilities and their
the intestine is inflamed.
women in addition suffered from sterility due
to chronic lead toxicity.
Signs and symptoms
As lead is a cumulative poison and as expo- In the early phase, chronic lead poisoning is
sure to lead is rather inevitable, particularly manifested by facial pallor, anaemia, ba-
in the urban, semi-urban and industrial ar- sophilic stippling of red cells , blue line in the
eas, some amount oflead is being constantly gum, retinal stippling and in the later phase
• - ·'~o-' and remains accumulated in the by colic, constipation, palsy, encephalopathy,
. When the level of the accumulated lead disturbance of genito-urinary and cardio-vas-
exceeds the threshold level, features of cular system.
oning appear. As a matter Facial pallor - It is one of the earliest
of fact, mcidents of chronic lead poisoning is signs of chronic lead poisoning. The exact
far more than the incidents of acute poison- cause of this though not known for certain,
ing. is understood to be due to vasospasm, mostly
due to contraction of the capillaries at the
Sources of chronic lead poisoning arterial side .
Chronic lead poisoning may occur in the in- Anaemia - It occurs in all cases of
dustrial environment due to inhalation of lead chronic lead poisoning. But usually it is not
dust or lead vapour arising from burning of severe. The RBC count may come down to
paints , battery, smouldering, glass blowing 3.5 million per cu.mm. and the Hb level to
and polishing, enamel factories , dye , cosmetic 65%. The anaemia is due to impairment in
and colour factories . It may occur due to low the synthesis of haeme from protoporphyrin
dose consumption from drinking water sup- and of porphobilinogen from delta-amino
plied through lead pipe , food preserved in tin levulinic acid.
Another cause of anaemia is increased anterior tibial muscles respectively. There

fragility of the RBCs due to loss of intracellu- may also be paralysis of deltoid, biceps,
lar potassium due to increased permeability occular muscles and intrinsic muscles of the
of the cell membrane for potassium. The ba- fingers and toes.
sophilic stippling of the red cells is due to Lead encephalopathy- Minor degree in-
condensation of iron containing ribonucleic
volvement of brain function is said to be
acid near the mitochondria It is present in present in all patients which may not be
about 25% of the patients. Chronic lead poi- alarming or apparent in all. However, en-
soning has an anti-thrombin effect resulting cephalopathy is frequently encountered in
in defective blood coagulation. children This may be due to inactivation of
Retinal stippling is noticed by ophthal- monoamine oxidase due to combination of
moscopic examination with presence of grey- .... .:..:...with the SH radical of the enzyme. There
ish glistening lead particles, in the early phase are changes in personality, restlessness, fa-
of chronic lead poisoning. tiguability and mental dullness, in some. In
Lead line or Burtonian line is a bluish others, there may be acute conditions like
discolouration over the gingival line with convulsion, delirium and coma With clear
deposition of lead sulphide granules, seen in signs of encephalopathy, death rate is as high
not more than 50% of cases, in whom dental as about 50%.
hygiene is poor. Developmentofbrain of foetus of affected
Colicky pain involving both large and mother is insufficient - Lead can pass pla-
small intestines, ureters, uterus, blood ves- cental barrier.
sels, is a more common feature and occurs Optic atrophy - A few patients may de-
in about 85% of chronic lead poisoning cases. velop blindness due to optic atrophy.
The pain is spasmodic and paroxysmal. Dur-
Lead osteopathy - In children or young
ing pain, abdomen is tense. The pain is
individuals, lead is deposited beyond the epi-
slightly releived by application of pressure
physis of the growing long bones. The depo-
over abdomen. sition is promoted by calcium and vitamin D
Constipation - It is also a common fea- and is detectable by radiological examination
ture and usually precedes colic. During the Deposition oflead at the growing ends of the
pain there is a desire for defecation. long bones may lead to their abnormal de-
Lead palsy is rather a late and uncom- velopment
mon phenomenon. Only about 10% of the Effects on reproductive system- Chronic
patients suffer from this condition. It occurs exposure may cause sterility to both male and
due to degeneration of nerves and atrophy of female patients. Birth of physically or men-
muscles which may be the result of interfer- tally handicapped child is possible. In males,
ence with the phosphocreatine metabolism there may be loss of libido. In females, there
at the muscular level. To start with, there is may be menstrual irregularities and in car-
numbness, hyperesthesia, fibrillation, tremor rying women there may be abortion due to
and cramps in the muscles. Ultimately there chorionic atrophy or spasmodic contraction
may be wrist drop and foot drop due to pa- of the uterus. In males, spem1 count is re-
ralysis of extensor muscles of wrist and of duced.

784 I PRIN CIPLES OF FO RENSIC MEDICINE
Effects on circulatory system - There than 250flg per litre of urine. In industrial
may be de~~>nerative changes in the arter- workers with exposure to lead vapour or
ies , including arteriosclerosis, with resultant dust, less than 80J.lg per litre is safe , between
h~, ertenu1on and hypertensive cardiopathy . 80- lOOflg it should be considered a border-
Effects on k1dneys - There may be line case. Above lOOflg per litre, care must
chronic inter,;titial nephritis . be taken not to allow further exposure and
preferably treatment should be administered
Effects on liver - Acute or chronic degen-
to enhance the excretion of lead from the
eration may occur.
body.
Effects on peripheral nerves - In addi-
In chronic lead poisoning, there may be
tion to meni 1go-encephalitis , chronic lead
irregular excretion oflead in urine. Hence if
poisoning may cause degeneratiOn of ante-
other features are present then diagnostic
rior hom cells and demyelination leading to
therapy of one dose of EDTA should be given
periphe ·a] ne cl J.tis .
and then 24 hours' urine collected and exam-
Hair - There may be alorecia. ined . In persons without features of poison-
ing, excretion in 24 hours will be less then
Laboratory investigation and findings
0. 5 mg. But in patients suffering from lead
In living patients, llood , urine and stool may toxicity , the quantity excreted may be more
be subjected to laboratory tests for quantita- than 1 mg and usually much more .
tive estimation oflead in them and for other There will be porphyrinuria , the amount
tests. In d1Ild.-en , in addition, X-ray exami- of excretion may be more than 500 mg per
nation ofthe ep1ph:yseal ends of the long bones day.
may be useful.
There is excretion of delta-amino-
levulinic acid .
Blood
In children, excretion of amino acid is
No 1nal range of level of lead - 0 - 50 J.lg% . increased.
Some consider 50J.lg is too high a figure to
leave withou t care. According to others Stool
70flg% is the borderline blood level. The blood
A tot al daily excretion of more than 0. 5 mg is
range with presence of clinical features vary
suggestive oflead toxicity . But too much im-
usually between O.l mg<k - 0.6 mg% .
portance cannot be given on this because,
Apart from estimation of lead in blood, though absorbed lead is excreted through
the peripheral blood picture should also be stool, much of the lead excreted through stool
studied. may be the unabsorbed ingested lead.
In lead poisoning, more than 75% of the
patient s show fluorescence ofRBC in thin wet X-ray examination
preparation, with use of long waves of UV In children, X-ray of ends oflong bones will
light. show higher density beyond the epiphysis.
Urine Treatment
Clinical features may not appear with less Prophylaxis - Precautionary steps to prevent

toxicity iT\ theworkers ofth~ le~d industn~s · . For severe colic, 0.5- 1 mg of atropine
·are must. · Inhalat'ion of ·lead dusts m.ay' qe . ~u]phate and/or hot compression on the ab-
prevented by moistening devices. P'rcipe·r . · donie.n is .h~lpful.
ventilation should be there and masks may For constipation Mag. sulphate purgative
be used to avoid inhalation of lead vapour.
is used.
Regular medical check up of the workers
should be there and appropriate steps should Lead encephalopathy in children may
be taken when they develop minor signs or need surgical decompression of the skull .
when the amounts of lead in the urine and Some prefer use of sod. or Pot. bi-car-
blood approaches threshold levels. Change in bonate and restriction of calcium diet and vit.
the place of work is one of the ways to pre- D , for quick mobilisation oflead from its site
vent further exposure . of accumulation in the bones .
Unwashed fruits (for preservation of In chronic lead poisoning, in case of cri-
which lead-arsenate is used), water supplied sis due to high level of lead in blood due to
through lead pipes , food preserved in tin con- rapid mobilisation from the bones or other-
tainers lined with lead may be consumed,
wise, or due to acute condition related to
keeping the danger in mind. Lead vermilion ,
chronic lead poisoning, calcium gluconate ,
cosmetics and dyes , should also be used keep-
lactate or milk intake for a few days, helps
ing in mind that the same is dangerous. Once
to shift lead from blood to the bones .
very early symptoms appear, use of these
substances should be stopped. Children may Death occurs due to encephalopathy, liver
be in the habit of chewing materials painted or kidney damage , due to circulatory failure
with lead compounds, like a wood pencil or a or due to inter-current infection .
toy. This should not be allowed.
Postmortem findings (chronic poisoning)
Curative - If signs-symptoms of chronic
lead poisoning have already developed then Externally, the body may appear emaciated
further exposure should be avoided in the line due to chronic ill health. Blue lining may be
of prophylactic steps, as discussed above. present in the gum.
CaNa2 EDTA in the dose of 30- 40 mg Internally , there will be degenerative
per kg body weight, given in one hourly infu- changes in different tissues and organs . Liver
sion , twice a day , for 5 days and repeated af- may show acute or chronic degenerative
ter a gap of 3 - 5 days for a similar course. changes. Kidneys may show signs of intersti-
Penicillamine in the dose of 500 mg 4 times
tial nephritis . Arteriosclerotic changes will
a day may also be given in place of EDTA.
be present in the vessels. In the bone mar-
Dimercaprol is useful for excretion ofthe lead
row , there is decrease in fat cells with in-
in circulation but cannot de-lead the bones
crease in erythroblasts and leukoblasts . Mus-
and other tissues.
cles show change of fibrotic myositis . There
Sod-iodide or Pot-iodide 1-2 gm, thrice are demyelination, signs of degeneration of
a day helps removal oflead from bones . anterior horn cells and meningo-encephali-
Sodium or potassium citrate helps excre- tis . There ma,y be ·ulcerative and haemor-
tion of the lead in circulation. rhagic changes in the stomach and intestine .

There may be degeneration of the germinal as crystalline powder. It is odourless but has
epithelium of testis in males. a burning, metallic taste. It is used in medi-
cine, in laboratories, as preservative and in
Medicolegal aspects of poisoning with industries. It is soluble in gastric juice, is
lead absorbed through GI tract and is highly
Acute poisoning with lead is uncommon. The toxic.
victims are usually children who chew sub- Mercuric cyanide is used in medicine and
stances painted with lead paints. mercuric oxide and merc'..!ric sulphate are
Chronic poisoning is much more common used in industries.
and may occur from various sources. Mercuric sulphide, used as vermilion, is
Poisoning with lead is mostly accidental. not absorbed through the skin and is as such
The sources of poisoning are extensive and non-poisonous.
have been discussed under the heading of Mercurous chloride or calomel is used as
prophylactic treatment. purgative as it is non-toxic for human con-
Suicidal and homicidal uses a.re very very sumption in therapeutic dose.
rare. Suicides do not prefer it due to long
Many of the organic mercurial com-
painful sufferings before death. Homicides do
pounds are toxic for human consumption.
not use it due to chance of detection from
Mercurial diuretics (mersalyl) may damage
the taste of the poison and other signs symp-
the kidneys. When given I.V., mercurial diu-
toms as well as due to the high fatal dose (20
gm) of the most toxic compound (lead acetate). retics may cause anaphylaxis in sensitive
persons.
Preparations oflead are used for procur-
ing criminal abortion. Alkyl mercuric compounds like phenyl
mercuric acetate are used for preservation
Lead has sometimes been used as cattle
poison. of seeds as fungicidal agents and are toxic to
human beings. Consumption ofliving stocks,
fed with seeds preserved with mercurial com-
MERCURY pounds, have caused mass poisoning.
Mercury is methylated under sea water
Pure metallic mercury is a heavy, silvery,
and certain sea fish particularly sword fish is
non-adhesive liquid which is not absorbed as
rich in methyl mercury, prolonged excessive
such through the GI tract, being insoluble in
use of which may cause chronic mercurial
gastric juice. Mercury is volatile at room tem-
poisoning.
perature and the vapour may be absorbed by
way of inhalation. Forceful rubbing of the
Absorption, fate and excretion
metallic mercury may result in mild degree
absorption through the skin. Mercuric chloride and some other mercurial
salts being soluble in the gastric juice are
Poisonous compounds of mercury and
readily absorbed through the GI tract. Va-
their sources
pour of mercury and soluble mercury salts
Mercuric chloride or corrosive sublimate is are also well absorbed through the respira-
available as colourless prismatic crystals or tory tract, through the vagina (douche) and

chapfer31: METALLIC CHEMICAL IRRITANTS I 787
urinary bladder (mercurial antiseptic wash- Fatal period

ing agent), to some extent. Microscopic par-
Death may occur usually between 12 hours
ticles of mercury and calomel (which is not
to 7 days.
absorbed through the GI tract) are absorbed
through the skin, via sebaceous glands. Skin Chance of recovery is high after about 7
ointment of mercury, when used for a long days.
period, may cause chronic poisoning. With I.V. injection of mercurial diuretics
·After absorption, mercury gets depos- anaphylaxis may cause very rapid death.
ited in all tissues of the body, particularly
in liver, kidneys, spleen and bones . When Signs and symptoms
absorbed by way of inhalation , maximum
After swallowing, there are signs and symp-
concentration occurs in the brain tissue. In
toms of corrosion and irritation with burn-
the kidneys, it is found in the tubules ,
ing pain and metallic taste in the mouth.
where it may stay for up to 3 months but it There are difficulty in deglutination and feel-
is not deposited in the glomeruli. End part
ing of constriction in the throat, pain and ten-
of the proximal convoluted tubules , loop of
derness in the abdomen with vomiting. The
Henle and the distal convoluted tubules are
vomitus contains mucus and altered blood and
the sites of deposition in the kidney. Though shreds of gastric mucosa. The mucosa of the
mercury is not a constituent of the body, it mouth, tongue and gum appears greyish
may be found in trace quantity in tissues white and is necrosed. With development of
(5 J..tgto 150 J..lgper 100 gm, more in kidneys renal damage there are oliguria, albuminu-
and less in liver). In toxic deaths , the con- ria and haematuria. After a day, there will
centration in liver may go as high as 1 mg be blood-stained loose stool with presence of
per 100 gm and the concentration in kid- Iiecrosed mucus shreds from the colon. Re-
neys up to 2 mg per 100 gm. With injection nal damage leads to oedema. Subsequently,
of mercurial diuretics liver may contain 2 more generalised symptoms start with loss
mg% and kidneys 3 mg%. Organic mercu- of appetite, headache, tremor, fatigue, ataxia,
rial compound passes placental barrier very deafness, scotoma, emotional instability, loss
easily and the foetus may have more con- of memory. Symptoms due to phenyl mercu-
centration of methyl mercury than the ric acetate may be restricted to CNS. Death
mother. may occur due to renal failure. Death may
Mercury is mainly excreted through the also occur due to depression of heart, hepati-
kidneys , liver (bile) and large intestine , tis, colitis and starvation.
though other body secretions also may show
the presence of mercury in very trace Treatment
amount. Proteinous substance like, egg albumin, milk,
gelatin should be given along with other
Acute poisoning demulcents so that, the protein will combine
with the mercury compound and the demul-
Fatal dose
cent agents will protect the wall of the stom-
0.5 gm to 4 gm of mercuric chloride is the ach from the corrosive action of mercuric •f . ·,
normal range of the fatal dose .- chloride, if it has been ingested. T~en emet-

ics should be given or the stomach should be purging. In hypersensitive persons , there
washed out with tube. Lukewann sodium may be inflammatory skin lesions due to con-
bicarbonate solution or ipecacuana syrup may tact with mercuric chloride.
be chosen for emesis. Internally, mucus membrane of mouth,
For absorbed part of the poison, BAL or including tongue and gum and that of
penicillamine CD-penicillamine or N -acetyle- oesophagus appear necrotic. The stomach is
DL-penicillamine) in usual doses may be swollen with evidence of desquamation,
given. 100 ml of 5% sodium sulphate solu- haemorrhage and ulceration. Necrosis of the
tion may be given I.V. , to help anuria. Na- mucus membrane of intestine with ulcera-
citrate or bicarbonate , if given orally, may tion at places are quite common. Kidneys are
also be helpful. High colonic wash is recom- swollen with lower nephron nephrosis. In
mended to free the colon from the poison. chronic poisoning further changes are noticed
Peritoneal or haemodialysis helps excretion (see page 787). Liver tissue shows central
of the absorbed poison quite effectively, in necrosis. There may be necrosis of the myo-
acute cases. Some prefer exchange transfu- cardium. Serum albumin decreases with
sion. change in albumin-globulin ratio.
Postmortem findings Laboratory findings regarding estimation

of mercury in different body fluid and tissue
In cases of death due to acute poisoning, ex- have been discussed in page 787, 789.
ternally, the body may look emaciated due
to loss of body fluid by way of vomiting and Chronic poisoning
Sources
Sources of chronic mercurial poisoning is

many-fold. It is likely to occur in mercury
miners , during smelting, inhalation of con-
taminated air in industries or factories using
mercury or mercurial compounds, use of
mercurial insecticides, consumption of sea-
fish rich in organic compounds of mercury,
bio-accumulation in edible plants through use
of mercurial insecticides , medicinal prepara-
tion . Improper disposal of wastes - mercury
spills , spoiled fluorescent light etc.
Signs symptoms
There is a constant metallic taste in the

mouth with signs of gingivitis, glossitis, sali-
vation , loosening of teeth with blue line in
the gum. There are loss of weight, anaemia
Fig. 31.6 : Submucosal haemorrhage in corrosive and lymphocytosis, constipation or diarrhoea,
sublimate poisoning increased urination (kidney dysfunction -

Falconi syndrome), jaundice, photophobia and cal antidote for excretion of mercury from
restricted field of vision with damage of the the body.
retina. Mercuriolentis may develop with depo- 2. VitaminC
sition of mercury in lens capsule. Repeated
3. High sulphur containing food
local contact may cause dermatitis . Acrody-
nia occurs due to absorbed poison, with red- 4. General health and oral hygiene should
ness , swelling, vesiculation and desquama- be maintained.
tion of palm, fingers , soles and toes .
Prevention
It blocks degradation process of catecho-
lamine , epinephrine causes profuse sweating, Careful dealing with all circumstances of
tachycardia, low sperm count , excessive sali- source of poisoning as enumerated above, like
vation . There is loss of hair, teeth , nail . at factories orotherworkingplace, in the labo-
There is muscular weakness , hypertension , ratory, while using as insecticides, taking of
pheochromocytoma (Kawasaki disease). possible contaminated food like, sea fish, veg-
etables, disposal of spoiled mercury lamps, i.e.,
There may be mercurial erethism (insom-
at all possible sources of poisoning.
nia, anxiety, irritability, emotional and insta-
bility and fatiguability). There is tremor of
Cause of death
hands (Hatter's shake ) and tongue , exagger-
ated reflex, unsteady gait which is more like Renal failure , hepatitis , colitis , and intercur-
that due to pyramidal tract lesion. Chronic rent infections are the usual causes of death.
mercury poisoning may cause amyotropic
Postmortem findings
lateral sclerosis like condition . There is also
a personality change. Apart from gingivitis , glossitis , colitis , necro-
Organic compounds of mercury like dime- sis of liver and kidney , certain specific
thyl mercury irreversibly inhibit pyruvate changes occur in the tubules of the kidney.
dehydrogenase. Damage to brain and liver is The tubular cells degenerate, to start with,
more common with organic compounds. flattened cells gradually changing to cuboi-
dal . A s~'Tlcytial pattern develops in the cells.
In infants mercury inhibits the proper
There is calcification of the necrosed tubular
formation of myelin sheath .
cells.
Mercury vapour inhalation causes
tremor, disturbed sleep and impared cogni- Chemical test for mercury
tive capacity.
The testing material is mixed with half of its
In chronic poisoning the daily urinary volume of cone. hydrochloric acid in a test
excretion may be over 300 J.Lg. tube, in which a clean copper foil is placed
and the tube is heated. If the testing mate-
Treatment
rial contains mercury then, there is silvery
In chronic poisoning cases, deposition on the surface of the copper foil.
1. Chelating agent like , 2-3 dimercapto-
Medicolegal aspects
sulfonic acid CDMSA) or 2-3 dimercapto-
1-propain sulfonic acid (DMPS) or EDTA Suicidal poisoning is not common due to the
or penicillamine -which acts as chemi- prolonged painful suffering before death.

\II! '
•
Homicidal poisoning is also rare due to acute Signs and symptoms
signs-symptoms produced by most of the com-
pounds and chance of detection. Accidental These are nausea, vomiting with greenish
poisoning occurs from medicinal uses , in in- blue vomitus which turns deep blue if
dustries , from agricultural use, in laborato- treated with a1mnonia, diarrhoea, abdomi-
ries from mercurial vapour, due to consump- nal pain, urinary suppression, haematuria,
tion of food contaminated with preservative jaundice due to damage of the liver, paraly-
and consumption of sea fish . Mercurial prepa- sis oflimbs , increased fragility of the RBC,
ration is used as an abortifacient agent. shock and respiratory distress due to haemo-
Chronic poisoning is more common . lysis , anaemia with increased leucocyte
count, coma.
In chronic poisoning cases there are GI
tract disturbance, unhealthy gum with blue
lining, jaundice, muscular weakness , paraly-
Pure metallic copper is no poisonous . Cop- sis oflimbs . Hair contains copper.
per is soluble in liquid or water with pH less
than 5.5 . Hence food with pH less than 5.5 Treatment
stored in copper utensils or cooked in copper
Stomach wash with 1% potassium
vessels will cause poisoning. At some places
ferrocyanide . Castor oil purgative , Penicilla-
pickles are given green colour by addition of
mine (beta, beta-dimethyl cystine), BAL in
copper.
their usual doses .
Source
Postmortem findings
Copper and its chemical compotmds are used
There are not many external signs on the
in industries , commercial centres , as fungi-
dead body in acute poisoning cases. The mu-
cide , pesticide , household appliances .
cus membrane of mouth and tongue may
Common toxic compounds have bluish or greenish blue tinge .
Internally , the same discolouration is
Copper subacetate (verdegris ), copper sul-
present in the mucus membrane of the
phate (blue vitriol), copper chloride. In fact
oesophagus and stomach. The mucus mem-
many compounds of copper, after ingestion,
brane of the stomach is congested with desq-
may get dissolved in the gastric juice, form-
uamation and haemorrhage at places. Mu-
ing copper chloride .
cus membrane of the upper part of the small
intestine shows signs of mild to moderate ir-
Fatal dose
ritation . There are degenerative changes in
Copper subacetate- 15 gm, Copper sulphate the liver and proximal tubules of the kidneys.
-30gm. In chronic poisoning cases gums appear
unhealthy with bluish lining. There is mus-
Fatal period
cular atrophy:· Liver and kidneys show vary-
.·Usually more than a day, ma~ be up to io - ing degree of d~generation. In pois~ning~ due
12.days . to .ii1halatio~i .
. of vapours;, signs . of chronic
pneumonitis may be there. Blood picture is Signs symptoms of acute poisoning

altered with presence of premature cells in
Within 15 mts to one hour, there are signs of
peripheral blood.
GI tract irritation followed by signs of rest-
Medicolegal aspects lessness , collapse and drowsiness. There are
increased rate of respiration and heart beat .
Poisoning is mostly suicidal or accidental. Frequency of vomiting increases with pres-
Number of successful suicides are much less ence of altered blood in the vomitus . Diar-
than attempts due to the emetic property of rhoea with offensive stool follows . There may
copper sulphate which is commonly used by be muscular twitching and convulsion . IV
the suicide, and is mostly vomited out. How- injection may cause anaphylaxis . Jaundice
ever, suicidal deaths with copper sulphate is may develop due to centrilobular necrosis of
not very infrequent in our country . Acute liver, and there may be presence ofbilirubin ,
accidental poisoning occurs mostly in children bile salts and high urobilinogen in the urine .
who being attracted with the colour and glaze Liver damage may lead to hepatic coma .
of the copper sulphate crystals , may chew Blood serum contains very high amount of
them . It may also occur due to preservation iron being bound with transferrin , the iron
and cooking of food and drink in copper con- binding plasma protein, and also being
tainer or utensils . Chronic poisoning occurs present as free iron or being loosely bound
in industries and from commercial sources. with other plasma protein. There may be al-
Homicidal poisoning is not possible due to bumin in the urine due to damage of the re-
detectable colour and high fatal dose . Prep a- nal tubules . Pulmonary haemorrhage , in-
ration of copper may be used for causing abor- crease of the level of serum transaminase ,
tion and as cattle poison . slow delta wave in the EEG are the other
features. Necrosis of the upper GI tract with
Chronic poisoning with copper may oc-
pyloric stenosis are the complications. In
cur in the industrial environment and in do-
acute poisoning cases death may occur within
mestic environment due to constant use of
3 to 4 days .
copper utensil or consumption of vegetables
treated with copper sulphate solution as pre-
Signs and symptoms of chronic poisoning
servative or colouring agent .
Prolonged treatment of anaemia with heavy
dose offerri-et-amon-citrous may cause iron
IRON encephalopathy . Absorption of small amount
over years leads to siderosis or lung fibrosis .
There will be signs of damage of liver, kid-
Acute poisoning
neys (tubules) and GI tract .
Acute poisoning-with iron occurs mostly in
children due to consumption of adult dose of Absorption, fate and excretion
ferrous sulphate or during IV injection of iron Iron is efficiently absorbed from the upper
preparation . part of the intestine , though the greater part
Also available as chloride as welt as other of it remains unabsorbed and is excreted with
medicinal preparation. stool . Absorbed part circulate with blood

plasma as described above. It is slowly ex- Absorption, fate and excretion

creted through the kidney.
Through skin and mucus membrane of GI
Treatment tract and respiratory tract. As a cumulative
poison it is deposited in liver, kidneys, mus-
1. Use of emetics or stomach wash with Na- cles and bones. It is deposited in maximum
bicarbonate solution. 2. Demulcent drinks concentration in th~e lb-ididymis. Excretion is
like milk or egg albumin. 3. Desferrioxamine through kidneys mainly. It is also excreted
by mouth to neutralize the poison in the stom- through milk Thallium can pass through the
ach. After initial 8 gm dose by mouth, it is placental barrier.
repeated with a daily oral dose of2-3 gm or
IV dose of 1-2 gm, for the absorbed part of Fatal dose
the poison. It fom1S ferrioxamine with iron
which is readily excreted through urine. Al- Adult- 200 mgm to 1 gm. Children- about 8
ternatively., EDTA or penicillamine may be mgm per kg of body weight.
used in their usual doses . In acute cases if
there is shock, pressure· agent should be Fatal period
given. Haemodialysis or peritoneal dialysis
may be necessary in acute cases . Variable.
Postmortem findings Signs and symptoms
Pulmonary haemorrhage , centrilobular In acute poisoning, signs and symptoms start

necrosis of liver, necrosis of kidney tubules , late, between 12- 36 hours, though in some
signs ofGI tract irritation in acute cases and cases it may be early. There is GI tract irrita-
necrosis of the upper GI tract in chronic cases tion with metallic taste in the mouth, nausea,
are the usual findings. Serum iron content vomiting, anorexia, dryness of mouth, colic,
and serum transaminase levels are high. diarrhoea or constipation. There may be res-
piratory distress, conjunctivitis and in some,
Medicolegal aspects
running from the nose. Neurological symp-
Both acute and chronic poisoning cases are toms start with signs of polyneuritis , tingling
almost always accidental, from over-dose , and pain sensation in hands and feet , muscu-
prolonged therapy or IV administn..tion . lar weakness with paralysis of some muscles,
within a few days. In some cases, there may
be tremor and ataxia. There may be insom-
nia, deafuess and scotoma with ultimate blind-
ness . Within some days, there may also be
Toxic compounds
stomatitis. There is loss of scalp hair, eye
Thallium sulphate and thallium acetate are brows and axillary hair. In subacute cases there
usually responsible for poisoning. are encephalopathy, white stripes across the
nails , loss of nails . In chronic exposure, these
Uses symptoms appear in milder forms. In fatal
As rodenticidal agent , cosmetic (as depila- cases, death is preceded by delirium, convul-
tory), in industries . sion and coma. Eosinophilia is a common phe-
nomenon. Symptoms occur at over 40 mg%

in blood and 150 mg per litre in urine·
Treatment Poisonous zinc compounds
Though usually there is vomiting, there may Zinc chloride, Zinc phosphide, Zinc sulphate,
be necessity for induction of emesis or gas- Zinc oxide and Zinc stearate.
tric lavage. Stomach wash is performed with
Uses and source
1% sodium or potassium iodide solution. It
forms insoluble iodide salts of thallium. Io- Zinc chloride is used to clean metals before
dide also acts as a systemic antidote. Absorp- soldering. Zinc phosphide is used to kill ro-
tion can also be prevented by administration dents. Zinc stearate is used as cosmetic (baby
of activated charcoal, followed by saline pur- powder). Zinc oxide and sulphate are indus-
gative. Sodium diethyldithiocarbamate in the trial hazardous agents.
dose of 25 mglk.g body weight in t litre of 5% Zinc is normally present in our body.
glucose saline is given by IV drip over a pe- Liver contains around 10 mg of zinc per 100
riod of 5-6 hours, repeated for 3 more doses, gm Blood concentration is about 6- 7 mg%.
once daily. Pilocarpine in its usual dose is
Fatal dose
also considered as a physiological antidote.
BAL is also useful. In case of tremor, anti- About 5 gm of zinc chloride and zinc phos-
parkinsonism drug is helpful. Stimulants. phide and about 15 gm of zinc sulphate.
dextrose and calcium salts are other drugs
Fatal period
which are used according to necessity.
Within 3 days.
Postmortem findings
Action and signs and symptoms
Externally, there are loss of hair and anae-
mia. Internally, there is fatty degeneration Zinc compounds are locally strongly irritat-
of liver and kidneys. Thallium is retained in ing and after absorption cause metabolic aci-
body for years. dosis, hypocalcemia, damage to liver and kid-
neys and neurogenic signs and symptoms.
Medicolegal aspects Zinc chloride causes severe GI tract irri-
tation with nav"'ea, vomiting, pain in the ab-
Poisoning is mostly accidental and chronic
domen and diarrhoea. The vomitus and the
due to exposure in industries or use of cos- stool may contain blood. There is degenera-
metic preparation or acute due to consumption of the stomach wall with occasional per-
tion of preparations used for rat killing pur- foration . There is degeneration of liver and
pose. Suicidal poisoning occurs, but is com- kidneys.
paratively less now-a-days. Homicidal poison-
With zinc phosphide, in addition to the
ing is not common. One advantage of homi- above features, the vomitus give the smell of
cidal use is, late starting of symptoms. But phosphine, there are degenerative changes
greatest disadvantage is its detectability from in the heart, hypocalcemia, metabolic acido-
body, years after death. sis and chillness.
Inhalation of zinc oxide vapour in indus- bonate , hydrate etc. Barium sulphate is in-
tries causes chill and fever , a condition known soluble and not toxic .
as metal fume fever .
Source and uses
Inhalation of zinc stearate used in baby
powder may cause pneumonitis . Barium carbonate is u sed as a rodenticidal
agent. Other soluble salts are used in indus-
Treatment
tries and laboratories . The insoluble barium
Stomach is washed with alkaline solution sulphate being radio-opaque and non-toxic is
(NaHC0 3 ). Purgatives are given for elimina- used in radio-diagnosis . Barium sulphide has
tion from the intestine. Treatment for liver, been taken for barium sulphate by mistake.
renal, cardiac damage and metabolic acido- Old stock ofbarium sulphate may change to
sis and hypocalcemia is given in the conven- barium sulphide in small amount and cause
tionallines . poisoning .
Postmortem findings Absorption, distribution and excretion
No specific external signs may be seen. Signs The soluble salts of barium are well-ab-
of irritation of the GI tract with degenera- sorbed through the GI tract. After absorp-
tive changes in the stomach wall and occa- tion, it is distributed to all tissues. In com-
sional perforation of the stomach wall may parison with other tissues, in bones it stays
be there. Degenerative changes in the liver , deposited for a longer period. Absorbed salts
kidneys andheart may occur. Signs ofpneu- are excreted mainly through the bowel (GI
monitis is present when it occurs due to in- tract) and to some extent through urine .
halation of zinc stearate powder. Excretion of the metal from tissues other
than bones is complete in two or three days
Medicolegal aspects after absorption.
Most of the poisoning cases are accidental in
Fatal dose
nature as in case of chronic exposure in in-
dustries or acute poisoning cases due to con- Barium chloride , Barium sulphide and
sumption of food stored and cooked in zinc Barium nitrate-! gm ; Barium carbonate-5
galvanised metal containers or that contami- gm .
nated with the rodenticide zinc phosphide.
Inhalation of zinc stearate containing pow- Fatal period
der may cause fatal pneumonitis in infants.
Death occurs within 12 hours .
Suicidal poisoning occur mostly with the
rodenticidal preparation. Homicidal poison- Actions, signs and symptoms
ing is not common.
The soluble salts are locally irritant . After
absorption they act as stimulants , both for
BARIUM voluntary and involuntary muscles including
heart muscles, which are lastly paralysed .
Soluble barium salts are most toxic . These On ingestion, there is burning colicky ab-
are barium chloride , nitrate , sulphide , car- dominal pain with vomiting and motion . There

chapfer31: METALLIC CHEMICAL IRRITANTS I 795
are tingling sensation and tremor of muscles. carbonate for rat killing. Suicidal consump-
Pulse - irregular, B.P . - raised. There is con- tion of barium carbonate may happen. Homi-
traction of muscles. Voluntary muscles may cidal poisoning is not expected.
have fasciculations . There are cardiac arrhyth-
mia, ectopic beats, forceful systolic contrac-
tion and lastly ventricular fibrillation. In sur-
viving patients paralysis of muscles occurs with
loss of deep reflexes. Paralysis of respiratory Potassium toxicity or hyperkalemia may oc-
muscles at this stage may be the cause of cur from exogenous or endogenous sources . .
death. Thus, death may occur due to shock Exogenous causes are: 1. High dose or rapid
fromabdominal pain at the initial phase, then potassium therapy, 2. Poisoning with potas-
due to ventricular fibrillation and lastly due sium permanganate or potassium iodate.
to paralysis of respiratory muscles. Endogenous cause is renal failure.
Treatment Fatal dose

Sodium sulphate 15 gm or magnesium sul- Fatal dose of potassium iodate or potassium
phate 15 gm is given orally to convert the permanganate - 12 to 15 gms.
ingested soluble barium compound to insolu-
ble barium sulphate, to prevent absorption. Fatal period
To lower the raised blood pressure 30 - 60
mg, sodium nitrite works better. To prevent Variable.
or counter ventricular fibrillation, quinidine
Signs and symptoms
sulphate 100 to 200 mg, orally or
procaine amide 500 mg by very slow IV injec- 1. Exogenous poisons, like potassium iodate,
tion may be gi ven. The danger (stoppage of when taken orally, cause severe irritation
heart) of IV procaine amide injection should of the GI tract locally and haemolysis and
be kept in mind. Anti-spasmodic may be use- symptoms related to damage to liver, kid-
ful to combat colicky spasm of the intestine neys, urinary bladder and retina after ab-
and the vessels. sorption. With potassium permanganate,
there may be severe gastroenteritis,
Postmortem findings oedema of glottis and respiratory distress,
Nothing specific. Submucosal haemorrhage when taken orally and gross ulceration
in the GI tract occurs, often due to excessive with necrosis and perforation of the vagi-
spasm. nal wall when used intra-vaginally.
2. With endogenous hyperkalemia or with
Medicolegal aspects high dose potassium therapy, there may
Barium sulphide causes accidental poisoning be tingling, numbness and weakness of
when it is taken by mistake for barium sul- the limbs and fingers and toes, with mus-
phate, for X-ray examination. Exposure may cular paralysis in some cases. There may
occur in c~emical industries. Accidental poi- be mental confusion, bradycardia and cir-
soning has occurred due to contamination of culatory collapse.
fdod g-rains with grains treated with barium ECG test shows elevation of T waves.

Treatment Signs and symptoms
When large dose is taken orally, emesis or Causes vomiting, GI tract irritation, purging,
stomach wash should be perfonned. Demul- cardiovascular symptoms, weakness, oligu-
cent drinks should be given. Calcium chlo- ria .
ride or calcium gluconate are considered spe-
Treatment
cific antidotes for absorbed part of the poi-
son. Either of them is given in 1 gm IV dose . 1. To give vegetable astringent
2. For butter of antimony - weak vegetable
PM findings acid
When potassium pennanganate is taken by
mouth, there are signs of irritation of the
mouth and upper GI tract. With this and with
potassium iodate , there are signs of severe
GI tract irritation which also shows varying Available poisoning compounds/preparation
degre e of degenerative changes with are - Gold chloride , fulminating gold.
discolouration. Systemic toxicity due to both
Signs and symptoms
exogenous and endogenous causes leads to
degenerative changes of liver , kidneys and GI tract irritation , urinary suppression pink
urinary bladder . When used per vagina, ul- colouration around lips and in the mouth .
ceration of the vaginal wall with occasional Fulminating poisoning cause cardiovascular
perforation leading to peritonitis may be failure and collapse .
there.
Treatment
Medicolegal aspects 1. BAL orpenicillamine in their usual dose.
Endogenous toxicity is due to natural disease 2. Supportive and symptomatic treatment.
conditions or develops as complication of some
other condition. Exogenous causes include
high dose or too frequent dose treatment with
potassium preparation. Suicidal uses are re-
ported . Homicidal use is not possible due to Available bismuth nitrate , pearl powder, face
high fatal dose and detectable colour . Used powder .
as local criminal abortifacient agent , potas-
sium pennanganate may cause death or some Signs and symptoms
complications including perforation of vagina
GI tract irritation , vomiting, hiccup , urinary
and peritonitis.
suppression , muscular cramps .
Treatment
1. Penicillamine in usual dose
Available as Tartar emetic , oxide of antimony, 2. Plenty of milk
butter of antimony. 3. Supportive treatment
. ·, 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
chapter 31: METALLIC CHEMICAL IRR ITANTS I 797
• A K. Chaudhury, S. Ghosh, D. Pal - Acute copper

sulphate poisoning, Journal of Ind. Med. Ass. Vol. 36,
1961 .
Available as chloride, oxide (and in alloid
forms) • J C Ayub, et al. -Lead poisoning, 1926
• C H. Thienes and E. J. Haley- Clinical Toxicology,
Signs and symptoms 1972
GI tract irritation, vomiting, purging pain in • Michael J Skrun and Davidson A Ramsay - Pathol-
the stomach, twitching and convulsion.
Treatment S Fisher- Spitz and Fishers Medicolegallnvesdgation
of Death - 2006.
1. Copious milk
• W Dog las Hemming - Forensic Medicine and Toxicol-
2. Fresh egg
ogy- 2008.
3. Penicillamine in usual doses
4. Symptomatic treatment
Silver nitrate Long questions

Sources, Signs-symptoms, Treatment, Postmortem
Signs and symptoms
findings, Medicolegal aspects of poisoning with,
GI tract irritation, vomiting, purging burn- White arsenic, Mercuric chloride, Lead and copper
ingpain in mouth and abdomen, dehydration, sulphate, Chronic lead poisoning.
suppressed urination. Collapse.
Short questions
Treatment Arsine, Chronic arsenic poisoning
1. Spoonful of common salt by mouth at an Mercurial erethism, Chronic lead poisoning, Neuro-
genic involvement in lead poisoning, Difference be-
interval of 10 minutes
tween arsenic poisoning and cholera/gastroenteritis.
2. Starch or barley water
3. Penicillamine in usual dose Oral questions
4. Control dehydration Fatal doses of the poisons and other questions from
5. Symptomatic long and short questions, Uses and sources of differ-
ent poisons, Metal fume fever, Lead palsy, Lead
encephalopathy, Hatters' shake, Acrodynia, Most toxic
compounds of Arsenic, Mercury, Lead, Copper, Zinc,
• P L. Bidstrup- Toxicity of Mercury and its compounds, Barium, Uses of Arsenic, Lead, Mercury, Copper, Source
1957. of poisoning with iron.

NOTES

AGRICULTURAL POISONS (b) Chlorate of sodium- It is an irritant
(c) Arsenite of sodium - It is also an ir-
Various pests, ftmgi, weeds and rodents cause ritant Those who handle it regularly
much harm to the production and storage of and carelessly, may develop signs of
agricultural food. This has given rise to the chronic arsenic poisoning
use of various chemical agents to combat and (d) Cyanate of potassium- It causes tis-
control these harmful agents. Some ofthese sue anoxia
chemical agents are non-toxic to human be- (e) Dinitrocresol products - These are
ings, some are only mildly toxic, some are metabolic poisons.
moderately and some are highly toxic.
(f) Paraquat (Dipyridyl herbicide)
Agents harmful to agriculture being dif- 3. · Insecticidal - These are used to kill in-
ferent, chemical agents used to control them sects which destroy plants or plant prod-
are also different and the chemical agents are ucts. S~me of these are ovicidal which
classified according to their nature of action kill ova of the insects . Insecticidal
Thus, they may be agents
1. Fungicidal - Used mostly to preserve (a) Organophosphorus compounds or
seeds for seedling purpose. Ex. Alkyl mer- organic polyphosphates. These
curial compounds like phenyl mercuric agents are most popular among the
acetate. In human beings, consumption Indian cultivators. Some of the prepa-
of seeds preserved with this agent causes rations are also used as domestic in-
mercurial erethism and encephalopathy secticidal agents. Two chemical
(other ex. cap tan, captafol). groups are available.
2. Herbicidal or weed-killer - Growth of (i) Alkyl compounds - e.g. Tetra-
undesirable herbs or weeds in the field is thy! pyrophosphate (TEPP),
a major cause of low production. Hence, Hexaethyl tetraphosphate
herbicidal or weed-killing agents are use- (HTP), Octomethyl pyro -
ful and available. These are phosphoramide (O:MPA), Systox,
(a) 12% sulphuric acid - For human be- dimefox, isopestox, dipterex,
ing it is a corrosive agent. sulfotep, malathion, etc.

799 CoMC-24
800 I PRINCIPLES OF FORENSIC MEDICINE .. •
Aryl compounds - Chlorothion,

(ii)
diazinon, paraoxon, parathion
methyl parathion
(b) Halogenated hydrocarbons -A good Much of the success in the agricultural fields
number of preparations of chlorin- in our country is due to the knowledge and
ated hydrocarbons are available in use of agricultural insecticides. There are
the market for use as insecticidal other u ses of these insecticidal agents e.g.
agents in different fields . These are
domestic and commercial uses. As has already
Aldrin, dieldrin, endrine, chlordane, been mentioned earlier, some of them are
DDT; gammexane, heptachlor, non-toxic to human being, some are mildly
methoxychlor. toxic , some moderately and some deadly .
(c) Carbamate compounds - Carbaryl, Organophosphorus compounds are deadly
aldicarb, carbofuran, propoxur. toxic to human beings, as they are also most
(d) Miscellaneous preparqtions - Apart effective as insecticidal agents. Hence, these
from organic polyphosphates and preparations are most popular on one side
chlorinated hydrocarbons, a good and also takes many lives every year, though
number of other preparations of in- mostly in the rural areas but also to a con-
secticidal agents are also available. siderable extent in the urban areas .
These are These are dangerous to factory and agri-
Salts of mercury and arsenic , fluo- cultural workers . They pollute air and water
rides , cyanides , phenolic compounds in the rural side. They disturb eco-system by
- particularly the chlorinated prep a- killing harmless insects and helpful animals .
rations like pentachlorphenol, plant They create resistance in disease carrying
products like pyrethrum, nicotine, vector insects . Prolonged use causes direct
etc. effect on human body and indirect effect on
4. Rodenticidal - In India and many parts economic condition of the society.
of the world, huge quantity of grains is
eaten up and destroyed by rats and other Mode of use of organophosphorus
rodents . Hence, for preservation of compounds
grains, use of rodenticidal agents has
become imperative. They may be- In the agricultural fields these are either used
(a) Inorganic preparations like , barium as aerial spray , mixed with suitable liquid or
carbonate, phosphorus, thallium, dust as their vehicle, or they are mixed with
zinc phosphide. soil . When sprayed in air, absorption in the
plants occurs through leaves and stems .
(b) Organic preparation like fluoroace-
When used by mixing with the soil, absorp-
tate compound .
tion occurs through the roots of the plant. In
(c) Convulsant , like strychnine.
case of herbicidal agents, undesirable herbs
(d) Anti-coagulant , like warfarin. or weeds die. In case of insecticidal agents
5. Acaricide - To destroy mites , ticks and like organophosphorus agents no harm is
spiders , e.g. chlorobenzilate, axobenzene. caused to the plant. When the insect sits on
6. Nematicide - To destroy nematodes , e.g. the plant , the poison is absorbed through their
Ethylene-di-bromide. exoskeleton or when it eats the leaves of the
chapter 32: ORGANIC CHEMICAL IRRITANTS (INSECTICIDES AND ENVIRONMENTAL) I 801
plant, it consumes the poison alongwith. In they are primarily nerve poisons. They have
human being no harm is caused by consum- action both on the autonomic nervous sys-
ing the grain, fruits or other parts of the tem as well as central nervous system. On
plants, if used with recommended cautions. autonomic nervous system, they have para-
sympathomimetic action by inactivating
Absorption, fate and excretion cholinesterase and thereby prolonging the
action of acetylcholine. The actions are both
Organophosphorus compounds are well ab-
muscarinic and nicotinic. Ori the CNS, the
sorbed through the mucus membrane of the
action is depression.
GI tract, respiratory tract and through the
skin. Parathion is stored in the body fat and Acetylcholine as a chemical transmitter
is slowly released in the circulation, prolong- plays the vital role to propagate cholinergic
ing the duration of its toxic action. It is first nerve impulse across the synapses of the pe-
metabolised to paraxon which is the active ripheral and central nervous system In the
toxic agent of the preparation and then to blood and nervous tissue cholinesterase in-
paranitrophenol to be excreted through urine. activates acetylcholine after its liberation and
Malathion is metabolised in the liver by the action which prevents its sustained action.
esterases. A part of the metabolised product Cells of the blood and nervous tissue contains
is excreted in urine as phosphate. The rate true or specific cholinesterase, while plasma
of excretion varies. Some of the preparations and white matter of brain contains pseudo-
remain in the body longer than others. Par- cholinesterase. Ordinarily, true choli-
athion may be retained for a period of about nesterase present in the cells is at work to
a week and malathion for a period of more inactivate the acetylcholine after its libera-
than a week tion. When excess of esters of choline escapes
in blood, plasma esterase becomes important
Fatal dose and acts as a safeguard against the unre-
stricted action of acetylcholine. Most of the
According to the fatal dose, organophospho- parasympathomimetic drugs and the organo-
rus compounds can be classified as: phosphorus compounds inactivate the
Mildly toxic - Fatal dose more than 25 cholinesterase to facilitate the action of ace-
gm and up to 60 gm e .g. chlorothion, tylcholine. This occurs first at the plasma
malathion, dipterex. level and then at the cellular and brain level.
Moderately toxic - Fatal dose - 10 gm to Inactivation of the esterase by neostigmine
25 gm e.g. diazinon. and similar drugs is reversible. Organophos-
phorus compounds inactivate the polypeptide
Highly toxic - Fatal dose - 15 mg to enzyme by phosphorylation of one of its con-
5 gm e.g. parathion (15 mg to 30 mg), methyl stituent aminoacids. This inactivation is re-
parathion (15 mg - 50 mg), systox (20 mg), versible for a few hours only. Then it becomes
pestox (200 mg), trithion (600 mg), phosdrine irreversible. Hence, a sustained action of ace-
(150 mg), TEPP (5 gm), delnav (5 gm). tylcholine continues so long the drug is not
inactivated or removed or fresh esterase is
Action and mode of action synthesized to resume function.
Organic polyphosphates, though cause some Some of the polyphosphates like TEPP
degree of irritation to the mucus membrane, are active in vitro and start acting rapidly
fF M . - 51 1
after absorption in the body. But their action fested as various forms of muscular weak-
is for a short period. On the other hand, oth- ness, paralysis oflimbs and flexor spasms.
ers like parathion are inactive in vitro. To
start their action, after absorption in the body, Diagnosis
they first have to change to some intermedi- History of exposure, signs and symptoms,
ate state (e.g. parathion changes to paraxon). estimation of cell and plasma cholinesterase
But their action is more persistent, insiduous (less than 30% of normal) are diagnostic of
and proves more fatal. poisoning with organophosvharus compound.
Fruits and vegetables contaminated due In some cases however, gastrointestinal and
to spraying becomes free from danger after a pulmonary symptoms may cause confusion
few days. in diagnosis.
Signs and symptoms Treatment

1. Avoiding the risk of further exposure-
Depending on the action, the signs-symp-
toms are parasympathomimetic (muscarine (a) Removal of the patient from the
like and nicotinic) and those of CNS depres- place of exposure (e .g. from the field
sion. when spraying of the poison in the
field is the cause of poisoning).
Parasympathomimetic signs-symptoms -
Nausea, excessive salivation, vomiting, pal- (b) Removal of the clothings- If the con-
lor, colic, slow pulse, low BP, cold sweating, tact is through the skin, then the con-
diarrhoea, constriction of pupils, bronchos- taminated clothes should be removed
pasm, muscular weakness. to prevent further absorption.
(c) If the skin is contaminated then
Signs-symptoms related to CNS - Ma-
washing of the contaminated part or
laise, headache, dizziness , restlessness ,
fibrillatory twitching in the face and tongue, bathing will be necessary.
general weakness, ataxia, convulsion. 2. Stomach wash with strong KMn0 4 solu-
tion.
Severe signs and symptoms consist ofboth
parasympathomimetic and CNS depression. 3. Atropine sulphate, IV in 2 rnglhr. doses till
These are - bronchospasm complicated by atropinisation i.e. dilatation ofpupils. Apart
excessive secretion in the respiratory tract from stimulating respiration and relieving
(parasympathetic) and weakening of dia- bronchospasm, atropine also helps by re-
phragm (relaxant action of acetylcholine). ducing secretion. In case ofpoisoningwith
These two actions along with the interference parathion, atropine in lower doses should
of normal activity of central nervous system be continued for a few days.
cause anoxia leading to death. At the termi- 4. Oximes are 'considered proper antidotes
nal phase anoxia cause dilatation ofthe pupils of organophosphorus poisons. They re-
when the patient is cyanosed and collapsed lease cholinesterase from the esterase-
with periphery circulatory failure, acute pul- phosphate combination by removing phos-
monary oedema and respiratory failure. phate radical. The time factor is impor-
Repeated exposure causes toxic demyeli- tant for this reaction to occur, because,
nation resulting neurological disorder, mani- the esterase-phosphate combination loses

alkyl group with passage of time . This 2. Washing ofhead and face with soap after
makes other phosphorylated esterase use .
ineffective to oximes. Different prepara- 3. Spraying in the field should not be done
tions of oximes are available, namely, for more than 2 hours a day and more
Diacetyl monoxime (DAM), Pralidoxime than 6 days in a week.
or pyridine 2 aldoxime methiodide
4. Diseases of lungs, liver and kidneys are
(P 2AM), Pyridine 2 aldoxime methane sul-
contraindications for spraying.
phonate (P 2 8 ). Dgse is 1 gm in 1- 2.5%
isotonic solution (40- 100 ml) given in- 5. No smoking, drinking or eating should
travenously. A second dose may be re- be allowed during spraying.
peated after 1 to 6 hours according to 6. There should be proper instruction to the
necessity. Alternatively, a separate regi- sprayers and supervision of the spraying
men may be followed in which the dose work.
is calculated as 30 mg!kg body weight 7. While spraying, the sprayer should spray
given intravenously.in similar dilution, backward and move against the current
0.5 gm dose at the start, repeated after of the wind.
112 hour with a similar dose , followed by
8. Appliances should be thoroughly washed
125 mg dose intramuscularly, halfhourly
after use .
for4- 5 injections. Ifpralidoxime therapy
is started , then the dose of atropine 9. Workers (sprayers and others) should be
should be cautiously calculated to avoid subjected to intermittent neurological
test.
subsequent atropine toxicity.
5. The respiratory tract lumen should be Postmortem appearance
made free from mucus secretion by way
of suction. Externally, there are 1. cyanosis, 2. deep
6. Oxygen inhalation. postmortem staining, 3. congested face,
4. frothy discharge, often blood stained, from
7. Artificial respiration if necessary.
the nose and mouth, and 5. kerosene-like
8. Absolute rest is given, if necessary by
smell due to the diluent of the poison (may
giving suitable sedative.
or may not be appreciated near the mouth).
9. Diuretics may be given to prevent pul-
Internally, 1. the mucosa of the stomach
monary oedema.
and intestine is congested, 2. the stomach
content may give a kerosene-like smell due
Prophylaxis
to the vehicle or diluent used for the poison,
To prevent accidental exposure and poison- petechial haemorrhagic spots may be present
ing, certain precautionary steps are recom- at the sub-pleural level and sub-mucosal level
mended during its manufacture, storage, dis- of other viscera, 3. gross congestion and
tribution and while using the insecticide in oedema of lungs, 4. congestion of other or-
the agricultural field and elsewhere. These gans, 5. oedema ofbrain, 6. blood stained froth
are- in the respiratory tract.
1. Use of protective clothes (apron, gloves, Cholinesterase level of cells and plasma
boots, mask). is low.

Medicolegal aspects Absorption, fate and excretion

Accidental poisoning occurs in manufactur- For the insects, chlorinated hydrocarbons are
ers, packers, sprayers and other users, chil- contact poisons and are absorbed through the
dren of the users, and due to contamination exoskeleton of the insects. In human being,
of food grains by seeds preserved by the in- except endrin and dieldrin, chlorinated hy-
secticide for seedling purposes. drocarbons in dry powder form are only poorly
Suicidal poisoning is common in our coun- absorbed through the mucus membrane of
try, both in rural and in urban areas, but '" GI tract, and are not absorbed through the
more commonly in rural areas. skin. Dieldrin and endrin, in dry powder form,
Homicidal poisoning does not occur due are absorbed well through the skin and mu-
to detectable smell of the substance used as cus membrane of the GI tract. Chlordane
diluent of the poison and due to alarming being liquid, is absorbed through the skin.
signs and symptoms which appear rather When dissolved in kerosene and other sol-
early. vents, all are rapidly absorbed, both through
skin and mucus membrane. In the body, these
are mainly deposited in the body fat and also
CHLORINAiED HYDROCARBONS to a small extent in liver, kidneys and brain.
These are destroyed mainly in the liver. Some
DDT (Dichloro-diphenyl-trichlo-roethane or part of some metabolic products are excreted
Chlorophenothane), Aldrin, Dieldrin, Endrin, in stool, urine and milk.
Hexachlorocyclohexane (Gammexane, Lin-
dane , Benzene Hexachloride), Chlordane,
Mode of action
Methoxychlor, Toxaphene.
These chlorinated hydrocarbons are used These are stimulants of central nervous sys-
at home, in gardens and in agricultural fields tem and cause death by overstimulation. But
as insecticidal agents. They are insoluble in these compounds are not always very toxic.
water. DDT is a volatile (slow of course) solid Sometimes their solvents are more immedi-
having a faint smell. It is highly soluble in ately toxic than them.
benzene and chloroform, moderately soluble
(11%) in kerosene, and slightly soluble (2%) Fatal doses
in ethyl alcohol. Other chlorinated hydrocar-
bons are soluble in fat solvents including kero- For Aldrin, dieldrin and endrin- 2.5 gm
sene. Aldrin, dieldrin and chlordane are poly- For Chlordane - 5 - 7 gm
cyclic, polychlorinated hydrocarbons. Meth- For DDT and lindane - 15 - 30 gm
oxychlor is methoxy analogue of DDT and lin-
For gammexane - No reliable estimated
dane, gammexane and benzene hexachloride
fatal dose is available . With gammexane fa-
are isomers of hexachlorocyclohexane.
tality is not expected.
Mode of insecticidal use
Fatal period
Being insoluble in water, these are used ei-
ther as dust or emulsion or mixed with sol- With optimum dose death occurs within some
vents like kerosene. hours.

chapter 32: O RGAN IC CH EMIC A L IRRITANTS (INSECTICIDES A ND ENVIRON MENTA L) I 805
Signs and symptoms 3. If after first convulsion excitability per-

sists in the form of hyperexcitation, ex-
With DDT and gammexane , nausea, vomit-
aggerated reflexes and muscular twitch-
ing and diarrhoea occurs, possibly due to the
action of their solvents . After an hour or two, ing, then pentobarbitone sodium, 180 mg,
absorption of the poison causes headache , IV or paraldehyde , 4 - 6 ml IM is given .
dizziness and weakness . With higher dose 4. If convulsion repeats , then controlled
cerebral disturbance like restlessness, irri- respiration is recommended with the help
tability, dizziness, palpitation , tremor, twitch- of an anaesthetist.
ing of muscles and convulsion occur. In chil-
dren, death may occur within a few hours Prophylaxis
due to respiratory failure . After the immedi-
To prevent exposure and poisoning, precau-
ate danger is over, risk of hepatitis , irrita-
tionary steps as recommended for organo-
tion of the gut with vomiting (often mixed
phosphorus compounds are also recom-
with blood), melena , bile in urine and tachy-
mended for chlorinated hydrocarbons (see
cardia may persist.
page 803).
Gammexane causes more irritation but
is less toxic than DDT . Postmortem appearance
Aldrin , dieldrin , endrin , chlordane ,
Externally , there is cyanosis with other signs
toxaphane are more active convulsants . With
of asphyxial death, kerosene-like smell near
these, there are dizziness, nausea , headache ,
the mouth, discharge of blood stained froth
and ataxia . Convulsion comes suddenly. If
from the nose and mouth.
convulsion or1mconsciousness occur without
any other preceding symptoms, then the prog- Internally , the stomach content smells
nosis is grave . Convulsions are like that of like that ofkerosene . There are signs of irri-
grandmal epilepsy with tonic and clonic tation of the stomach mucus membrane.
phases followed by stupor . Lungs are congested and oedematous with
Complications or delayed effects of thase subpleural haemorrhagic spots. There is froth
agents are gastro-intestinal irritation , hepa- in the lumen ofthe respiratory tract. Organs
titis and renal damage . are congested. There may be fatty degenera-
tion ofliver, kidneys and adrenal.
In chronic poisoning with chlorinated
hydrocarbon compounds, there are vague
Medicolegal aspects
neurological symptoms and toxic rash in the
skin. Accidental poisoning occurs , more in case
ofchildren who have access to the poison. It
Treatment is also because, tolerance for the poison is
1. Removal of the ingested poison by em- less in children . Accidental poisoning may
esis or gastric lavage and magsulph pur- also occur in persons who handle the poi-
gation . son. But fatality in this way in adults is not
2. When poisoning is through surface con- expected.
tact - removal of clothings and washing Suicidal poisoning is common, more in
ofthe skin. the rural sides.
Homicidal poisoning is very very rare. In

homicidal poisoning, the smell of the poison
is masked by administering it with alcohol. Alphos , Celphos , Phosfume , Phostoxin ,
Many of the signs and symptoms in poi- Phosphotek, Quick ph. etc. Available as
soning cases may be due to the effects of the greenish-grey tablets of aluminium phosphide
solvents like kerosene . urea and ammonium carbonate . The prepa-
ration has a garlicky smell. On exposure to
air it releases phosphine ammonia and car-
bon-dioxide.
These are Aldcarb, Propoxur (baygon pow- Signs and symptoms

der, aerosol, spray, baygon bait) carbaryl , Dizziness, vomiting, diarrhoea, epigastric
carbofuran (Agrofuron) etc. pain, restlessness, cyanosis, rapid respiration,
pulmonary oedema, tachycardia, cardiac ar-
Signs and symptoms
rhythmia, peripheral circulatory failure , con-
Salivation, lacrimation, vomiting, GI tract vulsion, CNS depression, coma. Death is due
disturbance, sweating, dyspnoea, bronchos- to circulatory failure .
pasm, deafness, slow pulse , low BP, muscu-
Treatment
lar weakness , twitching, tremor, convulsion.
Death due to respiratory failure . 1. Fresh air.
2. IVfluid.
Treatment
3. N a-bicarbonate.
1. Removal of the patient from the source 4. Dopamine - 4-5 mgm!kg, body wt.
of poisoning.
MLI - Poisoning is suicidal or acciden-
2. Removal of clothing and washing of ex- tal.
posed body parts if it is contact poison-
ing.
3. Removal of the patient to the hospital.
4. To prevent vomitus inhalation, siding the
Allethrin, Cypermethrin, Deltamethrin, Per-
patient and/or use of endotracheal tube.
methrin etc.
5. Oxygen inhalation.
Absorbed comparatively rapidly through
6. Artificial respiration with ventilator. mouth, less through skin and respiration.
7. Inj . atropine sulphate . It is less toxic in human being due to low
8. In case Df convulsion- diazepam, barbitu- absorption, rapid metabolisation and quick
rate . excretion.
9. Washing of the stomach with activated
animal charcoal with use of endotracheal Signs and symptoms
tube. Increased salivation, vomiting, diarrhoea,
MLI - Poisoning may be suicidal or acci- muscular incoordination, tremor, convulsion.
dental. Contact with skin causes, itching, burning

sensation, tingling and numbness, which ag- 1. Activated charcoal

gravate on exposure to sun or application of 2. Stomach wash
water. Locally causes irritation of eye.
3. Saline purgative
Treatment 4. (Acute and Chronic) symptomatic.
1. Preventive - use of gloves and body cov- MLI - Poisoning is Accidental mostly.
ered with clothes during use.
2. For eye contamination washing the eye
with plenty of water.
This poisonous agent has biotoxic character-
3. When ingested - Stomach wash with ac-
istics . It is a mixture of equal parts of trichlor
tivated charcoal.
phenoxy acetic acid and 2-4 dichlor phenoxy
4. Saline purgative.
acetic acid . It has the capacity to penetrate
5. Atropine in usual dose to prevent secre- waxy covering of plant leaves and spread to
tion. all parts of the plant. Human consumption of
6. Sedatives if convulsion or tremor is any part of such toxicated plant causes birth
present. defect to new born (poisoned in the womb due
MLI -Poisoning is accidental mostly. to consumption by the carrying mother) . In
adults consumption of any part of the plant
causes skin rash , non-Hodgkin lymphoma
and also malignancy . This genocidal chemi-
cal was sprayed on edible plants in Vietnam
Absorbed through GI tract, respiratory tract by USA, during Vietnam War between 1959-
or skin. 1975. It was also sprayed on edible crops .
Sign and symptoms
Burning sensation of mouth and throat, diffi-

culty in swallowing, pain in abdomen diar- Chloracetaphenone , chloro-acetylenone , bro-
rhoea. moacetone , ethyl bromoacetate , bromome-
thyl-ethyl-ketone chloropicrin and bromo-
Fatal dose benzyle cyanide cause irritation of the eyes
4-5gms . and lacrimation . Inhalation of these gases
also cause irritation of the respiratory tract
Chronic poisoning may have neurogenic, and pulmonary oedema . General irritating
teratogenic effects, da1rage to liver, kidneys, action on exposure to higher concentration
adrenal glands degenerative changes in GI causes itching, burning sensation and even
tract, pancreas, brain, heart,' muscles. Sur- blister formation .
face contact may cause skin lesion; inhala-
Churchill favoured use of poisonous gas,
tion causes nasal bleeding, contamination of
like tear gas (mustard gas or lacrimatory gas )
eye may cause keratitis.
against ''uncivilized tribes " to spread a lively
Treatment terror. Lacrimatory gas and phosgene were
j I • ' j ·, ~
used by Germans in world war - I. Now , it is
For ingested poison r, mostly used for riot prevention , to disperse
agitated mob by civil peace keeping agents • R. H. Dreisbach - Handbook of Poisoning, Preven-
like police. tion, Diagnosis and Treatment- Asian Edn, 1983.
• Sanjay Sengupta - "Health Hazards of Pesticides
Treatment
and its management" - 1996.
For irritation of the eye, wash the eyes freely • David Dolinak, Evan Matshep, Emma 0 Lew- Foren-
with water. For irritation of respiratory tract, sic Pathology: Principle and Pracuce- 2005
removal of the person to free air, oxygen in-
halation and artificial respiration.
S Fisher- Spitz and Fishers Medicolegallnvesugauon
of Death- 2006.
• Mclaine John Cupp - Toxicology and Clinical Phar-
macology of Harbated Products- 2000.
Many polycyclic aromatic hydrocarbons e.g. • Richard Stripp and Lawrence- The Forensic Aspects
3- 4 benzpyrene are in use in incense smokes. of Poison- 2006.
They cause chronic irritation of the respira-
tory tract and are occasionally carcinogenic.
Long questions
Sources, Signs-symptoms, Treatment, Postmortem
Acetone , Methyl isobutyl ketone , Ethyl amyl finding s of organophosphorous and endrine
ketone and Methyl n-amyl ketone according poisonings.
to concentration are mild to moderate irri- Short questions
tants. Apart from respiratory tract irritation
Prophylaxis against organophosphorus and halogen-
they also cause nausea, headache and dizzi-
ated hydrocarbon insecticides. Carbamate aluminium
ness.
phospid agent orange carbamate compounds, tear
Treatment gas exposure.
Symptomatic. Oral questions

Name some Fungicidal, Insecticidal, Herbicidal and
Rodent icidal agents, Classify and name
organophosporus and halogenated hydrocarbons
Fatal doses of Parathion, Diazinon, Endrine, DDT.
Gammexane. Actions and antidotes of organophos-
• R. L. Brown- Pesticides in Clinical Practice, Identifi-
phorus compounds and Chlorinated hydrocarbons.
cation, Pharmacology and Therapeutics, 1966.
What is meant by atropinisation? Causes of death
• W. B. Dei chmann and H. W. Gerarde- Toxicology of due to organophosphorus and chlorinated hydrocar-
Drugs and Chemicals, 1969. bans; their most toxic compounds. Different oxime
• R. Das - Guidelines in the Management of poiso- preparations and their doses Composition of Tear
ning cases in Practical Medicolegal Manual published gas, Incense smoke, Ketone bodies, signs symptoms
by Indian Academy of Forensic Medicine, 1988. caused by them and treatment.

Many plant extracts are irritant to human red in colour over the most surface area with
tissue. Many of them have mild to severe blackish surface at one end. Each mature
systemic toxic effects. Vegetable irritants seed weighs about 105 mg and the weight of
having wide range of systemic toxic actions the seeds is more or less constant. Abrin is
which are available and of concern, in India thermolabile and its toxicity is destroyed by
will be dealt in this chapter. These are - boiling the seeds. Hence , though as such
Abrus precatorius (Kunch, Rati); Ricinus com- deadly poisonous, the seeds are sometimes
munis (Castor, Jara, Reri); Croton tiglium consumed as food, after boiling. The seeds
(Croton); Semicarpus Anacardium (Bhalia, are also harmless when taken intact, as the
marking nut); Ergot; Calotropis gigantea seed coat does not allow the toxin to come
(Akand); Calotropis procera (Madar); Plum- in contact with the intestinal wall and the
bago zeylanica (Chitra); Plumbago rosea (Lal seed passes out undigested. Poisoning oc-
Chitra); Capsicum etc. curs only when crushed seeds are taken or
when the seeds are chewed before swallow-
ing. Abrin is slightly inactivated by the gas-
tric juice. It is most effective when used
parenterally. The seeds are tasteless and
(Synonyms - Kiinch, Rati, Precatory bean, odourless.
Jequirity bean, Crabs eye, Prayer bead, Ro-
Action
sary pea, Lucky bean).
The plant is a slender, woody, climbing It is a local irritant and CVS depressant.
plant. The seeds contain the toxic active prin- When used parenterally, the toxin causes
ciple ABRIN which is a TOXALBUMIN. A viper snake bite like action.
toxalbumin is a phytotoxin or toxic protein. Fatal dose
It is antigenic in character and agglutinates
red cells and also causes haemolysis. In these 1 to 2 crushed seeds for an average adult.
regards, it is similar to bacterial toxins .
Fatal period
Abrus seeds are oval in shape, nearly 8
mm x 6 mm in dimensions, glossy scarlet A few hours to a few days.
809
Signs and symptoms Medicolegal aspeds
When taken orally , there are signs and symp- Most of the poisoning cases are accidental in
toms ofsevere gastrointestinal irritation with children who being attracted by the colour
nausea, vomiting and diarrhoea which often may chew the seeds . Homicidal poisoning
bears evidence of internal haemorrhage . occurs mostly through parenteral route . For
There may be flushing of face , rapid pulse , homicidal parenteral use , the seeds are
fall of blood pressure , muscular weakness , crushed to powder . This alone or mixed with
dilated pupils, tremor , tetanic spasm , convul- datura and opium is made to a paste . Spikes
sion , coma and death due to. circulatory fail- oflength of about 1.5 em , weighing about 100
ure . In some cases there may be hallucina- mg each , commonly known as 'sui' or 'sutari'
tions . are made out of the paste and dried under
When used parenterally in t~~
e rm of the sun . These spikes are held in between
'sui' or spike (see below), there is se ere lo- fingers and the victim is forcefully slapped to
cal reaction like viper snake bite. ere are insert the spikes in the flesh. The spikes are
oedema , oozing , ecchymosis and necrosis of also used to kill cattles. For this the spikes
the tissue . Then there are vertigo , general are fixed on wooden frames and the animal
prostration , dyspnoea , fall of blood pressure , is forcefully hit on the buttock to inject the
weak irregular pulse , circulatory collapse and spikes in its body. Crushed seeds are often
sometimes convulsion before death . taken to commit suicide . Abrus seed pastes
are used as arrow poison . This has also been
Treatment
used locally to cause abortion . Seed dust is
Ifanti-abrin is available that should be used. used by malingerers to produce conjunctivi-
However , in any case, treatment is mostly tis . This may cause permanent damage of the
symptomatic . Stomach wash is performed and eyes.
demulcents are given, ifpoisoned by mouth .
Spikes are taken out from the site of
parenteral injection. Calcium gluconate is
given to combat tetany . Circulation is main-
tained and other symptomatic treatment (Synonyms - castor , jara , reri , verenda ,
given. arand , palma christi ).
Castor plants grow wild in India and are
also cultivated for castor oil. The fruits are
When taken by mouth, there may not be any clustered in bunches, have multiple spikes
remarkable external sign. When used in the on the surface . The seeds are available in two
form of spike then the site of injection will sizes . The smaller variety is about 1.2 em x
be swollen ,inflamed and necrosed with pres- 0.8 em in dimensions . The surface is mottled
ence of spike in the tissue, at the site of le- brown and glossy . The seeds contain the ac-
sion. Internally , when taken by mouth , the tive principle ricin which is a toxalbumin .
GI tract is inflamed with evidence of Castor oil extracted from the seed is not poi-
haemorrhagic points. Organs are congested sonous . The pressed cake of the seed retains
with evidence ofhaemorrhage in the organs ricin , after extraction of the oil which is not
and at the undersurface of visceral covering . poisonous .

chapter 33: VEGETABLE IRRITANTS I 811
Fig . 33.2: Ricinus communis plant (castor plant)
Complication
Damage of liver and kidney tissues.

Fig . 33 .1: Rici nus communis (castor plant - a part)
Nothing specific externally. Internally, mu-
Fatal dose cus membrane of stomach and intestine is
congested and haemorrhagic Cmshed seed
6 - 8 seeds; 20-30 mg of ricin. Some believe
with intact testa may be present in the stom-
that pure ricin is not absorbed from the in-
ach. Organs are congested with haemorrhage
testine.
in the organs and on their surface.
Fatal period
Medicolegal aspects
Within a day or two.
Suicidal use in the village areas. Accident in
Actions
children. Homicidal use is not common. Is
occasionally used as abortifacient agent.
Similar to the action of abms precatorius.
Signs and symptoms CROTON TIGUUM
There are burning pain in the throat, pain in (Synonyms - Purging croton).
abdomen, vomiting, diarrhoea, dizziness,
rapid weak pulse, low blood pressure, cold All parts of the plant are poisonous but the
seeds contain maximum concentration of the
extremities, muscular cramps and collapse.
active principles. The seeds are dark brown
When powder is applied in t he eye, it pro-
in colour, ov~.l in shape and are of the size of
duces conjunctivitis.
smaller variety of castor seeds. Crotin, a
Treatment toxalbumin and crotonoside, a glycoside are
the active principles. Croton oil is extracted
If there is no vomiting, then stomach wash, from tlie. seeds which is also toxic, though it
demulcent drink, maintenance of circulation does not·contain the toxalbumin crotin, which
and other supportive treatment are necessary. is retained in the pressed cake.

Fatal dose On exposure to air, the juice turns blackish .

The juice is used by the laundries to inscribe
4 - 5 seeds and 1. 5 ml of croton oil .
identification number on clothes .
Fatal period
Fa~
Some hours to 2 - 3 days .
6- 8 seeds .
Action and signs and sym ptoms
Fatal period
Actions are same as in case ofabrus and cas-
tor . When taken by mouth it causes burning 12 - 24 hours .
pain in throat and abdomen with vomiting
and purging. It also causes vertigo, prostra-
tion and circulatory collapse . Croton oil When spilt over the skin, there is bruise-like
causes erythema and blister formation of the painful leswns with nm:-ginal .,mall blisters .
skin. The lesions itch and may ulcerat e .
Treatment When t aken internally by mouth, there

is burning pain in the throat and abdomen
Stomach wash , demulcent drink , mainte- with blister formation in the throat some
nance of circulation and other supportive times. There may be dyspnoea , cyanosis ,
treatment . rapid pulse , fall of blood pressure , loss of re-
flexes . Death may be preceded by delirium
Postmortem findings
and coma .
As in case of castor seed poisoning.
Treatmeni
Medicolegal aspects
To wash the contaminated part of the skin
Accidental poisoning occurs due to ingestion ' with soap water. To give demulrent drink and
of croton oil by mistake for some other sub- symptomatic treatment.
stance . Suicidal uses occur but are not com-
mon . Homicidal use is very rare . Croton oil Postmortem appearance
is used as abortifacient agent . Root may also Externally , bruise-like lesions with sur-
be used locally with the same purpose . Cro- rounding small blisters may be noticed near
ton oil is also used as arrow poison . the angle of the mouth or on the lips, if juice
is swallowed. Internally , inflammation and
blister formation may be seen in the ph ar-
SEMJCARPUS ANACARD!UM ynx and oesophagus . The stomach may be
{BHALIA, MARKl~ Nun highly congested. Other organs are con-
gested. Liver may show early degenerative
Testa or coat of the seed cont ains toxic chemi- change.
cals . The seeds are heart-shaped and black .
Medic lege! aspects
The seed and carp yields brownish oily juice
which is irritant to the skin and contains the The juice has quackary medicinal use and that
active principles , semicarpol and bhilawanol . way accidental poisoning may occur. Suicidal

Fig. 33.3 : Lesion produced by

superficial injection
of semicarpus juice
(Dorsum of Lt. hand)
2nd day
4th day
7th day

and homicidal uses are uncommon. The juice ergotoxin , ergotamine and ergometrine . The
may be spilt on the body to cause injury and last one is also known as ergonovine or
annoyance. It is used as a local abortifacient ergobasine . Ergotoxin is a combination of
agent . The juice is used externally , to pro- ergocornine, ergocrystine and ergokryptine.
duce bruise like lesion and frame a false Ergotamine has a less toxic derivative,
charge of assault against an enemy. dihydroergotamine. Ergometrine is specifi-
cally used as an oxytocic agent.
Table 33.1: Differences between bruise and lesion Apart from these groups of alkaloids, er-
produced by semicarpus juice. got also contains some amount ofhistamine ,
Points Bruise Lesion due to tyramine and acetylcholine .
s~micarpus juice
Fatal dose
Shape regular irregular
10 gm or 10 - 12 ml of fluid extract.
Margin diffused sharp and clear
Swelling present C!bsent in some cases Fatal period
Colour change occurs does not occur Death occurs after a few days except when
Itching absent present the victim suffers from some cardio-vascular
diseases when death may occur within a very
Blisters absent present on the margin short period (some hours ).
Cause rupture of chemical damage
subcutaneous of the skin Action and signs and symptoms
capillaries Active principles are absorbed from the GI
Extravasation present absent tract , except histamine . Poisoning effects
in the tissue may be acute or chronic.
Nail beds nothing similar lesion due In acute poisoning, there are GI tract ir-
significant to itching ritation and vasoconstriction and contraction
of other smooth muscles . There are nausea,
vomiting and diarrhoea. There is respiratory
distress with a feeling of tightness in the
ERGOT (ergotism) chest . There are dizziness , numbness , dim-
ness of vision , raised blood pressure with oc-
Ergot is primarily a vasoconstricting agent casional bleeding from nose . There may be
which is present in the dried sclerotinum of unconsciousness .
the fungus claviceps purpurae , formed by its
Chronic E!rgotism may either be convul-
mycelium deep inside the ovary, which grows
sive type or gangrenous type. Combination
on stale grains , particularly rye and maize
of both type·'may occur in the same indi-
and on grass .
vidual , very occasionally. In convulsive type ,
Active principle there are twitching, tingling, numbness and
pain in the muscles. There may be convul-
About 12 alkaloids of more or l6lss similar sions. Contracture of muscles are not un-
actions are available from ergot. These are common.r Dementia may result in some. In
divided into 3 different combinations namely, gangrenous type, there is burning pain

(called St. Anthony's fire ) in the limbs with HISTAMIN-E

inflammation and swelling with alternating
heat and cold sense, numbness, tingling or
In trace amount it is available from ergot The
anaesthesia. There are vesicle formation
amine can also be synthesized. In human body
and cyanosis of the affected limb with gan-
mast cells or basophil liberates histamine.
grenous ulceration and sloughing. In fin-
gers, toes, ears, nose or hands and feet there Action, signs and symptoms
may be dry gangrene without swelling and
ulceration. It causes quick dilation of blood vessels and
increases their permeability causing as is
Treatment commonly known, allergy. As a result of dila-
tation and increased permeability of the ves-
In case of acute poisoning, where there has 8t:::.o, there is oedema with resultant respira-
not been loss of much time, vomiting may be tory distress, fall ofblood pressure ancl. shock.
induced or stomach wash may be given. Pur- There is increased contraction in GI tract with
gative is also usefuL ·Nitrite is given to coun- increased secretion Histamine localizes the
ter vaso-constriction. Vit. A is useful in con- toxic agent (Allergent) and increases the
vulsive variety. Pentobarbital or bromides blood supply in the affected area
may be given to sedate the patient.
Postmortem appearance CAt.GTRpPIS (CALOTROPtS GIGANlM

AND CAl:.OTRt>PIS-PROCERA) . '
In gangrenous type, there is primarily, de-
generation of the intima of the arterioles with Calotropis gigantea (Akand) with purple
thrombus formation. Gangrenous change flower and Calotropis procera (Madar) with
may be present in some part of the body. In white flower, grow wild all over in India. Their
convulsive type, degenerative changes may toxicological effects are more or less same.
be seen in the posterior column of the spinal
cord. Active principles
Calotropin, calotoxin, gigantin and uscharin

Medicolegal aspects
Fatal dose
Poisoning is mostly accidental Acute acciden-
tal poisoning may occur due to consumption Uncertain.
of food prepared with affected rye or grain.
Fatal period
This may cause mass poisoning in an area.
Ergot is used as an abortifacient agent. Sys- Within some hours.
temic poisoning may also occur from this use.
Signs and symptoms
Chronic poisoning occurs when ergot prepa-
ration is used in the treatme.n t of migraine Juice from the plant's leaves or stem causes
or prolonged uterine haemorrhage. With irritation of the skin with occasional blister
thera-peutic dose, death may occur in patients formation which excoriates later. When juice
of cardiac insufficiency or in arteriosclerotic or part of the plant is taken by mouth then,
persons. there are bitter taste and burning pain in the

816 I PRINCIPLES OF FORENSIC M EDICIN E
Fatal dose, fatal period, signs and symp-

toms, treatment and postmortem findings are
same as in cases of calotropis .
Medicolegal aspects
Suicidal poisoning is not usual. Homicidal
poisoning is very rare . Used as an abortifa-
cient (roots being used locally). Used as cat-
tle poison. Used to produce lesions to bring
false charge on an enemy.
Fig . 33.4: Calotropis procers plant
CAPSICUM ANNUM
mouth, throat, and abdomen, salivation, vom-
iting and diarrhoea. There are tetanic con-
Capsicum or chilli is a popular condiment in
vulsion and dilated pupils . Circulatory collapse
oriental countries . The fruit and the seeds
may cause death. Others develop stomatitis.
are irritants and have burning irritating taste.
Treatment
Active principles
Stomach wash, demulcent drinks and symp-
tomatic. Capsicin, capsaicin.
Postmortem findings Signs and symptoms

When taken by mouth, they or the dust prepa-
Nothing specific; signs of irritation of mou th
rations of the fruit or the seeds causes burn-
and stomach. Organs are congested.
ing sensation, irritation, redness, swelling and
Medicolegal aspects salivation of the mouth and the throat. There
will be pain in the abdomen. Burning sensa-
Suicidal and homicidal poisonings are rare . tion occurs for a few times during defecation.
Accidental poisonln g may occur from its The dust, when rubbed on the skin or sprin-
quackary medicinal use or its use as a de- kled in the eye, causes redness and irrita-
pilatory agent. It is u sed as a cattle poison . tion. Death is unusual except in homicidal
The juice is used in abortion stick as a local use on infants .
abortifacient agent. The juice is also used as
an arrow poison. The juice is applied on the Treatment
skin to produce chemical lesion to bring a
When swallowed, bulky food and demulcent
false charge of assault on an enemy.
drink relieve the symptoms. When applied on
skin or in the eyes, washing with plain water
PLUMBAGO [Plumbago Zey!anic<~ (Chitra) is sufficient. If the reaction is severe then,
<1nd Plumbago Rosea (Lal Chitra)J xylocain ointment may be applied locally.
Medicolegal aspects
All parts of the plants are poisonous . But
maximum concentration of the active princi- Criminal uses comprise of the following cir-
pal plumbagin is present in the roots . cumstances

1. Chilli dust may be thrown in the eyes to falls , muscular cramps present. When comes
snatch money or the belongings and to in contact with eye- conjunctivits .
escape arrest after a crime .
2. To kill unwanted new-born babies.
ANACARDIUM OCCIDENTALE (Cosh~w Nut)
3. Powder may be applied in eyes , nose ,
anus or vagina to extract confession. The testa of the nut contains the active prin-
4. May be applied in the vagina as a punish- ciple , cardol , which is an irritant.
ment for infidelity.
Signs and symptoms
Contact dermatitis with redness and urticaria
ALOE like lesions. In workers regular contact may
cause chronic dermatitis .
Aloe vera (Ghritakumari , Gheekumar ,
Lalisara, Chirukattali , Kumarpathu). Treatment
Aloes taste bitter. It increases intestinal Wash the part with soap water. Give symp-
movement , causes congestion of pelvic or- tomatic relief.
gans and may precipitate abortion as an
emenagogue . Medicolegal aspects
The dried juice of the plant parts contain Usually non-criminal contact by workers who
a glycoside, barbaloin. collect and process the fruits for extraction
of the nuts .
Signs and symptoms
When swallowed it causes pain in the abdo- ARGIMONE MEXICANA {Argimone OiJ)
men, vomiting, diarrhoea and inflammation
of the kidneys. In pregnant women it may All parts of the plant, particularly the seeds
cause reflex abortion . are poisonous .
Treatment Active principles
Symptomatic. Berberine , protopine, sangunarine .
Medicolegal aspects
.
Principle signs a nd sym ptoms
Quackary use to procure abortion. Consumption of edible oil contaminated or
adulterated with argimone oil causes circu-
latory collapse , abortion, epidemic dropsy and
general neuropathy.
Treatment
Active Principle- signs and symptoms
Use of the suspected edible oil should be
Podophyllin/Podophyllotoxin - Irritant to GI stopped. Symptomatic treatment; nursing care
tract causing enteritis type of features . Res- and physiotherapy are given in dropsy cases.
piration rate increased, body temperature Recovery may be full within some months.
fF M. - 521
818 I PRINCIPLES OF FORENSIC M EDICIN E
Medicolegal aspects Signs and symptoms
Usually accidental poisoning through con- There are dyspnoea, cyanosis , excitement,
sumption of edible oil adulterated with ataxia, convulsion . Death occurs due to cir-
argimone oil . culatory collapse .
Treatment
CHRYSANTHEMUM CINERARIAEFOUUM
Safeguarding respiration, maintenance ofcir-
(Pyrethrum}
culation and other symptomatic treatment.
Active principles Medicolegal aspects
Pyrethrin I , pyrethrin II , Cinerin I and Cin- Poisoning m ay occur due to accidental swal-
erin II . Flowers of the plant cont ain the ac- lowing of eucalyptus oil by mistake for some
other thing. Suicidal poisoning is very uncom-
~ri~ciples in maximum concentration.
mon . Homicidal poisoning is not possible for
Signs and symptoms its detectable smell.
It has an acrid bitter taste and causes numb-

ness of tongue and mouth , when taken CINNAMOMUM CAMPHORA (Camphor)
orally . It causes GI tract irritation like nau-
sea and vomiting; headach e, restlessness ,
(Toxic effect of plant parts, or diluted prepa-
tremor, muscular weakness and respiratory
ration)
failure in acute poisoning circumstances. In
chronic exposure, the person gets sen sitized Camphor is the active principle, present
and there are different allergic manifesta- in the stem.
tions
Signs and symptoms
Treatment There is pain in the abdomen , circulatory
Prevention of exposure and symptomatic collapse and convulsion. Death is due to car-
treatment including respiratory aids . diac failure . In chronic poisoning there is
neurological symptoms with convulsion .
Medicolegal aspect There may be hallucination and delusion .
Exposure is mostly accidental . Inhalation of Treatment

pollen grains of the flowers may sensitize a
person and may subsequently lead to aller- In acute cases , stomach wash, maintenance
gic reactions . Suicidal and homicidal u ses are of circulation and use ofparaldehyde may be
not usual. necessary to combat convulsion. In chronic
cases precautions against further exposure.
Medicolegal aspects
EUCAl YPTUS GLOBUlUS
Acute poisoning may occur in children acci-
The active principle is cinehole , a volatile oil dentally or .in .a,g~lt . due to suicidal use .
present maximum in the leaves of the plant . Chronic poisoning may occur in workers and

users . It is used by many in drinking water Medicolegal aspects

or in sweet-meat preparations (See also page
Poisoning is accidental and as abortifacient .
862).
CYTRULUS COLOCYNTHJS (Colocynth or

Bitter Apple, Malml, lndrayan, Pava,
Mekka, Kayi) Active principle
The active principle colocynthin is present Colchicin . In large doses it causes G.I. irrita-
in the fruits . tion with pain abdomen , diarrhoea and vom-
iting .
Signs and symptoms
Pain in the abdomen, blood tinged watery TURPENTINE (Pinus Palustris)

c... ~... ,,,nm.~ ...... rn.n ...... ''"''"'"~.nnnl
diarrhoea, raised body temperature, circula-
tory collapse . Active principle
Treatment d and 1-pinene .

Signs and symptoms
Symptomatic .
When swallowed , there is pain in the abdo-
PM findings
men with vomiting and diarrhoea. When in-
Irritation ofthe GI tract , inflammation of the haled , there is irritation of the respiratory
kidneys , congested organs . tract . In either case, after absorption there
are excitement , mental confusion , coma , ol-
Medicolegal aspects iguria and haematuria .
Poisoning is accidental ; used as an abortifa- Treatment

cient agent.
Stomach wash and symptomatic .
JUNIPERUS SABINA (Savin} PM findings

Inflammation of stomach, intestine and kid-
Shoots contain the active principle , savin .
neys .
Signs and symptoms
Medicolegal aspects
Nausea, vomiting, diarrhoea, pain abdomen,
circulatory collapse leading to death . Poisoning is accidental when taken by mis-
take for something else or very occasionally
Treatment may be taken for committing suicide .
Stomach wash; fluid and electrolyte intake ,
maintenance of circulation and symptomatic . CARUM COPT!CUM (Jowan, ajowan)
PM findings (Oman} (Oman- U) CUMINUM
CYMINUM (Jirat Jeerige, Jiraka).
Nothing specific except irritation of the stom-
ach and intestine. These are stimulant and antispasmodic .

820 I PRINCIPLES OF FORE NSIC MEDICINE
Active principle is anthraquinone derivatives. Active principle
Tanpin, Caryophyllin.
Active principle is lycorine, available from the

bulb of the plant. Asafoetida·CHing, Hingu, Kayamlnguva). Di-
gestive stimulant, has also psychogenic and
Sig1nd symptoms neurogenic action.
Pain in the abdomen, nausea, vomiting, te-
l
tan1c convu1s1on.
.
INDIAN WINTERGREEN (JAV}
Treatment ---""'- "'
Active principle
Stomach wash and symptomatic.
Methyl salicylate - in high dose sign symp-
PM findings toms of mild to moderate salicylate toxicity.
Non-specific; inflammation of the stomach
mucosa.
Gl)'CYRRHtlA (Jashtimqdhu)- Indian
Medicolegal aspects liquorice.
Accidental and suicidal poisoning are possi- Active principle

ble where the plant is available.
Glycyrrhizic acid - Causes haemolysis.
POISON IVY (Rhus Toxicodendron)

'" """"
Active principle is present in the resinous Oil extract contains the active principle
exude of the fruit stalk which is an irritant. a-pen tadecyl-catechol
Signs and symptoms
Causes irritation and contact dermatitis.
Treatment
Application of bland or antiseptic or
antiallergic ointment.
.Medicolegal aspects
Fig ; 33':~ : _ Poison Ivy
Malingering

chapter 33: V EGETABLE IRRITA NTS I 821
Signs and symptoms

Causes contact dermatitis . Smoke causes
respiratory irritation.
ARISTOLOCIA INDICA
Active Principle and action

Aristolochin ~ Respiratory paralysis and
mascular weakness , Haemorrhagic nephri-
tis and GI irritation when taken orally.
Treatment
Fig. 33.7: Poison S~,Jmac
Applicat~on~ antiseptic and antiallergic oint-
ment.
Medicolegal a~ects FERN (Aspidium}
Contact dermatitis . Male ferns are poisonous which contain filicin ,

POISON OAK and SUMAC are two other an oleoresin active principle.
plants which ate skin irritants and cause rash
and dermatitis , on touch. Signs and symptoms
ST. JOHN'S WORT causes photosensiti- Pain in the abdomen, vomiting, diarrhoea,
sation in fair-complexioned subjects , who af- defective vision, delirium, circulatory col-
ter touch with parts of plants are exposed to lapse, coma and death.
sunlight.
Treatment
Treatment in these cases consists of use
of antiallergic ointment, locally. Symptomatic.
Fig. 33.6: Poise~ oak Fig. 33.8: St. John's wort

• C A Franklin- Modi's Medical Jurisprudence and

Toxicology, 1985.
• Wilma Roberts James- Know your Poisonous Plant
-1973
• T. Acamovic, C.S. Stewart, T. Pennycott- Poisonous
Plants and related Toxicology- 1989.
• David Ellis- Medical Herbs and Poisonous Plants-
2008.
_) K. A Kartikara- Poisonous ~ants of Bombay- 2003.
Fig. 33.9 : Loco weed

Questions
PM findings
Long questions
Nothing specific. Signs-symptoms. Treatment and circumstances of
poisoning with abrus precatorius.
Medicolegal aspects
Short notes and Oral questions
Accidental poisoning (food poisoning). Castor seed, Croton seed, Marking nut; Differences
LOCO WEED is a cattle poison which between bruise and chemical lesions produced by
causes abnormal excitation and restlessness marking nut juice; Ergotism, Argimone Mexicana, Tur-
if the animal eats the plant parts. pentine; Physical appearance of seeds of Abrus. Cas-
tor. Croton. Semicarpus, How is ergot obtained ?VI/hat
are the active principles and circumstances of poi-
References soning of different vegetable poisons? How is abrus
used for homicidal poisoning ? With what poisoning
• F. E. Camps. Gradwohl's Legal Medicine, 1976. abrus is similar. Fatal doses of different vegetable
• C. H. Thienes anT. J Haley- Clinical Toxicology. poisons. Antidote of abrus.

are not poisonous- Out of the more than 2,500
SNAKES
species of snakes, something more than 300
species are only poisonous. Again not all of
Snakes are scaly, legless reptiles without any them, are dangerous to human beings.
external ear and movable eyelids- The en-
Zoologically, snakes belong to the class
tire length of th e body is flexible .
Reptilia, order squamata and sub-order
Snakes are among the most dangerous serpentes (snakes). They have several
venom possessing animals. However, all types superfamilies, families, subfamilies and
Classification of snakes tribes.
Class- Reptilia
Order- Squamata Rhynchocephalia Testudines Crocodylia

(Scaly reptile) (Tuatara) (Alligator, crocodile, gravial)
Suborder-
~
Serpentes sf.
auna
t
Amph\ .
IS aen1a
(Snakes) (Lizards) (Worm lizards)
Superfamilies-
r-
So idea Typhlopoidea Colubroidea
(Primitive snakes) (Blind snakes) (Advanced snakes)
~ ! •
Families- Boidea and others
(Pythons and Boas) '
Colubridae
(Harmless)
Elapidae
(Cobras and allies)
t
Viperidae
(Vipers)
Subfamilies-
~
Pythons, Boas
f
Elapinae
t
Example-
Russell viper,
Hydrophiinae Pit viper,
and others (Terrestrial) (Sea snakes) Echis viper
~ 1. Cobra
2. King cobra
Tribes- Pythons 3. Krait
4. Others
823
824 I PRINCIPLES OF FORENSIC MEDicl NE
Fig. 34.3 : A banded krait Fig. 34.4: A common krait
Snakes are of various sizes, morphology, Hearing capacity of snakes is doubtful

colours and habits. They have some peculi- They have no external ear. Though they have
arities in their sense organs, food habit, ac- middle ear, there is no definite proof that
tivities, body temperature, reproduction and snakes can hear.
behaviour.
Smell - The two small nostrils function
Sense organs of snakes well and snakes have a strong smell sensa-
tion.
1. Vision - Snakes have eyes without eye-
lids. Elapidae family has circular pupils Vibration - Though snakes may not hear
and viperidae, mostly vertically elon- sounds, they can recognise moving objects
gated pupils. Vision is most effective for from the vibration of the ground.
moving objects and a static object may Jacobson's sense organ - Snakes have
not stimulate the visual capacity of a some special sensitive cells in the palate called
snake . Jacobson's organ. The flicking forked tongue
Touch sensation is quite effective in of the snake carry stimuli from the air which
snakes except in some rough thick-scaled when touches the palate, helps the snake to
snakes which may not feel light touch. know the presence of a thing in thP area.
chapter 34: ANIMAL IRRITANTS I 825
Fig . 34.6: The king cobra has almost finished its eating
Sense related to temperature variation - Jacob. o· 1 "' • • atwn of the
In pit vipers there is a pit or depression on ground help the snakes to move freely and
each side of the head in between the eye and safely during the night hours.
the nostril. These are sensitive to any tem- i' ood 1> abLt - Mr c- of the snakes are car-
perature variation in the area in contrast with nivorous. They eat .. .,e _ , o'lds, lizards,
the environmental temperature . Thus, pit rodents, chicks aPd v 1 Ler snakes. Py-
vipers can recognise and locate any animal thons eat even larger animals like small goats
or anything having a temperature different or lar"~bn . They swallow the whole animal
than the environment. Pythons also have ·•<! without chewing. The shape of their jaws al-
with similar function at the ends of he lms, low swallowing of comparatively bigger preys.
though less sensitive than pits of the vipers. Depending on the type of the snake and the

Fig . 34 .7: Eggs of snake Fig . 34.8 : Poisonous fang of a cobra
Fig . 34.9: Russell viper Fig . 34.10: Ventral aspect of hood of a black cobra
size of the meal, a snake may take food even they survive a body temperature as low as
once in a week or a month only. During hi- 4°C. They die if the body temperature comes
bernation period, snakes refrain from taking down t o 0°C. Between this range some of
any food as they refrain from doing any other them survive, some die. On the other hand,
exercise. if during hibernation environmental tem-
Activities - Snakes cease to be active for perature goes up, then the snake may die
some time during the winter when they go due to starvation, after the stored food of the
in hibernation. During this period their meta- body is exhau sted due to increased metabo-
bolic activities are extremely low and they lism.
remain dormant in all senses. Their body Reproduction - Most of the elapidae lay
temperature also falls . eggs and most of the viperidae give birth to
Body temperature - Snakes cannot gen- new ones . Eggs are layed in protected places.
erate heat and their body temperature var- But, except king cobra and a few others ,
ies with the environmental temperature. snakes do not take any care of the eggs. E ggs
During hibernation in winter, in cold zones are hatched with the help of natural atmos-
their body temperature falls markedly and pheric temperature . King cobra builds nest

Fig . 34.11: Speck mark on the hood of a cobra (Dorsal . 34.12: Ventral aspect of hood of cobra
aspect)
to lay eggs and sits on the eggs protecting respiratory gases (oxygen and carbon di-ox-
them and also helping them to hatch out by ide) between the snakes' body fluid and eggs
generating some heat by shivering its body. through the thin layer covering the eggs.
The vipers keep their eggs in the oviducts The young ones, after hatching out of the
till they are hatched. There is exchange of eggs or birth from the mother' body, are
------------------------------------------~~--------·-------------~
Table. 34.1: Differences between Cobra and Viper
Features Cobra Viper
-
Head Smaller and slender, covered witli large scale Larger, triangular and covered mostly with smaller
scales
Pupils Circular Vertical, sl it~ike
Neck Not prominent Narrow prominent neck
Tail Less tapering More tapering
Fangs Shorter and grooved Longer and channelled
Other teeth Present in the upper jaw Absent
Reproduction Oviparous, by laying eggs which hatch outside Viviparous, gives birth to young ones. Eggs are
the body hatched inside the body of the mother
Venom Mostly neurotoxic Mostiy haemotoxic

/
828 I PRINCIPLES OF- FORENSIC MEDICINE
Fig. 34.13: Sancf snake Fig. 34.14 : Sea snake
ready to fight, bite (venomous) and search the third labial scale touching the eye and
out their food with equal efficiency like nose margms or with 4 in1r .1-labial scales , the
adults . They reach the age of reproduction fourtr being the largest. Most of them are
by 3 - 5 years. usually nocturnal in habit .
Behaviour - Most snakes are docile in
Snake venom
nature. When annoyed or disturbed, they
make a hissing sound as a threat. When at- The bite of a poisonous snake inject venom
tacked or cornered or angry, they bite. King or toxic substances in the tissue, at the site
cobra is by nature to an extent aggressive of bite. Venom is secreted by special glands
and pursue its enemy . near the upper jaw of the snakes which are
Snakes are found all over the world ex- akin to human parotid glands . During the
cept in Greenland, Ireland and New Zealand. process of bite , the glands are pressed and
the venom is squeezed and channelled through
Features of poiso nous snakes the grooves or channds of the fangs .
Poisonous snakes are of various sizes and Freshly secreted venom is transparent
colours. The most important feature is that, and pale . On stori:1g and exposure to light , it
becomes yellowish and ( paque . Venom in
they have fangs , one each on either side of
the upper jaw , which are either hollow or
grooved. These are actually the biting teeth
of the snakes, and are connected with sali-
vary glands possessing venom. Ordinarily ,
they remain folded but during biting they
become vertical . Tail of poisonous snakes are
usually compressed and stouter. Their ven-
tral scales are larger , each pass across the
whole of the breadth of the ventral surface.
Head scales are usually small or large as m
pit vipers with pits in between eye and nose
Fig 34.15 Cobra removing its outer sheath or covering
on each side. The scales may be large with

chapter 34: ANI MAL IRRITANTS I 829
winter Is thicKer than venom secreted in Respiratory paralysis is due to curare-like

summer . But venom is ·no··e to ic during action and also due to action on the central
summe. than during winter (Deoras, P . J . of nervous system. 3rd, 4th and 6th cranial
Haftkine Institute, Bombay). nerves are affected serially, 9th and lOth
nerves are affected later.
Venoms 8. protemrms in nature most
of which are .,1 c<'. ' -vpw tic.es and are Absorption - Absorption cannot occur
enz)'l.1rl .c in their actions. A good number of through unbroken skin or mucus membrane.
these have been chemically identified from Absorption from subcutaneous injection is
various snakes and each variety of snake con- quite rapid.
tains some of them. Some of these toxic sub- Fatal dose and amount injected in one
stances are neurowxic, some hatmotoxic and bite-
some act or. ~ome other tissues. The constitu-
ents o+ different snake venoms are - Neuro- Snakes Fatal dose Quantity injected in
toxin, haemolvsin, proteolysin, fibrinolysin,
one bite
cholmestera ~e, coagulase, cardiotoxin, nucle-
otidase, hyaluromda"'l , rhospholipase-A etc. Cobra 15mg More than 200 mg
The Cobra varieties pnmarily possess neuro- King Cobra 12mg About 100mg
toxic agents and viper varieties primarily
Common Krait 1mg More than 5 mg
possess haemotoxic agents.
Banded Krait 10mg More than 40 mg
Action of venoms Russell Viper 40mg About?Omg
Locally, there is ir -itation and ecchymosis at Green pit Viper 100mg About15mg
the site of the bite. "'ystP.nric act' on may start
as quickly as within 10 m·nutes. There is in-
creased catecholamines in the circulation. Fatal period
There is depressiOn of spmal cord and me-
For cobra varieties - 1/2 hr. to 24 hrs.
dulla. Some of the venoms inhibit blood co-
agulability, othP.rs cause mLravascular clot- For viper varieties - 1 to 3, 4 days.
ting of blood by r.hrombo1- 1ase and calcium-
Signs and symptoms
like action ~r directly chm gug fibrinogen to
fibrin. In some venom, t 11ere is heparinase With cobra bite local pain is less, with less
which causes clottmg by des1royi "lg heparin. local reaction and swelling. Two fang marks
However, fibnnolysm present in the venom, are present which ooze less. The area gradu-
breaks down fibnn and cau;:;E- lysis of the clot. ally becomes bluish. There are malaise, drow-
Blood fibru.~gen is grossly 1 duced. Haemo- siness, nausea, vomiting, flushing of face .
lysin and pho:oJ hol' pase--\ cause h:1emolysis. Pulse is initially normal which is later de-
Huma. and df'lg re ~ cblls are .-,._ e suscepti- pressed and irregular. Blood pressure may
ble than ro'-' 1 6nat red cells. remain unaffected. Muscles of the extremi-
Brad) ki :P like action and loss of fluid ties become weak. Paralysis ensues in the
through the da <aged endothelium result in lower limbs first, which ascends gradually
the fallofblood pressure. Cobra venom how- affecting the respiratory muscles including
ever causes rise of blood pressure by vaso- the diaphragm Respiration becomes difficult.
constriction. With paralysis of muscles of neck there is

drooping of head . There is difficulty in swal-

lowing and articulation ofspeech . There are
frothing from the mouth, drooping of lower
lip and eye lids . The vision becomes blurred
with loss of accommodation reflex . Death is
due to respiratory failure .
With krait bite, the signs symptoms are
less rapid . There is no nausea and frothing
butdrowsiness is more.
With viper bite there is more local reac-
tion with more local pain and oozing . Local Fig . 34.16: Oedema at the site of a viper bite
necrosis is extensive, which may lead to gan-
grene . ThePulse is weak and irregular Blood
pressure falls with signs ofcollapse . There 5. Polyvalent anti-snake-venom serum (pre-
is bleeding from nose and in urine . Death pared inHaffkine's Institute, Bombay, by
occurs due to circulatory failure in the early injecting horses with snake venom of
phase and due to haemorrhagic and haemo- both cobra and viper variety) is given in-
lytic complications at the later phase . travenously in the dose of20 ml prepared
freshly b,v l i.ssolving the powdered serum
Treatment in distillea water. Half of the initial dose
is repeated at every 2 hours interval, if
1. Two tourniquets are to be applied on the necessary. Before injecting the dose of
limb, proximal to the site of bite. the serum , it should be tested for sensi-
2. Multiple incisions ;1re given over the bite tivity of the patient.
marks, depth of the incisions being not 6. If antisnake venom serum is not avail-
less than 2/3rd of the measurement be- able or if the patient is very sensitive to
tween the two fangmarks (bite marksL it then, polyvalent antivenene (a drug pre-
After the incisions are given, as much pared at Kasauli) may be used as a sub-
venom (With local tissue fluid ) as possi- stitute. Cortisone, adrenaline, anti-hista-
ble is squeezed out or sucked out by a mine and nikethamide may be used as
sucker or by mouth . supportive treatment.
3. If suction is of not much help then the 7. Ifantivenom serum orantivenene is not
local tissue around the site of bite may readily available then, the limb may be
be infiltrated with injection of 2 ml of kept dipped in water at 10- 15°C .
weak potassium permanganate solution 8. Complications should be treated accord-
nr 2.5% solution of hypochlorite of lime ingly.
or 3 ml of polyvalent antivenene or
antivenom serum Postmortem findings
4. After the first hour, each of the tourni- The site of bite is swollen and bluish with
quets used should be released alternately oozing of reddish fluid from the bite-punc-
for 10- 15 seconds at an interval of10- tures , which are usually two in number.
15 minutes When death occurs after a day or two, effects

ofnecrosis may predominate with gangrenous as spanish fly. It is about 1.5 em long, shin-
change in some. The non-gangrenous lesions ing greenish in appearance.
on dissection show tissue oedema with ec-
chymosis. These local findings are more com- Active principle
mon in viper bite cases. In cobra bite, there Cantheridin.
are some oedema and ecchymosis but necro-
sis and gangrenous change is uncommon. In Both crushed cantheride and cantheridin
cobra bite , there may be evidence of frothy are toxic.
discharge from the mouth. Internally, in case
Uses
of cobra bite, pulmonary oedema is a com-
paratively common finding. In case of viper As counter irritant and in other medicinal
bite , haemorrhage in the organs and in the preparations.
undersurface of serous or mucus coverings
are common. Intra-vascular clotting with Fatal dose
microscopic damage of the enGI.othelium is also
Crushed cantheride - 1.5 gm, Cantheridin -
common in viper bite. Urine in urinary bid-
30mgm.
der shows presence of haemoglobin anu al-
bumin in these cases. Microscopically, the
(c
Fatal period
lymph node sacs show presence of RBC and
phagocytes . 12 - 24 hrs
Action
Medicolegal aspects
Locally irritant, Remotely- nephrotoxic.
Snake bite deaths are almost exclusively
accidental, occurring mostly in agricultural Signs and symptoms
fields , gardens and in village roads and
fields . Snake channers occasionally are the External application causes burning pain,
redness and vesiculation. When ingested -
victims of accidental snake bite. Occasion-
burning pain in throat and abdomen, vomit-
ally suicidal cases are recorded in snake
ing, scanty urination, haematuria, albuminu-
charmers. Death may occur due to circula-
ria, painful swelling of penis , blood tinged
tory collapse , out of fear even in non-ven-
mucus stool, straining during motion, CVS
omous snake bite. Snakes cannot bite out-
collapse , renal failure , convulsion, coma,
side the radius of the length of its erected
death
body part. A snake does not bite if a person
does not move his body parts, and stands Treatment
still. Shoes protect feet successfully from
snake bites. Restriction of fat by mouth as fat dissolves
cantheridin and helps absorption, Demulcent
drink, stomach wash, plenty water, and symp-
CANTHERIDES tomatic treatment.
Postmortem findings
Cantheride is locally irritant and also a ne-
phrotoxic agent. It is an insect, also known Signs of irritation in mouth oesophagus, stom-

832 / PRINCIPLES OF FO RENSIC MEDICINE
Fig. 34.17: Oozing of oedema fluid from the site of viper Fig 34.18: Ecchymosis and oedema fluid in the tissue
bite at the site of viper bite (on dissection)
ach. Stomach - morrhag~c , an abortifacient agent. Used to increase

contains shining exoskel- libido in males.
eton of the . Kidneys swol-
len with ha in pelvis and
Urinary bladder contains (for blood)
urine with areas on mucous
membranes. under The end part of the tail of a scorpion has two
and endocar . Lungs..:. , sub- poison glands and a sting. An agitate_9. scor-
pleur al haemorrh gic spo . pion presses its sting onto the body of the
vict im injecting the venom and sometime
Circumstances of poisoning leaves the broken tip of the sting in the tis-
1. Counter irritant preparation in home sue .
may be taken accidentally . Suicide is rare . The venom is proteinous substance and
Homicidal use is far mor rare . Used as is haematoxic and neurotoxic in action.
Fig. 34.19: Scorpion

Signs and symptoms sweating, fall of blood pressure . There may

be nausea and bronchospasm.
Locally , there is pain and oedema . Systemic
effects appear within 15- 30 minutes . There Treatment
are anxiety, sweating, salivation and nasal
secretion. Pulse is slow and BP is raised. Epinephrin HCL- 0.3 mg SC , Ca-gluconate
Muscular f~sciculation and convulsion may 1 - 2 gm IV, Glycocorticoids IM, Artificial
occur. Also , there may be pulmonary respiration , 0 2 inhalation, and Antihista-
oedema , canli~ c ythmia and myocardial minic cream locally.
infarction , pa ·cularly of the papillary mus-
cles . RED ANTS
Treatment
Bite by red (fi re ) ants causes injection of an
A tourniquet is applied proximal to the site alkaloid, solenopsin-A. It has haemolytic and
of sting. Multiple pnnctures or incisions to phytotoxic actions. At the site ofbite there is
squeeze out or suck out the venom is useful. urticarial lesion followed by pustulation .
The broken sting is taken out if left at the There may be raised blood pressure ,
site. Specific rultivenin , if available, should retrosternal pain and respiratory difficulty.
be injected, both for systemic action and lo-
Treatment
cal infiltration . Calcium gluconate is given
I.V. for reducing local pain and oedema. Bar- Adrenaline & antihistaminic drugs.
biturate or chlorpromazine is helpful to conn-
ter convulsion and sedate the patient. Atro-
CENTIPEDES AND MILLIPEDES
pine sulphate prevents pulmonary oedema.
Postmortem findings - Fatality is com- They secrete phenol , quinone and cyanogen
mon in children . The affected site is swollen . from the base of their feet which may pro-
The sting may be present at the site. On dis- duce ulcer.
section the surronnding tissue , may show
some degree of ecchymosis . Infarction of
BlACK SMDER
myocardium and pulmonary oedema may be
noticed in some cases. Black spider (Black widow spider) bite is toxic.
There is pain at the site of bite . After half an
hour or more there are cramps at the site of
bite yvhich extend upwards. There may be
nausea and vomiting and the BP may be
The sting of be~s injects histamine , raised . Action on the CNS and at the nerve
cardiotoxin and phospholipase-A. Venoms of endings of the diaphragm may cause respira-
wasps and hornets contain histamine , serot- tory problem.
onin, curare-like substance and kinin.
Treatment
Stinging by these insects causes local pain
and oedema. Systemic effects of the venoms Sedatives , Ca-gluconate , combination ofNe-
are seen in multiple stingings when death_ ostigmine and Atropine (0.5 mg each) and
also may occur with signs of collapse with Curariform drug.
fF. M. - 531
8J4 I PRINCIPLES OF FORENSIC'MEDICINE
are samandarone, samandarine, 0-acetyl- ,

samandarine, samandaridine, samandanine,
samandenone, samanine, cycloneosa-
Bite causes injection of haemolysin and nore-
mandione, cycloneosamandaridine.
pinephrine.
The alkaloids are poisonous to all verte-
There is painful ulceration at the site of
brates. Externally, contact with the venom
bite. Some n:utY develop nausea, vomiting, fe-
causes burning sensation of eyes and mouth
ver, haematuria, albuminuria and arthralgia
When in circulation, there !'Ire restlessness,
Treatment weak respiration, irregular pulse, convulsion
which continues for a few minutes followed
Symptomatic. by relaxation and stronger convulsion The
BP is raised, pupils are dilated There are
loss of reflexes and paralysis oflimbs. Action
is on the CNS, particularly the spinal cord.
Death occurs due to respiratory failure.
These are big land lizards. TWo varieties,
e.g. Arizona and Mexican gila monsters have On postmortem examination, the organs
been studied in some length. They are known are congested There is haemorrhage in or-
to carry poison and inject the same in bites. gans, particularly lungs and spinal cord. '-
Both upper jaw and lower jaw teeth possess
grooves to channel the poison. Their aver-
TOADS AND FROGS
age sizes vary around 15"- 20". Gila mon-
sters are also available in Bangladesh and
northern part ofWest Bengal where they are Toads and frogs have two types of glands on
commonly termed a 'Gui-saap'. They are their body surface. The mucus glands are
larger than the American variety, and are smaller and shallower, distributed all around
believed to possess venom in their saliva. and their secretion is thin which lubricates
There has been no authentic study in details. the surface to make i(easy to slip out when
caught. The granu!ar glands are larger in size
and their secreil.on is thick and creamy.
OISONOUS AMPHIBIA S, These glands ar~ 'more defined in their loca-
OISONOUS SAlAMANDERS tions. The 'fW·o patotid glands situated behind
the orbitaP c~sts· or over the shoulders are
Salamanders have deadly pois6n6us glands the largest bf'th~~ granular variety. Smaller
on different parts of the body. They ·Iilay be granular glands may be present at other sites,
on the do~al aspect along the midline or may like, neatrthe flnge:rs or toes.
be in rows in that b.rea: 'Parotfd'. ~poisO"ndus Secreti6n:{)Hhesi3 glands are poisonous.
glands are situated in c1usters 'ii{l::i&th 'sides But a toad or a frog does not liberate venom
of head in European earth salamanders. In by itself ~is is liberated due to wrong han-
some, the poisonous glands are distributed dling or manoeuvering of the animal. The ac-
all around the body surface. The poison can tive principles available in toads and frogs are
be spilled out·efthe glands up,to a few inches. many, e.g. serotonin, N-methyl-serotonin,
JI'he active princijlles in the venom are butenine, _dehydro~ufotenine, bufotenidine,
alkaloidal in nature. The differeri.tra:lkaloids b1;1fothi~"A..in~J~fq-vj.:ri.Q.ine, heptodactyline,

chapter .'?4: ANIMAL IRRITANTS I 835
peptides like bradykinin, histamine, steroidal swollen and there may be some degree necro-
alkaloids, bufogenins, bufotoxins etc. sis of the marginal tissue. There may be nau-
sea, vomiting, faintness, vertigo, diarrhoea,
Tick Paralysis
sweating, fall of blood pressure (due to ordi-
Occurs due to bite by the tick Rhipicephalus nary mild dose injection), arrhythmia and
Sanguineus. muscular paralysis (spastic or flaccid).
Poisoning occurs usually in divers.
VE Hom Sharks
Among the venomous aquatic animals , some There are two dorsal spines at the anterior
are vertebrates and some are invertebrates. margins of the two dorsal fins. The spines
Among the vertebrates, sea snakes and ven- are grooved anteriorly. Near the base of the
mous fishes (icthioacanthotoxic fishes) are spines, there are glandular cells. Venom pro-
mentionable. Poisonous fishes are described duction is of holocrine type.
in this chapter in short. 'Among the inverte- Signs and symptoms
brates, there are, shells, mussels, squids,
crustaceans, jelly fish. Poisoning due to There is immediate intense stabbing pain af-
ter stinging with swelling and redness of the
aquatic animals may occur by way of biting
affected part. Death may occu!: due to shock
(sea snakes) stinging (spines of various ven-
omous fishes), surface contact (jelly fish) and Catfish
consumption as food (shells, mussels, squids
A catfish has three stings, one dorsal in front
and crustaceans).
of the anterior dorsal fin and two pectoral
stings one in each side in front of pectoral fins.
OMOUS FISHES The venomous glands are axillary glands for
the pectoral sting and glandular structures
Stingray situated at the anterolateral and posterolateral
margins at the base of the dorsal sting.
The sting is located in the dorsal aspect of The venom of the catfish consists both
the tail either near the base of the tail or at neurotoxic and haemotoxic agents.
some place in its length. The venom is origi-
nated in the ventrolateral glandular tissue Signs and symptoms
and the adjacent cuneiform area. The sting Catfish stinging causes intense pain which
or the spine has furrows . may lead to primacy shock resulting in death,
. The venom of the stingray fish causes in a unusual case. Respiratory distress is a
vasoconstriction in large dose and vasodila- common .feature. The wound may get second-
tation followed by vasoconstriction in small ary infection and may take long time to heal.
dose. It also inhibits auricul~r. and ventricu-
lar contractions and dilatatio:q..,
Signs and symptoms

Zebra-fiSh and .stone-fish have 13 dors·a l
There is intense, sharp, shooting, spasmodic spines;.3.canal•spines and :2 pelv.ic-spines, with
or throbbing pain at the site. The area is associated·venom glands.
Scorpion-fish proper has 12 dorsal spines, ache, nausea, vomiting, chill, fever, palpita-
3 anal spines and 2 pelvic spines with associ- tion, bradycardia, heart block, respiratory
ated venom glands. distress, ankylosis, convulsions and delirium.
Venoms of scorpion-fishes consist ofneu- In some cases , there may be aphonia and
rotoxic, haemotoxic and cardiotoxic agents . psychic depression. Death may occur. Anky-
losis, peripheral neuritis and muscular atro-
Signs and symptoms phy are complications.
Treatment in cases of stinging by ven-
There is pain at the injured site which is most
omous fish-
intense with stone-fish stinging. The area
becomes bluish with a surrounding red zone 1. To relieve pain, analgesic is given.
and is1 swollen and warm. There may be nau- 2. Symptomatic treatment.
sea, ~miting , nervous disturbances , convul- 3. Steps to prevent secondary infection.
sion, dEiliriU:m, fever , pain in the joints, res- 4. To attenuate the venom, hot compres-
piratory distress and cardiac failure . There sion with magnesium sulphate solution
may be lymphadenitis and lymphangitis . or plain hot water is helpful.
Death may occur.
5. Antihistaminic cream locally, reduces
reaction.
TOAD-FISH
POISONING BY INVERTEBRATE AQUATIC
In toad-fish there are 2 dorsal spines and 2 ANIMALS
opercular spines with associated venom
glands. Poisoning occurs either by surface contact or
when used as food.
Signs and symptoms
By surface contact
Local pain with swelling, redness and warm-
ing of the affected area. Here poisoning occurs due to injection of the
venom by stinging cells of the invertebrate.
1. Jelly fish like Portuguese Man of War,
VENOMOUS WEEVERFISH SeaAnemone,.SeaNettle, Sea Wasp, Sea
Blubber and living Coral have long ten-
They have 5 - 7 dorsal spines and 2 opercu- tacles which have stinging cells which
lar spines with associated venom glands. The inject venom when come in contact with
venom stimulates sensory motor cortex and the skin. The venom contains 5-hydrox-
is also cardiotoxic. There is also paralytic ef- ytryptamine and urocanyl- choline.
fect on respiratory muscles. 2. Molluscs or mussels, like conch shells,
There is extreme pain at the site of sting- squid and octopus have highly developed
ing where gradually tingling and numbness venom apparatus which can cause punc-
develop. The area is first ischemic which tures on the skin and then inject venom.
gradually becomes red and swollen, which 3. Sea urchins have venomous spines cov-
• may persist for over a week. There are head- ering their body surface.

4. Bristle worm (stings with bristle).

References
5. Blood worm bites and injects toxic sub-
stance. • W. Bucher! and E. Buckley- Venomous animals and
their venoms. Vol. II. 1971.
Signs and symptoms due to stinging or
biting by poisonous invertebrates. • P J. Deoras- Snakes of India, 1966.
• F. E. Camps- Gradwohl's legal medicine. 1976.
There is local reaction with pain, swell-
ing and redness. In some cases there are • Encyclopaedia Americana. Vol. 25, 1975.
nausea, vomiting, muscular cramps, paraly- • Jimenez. Porras. J. M. (1970). Clinical Toxicology 3,
sis, convulsion, collapse, respiratory distress 389.
and death. • Reid H.A. (1970) Clin. Toxicology 3. 473 .
• Clinton H. Thienes and Thomas J. Haley - Clinical
Treat~~ Toxicology, 1972.
1. Washing the part with mineral oil oral- • Steven Foster and Roger A - Roger Terry Petersons
cohol or alkaline solution. Field Guider - Venomous Animals and Poisonous
2. Use of pain killer. Plants.
3. Symptomatic treatment.
Questions
Poisoning due to eating of poisonous
aquatic animals Long questions
What are the signs symptoms and treatment of co-
Consumption of California mussel, which eat
bra and viper snake bite ? How do you differentiate
planktons h aving deadly toxins, may cause
between cobra and viper snakes? How do you differ-
sensory and motor disturbances like
entiate between poisonous and non-poisonous
paresthesia , tingling, numbness, muscular
snakes ? What are the PM . findings of snake bite
weakness and paralysis.
deaths ?
Consumption of some shells, shrimps and Short notes
crabs may cause chronic arsenic poisoning.
Cantherides. scorpion stings, venomous fish .
Consumption of puffer fish causes tetro-
Oral questions
dotoxin poisoning, leading to vomiting, retch-
Venoms of cobra and viper. fatal dose of different
ing, lethargy, muscular weakness, low B . P .
venoms. antisnake venom serum or antivenin - how
and r espiratory depression.
is it obtained ? Where is it prepared ? What is
cantheridin ? What happens. when scorpion. bees
Treatment
and wasps sting? Nature of their venoms. Poisonous
Symptomatic. fishes. lcthiotoxicosis. Fatal dose of cantheridin.

--~---- ---- -
----
83~ J ~RiNc;:IPlES. OF FORENSIC MtDICINE
NOTES
.'

Brain is most protected anatomically as well cerous tissue or cells being abnormal in char-
as from toxic agents circulate in blood due to acter than the healthy tissue or cells can ab-
blood-brain barrier . Though many substances sorb certain chemicals which normal tissue
can reach the tissue due to physiological ne- cannot. This makes chemotherapy a success
cessity they cannot reach brain due to exist- in many cases . The abnormal cells absorb
ence of the barrier which consists of all the drug which the rest of the normal brain cells
endothelial cells and agents that line the blood do not.
vessels supplying to brain. Only few sub-
stances necessary forthe properfunctions are
able to get past this close-unit thicket of en-
dothelium. Opium and its Alkaloids Watural and Syn-
The blood brain barrier keeps out things thetic opiates ).
that may upset it. It also keeps essential Opium is a somniferous or sleep induc-
biochemicals such as neurotransmitters in ing drug. It is the unripe fTUit extract of the
their proper place inside it . But its vigilance plant Papaver Somniferum (poppy plant).
can be a drawback. For it also keeps out a
few things that might help brain, such as The milky exude from the incisions on
the unripe poppy capsule is air-dried to ob-
drugs. William Patridge found out a method
tain dark brown opium.
to cross the barrier for required drugs, by
tagging the ~rug alongwith a chosen natural Types of opiates i.e., alkaloids of opium
molecule which is permitted to the inner and similar alkaloids
sanctum. Further a drug can be made to ap-
pear more like a fat to disguise itself which Natural Derived or semi- Synthetic
are able to slide across the barrier because synthetic :i
the membrane surrounding the endothelium A Phenanth- Benzyl morphine Pethidne
are also composed offat. It is a general prop- rine group: Oxymorphone Hydroxypethi-
erty of fat that one can mix another. So if a
Morphine Hydromorphone dine
drug can be modified to make it more fatty,
Codeine Dehydromorphine Methaoon
it can often be absorbed in brain (Dr. Shshona
and Dr. Radar). A third method is that, can- Thebaine Diacetyl morphine lsomethadon
cantd.
839
Natural Derived or semi- SyntfJetic Opium contains more than 20 alkaloids,

of which morphine is most important. Its con-
sy 1thetJc
centration in opium varies with season, geo-
B. lsoquinoline (heroin) ----~
_,Ncfmelhadon graphic origin and the strain of the plant. In
group: N·allyi-Normor- a. metha~ the variety from Turkey, concentration of
Papaverine phrn (N~orphine} ~melhadJI morphine is about 20%. The concentration
Narcotine Hydrocodooe a. " recommended in British pharmacopoeia is
9.5%. In Indian variety the concentration of
Narceine bitartrate p "
morphine is about 10%. Of the alkaloids, mor-
Dehydrocodeina levorphanol
phine and codeine have maximum use as an-
t bitartrate tarnate algesic and cough depressant, respectively.
Ripe poppy capsule and poppy seeds are
Opium is bitter in taste and has a char- not toxic. Dried poppy capsule contains a lit-
acteristic smell The plant is native of Asia tle narcotine. Poppy seeds (Posto), is used in
Minor (mainly present day Turke~) but is now different food preparations.
cultivated worldwide, under government con-
trol. Its authorised cultivation and not the Actions of opium
illicit production is decreasing. In fndia,
opium is distributed under govt. supervision Actions of opium are primarily those due to
from Gaziabad in UP. morphine with some variation due to codeine
and narcotine. It causes CNS depression,
Total calculated need of opium worldwide analgesia and hypnosis . Combination ofhyp-
is about 680 metric ton every year. But its nosis and analgesia is known as NARCOSIS.
clandestine cultivation and production is Opium is a true narcotic. Opium depresses
many times more. For illegal ';Se of opium, all centres except occulomotor centre, vom-
it is available as dark brown solid or powder iting centre and sweating.
which is either smoked or injected through
IV route or taken by mouth by addicts. Signs and symptoms
Morphine is a central respiratory depressant

and acts at the bulbar neurons. Rate ofrespi-
ration, minute volume and tidal air reduce.
Children and old persons are more prone to
respiratory depression. Tidal air is reduced
due to constriction of bronchioles. Respira-
tion is slow and deep or slow and shallow.
These leads to hypoxia. There is Cheyne-
Stokes breathing. Body temperature reduces
due to reduction of oxygen consumption, low
metabolic activity and failure of heat regu-
lating mechanism. Pulse, perception, pain
and consciousness all are depressed.
On the basis of its actions on the CN~ ,
the signs and symptoms can be divided into
Fig. 35.1: Papaver somniferum
three stages:
chapter 35: CEREBRAL POISONS I 841
Reflexes are brisk at the early stage but

are sluggish terminally.
Face is flushed, conjrmctiva suffused,
skin dewy with sweat With heavy dose, skin
is cold, clammy, wet and pale
There is constipation due to constriction
of smooth muscles of the sphincter. Empty-
ing of stomach is delayed. Hence, even in
delayed cases gastric lavage is important Cit
is also important due to resecretion of mor-
phine in the stomach after absorption).
Fig. 35.2: Opium poisoning (left hand of the dead body)
There is oliguria Renal failure may oc-
Initially (stage of excitation) - There are cur after a heavy dose.
excitement, sense of well being, but soon There is hyperglycemia and glycosuriain
there is anxiety, dizziness. dulling of facul- a few cases.
ties, restlessness. nausea and dysphoria
Fatal dose
Later (stage of stupor or depression) -
Drowsiness, lack of attention, dullness of Opium- 2. 0 grn morphine by mouth - 200 -
perception, uneasy feeling, ataxia. dizziness. 250 mg; morphine parenterally 80- 100 rng;
disorientation. Codeine - 500 mg Tolerance to opium and
Finally (stage of coma or narcosis) - Un- morphine occurs easily and quickly. The tol-
easy sleep, coma, death. erance is true tolerance as the rate of me-
tabolism increases gradually.
Among other signs and symptoms, there
is progressive respiratory depression, in its Absorption, fate and elimination
rate and amplitude with increasing cyanosis.
Pulmonary oedema develops at the last stage. Opium and morphine are absorbed through
all mucus membrane of the GI tract When
Pupils are extremely constricted (pin-'
taken in the form of smoke, it is absorbed
point). Dilates after prolonged coma or se-
through the lungs They are metabolised in
vere anoxia or shock.
the liver. Morphine is excreted through kid-
Pulse is slow due to increased vagal tone. ney, stomach, intestine, bile, rnilk and saliva
BP is unaltered or raised initially. There may
be postural hypotension in mildly excited am- Treatment
bulatory patients. IV injection of both mor-
phine and pethidine however causes proformd 1. Respiration is to be safeguarded Bron-
collapse as there is liberation of histamine chial suction is done to make the airway
from mast cells. Pethidine has also local an- free from obstruction. Oxygen inhalation
aesthetic action on heart muscle like quini- is given. Artificial respiration may be nec-
dine. However, in all cases BP falls termi- essary. Endotracheal intubation in-
nally. Lack of oxygen causes cardiac irregu- creases the capacity of the lumen and
larities. Improvement of .anoxic condition ensures free air passage.
results in retum of normal BP and improve- 2. Naloxone in the dose of 0.5 mg. IV acts
ment of pulse. as good physiological antidote. N alor-

phine is not used now-a-days due to its Features of opium/morphine addidion

terrrrinal depressive action on respiration. (Chronic use) (Morphinomania)
Atropine is also ri~t used for the same
reason. ) There are GI tract disturbances with ano-
rexia, nausea, constipation, furred tongue.
3. Stomach wash~is given with 1 in 5,000
Irritability, disturbed sleep, insomnia with
dilution of KMn0 4 . It oxidizes opiates.
inadequate dose, fatigue, impotence in males,
The wash iscontinued till return backof fii.gidity in females, mental depression, moral
normal pennanganate colour of the so- degradation, loss of self-respect and moral-
lution which becomes brownish during ity, a desire to procure the drug by any means,
·the early washes. 200 rnl of potassium lying, stealing or committing any other crime,
permanganate solution is left in the are the usual features. For those who use
stomach after the last wash , to neutral- morphine parenterally (skin popping - sub-
ize morphine which is secreted in the cutaneous , main lining - IV ), there will be
stomach after absorption. This makes pigmentation and scar fonnation at the site
some to recommend stolllflch wash with of injections, which are often masked by ar-
KMnO4 solution even when morphine has tificial tattooing . Toxic dementia may de-
been used parenterally . velop. Addict pregnant woman may give birth
4. Methyl amphetamine hydrochloride 10- to addict baby .
20 rng which acts as stimulant to differ- Treatment
ent systems.
1. Sudden or gradual withdrawal of drug.
5. 20 grn of rnagsulph . to keep the bowel
Gradual withdrawal is better .
clear of opiate.
2. In case of too much untoward symptoms
6. Antibiotics to prevent pulmonary infec-
after complete withdrawal, methadone or
tion.
resumption to low dose of opium or mor-
7. Correction offluid and electrolyte imbal- phine.
ance. 3. Maintenance of food, nutrition, vitamins.
Morphine or opium addidion
4. Nursing care.
5. Physical restrain.
Definition ofaddiction (WHO -1950 ) - A state
6. Assure no scope of self-medication.
of periodic or chronic intoxication produced
7. Chlorpromazine, ifnecessary.
by the repeated consumption of a drug . The
followings are the features of addiction to a 8. Social supp_o rt with psychotherapeutic
drug- rehabilitation may be very much helpful.
1. An overpowering desire or need (compul- 9. Once used methadone as a substitute of
morphine or opium in addicts is no more
sion) to continue the use of the drug and
used as it itself.causes addiction .
to obtain it by any means .
2. A tendency to increase the dose . Signs and symptoms of withdrawal in
3. A psychological and physical dependence opium addid
on the effects of the drug. Weeping , running from the nose , sweating,
4. Detrimental effects on the individual and scratching, restlessness and with nalorphine
the society . acute or dang~z:o~ rnap.ia . Also, there are

pain in legs, shivering and goose skhl appear- tiva, dilated pupils, low body temperature,
ance of the skin, insomnia,__ho.t!and cold slow respiration but not as slow as in
flushes and weight loss. opium poisoning.
Dangers 2. Barbiturate poisoning - Pupils are di-
lated, low BP, perception and reflexes are
Debility, injury, in,tercurrent infection. depressed, slow respiration but not as
Treatment slow as in case of opium poisoning.
3. Carbon monoxide poisoning - History of
1. Chlorpromazine - 50 - 100 mg dose (or exposure, cherry red colour of the skin,
pentobarbitone). convulsion, carboxy-haemoglobin in
2. In serious cases of addiction, restart mor- blood.
phine or give. methadone.
4. Carbolic acid poisoning- Smell of carbolic
3. Physical restrain to protect from accident acid, patchy corrosion in and around the
and injury. mouth.
4. Food, fluid, electrolyte and vitamin in- 5. Cerebral haemorrhage - History of hy-
take should be assured to maintain pertension, paralysis (usually hemiple-
proper nourishment. gia), plantar extension, raised tempera-
5. Proper nursing care should be there. ture, dilated pupils.
6. Antibiotics may be necessary in some 6. Brain injury - History of injury, bleed-
cases. ing from mouth, nose and ear, pupils are
non-reactive and often unequal, paraly-
Postmortem changes in case of death due
sis of cranial nerves, subconjunctival
to opium morphine poisoning haemorrhage, rapid respiration.
Prominent postmortem staining, congested 7. Heat stroke - History of exposure, dry
face, evidence of extreme degree cyanosis skin, very high body temperature, con-
over the fingertips, lips and ear lobules, froth- vulsion.
ing from mouth and nose are the usual ex-
8. Cerebral malaria - High fever with rigor,
ternal findings.
enlargement of spleen , blood test for
Internally, the stomach content may give malaria parasite is positive.
the characteristic smell of opiwn It may even
9. Diabetic coma - Gradual progress of un-
show unabsorbed lump of opium. The lungs
consciousness, history of diabetes ,
is congested and oedematous with petechial
flushed face, deep respiration, air hun-
haemorrhagic spots in the under surface of
ger, smell of acetone in the expired air,
the pleura. There will be froth in the lumen
glycosuria, acetonuria.
of the respiratory tract. Blood in the vessels
will be dark and fluid. Organs are congested 10. Uremic coma - A clear aetiology should
with haemorrhagic spots in the substance of be there, gradual onset, ammoniacal
the brain which is also oedematous. odour of the expired air, convulsion, al-
bumin, blood and cast in the urine.
Differential diagnosis of coma due to 11. Encephalitis - Fever, involuntary move-
opium or morphine int«?xication ment, ocularpa1sies, changes in CSF.
L Acute alcohol intoxication - Smell of al- 12.,·Meningitis :..;Gradual onset, fever, signs
cohol, flushed face, congested conjunc- of meningeal irritation.

Chemical test - (Marquis test)

One drop from a mixture of 3 ml of concen-
trated sulphuric acid and 3 drops of formalin
is dropped to a blotting paper soaked with
the extract of the suspected material. If the
suspected material contained opium or mor-
phine then, there will be resultant changes
of colour which will-l:fe first purple then vio-
l~t and finally blt
Medicolegal aspeds
Fig . 35.3: Old marks of injections of drugs at the right
Opium and morphine are popular suicidal cubitus
agents, as they cause peaceful, painless death
in 'sleep'. It is not used as a homicidal agent makes it more vulnerable for adulteration by
for adults, as opium is detectable for its bit- lactose or similar suitable substance. It is
ter taste and characteristic smell. The smell used through intravenous route or by subcu-
and taste can be masked by food and drink. taneous injection or is smoked. I. V. use may
But as the signs and symptoms appear quickly
cause sudden grave intoxication, thrombo-
and as death does not occur so rapidly, chance phlebitis, infections resulting from use of the
of detection of the crime remains very high. same needle and syringe etc. With subcuta-
Opium or morphine is used to cause infanti- neous use there is danger of abscess . These
cide , particularly to kill an unwanted new are in addition to the other dangers of addic-
born infant. Accidental overdose may occur tion with the drugs. Addiction to heroin oc-
in addicts , in children or due to therapeutic curs easily and more quickly than other nar-
misadventure. cotic drugs.
Moral degradation, lack of judgement
may lead them to commit any crime particu-
larly to procure the drug. Code1ne (M thyl Morphin )
It is said to be an aphrodisiac drug but its It is a natural opiate and is also a derivative of
chronic use actually diminishes performance. morphine (methyl ether of morphine). It is a
Addicts can consume high dose of mor- crystalline solid, slightly soluble in water, but
phine or opium which a non-addict cannot. freely soluble in organic solvents. Its melting
point is 157°C, though crystalline character is
lost with application oflesser heat.
Codeine is popularly used as a cough de-
It is a semisynthetic opiate derived from pressant. Its side effects are less severe than
morphine. It is 2 - 3 times more toxic than morphine. For this it is advocated by many
morphine. It is also a narcotic and the action to use it as an analgesic. But to be therapeu-
is mostly like morphine but more intense. It tically useful, the required dose causes many
causes more euphoria and there is no vomit- side effects as commonly occur with mor-
ing tendency. These features make it more phine. Children are more prone to the harm-
popular to addicts. Its high market price ful effects of codeine than adults. Fatal dose
is 500 - 600 mg. It is less toxic than mor- dote of morphine. But its own depressive ac-
phine. Treatment is as for morphine poison- tion on respiration and other side effects have
ing. In toxic dose, codeine excites medulla made it unsuitable for the purpose.
and spinal cord and causes convulsion and
delirium. In comparison with morphine , it is
Methadon
less miotic, less constipating causes less de-
pending but is more nauseating.
It is a synthetic opiate and is a narcotic agent.
After use of methadone, patient should take
Dihydro• orphine bed rest. Movement precipitates dangerous
side effects.
Dihydromorphine is also a semisynthetic or
derived opiate. It is also a narcotic. Its ac-
tions are almost same with those of morphine
but are more intense and as such it is more
toxic than morphine. It is about 5 - 6 times
more toxic than morphine.
It is used as a drink for pleasure, to reduce
tension and to satisfY thirst. The consumer
Pethidin (Mcporidin 1 Dem rol)
gets some food in exchange. Along with this
It is a synthetic opiate and is a narcotic. Some he gets ill-health, poverty and death in a few
of its actions are in variation with morphine. cases.
It is a good analgesic and sedative. In con- Properties
trast with the action of morphine it is mydri-
atic. It causes dryness of the skin. It has di- Ethyl aleohol is a colourless liquid with a char-
rect action on the heart musculature which acteristic smell and sweet-fiery taste. It mixes
it inhibits. It liberates histamine from mast with water in all dilutions. It is inflammable
cells. Pethidine causes early loss of corneal in concentration above 50%, in water.
reflex, due to its anaesthetic effect on the
corneas. It is a highly addictive agent. Doc- Commercial production
tors and paramedical workers are the com- By fermentation of sugar, starch by living
mon victims. Pethidine is therapeutically yeast cells, and then concentrated by distil-
contraindicated in cases of high int racranial lation .
pressure. It is also not given in toxemia of
pregnancy. Uses
As drink, as solvent, as preservative, in in-

dustries and in laboratories.
Types of drinkers
It is a semisynthetic opia~. It causes analge-

1. Some are occasional drinkers
sia, respiratory depre.s~io~~ !f;v_sphoria and 2. Some are moderate or social drinkers
hallucination. It was popularly used as anti- 3. Some are excessive drinkers.

~6 I PRINCIPLES OF FORENSIC MEDICINE
Different preparations of ethyl alcohol which have been learned gradually over thou-
sands of years in course of progress of civili-
Absolute alcohol - above 99.9% concen-
zation. The simple un-inhibited behaviour of
tration.
an alcoholic matches more to a primitive so-
Rectified spjrit - above 90% concentra- cial pattern. Thus, with alcohol, ideas oflove,
tion. hatred, fear, greed, grief, violent rage and
aggression may influence the behaviour of a
Proof spirit person.
It is that concentration of alcohol in water in
which at 10.5°C temperature condition, vol- Fatal dose
ume of distilled water of an amount by weight For a non-addict, equivalent of 150 ml of ab-
will be 12/13th of the volume of alcoholic solute alcohol when taken at a time or very
preparation of same weight. Concentration rapidly in one sitting, may cause death.
above this is called over proof and below this
is called under proof. Methylated spirit con- Fatal period
tains 90 or 95% of ethyl alcohol.'
Death occurs within 24 hours.
Different drinks
Absorption, distribution, fate and excretion
Depending on the concentration of alcohol
in the drinks they are classified into three It is rapidly absorbed from the intestine and
types- to a small extent from the stomach. Its rate
of absorptwn is more than glucose. Rate of
Soft drinks - In these preparations con-
absorption depends on the amount and qual-
centration of alcohol is between 4- 8%. Ex.
ity offood in the stomach. Fat delays absorp-
beer.
tion. If stomach is not full then, peak blood
Moderate drinks - Concentration of al- level is achieved in one hour and absorption
cohol is between 10-20%. Ex. wines , cham- is complete in three hours. In higher con-
pagne. centration absorption is rapid. In high con-
Hard drinks -Concentration of alcohol _centration alcohol causes irritation and in-
is between 40-55% . Ex. whisky, brandy, gin, flammation of the stomach mucosa. In con-
rum. centration below 20% it increases the gastric
secretion. Presence of C02 gas causes very
Toxicity of Alcohols rapid absorption by irritating the gastric
Of the different alcohols, ethyl alcohol is least mucosa.
toxic. Methyl alcohol is more toxic than ethyl After absorption, from blood it goes
alcohol. Isopropyl alcohol is three times as mostly to intracellular and extracellular fluid
toxic as methyl alcohol. Isobutyl alcohol is of the tissue and less to body fat. When an
one and a halftime as toxic as isopropyl alco- equilibrimn of distribution has been estab-
hol, and Amyl alcohol is one .ru;td one-third lished, urine and CSF contain 20% more al-
time as toxie as isobutyl alcohol. cohol than ·bJ:ood due to their water content
being more . .Brain- having more blood sup-
Action on Central Ne~~us S~~~l'l1
ply, gets ·early higher alcohol supply. Mus-
The only action on CNS is depression. It re- cles at rest has less blood supply, but has
moves restra.il)ts on primiti"e:,,behaviour, more during exercise . So exercise causes

sharp fall in the supply of alcohol to the brain tagmus, dilatation.of pupils with sluggish re-
That is why alcohol is said to be "walked off'. action There is impairment of muscular co-
Intoxication can be eased by keeping the ap- ordination. There are tachycardia and mild
pearance and activities for half an hour. rise of BP, carelessness and lack of judge-
90% of alcohol is oxidised in the liver. Rest ment. .-
is excreted as such in urine and exhaled air. 2nd stage or stage of moderate intoxica-
Rate of oxidation is about 0.1 ml per kg body tion or incoordination- There is development
weight per hour. Thus, for an average man of squint, and double vision In some there is
blood level of alcohol reduces by about 10 constriction of pupils which dilate on being
mg% per hour and about 7 ml is washed out stimulated only to constrict shortly again. This
per hour this way. Thus, on an average it phenomenon is called McEwen's sign Squint
may take more than 12 hours for a man to onrl McEwen's sign are positive at or above
come to normal, after a severe bout of drink- 300 mg% of blood level of alcohol. There is
ing. Blood concentration of alcohol influences muscular incoordination which is somewhat
the rate of metabolism and ~xcretion only compensated during the declining phase of
slightly. the blood level. There are progressive slur-
ring of voice, tremor of the hands and lips,
High blood concentration causes conver-
loss of tone of facial muscle (owlish facial
sion of acetate to fat Exercise does not in-
look), incoordinate gait and failure to execute
crease the rate of breakdown of alcohol to
skilful works like driving a vehicle, though
acetaldehyde, because this occurs only in
he develops a false confidence. Driving ca-
liver. Oxidation of acetaldehyde to water and
pacity deteriorates due to lack of visual acu-
C02 yields 7 cal of energy per gm This causes
ity, tactile perception, reaction or refle.x;
reduction of intake of other food by alcohol-
judgement and due to overconfidence. There
ics, causing lack of vitamins and other nutri-
is moderate peripheral vasodilatation with
ents in them. This leads to degenerative
flushingofface. So there is loss ofbody heat,
changes of liver causing cirrhosis.
though there is a feeling of inward glowing
Tolerance to alcohol is on practice to in the subject. This added with depression of
maintain semblance and not on excretion or central and reflex activities makes exposure
increased metabolism to cold very dangerous.
3rd stage or stage of severe intoxication
Signs and symptoms
or coma - In severe intoxication, there is
1st stage or stage of mild or early intoxica- depression of heart muscles and vasomotor
tion or excitation- It cause,s central nervous reflex, leading to peripheral circulatory fail-
system depression with il}hibit~en of higher ure. Face is pale, limbs are cold, pulse- rapid
centres initially, leading to i.u.l:fE!I;trajned and and weak, reflexes are sluggish. There is res-
unabstained character of a person. There is piratory depression and the res:piration is slow
a sense of well being The person is talka- and noisy, gradually becoming shallow. Pro-
tive, may be quarrelsome•or aggressive. It is longed hypoXia ultimately causes irreversible
said that 'when alcohol is in wit is out'. In peripheral circulatory failure. Death in such
the early stage, there i~ l~ss lo{iV:isual acuity, extreme cases occurs in a state of coma But
particularly for colour vision.),Fhere are red- in «;>thers recovery occu rs after 5 - 8 hours
dening of conjunctiva, deyclopment of nys- sleep with some left-over symptoms like head-

ache ,nausea ,dizziness and mental irritation tion, along with 15 units insulin subcuta-
etc. Most of the left over or hangover symp- neously.
toms are due to resultanthypoglycemia and 6. In gross intoxication antibiotic cover
dehydration . should be given.
Vomiting occurs in alcoholics , when a 7. Any other symptomatic treatment is
large amount of drink is taken hastily which given, if required.
causes sudden and quick toxic level in blood 8. In case of acute intoxication, of chronic
and brain leading to vomiting.Vomiting saves alcoholics, vitamin B-complex therapy
some persons from more severe conse- with B 1 and B6 is given and normal in-
quences,but in semiconscious drinkers it may take of balanced diet is gradually re-
end their lives due to inhalation of vomitus . stored.
Blood level and intoxication Signs and symptoms of alcoholism or

chronic use of alcoholic drinks
50 mg - Euphoria
100 mg - Condition deteriorates In chronic alcoholics, there are GI tract dis-
150 mg - Unfit for skilful acts like turbances, liver damage with jaundice ,
driving asci tis , peripheral neuritis , tremor , insom-
nia, loss ofmemory , impaired power ofjudge-
300 mg - Intoxicated
ment , dementia , red eye , loss of vitality, in-
400 mg - Stupor termittent infection.
500- 600 mg - Coma ,death .
Treatment of chronic alcoholism or alcohol
The maximum allowed blood level for
addiction
drivers varies from country to country, be-
tween 50 mg to 150 mg . In India , no such 1. . Gradual withdrawal of alcoholic drinks.
demarcated level is defined. 2. To facilitate withdrawal, Antabuse
(disulfirum) is given once daily in the fol-
Treatment
lowing doses. 0. 75 gm daily for 2 days ,
1. Gastric lavage -Stomach wash is recom- 0.5 gm daily for 3- 5 days , 0.25 gm daily
mended within 3 hours of last intake or for a week and then a daily follow up dose
even after 3 hours if the stomach is dis- of0.125 gm .Antabuse blocks metabolism
tended with ill-digested food and alcohol. of alcohol at acetaldehyde state. Acetal-
Plain warm water orsodibicarb solution dehyde accumulates in blood and causes
may be used. untoward symptoms like flushing , palpi-
tation ,nausea andvomiting. The patient
2. 30- 60 ml of liquid paraffin is left in the
starts disliking alcohol. A stage comes
stomach to act as a demulcent.
when the very sight of drinks creates dis-
3. Respiration is safeguarded by cleaning the pleasure of the patient.
air passage and givingoxygen inhalation. 3. Citrated calcium carbimide (Temposil ) -
4. If the above treatment does not seem to In 50 mg daily dose has similar actions
improve the condition of the patient then, and side effects like antabuse and gives
analeptic, like Nikethamide is given. similar result.
5. If analeptic does not work then 50 ml of 4. Chlorpromazine in 50 mg dose may be
50% dextrose is given by slow IV injec- necessary.

chapter 35: CEREBRAL· POISONS I 849
5. Nutrients , vitamins and gradual return 5% dextrose solution by IV drip with or

to a normal balanced diet . without calculated dose of insulin . Vita-
6. Other treatments according to the ill mins and symptomatic treatment as the
health or damage the patient suffers from condition of the patient demands, are
administered.
Withdrawal symptoms in chronic
alcoholics Korsakoff's Psychosis
It is a psychological and neurogenic deranged
Alcohol is a drug of addiction and its with-
drawal is likely to cause serious withdrawal ·condition occurring in some chronic alcohol-
symptoms. These are - Tremor, weakness , ics . The condition was first identified by
pain in the muscle, cold sweat, insonmia, loss Korsakoffin 1887 and hence the name of the
of appetite, vomiting, diarrhoea, restlessness, condition.
exaggerated reflexes, raised temperature, There are peripheral neuritis with per-
fluctuated BP, hallucination, loss of memory, ception derangement, polyneuritis, muscular
restlessness and delirium tremens. degeneration with weakness, wasting, un-
steady gait. There will be disorientation,
Delirium tremens some hallucination and retrograde anmesia
It is a psychotic condition in chronic alcohol- (Loss of memory of recent events) with corti-
ics which occurs due to L Sudden increase of cal degeneration.
the dose, 2. Sudden withdrawal, 3.Injury or
Wemicke-Korsakoff Syndrome
infection.
Wernicke-Korsakoff Syndrome is a complex
Signs and symptoms
development of both Korsakoff's psychosis
There are tremor, nightmares , insonmia, and Wernicke's encephalopathy.
convulsion, mental confusion, agitated behav-
iour, loss ofmemory, disorientation, failure Alcoholic Confusional insanity
to recognise known things and hallucination This is one of the withdrawal problems in
of horror. chronic alcoholics who have , disorientation
of time and place, different hallucinations,
Treatment (for both withdrawal symptoms
delusion, and maniacal attack. There may be
and delirium tremens)
feeling of horror. The subject is in a state of
L Largactil - 100 rng by mouth, repeated complete mental confusion.
as required.
· 2. Meprobamate- 2.4 gm daily in 3 divided Alcoholic Anonymous
doses.
\
3. In some withdrawal symptom cases, only This is an association without having a for-
restoration of alcoholic drinks will do. mal body, place and other formalities of an
4. In cases where urgent sedation is needed association. The addicts (alcohol) from all over
as in delirium tremens, phenobarbitone, the world who are desirous to give up alcohol,
chlorpromazine injection or paraldehyde narrates their bad experiences to other alco-
can be given and then detoxification and holics through letters, press and other me-
maintenance of nutrition is carried on by dia, which act favourably for de-addiction.
[F. M. - 54) .
Drunkenness 2. General behaviour and attitude -

Sober, abusive, drowsy, alert, co-
operative, self-controlling capac-
Being Drunk means being under the influ-
ity.
ence of alcohol as to have lost control on one's
faculties to such eXtent as to render him un- 3. Whether the breath gives smell of
able tb execute safely the occupation in which alcohol.
he was engaged at the material time. 3. Specific physical examination -
Thus, drunkenness is not the usual and (a) Gait - Staggering o;:-normal, whether
normal -phenomenon after a sober dose. In can walk straight, whether can take
drunken state the behavioural pattern and - timely normal tum.
the functional capacity of the person are af- (b~tance - Whether can stand easily
fected. However, there are some conditions with eyes closed and the feet close
which accentuate the actions and effects of gether.
alcohol and in certain other conditions the (c) Writing - Whether can write with
signs and symptoms may suggest drunken- dictation. Whether can maintain
ness though alcohol might have not been con- straight line; Missing of a word or
sumed at all. A medical man is often required letter, if any; time required.
to examine a person and certify if he is drunk (d) Speech - Content, articulation, slur-
at the material time. To form an opinion as ring, clarity.
to drunkenness and the degree of intoxica-
(e) Memory - Recent and past.
tion, the subject should be examined in de-
tail. History should be taken to exclude other (f) Muscular coordination - A few tests
causes of apparent intoxication. Examination are to be performed - Picking up a
ofblood, urine and exhaled air should also be needle from the ground; after clos-
kept in mind. ing eyes ~o bring tips of both index
fingers clo.se, from outstretched po-
1. History - About the onset and progress sition; aft~r closing eyes to touch the
of the present condition. Whether he suf- tip of rio~~ -~ith the tip of one index
fers from any disease or pathological con- finger, st~r:t'ing from a distance .
dition which may give the symptoms.
(g) Reflex - Deep reflexes - normal,
Whether he admits having taken alco-
brisk or sluggish; Plantar- extension
holic drinks. If he admits then, the na-
or flexiop.
ture, quantity and time of consumption. . ' ' ) - -'
Is he a habitual drinker ? (h) Refle~ rei'tction ,....,Whether responds
to a qu¢:;;ti~.4 ·or other stimuli. Time
2_. General examination -
taken t() :~~t. •
(a) Manner ofdressing- Properly dressed
(i) Conditi-on :. of; _~~ ·eyes - Drooping of
or:not, soiling of clothes, if any. .
the-eyeli<hl;roongestion ofconjunctiva;
(b) General appearance - . - state 6f;V'isual ·acuity; pupils - nor-
1. Posture - Whether over-erect and mal, dilated or constricted, reaction
over-smart, whether can stand of pupils to light- sharp or slow and
steady or not, leans to a side or: time taken to return to normal size,
.stoops foiw:itd; ca:n-.statllf without McEwen.'.f!:frign;l·squint, strabismus;
support or not. i .-· 1>- • ·~ 7
rtystagmua.~ J.i.J ~~JI~

G) Skin - Dry, moist, dirty stain if any. modifications, like breath analyser,
(k) Tongue - Cle~, coated or furred. alcometer, intoxicometer or
drunkometer.
0) Temperature - Whether raised or
low. Postmortem findings in a case of death
(m) Pulse :.... Count, volume,regularity. with history of consumption of alcohol
(n) BP - Normal, raised or low. The body and clothes may be stained with
(o) Respiration - Hurried, slow, shallow, vomitus and soil. Clothes may be torn. Face
deep, stertorous, sighing, gasping. and conjunctiva may be congested. There may
(p) Any tremor of fingers of outstretched be minor to severe external injury.
hands. The organs are congested. Stomach con- .
(q) Liver - Enlargement, tenderness. tent smells like alcohol. Stomach mucus
(r) Ascitis, oedema. membrane is congested. Lungs are congested
and oedematus.
(s) Condition of the heart.
Liver may be cirrhotic in addicts with
4. Laboratory investigations -
ascitis. There may be pathology in other or-
(a) Examination of blood and urine - gans. There may be internal injuries when
Blood level of alcohol during the early the proximate cause of death is injury. Other
phase of absorption is higher than the signs of hazards of alcohol may be present.
urine concentration. But after some Effects of some other poisons may be present
time of achievement of peak blood in homicidal poisoning cases where alcohol
level, urine alcohol concentration is has been used as a suitable vehicle for the
higher and more reliable. particular poison.
(b) Examination of exhaled air - By us-
ing potassium dichromate crystals as Materials to be preserved during
postmortem examination
indicator a rough assessment of the
concentration of alcohol in the ex- 1. Usual viscera (stomach with content, loop
haled air can be made. Expired air is of small intestine, portion of liver, 112 of
collected in a polythene bag. The air each kidney) are preserved in saturated
is then passed through a glass tube solution of common salt. Rectified spirit
containing potassium dichromate or absolute alcohol must not be used.
crystals. Presence of alcohol causes 2. Blood, preserved with sodium fluoride or
colour changes in the column of the oxalate.
crystals in the tube. This instrument
3. Urine -May be preserved without use of
is rather a colunin chromatography
any preservative.
and gives both qualitative and quan-
titative (approximate) assessment of 4. Stain of vomitus, soiled stain should be
alcohol in the expired air. Alcohol preserved.
present in 2litres .ofthe expired air
Medicolegal aspeds
is approximately. the .amount of alco-
hol present in 1 ml of blood. Differ- 1. Alcohol causes death mostly due to the
ent makes ofthe apparatus are avail- hazards associated with its use (see haz-
able in different names with minor· ards, page 852).

852 I P.RIN~IPLES. OF FORENSIC MEDICINE
2. Accidental d.eath may occur due to inha- 2. Fall from height

lation of vomitus or due to associated 3. Electrocution
· pathology of some organs. 4. Drowning
3. Death may occur due to consumption of 5. Burning
adulterated drinks. 6. Choking (Cafe coronary)
4. Death may occur due to consumption of 7. Cooking gas poisoning
some other additive or synergistic drug 8. Excessive damaging dose
alongwith. 9. Death
5. A person may be killed by some poison, 10. Saturday night paralysis.
given mixed with alcohol to mask the
smell mid taste of the poison. Saturday night paralysis
6. A person may be killed by inflicting fatal This occurs due to excessive drinking. In in-
injury or by way of drowning, after mak- toxicated state the drinker rests his armpit
ing him unconscious by giving alcoholic on the back of his chair causing sustained
drink. pressure over circumflex nerve. When the
7. Alcohol is taken to strengthen the nerve intoxication is over he suffers from tempo-
before committing a crime. rary paralysis of his arm.
8. Consumption of alcohol may lead to a
desire to commit a criminal act.
9. It may lead to commit hannful act out of
negligence. It is synthesized from coke and water.
10. Alcohol is said to be an aphrodisiac. It is It is used as an industrial solvent, in labo-
said to actually increase the sex desire but ratories, with ethanol as an antiseptic spirit.
decrease the capacity for sex performance.
METHYLATED SPIRIT
Hazards of alcohol
Methylated spirit is a mixture of ethanol and
1. Vehicular accident methanol primarily. Mineralised methylated
spirit consists of 90% ethyl alcohol and 10%
Fig. 35.4: Accidental death due to over indulgence to

alcohol. Note the cigarette butt in lips , ash Fig. 35.5: In the same case as in Fig. 35.5, a transistor
d on. chest held in hand

methyl alcohol. It is coloured light pink for lapse. There is unconsciousness with high
. easy detection. Industrial methylated spirit CSF pressure . There is scanty urination
consists of 95% of ethyl alcohol and 5% me- which is acidic and contains acetone and for-
thyl alcohol. No colouring agent is added. Sur- mates. In some cases there is total suppres-
gical spirit consists of 95% ethyl alcohol and sion of urine. There are convulsion, coma and
5% methyl alcohol, in which oil of winter- death is usually due to respiratory failure .
green is added to give it a sweetish flavour, 115th of the drinkers become blind and oth-
for easy detection and pleasant use (wood ers have varying degree of residual visual dis-
naptha = impure methyl alcohol). abilities . Among other complications, neuro-
Methylated spirit is very cheap . Hence, logical disturbances and amnesia are mentio-
it is .an adulterant for country liquor. nable. Peculiarly, some persons can stand
high dose of methanol without any damag-
Metabolism ing effect.
Rate of oxidation of methyl alcohol is very Fatal dose

slow , only about 15% qf that of ethyl alcohol.
When taken along with ethyl alcohol, it is 60-140ml.
metabolised only after complete metabolisa-
tion of ethyl alcohol. Hence, in chronic users Fatal period
it accumulates in the body. In course of oxi- Usually between 24- 36 hours. However, in
dation, formaldehyde and finally formic acid many cases, death occurs as late as in the
are formed. These are very toxic. 4th or 5th day.
Adion
Absorption, distribution and excretion
It causes CNS depression. It is less respira-
. Absorption and distribution are same as in
tory depressant than ethyl alcohol. Its late
case of ethyl alcohol. Its oxidation and excre-
effects are very dangerous which includes
tion are much slower in comparison with ethyl
optic nerve atrophy.
alcohol. In presence of ethyl alcohol, its me-
Signs and symptoms tabolism and excretion are further delayed.
It causes nausea, vomiting, pain or cramps Treatment

in the abdomen, headache, dizziness, vertigo,
dyspnoea, cyanosis, cardiac depression and The patient must be hospitalized and kept
muscular weakness. There is smell in the under close observation, even after several
breath. days of recovery. An ophthalmologist should
be consulted.
Then there may be an apparent relieffor
1. Stomach wash should be given, if more
12 - 24 hours , after which condition wors-
than 3 hours have not lapsed.
ens . Most signs and symptoms return and
there is hang-over. By this time blurring of 2. Oxygen inhalation and artificial respira-
vision develops. Pupils are dilated and fixed . tion may be necessary.
Conjunctiva- injected. There is blindness due 3. Circulation should be maintained by giv-
to methanol or formaldehyde . There are rest- .ing amphetamine, fluid or noradrenaline
lessness, cyanosis , dehydration, low BP, col- infusion.

4. Dehydration should be combated and Absorption, metabolism and excretion

electrolyte balance should be maintained.
Isopropyl alcohol is well absorbed through the
If plasma bicarbonate level is low then,
mucus membrane ofGI and respiratory tract.
sod . bicarbonate should be given orally
It is metabolised in liver. A part of it is con-
in the dose of2 gm 4 hourly.
verted to acetone . Excretion is as isopropyl
5. Renal failure should be corrected. alcohol or acetone and mainly through urine.
6. Delirium, if occurs, should be dealt cau-
tiously. Sedation may or may not be pre- Action
ferred. It causes cerebral depression and renal dam-
7. Eyes should be kept covered and pro- age.
tected .
Signs and symptoms
8. Ethyl alcohol therapy is given to delay
the metabolism and action of methyl al- It causes cerebral depression and drunken-
c<;>hol and its damagi.ng effects. But it is ness . There is loss or sluggishness ofreflexes.
doubtful , if the damaging effects on the Pupils are constricted in coma, There are
eye can be prevented. The dose is 50 ml signs of renal damage .
of 50% ethyl alcohol by mouth for 3 - 4
Fatal dose and Fatal period
days .
More than 100 mg% in blood is fatal. Death
Postmortem findings may occur in a few hours.
Externally, there will be signs of asphyxia Treatment
with cyanosis and prominent postmortem
staining. There may be frothing from the 1. Stomach wash
mouth. Internally , mucus membrane of the 2. Symptomatic
sto~ch and the intestine is congested. Lungs 3. Protection of the kidneys.
and brain are congested and oedematous.
Urinary bladder mucosa is congested. There Postmortem appearance
will be fatty change of liver. There is renal Externally, there may not be any specific find-
tubular degeneration . ing. Internally , the organs are congested.
Lungs and kidneys are congested amd oede-
Medicolegal aspeds
matous. There may be renal degeneration.
Most of the cases of poisoning are accidental ,
due to adulteration of the common alcoholic Medicolegal aspects
drinks with methylated spirit. Suicidal and Poisoning is accidental , mostly by way of ex-
homicidal uses may occur but are not com- ternal medicinal use.
mon .
Hypnotics are sleep inducing drugs. Barbitu-

Isopropyl alcohol is more toxic than methyl rates top the list ofhypnotics followed by bro-
alcohol. mide , chloral hydrate , paraldehyde etc.

arbiturates
cells and plasma . But short acting ones cross
blood-brain barrier earlier. illtrashort acting
ones also passes rapidly to CNS, lipids and
Therapeutic uses of barbiturates are gra-
fat depots , and return t.o circulation after
dually decreasing due to its addiction prop-
some time. They are detoxified in liver by
erty and due to availability of many other
oxidation and dealkylation . They are ex-
suitable alternatives which are now used
creted slowly in urine, up· to a week. Liver
where barbiturates were used earlier.
and renal diseases reduce rate of excretion.
Barbiturates are derivatives of barbitu-
ric acid (malonyl urea ). They vary in their Actions
rate of absorption, distribution, excretion and
Barbiturates are CNS depressant , hypnotic ,
duration of action. According to duration of
sedative , anticonvulsant and anaesthetic .
action, barbiturates belong to four groups:
Their effects depend on type, dose, combina-
long acting barbiturates tion absorption and weight and size of the
patient.
Barbitone, phenobarbitone
Fatal doses and Fatal blood levels
Intermediate acting (medium duration)
Pentobarbitone Type of barbiturate F D. F. B. L

LOf'IQ actmg 4-7 gtns. 10mg%
Short acting
lntemledateacting 2- 3gms 7mg%
Hexabarbitone
Short ano ultra horl actmg 1.5-2 gms 3mg%
Ultra short acting
Fatal period
Thiopentone sodium.
It is very short for ultra short acting prepa-
Use of barbiturates rations (may be few minutes when given IV);
Barbiturate may be taken as one preparation it is short for short acting and some hours to
alone, two mixed, two separately, with a syn- 1- 2 days for others . However, much depends ·
ergist, with an antagonist (mixed or sepa- on combination, health, treatment given and
rately), with adjuvants_With alcohol there is other factors.
additive action, leading to .da.ngerous coma.
With chlorpromazine there is potentiation Signs and symptoms
which may be very dangerous. All sedatives, 1. Related to CNS - There are drowsiness,
tranquilizers, antic.o nvulsants, hypnotics, . mumbling of speech; clumsy movement,
antipyretics and analg~sj.QSf~ synergists of trembling, unsteady ·gaitj nystagmus,
barbiturates. disorientation, disordered ideation, stu-
por, unconsciousness. Barbiturate au-
Absorption. distribution. fate and excretion
tomatism may occur. After taking his dose
Barbiturates are rapidly absorbed through GI ofbarbiturate, the patient is confused and
tract . With short acting ones, blood optimum thinks he has not taken the drug. That
level is reached earlier:.v.Blit~biturates are dis- ..J ·~y:luLre,peats the dose and ultimately
tributed equally in all tissues as also in red consumes a toxic dose in total.

2. Related to respiratory system - There is appear in the skin. There may be sudden
respiratory depression. Minute volume development of irregular shaped ery-
reduces to 3 - 4 litres per minute. Respi- thematous patches. They appear in front
ration is either stertorous and slow or of chest and limbs where they are often
shallow with normal rate or it may be symmetrical on both sides. Irrespective
shallow and rapid (up to 30- 35/minute) of prognosis of the case, they do not last
with minute volume rising up to 20 litres long. The area of redness however con-
with minimum tidal air volume. These tinues to be red in appearance.
lead to suboxia. Hyperpnoea up to 50- 70 7. Gradation of coma or unconsciousness -
per minute may occur in diseases oflungs. It depends on type of barbiturate, time
3. Related to CVS - There is depression. and dose.
Barbiturate depresses heart muscle and In category I , there is cloudy conscious-
relaxes smooth muscle of vessels. Hence ness. Respiration and circulation are not very
there is fall of blood pressure. The de- much depressed. Patient appears flushed
gree offall depends on quantity and qual-
when he is excited or he may be depressed
ity of available barbiturate in blood. In
and quiet. Sometimes he may appear pale,
the initial phase of anoxic hypoxia, there
anxious and nauseated.
may even be slight rise of blood pressure.
In mild dose also, a rapid pulse without In the second category, the patient is
vasodilatation may raise the blood pres- stuporose and he may be restless. Pupils may
sure . Pulse is rapid and soft. Except in be normal in size and may react briskly to
very severe poisoning, peripheral circu- light. In some, the pupils may be slightly di-
latory failure is not quite common. lated and in a few others the pupils may be
constricted. Corneal reflex is lost early and
4. Related to muscular system - Muscular
returns late. Plantar reflex may be extensor.
activity is depressed. In heavy dose, mus-
Patient responds to different vigorous stimuli.
cles are flaccid. Contractile power of the
Respiration is depressed but circulation and
muscles is depressed due to depression
renal fqpctions are not much affected.
of neuromuscular conduction. Due to the
action ofbarbiturate on central nervous In the category of third stage of coma,
system and spinal cord, the tonicity ofthe the patient is deeply comatosed. He does not
muscles is lost. respond even to vigorous stimuli. Pupils are
5. Renal depression - Barbiturate reduces constricted and fixed. Superficial and deep
renal output. The renal depression is due reflexes are absent. Respiration is highly ir-
to fall ofblood pressure, decreased renal regular. There are pulmonary oedema and
flow, anoxia and due to direct action on inadequate ventilation. Blood pressure falls
renal tubules. and there is peripheral circulatory failure .
There may be acute heart failure. There may
6. Other features - Due to failure of tem-
be renal failure . Temperature is usually low
perature regulation centre the body tem-
except in presence of infection. Sometimes
perature rises or falls, which may even
there is loss of pharyngeal and cough reflexes.
be dependent on environmental tempera-
ture. Temperature may rise also due to
Treatment
accompanying lung infection. In a few
cases of severe poisoning, blisters may The patient should be removed to a hospital.

1. Respiration has to be safeguarded by soning occurs due to overdose (particularly

keeping the airways clean, by using en- due to automatism) or due to mixed therapy
dotracheal tube, by giving oxygen inha- with some other additive or synergistic drug.
lation and by artificial respiration. Homicidal poisoning is rare due to early ap-
2. Maintenance of circulation - Methyl am- pearan~e of signs and symptoms and chance
phetamine HCl - 10 mg dose. IV Infu- of detection.

sion of nor-adrenaline drip and fluid and
Dependence
electrolyte therapy.
3. Analeptics - Amphetamine, picrotoxine, Dependence on barbiturate occurs in chronic
cardiazole. Dose of cardiazole is increased users with physical and psychological with-
with repetition (5 mg, 10 mg, 15 mg). drawal symptoms, which are not as difficult
4. If the patient is not in coma and if it is to control as in case ofmorphine dependence.
felt that, a part of the poison is still there
in the stomach then, stomach wash
should be given.
5. In long acting barbiturate poisoning,
Sodium and potassium bromides are cerebral
purgatives may be given for elimination
depressants and they depress both sensory
from the intestine.
and motor functions. Other preparations in-
6. Forced diuresis (by giving fluid and diu- clude ammonium bromide, calcium bromide
retic) and urinary dialysis are two impor- and lithium bromide.
tant treatments.
7. Other symptomatic treatment as re- Absorption, distribution and excretion
quired.
Bromides are well absorbed from both small
8. The once popular megimide or bemigride and large intestine. They are distributed in
in 50 mg dose as antidote is no more used tissues of the body. They are mostly excreted ·
because of its subsequent respiratory through urine, sweat and other body secre-
depression action. tions.
Postmortem appearance Action

External - Cyanosis, congested face , promi- Bromides replace chloride and depress nerv-
nent postmortem staining. ous system and cause vomiting, abdominal
Internal - Stomach mucus membrane is colic, and fall ofblood pressure. Temperature
congested. Parts of tablets may still be and respiration is depressed, pulse is slow and
present in the stomach. Lungs are congested, weak. There are vertigo, weakness , skin
oedematous with presence of haemorrhagic rash, mental confusion, paralysis and coma.
spots under the surface. Kidneys may show
Fotal dose
tubular degeneration. Brain is congested,
oedematous with punctate haemorrhages. 30-45 gm.
Medicolegal aspects Fatal period

Poisoning is mostly suictdal. Accidental poi- Usually between 6 - 8 hours.

Treatment Signs and symptoms
Stomach wash, chlorides as sodium chloride Drowsiness, deep sleep, coma; low blood pres-
by mouth or drip. sure, slow, weak and irregular pulse~ respi-
ration is depressed; low temperature, mus-
Postmortem findings cles are relaxed ; there is albuminuria ; may
Nothing specific. Viscera and blood should be cause hepatitis .
preserved for chemical analysis in doubtful
Fatal dose
cases.
3-5 gm .
Medicolegal aspects
Fatal period
Poisoning is mostly accide~tal . Suicidal cases
have been recorded. Chroq.ic poisoning is Within 12 hours .
more common when it is taken for insom-
nia, epilepsy and nervous breakdown, be- Treatment
cause bromide is a cumulative poison and
Stomach wash; caffeine-et-sodibenzoate intra-
accumulation over a long period may give
venously , repeated after 15 mts. and then
toxic concentration.
after 1 hour; artificial respiration with car-
bon dioxide and oxygen mixture; for protec-
de tion ofliver- glucose ; strophanthine 0.3 mg
dose to protect heart; some recommend
naloxone as antidote.
Chloral hydrate is a synthetic.product.
Absorption, fate ~nd excretion
Signs of asphyxia, both externally and inter-
Absorption is rapid when given orally or per nally; liver damage in chronic cases; suppres-
rectum . In the liver , alcohol dehydrogenase sion ofurine in acute cases.
changes chloral hydrate to trichloroethanol
in the presence of diphosphopyridine. Medicolegal aspects
Trichloroethanol is further oxidised to
trichloracetaldehyde and trichloracetic acid. Suicidal poisoning occurs; Homicidal poison-
Chloral hydrate and its metabolic products ing is not possible due to its smell and taste.
are excreted through urine , either free or Accidental poisoning may occur in chronic
combined with glycuronic acid in the form of users due to gradual accumulation. It is used
chloraluric acid . for 'knockout drop '. It is a habit forming drug.
Physical properties
Chloral hydrate is a colourless crystalline

powder, freely soluble in water, bitter in taste
and has a pungent odour. It is also a synthetic CNS depressant .
Action Properties
Cerebral depressant, sonmiferus and seda- It is a colourless volatile liquid with an ethe-
tive. real odour.. ~er

Chf.!pler 35: GEREBRAL POISONS I 859
Absorption fate and excretion promotes alertness and suppresses depres-

sion and sense of fatigue. Drugs which directly
Paraldehyde is absorbed through mucus
exert this action are cerebral stimulants.
membrane of stomach and intestine. It is
There are other drugs which indirectly brings
oxidised in the liver to acetaldehyde and ace-
these action. They are grouped as antidepres-
tic acid. It is partly excreted through kidneys
sant drugs.
and lungs without change.
Cerebral stimulants cause direct increase
Action of the level of neuro-transmitters and thus
stimulate the limbic system to exert positive
Cerebral depressant, sedative , somniferus
reaction towards food, drink and sexual ac-
and basal anaesthetic.
tivity. However without these agents the
Signs and symptoms
opposite effects i.e. depressive effects at CNS
becomes promil).ent and sustained.
Ethereal smell in breath, ~eadache, giddiness, Mode of action of antidepressants is dif-
eructation, nausea , vomiting, drowsiness;
ferent in the sense that they can create,
respiration is depressed; pulmonary oedema,
breakdown or can block the use of neuro-
low temperature , weak pulse, coma.
transmitter, recycle and re-use them and
Fatal dose can also prevent binding of neurotransmit-
ters to some nerve cells so that they remain ·
About 100 ml; 60 ml may be fatal. available for use when required. So they act
as re-uptake blocker of neuro-transmitters.
Fatal period These are used to treat depression and sad-
Death may occur within a few hours . ness (hence discussed with depressive psycho-
sis), which may occur due to depression or
Postmortem findings lowering of activities of neuro-transmitters.
Signs of asphyxia, congested organs, con- Generally speaking, all these antidepres-
gested and oedematous lungs, smell of paral- sants are of little medicolegal significance.
dehyde on opening the body cavities. Hence we will discuss here some stimulants
and-antidepressant drugs only which have cryp-
Medicolegal aspects tic' abuse as mood elevator and cause depend-
Accidental overdose, pa![ticwarly in them who ence as after use for sometime as mood eleva-
are habituated. It forms a habit.
tor their use .becomes imperative to the sub-
jectir to counter the depression which occur in
Treatment their absence after their use for sometime.
Stomach and colonic wash artificial respira-

Amphetamine, Methamphetamine,
tion and respiratory stimulant IV Calcium
Dexoamphetamines -
gluconate . ".....1'' j:- t-r ·) ,;"':,,
These are powerful.rs'timulants of. central

nervous system including spinal cord. They
cause raised BP and tachycardia. Counteract
Cerebral stimulants stimulate neurogeniC ddp:re$BienAooilieris4ack'l1l.fappE\titeiand:th:ey
functions of central nervous system; ..They also reduce fatigue. Their uses are very rrnitih

86() I PRIN CI PLES OF FOREr:--tSIC MEDICINE
restricted presently. On prescription they are

Cocaine
only supplied to the patients suffering from
narcolepsy an~ in a controlled way in cases Cocaine is extracted from the leaf of a plant
of attention deficit hyperactivity cases. They named Erythroxylum Coca which grows in
quickly cause very strong psychological de- the mountains of South America and tropi-
pendance. Methamphetamine is a serious calAsia.
drug of abuse . The stimulant action is very
quick when taken intravenously or is smoked. Action
The pleasant actions of the drug are followed
by depression. Then there is craving for the It is a central nervous system stimulant and
local anaesthetic. Its central action was long
drug. lntimately they may form physiologi-
known, but its euphoric and central stimu-
cal dependence . lant action was extensively studied by
At a time these drugs, particularly _Sigmund Freud between 1884 - 1887. It is a
methamphetamine was used by students strong amino -oxidase inhibitor and
during examination to red~ce sleeping time potentiator of effects of adrenaline and nor-
and increasing alertness and efficiency. But adrenaline . Its action is somewhat like that
final outcome used to be just negative . With of amphetamine .
increase of confidence, sense of judgement Some opine that, it does not cause physi-
and performance suffered. Examination cal dependence but causes strongest psycho-
time importance of the drug is no more logical dependence , strongest among the
there, but development of dependance is known abusive drugs. Others opine that it
alarming~ causes strong physical dependence which
makes it a notorious drug of addiction . The
Adrenaline synthetic variety of the drug is non-addict-
ing; but all synthetic varieties oflocal anaes-
It is also a stimulant but acts indirectly by
thetics including cocaine have acute toxic ef-
stimulating the neurotransmitter in the
fects .
brain e.g. norepinephrine . Apart from stimu-
lation of nervous system it also causes rise Absorption, fate and excretion
ofBP and tachycardia. It also initially gives
a sense of increased alertness , well being Cocaine is absorbed through the mucus mem-
and competence . But high dose causes dis. brane ofGI tract and respiratory tract includ-
comfort. There is palpitation, tremor, anxi- ing the nasal membrane. 85% of cocaine is
ety, sweating. A sense of depression and metabolized in the liver. Rest is excreted
anxiety continues. If used for a long time through urine unchanged. It is also used by
injection or used as smoke-available as pel-
there is danger of developing hallucina tion ,
lets termed "crack".
paranoia, delusion and violent or delirious
behaviour. Long use also causes physical ill-
Fatal dose
ness resulting in loss of weight and appe-
tite. Adrenaline is also a drug of abuse. It is 1.5 gm orally, 1 gm parenterally.
occasionally used by athletes for better per-
formance though, its use in sports stands Fatal period
prohibited. A few minutes to 1/2 an hour.
Signs and symptoms causes vasodilatation and lowers blood

pressure and hence needs 24 hours con-
Taken by addicts, for euphoria and exhilara-
stant attention on the patient. The head
tion. But in acute intoxication, there is vio-
side ofth~ bed should be kept tilted down.
lent central stimulation leading to Convulsion
(d) In serious cases and where the drugs
followed by collapse and respiratory failure.
are not readily available, open cardiac
In some cases, there may be serious cardio-
massage may be life-saving.
vascular upset with stoppage ofheart action.
In cases with predominance of CNS effects, Postmortem appearance
the person is excited, restless, there is palpi-
tation, pupils are dilated. There are tremor, Nothing specific. There will be signs of as-
maniacal excitation, anxiety, irritability, para- phyxia and cardiac dilatation.
noid psychosis, ulceration of nasal septum in
case of use as snuff, or chronic scarring near
expected site if regularly taken by IV injec-
tion, convulsion, collapse and respiratory fail-
ure. Cases predominantly having cardiovas- Cocaine dependants suffer from the follow-
cular upset, have fall ofblood pressure, slow, ing signs and symptoms- Rundown of gen-
irregular pulse, cold and clammy skin accom- eral health , digestive disturbances, blackish
panied with signs of respiratory failure. pigmentation of tongue, ulceration of nasal
Death is due to respiratory failure or cardiac septum (when sniffed). There is degeneration
arrest. of central nervous system with development
of dementia. There is tactile hallucination
Treatment with crawling or creeping sensation as if due
to "insects or bug" known as "Magnan's" syn-
1. To counter respiratory failure , the air-
drome.
ways should be kept clean, artificial res-
piration and oxygen inhalation are nec- Medicolegal a1pec:t1
essary.
(a) It is not popular as homicidal or suicidal
2. To combat restlessness and convulsion -
4- 8 ml of paraldehyde, intramuscularly agent.
or 0.25 gm of thiopentone sodium, I.V. (b) Accidental poisoning occurs from intra-
as general anaesthesia, is given. dermal use or urethral or other uses.
3. Cardiac irritability and disaster are simi- (c) When u sed locally, it increases duration
lar to those as occur with chlorinated of sex performance of a male by causing ·
hydrocarbon general anaesthesia, like desensitization of the glans penis.
chloroform and cyclopropane. To control (d) It causes mental derangement in chronic
them (a) vagal stimulant e.g. IV injection users who may get involved in crimes.
of acetylcholine HCl- 1 mg. or carbachol
0.25 mg or neostigmine hydrobromide 1
mg is given. (b) IV injection of 100 mg
procainamide (1 ml of 10% solution) in-
hibits cholinesterase enzyme. (c) Slow Procaine is used as local infiltration anaes-
injection of diluted phenoxybenz amine - thesia or spirui.l anaesthesia. Dangerous signs
10 mg has antiadrenaline action. It and symptoms may appear with the drug en-

1 862 I PRINCIPLES OF FORENSIC MEDICINE
tering into circulation or from spinal induc- Butacaine, Lidoc ine, Tetracoine and
tion. Procaine is one-third as toxic as cocaine. Oibucain
Procaine is a synthetic prod1,1ct.
These are synthetic local and spinal anaes-
Absorption, fate and elimination
thetic agents. They are more toxic than pro-
Toxic symptoms occur when the poison is caine and cocaine. Butacaine and lidocaine
given intrathecally orwhen1t enters the cir- are twice as toxic as cocaine; dibucaine and
culation by wrong pushing into a vein or in- tetracaine are 4 times as toxic as butacaine
filtration into a highly vascular area. It is and lidocaine.
partly hydrolyzed by esterases while in cir-
Action, signs-symptoms (more intense),
culation and partly by the liver to para-arm-
treatment, postmortem findings and medico-
no benzoic acid and dieth ylaminoeth anol.
legal aspects are same as in case of acute
Para-aminobenzoic acid is excreted in urine
as such. Diethylaminoethanol is further bro- poisoning with cocaine or procaine. Fatal
doses are proportionately less.
ken down.
Actions and signs and symptoms

Dopamine
More or less same as in case of cocaine, when
it gets into circulation. There are CNS exci- It is a neurotransmitter. Liver manufactures
tation, circulatory collapse, tremor, convul- Dopa which . ~:o. taken up by neurons to from
sion, respiratory failure. There is dilatation dopamine . Dopamine is particularly associ-
of pupils. ated with emotion based motor functions. It
In case of spinal use, there may be post- also helps to control behaviour, motivation
anaesthetic myelitis with symptoms of cord . and autonomic functions . It can increase car-
degeneration. Pulmonary oedema and pneu- diac irritability; paroxysmal supraventricular
monitis are common. tachycardia and .arrhythmia. It lowers blood
pressure. Ischaeria with gangrene of distal
Treatment part has occurred ~hen dopamine has been
Prophylactic premedication with barbiturate injected in arter!,
and ephedrine is necessary before using as
spinal anaesthesia.
In case of toxic symptoms, to combat cir-
culatory collapse, pressure agent (noradrena- Camphor is naturally obtained from the cam-
line drjp):sqquld.· bf,l .giv,en. 1~~Pi!a,!4qn sh0~ld . phor tree or may be synthetically produced.·
be safeg~,J.ap:i~. by 9:qg~ ,~J:$a~atir;m .~q.,ar.: •
tificialresp~rl:\t~Qlil;.' ':' d, .••• ~.'. ~r- r,. Absorption, fate and elimination
Pure camphor or sphi.t.~fcamphor is rapidly

absorbed·fnlm the GH,ra~t. In the body, it is
partly o:xidised '3:Jld 11rotly conjugated with
glycuro:oiE< aGid:JtjS: ~areted mostly through
Medicolegal aspects
the· ·kidne~ and1lb a .small extent through
Poisonmg,ili;, ~iden~:froili·th·er~titro lise. the :li.mgs.... >S , fl:'l~~) rt'J J·,

chapter 35: CEREBRAL POISO NS I 863
Adions and signs and symptoms

Caffeine (Trimethyl Xanthine}
It is a central nervous system stimulant and
irritant to the GI tract. Caffeine is available from the leaves of tea
On the GI tract, it cause.s pain in the and coffee beans, cacao and some other
abdomen, vomiting and diarrhoea. Due to its plant.
central action it causes excitement , anxiety, It is used as drinks in preparation of tea,
epileptif?rm, convulsion and .delirium, fol- coffee or cola drinks.
lowed by a period of depression, often lead-
ing to coma There are rise of body tempera- Absorption, fate and excretion
ture and cyanosis. De~th occurs dul;l to respi- Caffeine alone or in combination with sodium
ratory failure (during convulsive phase) or benzoate is well absorbed through GI tract.
due to cardiovascular collapse. ArLer absorption it is demethylated and fur-
ther metabolised and is excreted partly as
Fatal dose
methylated xanthine, partly as xanthine and
10 - 15 gms for an· adult. partly as degraded product of xanthine,
through the kidneys.
Fatal period
Within 24 hours.
Caffeine stimulates brain and the spinal cord
Treatment It increases action of pain killer like analgin
During convulsive phase bromides (4 - 5 gm or aspirin. In toxic dose (higher than thera-
intrarectally), diazepam or inhalation of ether peutic dose), there are headache, anxiety, in-
vapour helps to combat convulsion and ex- somnia, tremor, convulsion and delirium.
citement. During the depressive phase stimu- · There may be vomiting. Due to adrenocorti-
lants like caffeine, pressure agents and IV cal stimulation there is rise . in serum
fluid should be given. Dialysis of blood has catecholamines and increased excretion of 11-
hydroxycorticosteroid
been recommended for rapid elimination of
camphor from the circulation. Fatal dose and Fatal period
Postmortem findings Not certain.
Signs of asphyxia, extreme congestion of Treatment
stomach mucosa and menjn~s..Other organs
are congested. Sedatives and tranquilizers like barbiturate,
bromide, paraldehyde or diazepam counters
Medicolegal aspeds cerebral or spinal stimulation. Oxygen in-
halation, artificial respiration and other
Homicidal poisoningd6e5.not occur. Suicidal
symptomatic treatments are given, as re-
.attempts though seen, are rare: Poisoning is
quired . .
mostly accidental whe:Fl. 1 sotne ·medicinal
preparation of camphor is ·taken by mistake Postmortem findings
for some other medicine. rr.he :more common
. mistake is with castor oil (See also page 818). Nothing specific. Signs of asphyxia.
Medicolegal aspects Medicolegal aspects

Not a homicidal agent. Suicidal cases are on As in case of caffeine.
record . Most cases are due to overindulgence
to coffee, tea or medicine. Accidental poi-
soning, by mistake for other drugs, may oc-
cur. Some are idiosyncratic to the drug.
Theobromine is 3, 7-dimethyl xanthine . It is
available from the seeds of Theobroma co-
cao.
Theophylline is 1, 3 dimethyl xanthine . It is
available from tea leaves and is also synthe-
sized. Same as caffeine.
Absorption, fate and excretion Action and signs and symptoms
These are same as in case of caffeine . As in case of caffeine. In addition, it is an irri-
Action and signs and symptoms
tant to stomach and also causes palpitation.
Fatal dose, fatal period, treatment, post-
As in case of caffeine. mortem findings and medicolegal aspects are
Theophylline causes haematuria. same as in caffeine.
Not certain.
Treatment
40% fonnaldehyde is formalin.
As in case of caffeine. Fonnalin is absorbed through the mucus
membrane ofGI tract and respiratory tract.
Postmortem findings
Mter absorption it is changed to formic acid.
Signs of asphyxia, cloudy swelling ofkidneys . Formalin precipitates protein.
Stomach in a case of suicidal formalin

poisoning poisoning (See Fig. 35.6)

Fig. 35.8: Stomach mucosa in case of death due to Fig. 35.9: Formalinised part of liver adjacent to stomach
formalin ingestion. (Same as in Fig. 35.6) (as in Fig. 35.6)
Action similar change in the adjacent organs due to

transudation of formalin through the stom-
Locally irritating. Aft~r absorption there is
ach wall; lungs congested and oedematous;
systemic acidosis .
liver and kidneys show fatty degeneration.
Signs and symptoms
Medicolegal aspects
Iftaken by mouth then, there are signs ofGI
Accidental mostly, suicidal rarely.
tract irritation in the form of nausea, vomit-
ing, abdominal colic, diarrhoea, followed by
death due to shock. In diluted form, after Kcros n
absorption it produces systemic acidosis and
other signs and symptoms as are noticed in Kerosene is locally irritating to the mucus
case of methyl alcohol poisoning. When va- · membrane of GI tract and after absorption
pour is inhaled there is bronchitis and pneu- has neurotoxic, nephrotoxic and respiratory
monitis. depression action.
Fatal dose Signs and symptoms
30-90 ml. Pain in the abdomen, nausea, vomiting, diar-

rhoea, smell ofkerosene in the breath, head-
Fatal period ache, giddiness, sometime drowsiness, men-
tal confusion, convulsion, respiratory failure,
Within 24 hours.
glycosuria, proteinuria and pneumonitis.
Treatment
Fatal dose
Stomach wash with 0.1% anunonia solution
30ml.
and sodium-bicarbonate soln. Demulcent
drink. sodium-bicarbonate with IV infusion. Fatal period
Postmortem findings Not fixed.
Stomach mucus membrane inflamed, smell Treatment

'of formalin; stomach wall hard and leathery; Artificial respiration, oxygen inhalation,
[F. M.- 55]

stomach wash with sod. bicarbonate with pre- plants. Seeds, leaves, roots of these plants
caution to avoid aspiration. Rest of the treat- contain the active principles. Concentration
ment is symptomatic. of the active alkaloids vary in different parts
of the different plants.
On opening of the abdominal or chest cavity, DATURA

there is smell of kerosene. Organs are con-
gested. Haemorrhagic spots may be present In India, Datura (Ununatta) plants are abun-
in the mucus membrane of stomach and on dant and grow wild all over the country.
the surface of the lungs. Stomach mucosa will Datura Fastuosa grows in plain and Datura
be congested. Lungs will be congested and Stramonium grows in the range of Himalayan
oedematous. Other organs are congested, De- altitude. In the plains, two varieties of Datura
generative changes may be present in the kid- Fastuosa are available. These are Datura Alba
neys . (flowers are white) and Datura Niger (flow-
e!s are purple). All parts of the datura plants
Medicolegal aspects
are poisonous. However, the active principles
Poisoning is accidental, mostly in children. are most concentrated in the seeds. The fruit
Some suicidal cases are recorded. of datura is commonly known as Thorn Ap-
ple. These are spherical fruits having multi-
ple spikes (about a hundred) on the surface
Delitiants (Datura and Stimulants)
and multiple (about a hundred) seeds inside.
The seeds have some similarity with the seeds
In this group we have, hyoscine (scopo- of capsicum from which the datura seeds can
lamine), hyoscyamine, belladona, stramo- be differentiated as being odourless, yellow-
nium and atropine (a combination of l and d ish brown, which are larger and thicker than
hyoscyamine in equal proportion). those of capsicum, having multiple depres-
These agents are available from Datura, sion on the surface, are kidney shaped and
Belladona, Hyoscyamus , Hyocyamus Niger have two ridges on their convex margins.
CKhorasani Ajowan) Stramonium and Scopola These seeds are bitter in taste and on dissec-
Rg. 35.10: Datura fastuosa Fig. 35.11: Datura,-fastuosa R9. 35.12: Belladona
(Part of plant)

chapter 35: CEREBRAL POISO NS I 867
tion their embryos show outward curving phase. But later, they depress the CNS in-
near the hilum. The capsicum seeds, on the cluding the respiratory centre. Stimulating
other hand , have pungent irritating smell, action of atropine lasts longer than hyoscine.
are roundish, pale yellow, smaller and thin- By its vagolytic action at ropine stimulates
ner than datura seeds, have smooth surfaces, heart. Hyoscine has no mentionable action
no double ridges on the margins, have burn- in this regard.
ing irritating taste and the embryos are
Signs and symptoms
curved inwards near the hilum.
With datura, when seeds are taken intact and
Adive principles swallowed after chewing, signs and symptoms
Active principles of datura are hyoscine , hyo- develop within 20 - 30 minutes ; when extract
scyamine and trace of atropine (equal volume preparation is taken, toxic features appear
oflevo-hyoscyamine and dextrohyoscyamine within 5 - 10 minutes; when pure alkaloids
in combination). or tincture preparations are used features
start very rapidly.
Fatal dose In whatever preparation it is taken, it
tastes bitter. There is dryness in the mouth
For atropine it is about 50 - 60 mg for an
with difficulty in speech and swallowing and
average adult. For hyoscine it is about 10 mg.
there is pain in the abdomen. Though there
Variations are on record. In terms of seeds
is depression of the vomiting centre, the bit- ·
ofdatura, more than 75 seeds should be fatal
ter taste may in some cases cause vomiting.
for an adult. Datura is a stupepfying agent
The skin is dry, hot and the face is flushed.
and the stupefying dose is around 40- 50 seeds.
Conjunctiva is congested, pupils are ex-
Fatal period tremely dilated with blurred and double vi-
sion . Pulse is rapid and voluminous. Respi-
Within 24 hours. ration is hurried. There are mental confu-
sion, restlessness , talkativeness , mania, con-
Absorption, fate and excretion vulsion and delirium with hallucination in
The alkaloids are well absorbed through the some cases. The patient tries to run away
mucus membrane of the GI tract and respi- from the_~ed, picks up bedsheets, draws im-
ratory tract. Ointment and similar prepara- aginary thread from the tip of a finger and
threads imaginary needles . This phase of
tions are absorbed through the skin . The al-
excitation passes off in about two hours in
kaloids are absorbed through conjunctiva.
case of hyoscyamine or atropine. But with
Atropine is destroyed in the liver by an en-
hyoscine this phase is very short. With datura,
zyme atropinase . A part is excreted through
a mixed effect is available and the depressive
the urine . In dead bodies , atropine is retained
phase may even come after about an hour or
for a long period.
earlier. In the depressive phase, the patient
Actions is in deep sleep or may even be in coma.
There is respiratory depression which in a
Atropine and hyoscine b lock the acet yl- few cases may lead to death. But in most cases
choline receptor and thus ~roduce sympatho- recovery occurs within ·24 hours with some
mimetic or parasympatholytic actions. These . ,}eft over symptoms and sign.s like dry skin,
are central nervous stimulant in the early mental confusion and dilated pupils.

Treatment 6. It is used as an adulterant in country liq-

uor.
Washing of the stomach is recommended with
potassium permanganate solution or tannic 7. It is said to have aphrodisiac action and
acid solution. For the excitement period, bro- is used with that purpose occasionally.
mides or tranquilizers can be used. In severe Datura was in use for stupefying travel-
cases, with convulsion and delirium, gaseous lers for robbery purposes in India as back
general anaesthetic agents are sometime as in 1896. News-item published in "The
recommended. Though, prostigmine in 0.5 Statesman" on 6. 11. 1896 narrates how
mg - 1 mg dose or pilocarpine in 5 mg - 15 on 12. 6. 1896 two persons were killed
mg dose is considered to be the physiological and on 19. 8. 1896 another was intoxi-
antidote, these agents may not give good re- cated, when they were given Datura to
sult in severe intoxication as the cholinergic rob them during their journey.
receptors are blocked. Purgative and colonic
Test
wash are also recommended. During the de-
pressive phase, amphetamine preparation, A drop of the stomach content extract, if ap-
oxygen inhalation and artificial respiration plied in a rabbit's eye, there will be dilata-
may be required. tion of the pupils.
Nothing very specific will be there. There will

be signs of asphyxia with congested organs.
The plant is 2-5 feet in height. Concentra-
Fragments of datura seeds may be present
tion of atropine like alkaloids is more in roots
in the stomach. Atropine may be detected in
than in leaves.
the body up to a long period after death.
Medicolegal aspeds
1. Datura seeds are occasionally used for

suicidal purpose. It is a synthetic preparation of pentathylene
2. There is history of very rare homicidal tetrazol.
use.
Absorption
3. Accidental poisoning occurs more com-
monly in children who may chew the fruit It is absorbed through GI tract Rapid absorp-
inspite of its bitter taste. tion occurs from parenteral use.
4. More common uses are for criminal pur- Adion
poses like, highway robbery, rape and kid-
napping after stupefying the victim after CNS stimulation, followed by cerebral hy-
giving it mixed with some food or drink poxia.
preparation or after creating smoke by
burning the dried seeds or leaves. Signs and symptoms
5. It is occasionally used for quackary abor- Excitement, anxiety, vomiting, purgation,

tion purpose. rise ofBP clonic and tonic convulsion.

Fatal dose, Fatal period

More than 1 gm and about an hour, respec-
tively.
Treatment
1. Stomach wash (if taken by mouth),
2. Anti-convulsant,
3. Sedative , and
4. Muscle relaxant.
Postmortem findings
Nothing specific. In severe cases of convul-
sion , there is rupture of muscle fibres and
Fig . 35 .13: Poisonous hemlock
fracture ofbones. In chronic uses, degenera- (Conium)
tive changes occur in the brain .
Medicolegal aspeds Adions, signs and symptoms
Mostly accidental from therapeutic overdose ; Signs and symptoms are related to paralysis
very very occasionally, there is a chance of of motor nerve ends followed by CNS paraly-
suicidal use. sis , with loss of consciousness. Death is due
to respiratory failure due to its action both
on peripheral and central nervous system.
Cam lha Sinensi (T< a Plant), Coffes
Acetylcholine released fiom the respiratory
Arabica
.nerve endings is blocked.
Stimulant, to CNS and CVS Treatment
1. Stomach wash with KMn0 4 .
Co ium Macvlatum (Poi on
2. Vasoconstrictor and adrenergic drugs.
a d Fool'$ Porsl y)
3. Nfluid.
The poisonous active principle of these two 4. Oxygen inhalation, artificial respiration .
plants is conine . Poison hemlock was the 5. External supplementary heat and hot
cause of death of Socrates . drinks .
Absorption Postmortem findings

Absorbed well through GI tract. Signs of asphyxia, congestion of organs in-
cluding brain.
Fatal dose
150 to 300 mg of conine. Medicolegal aspads
Poisoning is almost always accidental due to
Fatal period
eating of poison hemlock or fool's parsley by
1-12 hours. mistake for edible parsley.

870 I PRINCIPLES OF FO RENSlC MEDICIN E
Fatal period
Uncertain for both the poisons.
Actions, signs and sympto,ms

These are irritant to the mouth and the up-
per GI tract, causing burning pain, nausea,
vomiting, salivation, diarrhoea. There are
sweating, palpitation, pallor and weakness.
There is ·respiratory distress. Pupils are di-
lated. There are mental confusion, clonic and
tetanic convulsion with lock jaw and
opisthotonus. Death occurs due to respira-
tory stoppage during convulsion.
Fig. 35.14: Water hemlock, shoot Treatment

1. Sedative,
Fish-berries, Water Hemlock 2. Barbiturate or other anticonvulsant,
3. Stomach wash and
These have active principles acting on mid- 4. Glucose and parenteral calcium
brain, medulla and spinal cord which are gluconate to protect the liver, in case of
stimulated. cicutoxin (water hemlock).
Active principles Postmortem findings
Fish-berries - picrotoxin; Water hemlock- Signs of asphyxia with additional findings of
cicutoxin. liver damage in case of water hemlock poi-
Fatal dose soning.
Picrotoxin- 100 - 300 mg; Cicutoxin - 2 - 3 gm Medicolegal aspects

Extract of Fish-berries are used as 'knock out
drop' and water hemlock as suicidal agent.
Children may accidentally get poisoned with
any.
HAlLUCINOGENS
Cannabis (Marijuana/Marihuana)
Cannabis sativa is the plant which has two

varieties, namely Ca.IJ.Ilabis Indica (Indian
Fig . 35 .15: Water hemlock, root
hemp) and Cannabis Mexicana. Cannabis
.. . 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
Indica grows about 5' - 6' in height. It is also low" growth of cannabis leaf but not its sell.
called Indian hemp. Its seeds yield oil which Patients of AIDS point that, cannabis smok-
is used to prepare, soap , paints and varnish. ing eases symptoms and boosts appetite, un-
Fibres of the stem can be used in textile or to der chemotherapy and harsh AIDS regimens.
make ropes. The active principle 9-~-Tetra This is inspite of the fact that state adminis-
hydro-cannabinol is present in the leaves and tration and media insist that no "good sci-
floweFs . From these parts Bhang, Ganja ence" endorses marijuana's medical use. Oth-
(Marijuan.a ) or Hashish (Charas) are prepared ers fear that the development will bring dis-
(see below). In western countries particularly aster.
in USA different preparation have peculiar
names like- the plant is named Weed and Plants
Ganja as Marihuana or Marijuana or · The plant grows up to 5 - 15 feet in height in
Maryjane. This are the names used by users wide climatic conditions. Plenty of sunlight
of the cannabis for their own understanding. produces better quality of plants. The leaves
Reefer is another such name they use for ciga- consist of odd number of leaflets with ser-
rette, filled with ganja (see below). rated margins .
Cannabis has, in this century worried the
whole world to the greatest extent as being a Active principles
drug of dependence and for its rapid and wide-
Tetra-hydro-cannabinol is the primary active
spread popularity among the young people.
principle (~-1 , ~-8 and ~-9 tetrahydrocannabi-
Cannabis indulgence is maximum amongst
nol and tetrahydrocannabinolic acid which
neglected , restless youth, living in vicious
during smoking changes to tetra-hydro-can-
social environment.
nabinol due to heat). It's concentration in dif-
Cannabis is origin of Oriental world. His- ferent parts of the plant varies. The concen-
tory traces its use as medicine in China 4- 5 tration is maximum in the resinous extract,
thousand years ago. Its mood altering capac- less in flowers , lesser in leaves and very lit-
ity was· known to ancient Hindus. It was in tle or nil in stem, roots and seeds. Different
use in Hindu religious and socio-cultural life preparations of cannabis contain tetrahydro-
about 2,500 years back. It entered in west- cannabinol in different strength depending on
ern Asia about 1,500 years back, and in Eu- the relative proportion of different parts of
rope in the 19th century. Its use in USA is the plant present in the preparation.
traced from around 1920. Thereafter, it
spreaded all around USA within a very short Siddhi or Bhang
period. Now its use is legally prohibited in
that country. In India, its growth, cultivation Siddhi or Bhang, which mainly consists of
and marketing is controlled by legislation. On leaves and stems, has minimum amount of
7. 11. 96 defying police, Federal law and Medi- cannabinol (less than 2%). It is used as drink
cal opinion, California's long running cam- or sweetmeat. Majun is a sweetmeat prepa-
paign to legalise Marijuana won a stunning ration of Bhang.
victory on election night to allow medicinal
Ganja or Hashish
use of Marijuana. Arizona even approves
treatment and probation "ihstead of jail for Ganja or Hashish contains 5 - 10% tetra-
recreational drug users. California ~'will al- hydrocannabinol, prepared from the flower-

872 I PRINCIPLES OF FORENSIC·MEDICINE .
ing tops of the female plants. This prepara- with reflexes being either sluggish or exag-
tion is smoked, either as such or mixed with gerated. Recovery is the usual rule.
cigarette. "Reefer" is the cigarette prepara- In any case, with a low or "social" dose,
tion of ganja. there is a sense of well-being with initial rest-
lessness and hilarity followed by a dreamy,
liquid hashish or Hashish oil or Charas carefree sense of relaxation, hallucination,
A viscous, dark green liquid containing the disorientation of time and space, senses of
resinous extract in a solvent. The concentra- hunger, particularly for sweets. With low
dose, the behavioural pattern may not change
tion of tetrahydrocannabinol in liquid hash-
much.
ish varies from 20- 50%. Resin may be crush-
extracted or alcohol-extracted from leaves and With moderate dose the above effects are
flowers . more intensified.
With a high dose there may be distortion
Actions and signs-symptoms of body image, loss of personal identity with
mental disturbance and hallucination with
Generally considered, cannabis is not verj
sensory disturbance.
toxic and not fatal It is a hallucinogen. At
the initial phase it causes excitement, fol- Absorption, fate and excretion
lowed by sleep. The overall signs , symptoms
and behaviour of the consumer depend on If taken by mouth, they are well absorbed
1. personality of the subject, 2. whether he is through the digestive tract and if taken as
accustomed with cannabis consumption and smoke it is well absorbed through the mucus
3. environment at the time of consumption. membrane of the respiratory tract. They are
metabolised in the liver. The metabolic prod-
When taken in a peaceful environment, ucts are excreted through urine and faeces
the person passes a quiet time with visual (through bile).
hallucination of colour and form There may
be visual fantasy , often with sexual content. Treatment
There are flushing, red eye, dilated pupils,
1. Respiration is safeguarded.
wild look. There are mental confusion, lassi-
tude, disorientation of time, place and per- 2. Circulation is maintained.
son, tremor, jerky movements , followed, af- 3. Stomach wash given.
ter a few hours, by uneasy sleep. Hangover 4. Undue loss of the body heat is prevented.
symptoms may persist for a day. 5. Urinary bladder emptied when needed.
If the user is not accustomed to cannabis 6. In violent patients, sedatives like
or if the environment is exciting or disturb- tranquilizers or barbiturates or paralde-
ing one, then there is more dysphoria than hyde may be given but the subsequent
euphoria. Disorientation may lead to misap- period of sleep should be observed care-
prehension which may release aggressive fully as these drugs have synergistic ac-
impulses. Bouts of intoxication with uncon- tion with the depressive phase of action
trolled behaviour may be there with nausea, of cannabis.
vomiting, ataxia, dilated pupils, rapid pulse, 7. Lung infection should be prevented by
collapse; cold, clammy, pale or flushed skin giving antibiotics.
Lysergic Acid o·ethylamide (LSD - 25)
Signs of asphyxia with presence of unabsorbed
part ofbhang in the stomach when the same Lysergic acid diethylamide is synthesized
is taken by mouth. from lysergic acid which is a derivative of ergot
obtained from a type of fungus known as
Fatal dose claviceps purpura The fungus grows on cer-
tain grasses and stale grains.
Very high. Hence fatality is unconrmon with
cannabis except when death occurs due to The hallucinogenic action of the drug was
hazards like, inhalation of the vomitus or due first observed by Albert Hofinann in 1943,
to some accident (injury, electrocution, when he accidentally inhaled the drug in his
drowning etc.). laboratory.
Action, signs and symptoms

Chronic Use It is a strong hallucinogen and in chronic use
has damaging effect on brain and mind and
In chronic users, there is development of according to some on the chromosomal struc-
strong psychological dependence though ture.
there may not be any physical dependence. 25 J.J.g causes vivid visual hallucination for
There is general run-down ofhealth. Mental 12 hours. There is change in mood The sub-
and moral derangements may be there. Such ject laughs, cries with slightest provocation.
persons may turn violent and may "run There is a feeling of anxiety and tension. It
amock" when, after killing a person he con- is said to give desired vision and feeling in
tinues with the killing spree, to either sur- religious practice. There may be a feeling of
render or killing himself ultimately. universal oneness, transcendental calm, a
negative attitude towards earthly achieve-
Medicolegal aspects of use of cannabis ments and desires. Unaware user may feel
panic and may conrmit suicide or may turn
1. The drug causes mental and moral deg-
violent and conrmit an offence.
radation in chronic users.
The belief that its use causes chromo-
2. Used to stupefy a person to cheat or rob
somal abnormality in the offspring is not es-
him.
tablished
3. With high dose and in exciting environ-
In chronic users it may cause paranoia
ment the user may tum violent and com-
mit an offence. Fatal dose and Fatal period
4. The person may get a suicidal or homi-
Uncertain.
cidal tendency.
5. A chronic user may 'run amock'. Treatment
6. Accidental death does not occur due to Tranquiliser or barbiturate for excited and
high fatal dose. But death may occur due violent subjects .
to its hazards.
7. It is used as an aphrodisiac agent, but
the action is ·not certain Nothing specific.

Medicolegal aspeds Within a short period after consumption,

there is a feeling of nausea with occasional
1. Its marketing and use are prohibited in
vomiting. Anxiety and posterior headache are
India . Hence, the users carry it secretly
coupted as unpleasant symptoms. There are
either soaked in blotting paper or mixed
disorientation and pleasant visual hallucina-
with sugar cube . The drug is popular tion (colourful). Pupils are dilated, pulse is
among its users as blue pill . slow, muscles are relaxed, followed by a calm
2. Its homicidal or suicidal uses are not sleep. In high dose CNS depression with res-
known. But after use a person may turn piratory depression and failure are the ter-
violent and may commit a crime includ- minal events.
ing homicide or he may commit suicide
out of panic, a common feature in una- Treatment
ware users. Stomach wash and symptomatic.
3. Death may occur in users due to acci-
Postmortem findings
dents .
4. Chronic use may create criminals in the Nothing specific except signs of asphyxia.
users.
Medicolegal aspects
1. Suicidal uses are rare .

2. Homicidal use is very very rare .
3. Accidental overdose may lead to occa-
It is a hallucinogenic agent extracted from
sional fatality.
the dried tops of a cactus plant, native of
Mexico , Lophophora Williamsii . The other 4. Death may occur due to hazards as in
alcohol (page 852).
alkaloid available from this plant is
anhalonine. 5. Like cannabis, its chronic use causes
moral and mental degradation .
Absorption, fate and excretion 6. Like cannabis it is used as an aphro-
disiac agent.
Mescaline is absorbed well from the GI tract .
It is metabolised in the liver and the meta- 7. Though not known to cause strong de-
bolic products are excreted through urine . pendence, it is being abused in many parts
of the world.
Fatal dose
Uncertain , more than 200 mg of mescaline. Nutmeg
Fatal period Nutmeg is the dried seed of the tree Myristica

fragrans .
Uncertain.
Active principle
Actions and signs and symptoms
Myristicin.
It is a hallucinogenic agent and in low to
Absorption
moderate dose causes excitation. But heB'ly
dose causes depression of the vital systems. Absorbed through-the GI tract.
Fatal dose Hallucinogenic Mushrooms

Uncertain, more than 15 gms.
Mushrooms P. Mexicana and P . Baeocystis
Actions and signs and symptoms possess active principles, namely psilocin and
psilocybin, which have hallucinogenic action.
Initially there is euphoria Th~n there is a
dream-like state with hallucination of vision American Indians of Mexico knew their
hallucinogenic action and used them in their
There are palpitation, flushing offace, rapid
religious rites.
pulse. There is dryness of mouth. Agitated
activity, incoherent talk followed by drowsi- Fatal dose
ness and sleep-like state.
Not certain, above 20 gms of the mushroom
Treatment
Fatal period
Stomach wash and symptomatic.
Uncertain.
Nothing specific.
Apart from hallucination they have parasym-
Medicolegal aspeds patholytic actions. Upon consumption, they
cause dryness of mouth and skin, dilatation
Toxjcity develops mostly from accidental con- of pupils, raised blood pressure and body tem-
sumption. perature, loss of tonicity of muscles, lack of
orientation and convulsion in children.
Phen~clidine Treatment
1. Stomach wash
A strong hallucinogenic drug. It is previously
2. Cholinergic drug if and as needed
used in anaesthesia, but now discarded for
3. Symptoma~ic treatment.
its side effects. It has rrwod swinging effects.
The user gives a dream like state. There is Po$fmortem findings
anxiety, disorientation, a paranoid state, ir-
ritation, violent behaviou~: hypertension, Nothing specific.
convulsion, respiratory depression, sweating.
EEG pattern changes. M~ic<?legal · aspects
As in case of nutmeg poisoning
Treatment J ••
1. Safeguarding the patient from physi-

caldange~,
2. Controlling the adverse signs symp- Sympathetic Excitants
toms, .ai j
3. Early excretio~ of the p_oison, There:are a good nUIJlben:of drugs in this
4. Taking lifer8uppontm'g;gteps-:.· ~:tqJ:.'::foJJia~'Iile of them, these, ~re, epi-

876 I PRINC iPLES O F FO RENSIC MEDICINE
nephrine (adrenaline ), a mphetamines Adions and signs and symptoms

(benzedrine, dexidrine ), dop a , dopamine ,
These are sympathomimetic and CNS stimu-
norepinephrine , methamphetamine ,
lants . Due to their sympathomimetic action
mephentermine , methoxamine , ephedrine ,
they cause palpitation, extrasystole, tachy-
tyramine , phenylephedrine . cardia (occasional bradycardia), chest pain,
These drugs are available from various raised blood pressure, heart block. There is
sources. Epinephrine is naturally available dilatation of pupils. The chiefcentral actions
from the adrenal medulla of animals . It is comprise of anxiety, tremor, insomnia, de-
also synthesized . Amphetamine , meth am- lirium, convulsion, collapse and coma. Chlo-
phetamine and phenylephedrine are synthetic rine , bromine and methane containing drugs
products .'Ephedrine is available from a plant sensitize the heart muscles and then these
drugs are more dangerous and may cause ven-
Ephedra aequesetina and may also be pre-
tricular fibrillation . In serious cases, there is
pared synthetically .
pulmonary oedema.
Absorption, fate and excre,ion Treatment
Epinephrine , norepinephrine , methoxamine , If taken by mouth the stomach may be
phenylephrine and tyramine are not well washed with tannic acid solution. For coun-
absorbed from the GI tract . These are ad- tering systemic action, diazepam, chlorpro-
equately absorbed through subcutaneous mazine , barbiturate or paraldehyde may be
route . Ephedrine , amphetamine , metham- used. Sodium nitrite is helpful to combat the
phetamine , mephenteramine and dopa are blood pressure. In case ofpulmonary oedema
satisfactorily absorbed through the GI tract . intravenous hypertonic glucose or urea and
Epinephrine, norepinephrine are metabo- atropine sulphate may be helpful.
lised in the liver and excreted through the
urine . Ephedrine is excreted through urine ,
unchanged. P art of amphetamine is excreted Nothing specific . There may be evidence of
as such through urine and part after pulmonary oedema in some cases of
metabolisation in the liver . epinephrine-death.
Medicolegal aspads
Fatal doses
Fatality with epinephrine is due to IV over-
Epinephrine - lOmgsubcutaneously .I.V. Fa- dose . Amphetamine causes dependence . Fa-
tal dose is much less when pushed rapidly . tality may occur due to IV overdose in addicts .
But a higher IV dose given with infusion over Ephedrine is not usual to cause fatality . As a
a long period is tolerated. Fatal dose of am- drug of abuse it is, availability of ampheta-
phetamine is much higher and that of ephe- mine is now restricted in many countries.
drine is very high. Ordinary therapeutic dose
being around 20 mg. as large as 500 mg of
ephedrine given orally, may be tolerated.
Therapeutic dose of amphetamine being be-
tween 5 - 30 mg, addicts may tolerate IV dose Active principle ephedrine , pseudoephedrine ,
oflOOmg. are sympathomimetic , toxicity in very high
doses. Pseudoephedrine stimulates and inhib- Actions and signs and symptoms
its myocardium, rise in BP with other sym-
All these drugs stimulate the functioning of
pathomimetic action. In excessive dose ephe-
the organs supplied by cholinergic nerves. Ac-
drine causes nervousness, insomnia, head-
tion of muscarine is most broad based. There
ache, vertigo, nausea, vomiting, sweating,
are nausea, vomiting, loose motion, sweat-
palpitation, precordial pain.
ing, salivation, colicky pain, lacrimation, con-
striction of pupils, respiratory distress due
to constriction ofbronchus, fall ofblood pres-
Parasyn.pathatic Excitant
------------------~ sure and slow pulse. There may be twitch-
ing, convulsion and collapse. They also de-
Drugs which are parasympathetic excitant: press the respiratory centre in the medulla.
muscarine, acetylcholine, aerecholine , With muscarine, death occurs due to heart
methacholine, choline derivatives, carbachol block. With others the cause is respiratory
neostigmine, physostigmine, pilocarpine, or- failure.
ganic polyphosphates. Acetylcholine, metha-
choline, choline, carbachol and organic Treatment
polyphosphates are synthetically produced. 1. Stomach wash with KMn04 or universal
Muscarine is available from amanita antidote.
,,
muscaria Physostigmine is available from the
2. Emesis.
beans of Physostigma venenosum and pilo-
carpine from pilocarpus jaborandi. 3.· Atropine.
Aerecholine is available from betel nuts 4. Specific antidote m case of organic
(Rareca Catacheu). polyphosphate.
5. For twitching of muscles - I .V. Ca-
Absorption, fate and excretion gluconate.
Drugs other than acetylcholine are absorbed 6. Respiration is safeguarded by clearing
airways, artificial respiration and 0 2 in-
through the GI tract Acetylcholine is de-
halation.
stroyed by the alkalinity of the intestine and
is not absorbed when taken orally. Acetyl- 7. Body warmth should be maintained.
choline is readily destroyed by cholineste-
Postmortem findings
rase. Hence it is not excreted through urine.
Others change their form in the body and only Signs of asphyxia, frothing from the nose,
trace of them is available in the urine. pulmon ary oedema, congested organs with
haemorrhage in some.
Fatal doses
Medicolegal aspects
Not well ascertained. Physostigmine 10 mg,
neostigmine 50 mg, and carbachol 150 mg Suicidal uses of some like organic phosphates,
p h y sostigma venenosum is common .
may cause death.
Amanita Muscaria causes accidental poison-
Fatal period ing when taken by mistake fo~ edible mush-
rooms. Therapeutic toxicity may occur very
Uncertain. rarely.
.878 I PRINCIPLES OF FORENSIC MEDICINE
different metabolic products. Antihistamines

and other antidepressants are excreted in
urine as glucuronides.
Actions
Antihistaminic , antiadrenergic and depres-

santofCNS .
Signs and symptoms
Fig. 35.16: Suicide after consumption of heavy dose of With diazepam , lethergy, drowsiness, ver-
tranquilizer. See the note written on the palm
of left hand tigo, decreased libido and occasional skin
rash may result. Muscular rigidity and dys-
arthria may occur when taken in high doses
Tranquilizers for a long period. Intravenous injection may
cause cardiac arrest, hypotension and res-
Tranquilizers can be classified as follows- .piratory depression. Diazepam is specially
A Major tranquilizers dangerous in hepatic and renal patients, in
(a) Phenothiazine derivatives infants and i· •.ak.en with alcohol. Some with-
drawal symptoms are common in chronic
1. Chlorpromazine (largactil)
-users.
2. Thioridazine (melleril, thioryl)
With librium (Chlordiazepoxide), there
(b) Butophenon- are nausea, dizziness, skin rash, weakness
Haloperidol, Carbamezapine, Tegritol in limbs, tremor, ataxia, vertigo, dysar-
B. Minor tranquilizers thria, loss of coordinated movements for
(a) Benzodiazepine derivatives skilful works and in some cases hepatic
damage. Fatality is not common. Mild with-
1. Benzodiazepines
drawal symptoms may occur in chronic us-
Diazepam
ers.
Lorazepam
With chlorpromazine , there are seda-
Oxazepam
tion, low respiration, dilated pupils, fall of
2. Alprazolam blood pressure, hyperglycemia and loss of
. (b) Chlordiazepoxide (librium). body heat; ·collapse-and coma. In prolong
use it may cause tremor, parkinsonism type
Absorption, fate and excretion . rigidity ; . leuGpp~:P~i'l : 1;1nd hepatitis may oc-
Tranquilizers like antihistaminics are well cur. Cataract formation and corneal dam-
absorbed frqm the GI tract . Diazepall). accu- age have been noticed in some chronic us-
.. , iG v ·""t 't (
' ·, ,·... I
:mu'h1t~s' hi fatty tisiffie and'bnrin}riiei"iifulisdd ers.

Y,* 1::- 'f;-' J'ii(f· 1
in 'the ·H~e:r· ··aii~a ~:t~ -j~~~'i-e't~d''.irt7 :l:fH:B.e as
I .; · I, ·· \-: '
With Chlormezanone , there is drowsi-

gluclltbliid~s-. 'ChlJ~~~ik~ ·i's -~~~Btilised ness, dryness of mouth, dizziness, flushing
in the' 1iVeZ: ·knd'· is:·~*c.ie~'d.' rH (the lMlfie as offace and oet~s1bhaHiausea.
Fatal dose and Fatal period • A S. Curry- Poison Detection in Human Organs.
Not fixed. Low doses of diazepam and chlo- • J. D. P. Graham- Diagnosis and Treatment of Acute
rpromazine when given intravenously, may poisoning, 1962.
cause death though high oral dose ntay be • T Bewley- Heroin addiction in the United Kingdom.
tolerated. Tolerance in mental patients 1965.
treated with tranquilizers is high • H. W. Gerarde- Toxicology of Drugs and chemicals,
1969.
Fatal period
• R. V. Phillipson- Modern trends in drug dependence
Variable, within 2 to 3 days. and alcoholism, 1970.
• F. E. Camps - Recent advances in Forensic Pathoi-
Treatment
JY. 1969.
Wash out the stomach if the poison has been • E. Rentoul and H. Smith - Glaister's Medical Juris-
taken by mouth. Rest of the treatment are prudence and Toxicology, 1973.
symptomatic. Respiration should be safe- • Will H. Blackwell- Poisonous and Medicinal Plant-
guarded. Circulation, blood pressure and 1989.
body temperature should be maintained.
• Sandra B. McPherson, Harold V Hall and Errol Yudiko
With chlorpromazine, some advocate ex-
change transfusion. Hepatic damage re- Methamphitamine use- 2008.
quires specific care. Withdrawal symptoms • K. Panter, Twierenga and J. P. Rsher Poisonous Plants
are not much alarming and can be dealt com- -2007.
paratively easily. • Mahmoud A, Elsohly- Marijuana and Cannabinoids
-2006.
Medicolegal aspects
• Steven B. Karch- Drug Abuse, Handbook- 1997.
Poisoning is mostly suicidal or accidental from • Willium Livingston -Aphrodisiac, Sexual Stimulants
overdose or N use. Homicidal poisoning is -2008.
not usual. These drugs cause mild to moder-
• Richard Laing and J.A. Seigal- 2003.
ate addiction.
• Richard M. Gilbert- Caffine. the most popular stimu-
lant.
• Eric VanWyk- Mind altering and poisonous plants of
the world- 2008.
• L. S. Goodman. A Gilman -The pharmacological ba-
sis of therapeutics.
Questions.
• F. Borkenstein et al- The role of the Drinking Driver in
Traffic Accidents. 1964.
long ~uestions
.) '
• Sir Norwood East- Society and the criminal, 1949.
1. What are the signs-symptoms, Treatment, Post-
• H. W. Haggard and E. M. Jellinek- The alcohol ex- mortem findings and Medicolegal aspects of- Opium!
plored, 1950. · Mqrphine, Ethyl alcohol, Methyl alcohol, Barbiturates
. ' .
• S. Locket- Clinical Toxico~ogy, , 1,9~7. p.ois.oning? Give differential diagnosis of coma .

2. Name some hallucinogenic agents. Describe the signs of opium, morphine, codeine. Addiction, withdrawal
and symptoms, treatment and medicolegal aspects symptoms of opium and its treatment. Why heroin is
of cannabis intoxication. a preferred drug of addiction? What are absolute al-
3. Describe the signs-symptoms, treatment and medi- cohol. rectified spirit, proof spirit, hard drink, soft drink,
colegal aspects of a deliriant poison. McEwen's sign, Alcoholic anonymus, delirium tre-
mens, Korsakoff's psychosis, Alcoholic confusional
4. What is drunkenness? How do you diagnose a case
insanity, drunkenness. alcometer, methylated spirit ?
of drunkenness.
Fatal dose of alcohol, Blood level of alcohol with re-
Short questions lated intoxications, hazards of alcohol, Treatment of
chronic alcoholism, cause of deterioration of driving
Heroin, Codeine, Nalorphine, McEwen's sign, Delirium
capacity in alcoholics, dangerous effects of methyl
tremens, Korsakoff's psychosis, Alcoholic confusional
alcohol, its fatal dose. Name of different hypnotics,
insanity, Alcoholic Anonymous, Barbiturate automa-
treatment of barbiturate poisoning, How cocaine is
tism, Cocainism, Magnan's syndrome, Running
available, its fatal dose, Magnan's syndrome, Ac-
amock, LSD.
tions of kerosene, formaldehyde, their fatal dose and
medicolegal importances. Signs-symptoms, fatal
Oral questions
dose, antidote and MLI of datura poisoning, Why
What are natural, semisynthetic or synthetic opiates? poison Hemlock is famous? Active principles and dif-
Action of morphine on respiration, pupils; functions ferent preparations of cannabis; "running amock".
stimulated by morphine. How pethidine is different Action and MLI of LSD. Fatal doses of epinephrine
from morphine in its actions? Fatal dose and antidote and ephedrine. Actions of different tranquilizers.
NOTES

H Crushed seeds may cause signs and symp-
toms within 15 minutes to 30 minutes. When
strychnine is taken, signs and symptoms start
Strychnine is the potent active principle avail-
almost immediately.
able from the seeds of the plant strychnos
nux vomica. Another active principle but With minimum local effects, systemic •
much less potent, named brucine, is avail- signs and symptoms appear. The person is
able not only from the seeds but also from anxious and restless. His sensation becomes
other parts of the plant like roots, stems or more acute. Respiration and circulation are
leaves. Strychnine is over 10 times more po- slightly stimulated. He is apprehensive and
tent than brucine. The seeds of the ripe fruits has anxious look. There is twitching and
contain about 1% of strychnine and a higher tremor of muscles followed soon by clonic
amount of brucine. The seeds of strychnos convulsions and this then turns to tonic type.
nux vomica are circular, flat or slightly bi- At the beginning the convulsions are less in-
convex, 2 em in diameter and about 0.5 em tense but gradually the strength of contrac-
in thickness with very tough testa covered tions also increases. At first, the duration
with very fine , short silky fibres. The seeds between two contractions are more with pe-
and the active principles have no smell but riod of contractions being less. But gradually,
has a bitter taste. the position reverses with increase in the
Strychnine is used in medicine as a stimu- duration of convulsion and decrease in the
lant and also as a rodenticidal agent. interval between two convulsions. Each con-
vulsion· may continue for 1 - 2 minutes and
Action
the interval between two convulsions may be
Strychnine is a central nervous system stimu- 10 - 20 minutes. Mild external stimulation
lant and acts particularly on the anterior horn like some noise, air movement or mild touch
cells of the spinal cord. may initiate convulsion. During convulsion
the extensor muscles take upperhand and
Signs and symptoms thus, when in supine position, the body be-
When an intact seed is swallowed it may pass ing bent backward, the whole body may rest
off without causing any signs and symptoms. on the head and heels only. This position of
882 I PRI NCIPLES O F FORENSIC MEDICINE
the body is known as opisthotonus position. Absorption, fate and elimination

Occasionally the body may bend forward It is well absorbed through mucus membrane
(emphrosthotonus position), or may bent of GI tract. After detoxification in the liver it
sidewise (pleurosthotonus position). Contrac- is excreted through urine, bile, milk and
tion of the muscles of the f;:tce causes widen- sweat.
ing of the mouth as the angles of the mouth
are drawn wide apart with creases appearing Treatment
in and around the eyelids (a state known.as
1. The patient is kept in a dark, noiseless
risus sardonicus). In between the convulsions room so as to minimise stimulation.
the body is fully relaxed. Prognosis is good
2. He is sedated which may be up to the
when the period of each convulsion gradu-
state of anaesthetisation. For this pur-
ally decreases and the interval in between,
pose, paraldehyde, 4 - 5 ml (IV) or IV ul-
gradually increases. Prognosis is bad when
tra-short barbiturates can be given. In
the reverse occurs. exchange of paraldehyde, bromide or chlo-
Death occurs due to respiratory arrest ral hydrate can be chosen. Gaseous an-
during a prolonged convulsion or due to CNS aesthetic agents like chloroform or ether
exhaustion or due to cardiac arrest in a few can be given, when the patient is in a
cases. Mind of the patient remains clear till relaxed state.
death. 3. After full sedation or anaesthetisation,
stomach may be washed with full care
Fatal dose
with KMnO4 or tannic acid or with solu-
1- 2 seeds or 30 mg- 100 mg of strychnine. tion of iodine.
4. Mephenesin in the dose of 1 - 3 gm by IV
~atal period infusion, can be given. Alternatively,
30 minutes to two days. curariform drug can be used.
I
,. Table. 36.1: Differences between Strychnine poisoning and tetanus

... ..
,1 Points Strychnine poisoning Tetanus
1. Onset ; Rapid Comparatively delayed

2. History Of poisoning Of injury
3. Fever Not usual Usual
4. Onset of convulsion Involves whole body muscles all at a time Starts usually with face
5. Lockjaw .Absent Present
6. State in between Muscles relaxed Muscles not fully relaxed
convulsion
7, Fatality Between a few hours to 2 days Fatal period longer
8. Laboratory investigation Chemical test of blood etc. positive Microbiological test positive

chapter 36: SPINAL POISONS I 883
5. Tracheotomy with oxygen supply may be

necessary and helpful.
• Treatment of common acute poisonings, Henry
Postmortem findings Mathews- A.A. H. Lawson, 3rd Edn., 1975.
• Gradwohl's Legal Medicine, 4th Edn. 1984.
Rigor mortis appears early and stays long.
Signs of asphyxia present. Occasional rupture
• R. H. Dreisesch- Handbook of Poisoning .
• W. B. Deikman, H. W. Gerarde- Toxicology of Drugs
of stretched muscles may be noticed. Organs and Chemicals.
are congested.
• Will H. Blackwell- Poisonous and Medicinal Plant-
Viscera , blood and spinal cord should 1989.
show presence of strychnine on chemical • K. Panter, Twierenga and J. P Fisher - Poisonous
analysis: Strychnine is present in the tissue Plants- 2007.
of the dead body from days to years depend-
ing on the state of postmortem changes in Questi
the dead body. Long questions
Signs-symptoms, treatment and Postmortem find-
Medicolegal aspects
ings of strychnine poisoning.
Poisonings are usually accidental due to Short questions
overdose, accidental consumption of strych- Difference between strychnine poisoning and teta-
nine preparation by children, accidental nus.
chewing of seeds by children or contamina-
Oral questions
tion of food by rat poison containing strych-
Source, Active principles, Site of action, of strychnos
nine. Suicidal poisoning may occur due to
nux vomica/strychnine, its fatal dose, antidote and
use of rat poison preparation. Homicidal medicolegal aspects of its use. What is the type of
poisoning is rare . It is used as an abortifa- convulsion in strychnine poisoning, what are
cient agent. It is also used by tribals as an opisthotonus, emphrosthotonus and pleurosthotonus
arrow poison. positions, Cause of death with strychnine.
. ' ,· (
I' ;{' . . ... I

NOTES
J; I

P PH RA NERVE ENOS
an rare inhibitors, alreQdy des.:ribed) CURARETOX
CU R Signs and symptoms

Chief signs-symptoms consist of flaccidity of
The alkaloid is a peripheral muscle relaxant muscles which get paralysed . Muscles ofthe
which is available from the plant Chondroden- diaphragm and intercostal muscles are af-
dron tomentosum and some variety of Strych- fected early , leading to respiratory failure ,
nos plants . Synthetic preparations of active which is the cause of death .
principles are also available .
Fatal dose
Active principles
About 30 mg of curarine parenterally.
Active principles of curare and curariform
drugs are d-tubocurarine ,dimethyl tubocura- Fetal period
rine , flaxedil (gallamine triethiodide) ,
syncurine , intocostrin and succinylcholine 1-2 hours .
chloride .

Absorption of curarine is rapid through sub-
cutaneous and intramuscular route but is
very slow through GI tract . It is metabolised
in liver. Only a small amount is excreted un-
changed in urine .
Action
It blocks the action of acetylcholine at the
Fig. 37.1 : Curare (Vine)
nerve ends.
885
Treatment used by tribals (mostly South American) as ar-

row poison or at the tip of spear to kill animals.
1. As death is due to paralysis of respira-
In the same way these can be used to kill oth-
tory muscles, artificial respiration is the
ers. Poisoning does not occur due to consump-
most important part of treatment.
tion of flesh of the animals hunted this way.
2. Physostigmine (1..:_ 2 mg) or neostigmine
(0.5 mg- 1 mg), S. C., is effective except
R fenmces
in c~se of syncurine or succinylcholine
chloride, as the action of these two de-
rivatives are due to sustained action of
• Henry Mathews, A.A. H. Lawson, Treatment of com-
mon acute poisonings, 3rd Edn., 1975.
acetylcholine and due to blockage of its
• C. H. Thienes, T. J. Haley - Clinical Medicine and
action.
Toxicology, 1985.
3. 100 mg of Congo red in 10 ml. of 5% glu-
cose solution may be given by slow IV
• C. A. Franklin - Modi's Medical Jurisprudence and
Toxicology, 1985.
injection and may be repeated after an
hour. • Will H. Blackwell- Poisonous and Medicinal Plant-
1989.
Postmortem examination • Sandra B. McPherson, Harold V Hall and Errol Yudiko
Methamphitamine use- 2008.
Nothing specific. Skin and tissue from around
the wound due to the arrow or spear or in-
jection should be preserved and sent urgently Questions
for chemical examination.
Oral questions
Medicolegal aspects
Active principle, Action, Fatal dose, Antidote and MLI
The poison is not much effective orally. It is of Curare.

GENERAL ANAESTHETICS Causes of death due to general
anaesthesia
General anaesthetic agents during the early
1. Overdose of anaesthetics. This occurs
phase of induction cause excitement, and even
mania and hallucination , for a short period . primarily due to combination therapy.
Then they cause progressive cerebral depres- When more than one agent is used,
sion . In course, due to overdose or due to proper doses may not be maintained.
some other reason , death may occur. The use 2. Due to wrong connection in the gas ma-
of general anaesthesia gives clinical features
chine there may be undesirable danger-
in five distinguishable stages.
ous mixing up of gases.
1ststage : Stage of analgesia- result of depression of
3. Hypoxia may be the cause of death,
higher cortex.
which may occur due to respiratory de-
2nd stage : Stage of excitement- There is depression of
pression , hypoventilation , due to the
motor centres of the cortex.
action of muscle relaxants or due to
3rdstage : Stage of surgical anaesthesia -The lower
laryngeal spasm due to inhalation of
vital centres function inclepend3nt of the higher
vomitus on the operation table.
cortical control. This stage has four distinct
planes. In the first plane, there is disappear- 4. Some of the agents (I.V. Pentothal) de-
ance of spinal reflexes. In the second plane presses heart action , dilates blood ves-
muscular tonicity is decreased. In the third sels and lowers blood pressure with
plane, there is intercostal paralysis. In the consequent reduction of coronary ar-
fourth plane, there is loss of reflexes and com-
tery circulation causing myocardial is-
plete loss of muscle tone. This third stage is
chaemia , which may cause death, par-
suitable for surgical operation.
ticularly in the presence of heart ail-
4thstage : Gradually the site of depressive action de-
ment.
scends from the cortex to basal ganglia, cer-
ebellum, medulla and spinal cord. 5. Unexpected reaction.
5thstage : The fourth stage Is followed by death. 6. Misuse of anaesthetic agents.
Parvej
887
Different general anaesthetic agents are agent. It causes cardiac irritation and is
toxic in different ways. highly explosive. It should be given with ex-
cess oxygen and respiration should be con-
Ether trolled. For surgical anaesthesia, blood level
should be between 15 - 20 mg%. Fatal dose
It is an age-old anaesthetic agent which is
being higher, this level is safe when given
used on open mask, either alone or along with
nitrous oxide and barbiturate. It irritates the mixed with oxygen. Excretion is through
lungs and respiratory tract and causes excess lungs and the excretion rate is slow.
secretion. These bad effects on respiration Fluoromar
are, however, countered by its bronchodi-
latory .action. It has sympathomimetic action It is another halogenated compound which is
and cause hyperglycemia. It causes postop- less toxic, being eliminated very rapidly
erative vomiting, hyperpyrexia and convul- through the lung. Anaesthetic level is around
sion . It is explosive which adds to the danger 28 mg% in blood and fatal blood level is about
of its use . It is excreted mostly as such by 50mg%.
lungs and only to a small extent by urine .
For operation, anaesthetic dose should be 90 Nitrous oxide
- 130 mg% in blood. Fatal blood level is above It is a weak anaesthetic agent but is most
180 mg% in blood. 30 ml by mouth is fatal. commonly used as an adjuvant with some
Chloroform other agents . In dental surgery, it is often
used alone. It exerts anaesthetic effect along
It is a very powerful anaesthetic agent. It is with hypoxia. Hence, when given with oxy-
not explosive . But it is hepatotoxic and may gen, it is the safest of all anaesthetic agents.
cause ventricular fibrillation . This once popu- Excreted through lungs . For reaching suit-
lar anaesthetic agent is nowadays not in much
!'lble anaesthesia level 23% by vol . along with
use due to these dangers. But in low dose it
oxygen should be given.
can be used safely. It is excreted mostly by
lungs and only in trace by urine . Blood level Trichloroethylene
for operable anaesthesia is 20-30 mg% . Fa-
tal blood level is above 40 mg% . Oral fatal It is a weak anaesthetic agent. It causes car-
dose is 30 ml. diac irritation and tachypnoea. It is best used
along with nitrous oxide and oxygen.
Fluothane
It is another halogenated hydrocarbon gen- SPINAL A AESTHES A
eral anaesthetic agent. It is a powerful an-
aesthetic. It is non-explosive . It has one edge Spinal anaesthetics are local anaesthetics
over chloroform in that, it is less hepatotoxic. which when used intra-spinally are quite
Its anaesthetic blood level is 7 mg% and fatal effective and safe. The usual dangers are
_level is around 20 mg% . Excreted very rap- from
idly through lungs .
1. Use ofirritant agent causing death;
Cyclopropane 2. High dose causing direct depression of
Cyclopropane is a halogenated hydrocarbon respiration and cardiac function;
compound which is very powerful anaesthetic 3. Arachnoiditis causing paralysis.

chapter 38: ANAESTHETIC AGENTS I 889
Treatment
1. For cerebral stimulation - short acting

Some of the local anaesthetics are described barbiturate may be useful.
on pages 860, 861, 862. 2. For circulatory depression- Inj. adrena-
Local anaesthetics when infiltrated near line and for cardiac arrest - cardiac
a nerve , blocks the nerve and causes local massage . For respiratory depression -
anaesthesia. When it gets into circulation, artificial respiration and oxygen inha-
they exert their systemic toxic effects. In lation.
small doses in circulation, they cause cer-
ebral stimulation and cardiovascular depres- Postmortem examination
sion. ·In high dose in circulation, the effect
Injection mark, congestion of organs, pres-
is cerebral depression. The intensity of toxic
ence of the anaesthetic agent at the site of
action depends on the type of the agent,
injection and its metabolic product in blood
blood concentration and the rate of absorp-
and liver.
tion, detoxification in t!Ie liver and elimina-
tion. For detail about common local anaes-
thetic agent see pages 860, 861, 862.
Dangerous outcome may result from ac-
cidental intravascular injection or injection
to a highly vascular area without use of any
vasoconstrictor, injection of a more toxic
agent, use of concentrated form of the agent
or use in persons who are physiologically or
Muscle relaxants are used during operation
pathologically less tolerant to the agent. Out-
under anaesthesia and also in cases like
come is grave when the doctor has minimum
tetanus . They act either by competition
knowledge about the danger of the agent, its
blockage of the muscle end plates of the
maximum usable dose, the alanning signs
cholinergic nerves or by depolarisation of
and symptoms, the line of management of
the nerve end plates. In the first group we
the patients in danger and when the specific
have drugs like gallamine and tubocurar-
antidote or therapeutic agents are not avail-
ine which act by substrate competition at
able for treatment.
the nerve end plate, thereby making the
nerve ~nd plates ineffective to acetylcho-
The toxic signs and symptoms when the
line. Hence, to ~nd relaxation of muscles
agent gets in circulation
due to these drugs, neostigmine or phys-
With local anaesthetic agents there is cer- ostigmine is helpful. But for the other
ebral stimulation . There is headache, vomit- group, these drugs are of no use as depo-
ing, twitching of muscles and convulsion. But larisation occurs with sustained effect of
after some time there is cerebral depression acetylcholine. In this group we have deca-
with loss of reflexes and muscular paralysis. methonium iodide and succinylcholine. Of
On the cardiovascular sy~tem the action is these four drugs tubocurarine and decam-
depression , with slow pulse, fall of blood pres- ethonium iodide are long acting ones,
sure and circulatory collapse. Respiration is gallamine is short acting and succinylcho-
also depressed. line is very short acting.

References Questions
• Forensic Medicine- A study in trauma and enViron- Oral questions

mental hazards, Vol. Ill, 1977. By C. G. Tedeschi; W. Stages of general anaesthesia, Fatal doses and dan-
G. Eckert; L. G. Tedeschi. gers of Ether, Chloroform, Cyclopropane and Nitrous
• Recent Advances in Forensic Medicine~ F. E. Camps, ~xi de. Dangers of spinal anaesthesia. Names of local
1969. anaesthetic agents, their central actions, Fatal doses.
Names of muscle rela~ants.
NOlES

c 01 POtSONS
Hydrocyanic acid and its salts

Aconite
Nicotine
Digitalis
Cerbera thevetia
Nerium odorum
Quinine
Others
Many of the cardiac poisons are easily avail-

able. In contrast, the number of poisoning
incidents with them are comparatively less.
Some of these poisons are most potent in
their fatal action.
Among these poisons, HCN (hydrocyanic
acid) and its salts, digitalis and quinine have
frequent uses for various purposes. Nicotine, Fig. 39.1: Some cardiac poisons with a few others
Upper row - Yellow phosphorus
cerbera thevetia and nerium odorum are cul- Middle row from it. to rt. - 1. Seeds of abrus
tivated or grow as such all over India. Aco- precatorius, 2. Fruit of Datura, 3. Poppy
capsule, 4. Seed of oleander.
nite is a deadly poison. The plant grows in Lower row from it. to rt. - 1. Aconite root,
the Himalayan range, but its deadly root is 2. Tobacco leaf, 3. Cannabis leaf (dried),
available all over India. 4. Seeds of stryc nos nu_..;.:x~v~o.:..:.
m::.: ic:.::a_ _ _~
Parvej 891Uddin (Nayan)

Dr. Md. Ahsan CoMC-24
892 I PRINCIPLES O F FORE NSIC MEDICINE

Liquid HCN can be absorbed through all
mucus membranes and skin . The gaseous
Hydrocyanic acid or cyanogen is very potent , form is readily absorbed through the respi-
extremely lethal and most rapidly fatal . Poi- ratory tract . Absorption of HCN is quicker
soning with HCN is almost always fatal be- than its salts . Gastric HCl changes the cya-
cause of the low fatal dose and the rapidity nide salts to HCN , when it is absorbed read-
with which it acts. ily . This is why the fatal period of HCN is
HCN is toxic to all sorts of lives except much less than with KCN or N aCN. For this
bacteria . again, it is believed that , achlorohydric per-
sons are resistant to the toxic action of KCN
Availability and usage of Hydrocyanic acid and NaCN, as in achlorohydric persons due
(HCN), sodium cyanide (NaCN) and to non-conversion of these compounds to
potassium cyanide (KCN) HCN, these are not absorbed in the system.
These are extensively used for hardening of This is not wholly correct because , even in
metals , metal plating , for purifYing metallic absence of HCl, a part of KCN and N aCN
ores , in synthetic rubber and plastic indus- change to HCN when in contact with the
tries , in photography , for fumigation and in mucus membrane. Apart from this , food in
laboratories . It can be derived from kernels the stomach delays the conversion of the salts
of certain fruits like, almond , apple , apricot , to HCN and further delays the process of
cherry , peach , pears , plum , some oil seeds absorption and the rate of absorption in such
and bamboo shoots . a case being low, the body gets scope to de-
toxify a part of the absorbed poison. All these
HCN in ordinary temperature and pres- account for the higher fatal dose and longer
sure is a gas . But in cold temperature and fatal period ofKCN and NaCN than HCN .
under pressure it can be kept in liquid form.
After absorption ,HCN is changed to thio-
Fatal dose cyanate which is non-toxic . A small amount
is eliminated through the expired air which
HCN gas - 100- 200 ppm in air . is appreciable due to the peculiar bitter al-
HCN liquid - 50 mg . mond like smell of the expired air. The main
Prussic or Scheele's acid (a 4% soln .) - 1 route of excretion is urine .
- 2ml . The smell of HCN cannot be sensed by
KCN , NaCN - 200 mg . all . Capacity to appreciate the smell is said
to be gene linked .
Fatal period
Action
For liquid HCN - some minutes , may be as
less as 2 - 5 minutes . It kills a person by causing bulbar paralysis .
This is why it is so rapidly fatal . Mode of ac-
For HCN gas - 100 ppm in air - 1 hour . tion is by chelation of the metallic moiety of
200ppm in air - inunedi- cytochrome and o(l;w;r;: intra-cellular enzymes
ate death . necessary for utilj~~tiP.~ of.oxygen by the tis-
ForKCN and NaCN - 30 minutes . sue . Thus, poisoning causes asphyxia at the

chapter 39: CARDIAC POISONS I 893 .
tissue cellleve~ though there may be ample haemoglobin to form methaemoglobin

supply of oxygen and the blood also may be which combines with cyanogen of cyano-
saturated with oxygen gen-cytochrome oxidase combine and
As for cyanide salts, their strong alkalin- frees cytochrome oxidase so that tissue
ity causes corrosion oxygenation is possible again.
5. This should be followed by very slow I.
Signs and symptoms V. injection of 25 ml of 50% Na-thiosul-
phate which converts cyanogen to thio-
Onset of action depends on the form of the
cyanate, under the influen ce of a wide-
poison, concentration and rate of absorption.
spread enzyme called rh odanase. Thio-
When the gas is inhaled, consciousness cyanate is harmless Na-thiosulphate in-
may be lost at once. Violent breathing and jection should be repea~d at suitable in-
convulsion follow. Heart continues to beat for tervals.
sometime more. Death occurs within 5 min-
6. Artificial respiration and oxygen inhala-
utes.
tion should be continued, though inhala-
In empty stomach, cyanide salts also may tion alone is meaningless.
act very quickly. When concentration is low 7. Methylene blue, and
or when there is food in the stomach, the
8. Cobalt edetate are indicated by some.
onset of signs is delayed and are less violent.
Dyspnoea, headache, vomiting, dizziness, 9. Though cyanogen does not persist in the
ataxia, loss of consciousness come in order. body for long, yet complete bed rest for
Then there are coma, pink colouration of two days is indicated as there may be re-
skin, widely dilated pupils, imperceptible sidual effect of deprivation of oxygen to
pulse, low B. P. , shallow breathing, distant organs like heart, brain and k idneys
heart sound, absence of reflexes. Cond~tion These may require prolonged care.
of the patient does not improve with oxygen 10. In case of poisoning with cyanide salts,
therapy. stomach should be washed with a chemi-
cal containing a mixture of 6% NaC03'
Treatment 15.3% ferrous sulphate and 3% citric acid
in water.
1. If the poisoning is from the gas, the pa-
tient is removed from the place immedi- 11. Therapy with solution of cytochrome oxi-
ately. dase.
2. In case of respiratory arrest, H olger- * Ferrous sulphate and citric acid so-
Nielson method of artificial respiration lution should not be of more than a
should be tried. month's old.
3. Inhalation of up to 6 ampoules of amyl ** Nitrites reverses the inactivation of

nitrite is recommended. cytochrome oxidase and thiosulphate
inactivates cyanides.
4. This is followed l?Y I. V. injection of 10
ml. of 3% N a-nitrite. HCN forms cyano-
Pos1mortem appearances
gen-cytochrome combination with cyto-
chrome oxidase which then cannot help Rigor mortis comes early and lasts longer.
tissue oxygenation. 'Nitlites combine with Pinkish postmortem staining Froth from the

894 I PRINCIPLES OF FORENSIG:: MEDICINE
Stomach in case of KCN and organophos- Fig. 39 .3: Cyanide capsule in the neck-lace for use to
phorus . (Bright red in case of committ suicide when necessary
mouth and nose . Smell , like ·that of bitter

ACONITE.(11MITHAatSH"}
almond , particularly on opening of the body
cavities. Viscera are congested and bright
Aconitum has about 24 species . In India,
red . Blood is bright red . Echymosis on the
about 9 are a nilable.
surface of different organs. The stomach mu-
cosa is congested and with cyanides is irri- Aconitum Heterophyllum (Atibisha,
tated and is often mild to moderately cor- Atish, Ataicha Ativadayam). Aconitum
roded with haemorrhagic points . Minute Napellas (Visha, Mithazahar, Kath Bish).
necrosis and haemorrhages in the lenticular Aconitum FerojX . Though named Ativisha,
nuclei and other parts of the brain . Degen- Aconitum heterophyllum is rather not so poi-
erative changes in the nervqus system as a sonous . It was the TJlOSt popular poison in an-
cient Greece.
whole .
Sublethal inhalation over a long period Source
may cause chronic poisoning leading to patho-
Dried root of aconitum ferox or aconitum
logical condition of liver , kidneys and nerv-
napellus or Monk's hood (as is commonly
ous system.
known) is the most toxic part of the plants .
Medicolegal aspeds In our country the plants grow in the
Suicide is quite common. A trend is noticed

that, individuals involved in anti-state actiVi-
ties carry cyanide capsule and ~h~n 'Cci~~'rt;(l
by law-keeping authorities they prefer to com-
mit suicide by consuming the cyanide in the
capst?-le than to be caught and subjected to
torture and·'confessional statemen~~ ,'Occ~
sional accidental poisoning ocHtfu3~f\-6ffi;1abo
ratory and industrialstru~~ . :Baitlicilliil use
F,;ig . 39.4:
is very very rare.

chapter 39: CARDIAC POISONS I 895
Himalayan altitudes. All parts of the plant~ hippus reaction (a,ltemate constriction and
are however poisonous. From the leaves dilatation). There are signs of circulatory col-
and flowering tops an ex~ract is made, lapse, unconsciousness and convulsion Death
From the root tincture and liniment are occurs due to ca:fdiac or respiratory failure.
prepared. It is used in homoeopathy in
" micro" dose, mixed with alcohol as Fatal dose
tincure of aconite , for in a good nurp.ber of 1 gm of the root;
diseases . The dose of use in homeopathy
21)0 mg of the extract
being so low " micro ·dose" is not expected
to cause poisoning. 2 - 6 mg of aconitine.
Adive principles Fatal period

45 minutes to 24 hours.
Aconitine is the chief active principle, Other
alkaloids like, pseudo-aconitine, aconine etc. Treatment
are derived from aconitine.
1. Milk or activated charcoal should be
Identification of the root given, which delays absorption.
The root is conical in shape like tlte monk's 2. Stomach is washed first with warm wa-
hood and hence the name. Usual length is ter and then with KMn04 or a mixture of
2" - 4". Base is 1.12" to 1" in diameter. The iodine and potassium iodide.
surface of the root b,as multiple scars from ~. Emesis may be tried alternatively.
removed rootlets. Aconite root may be con- 4, Digitalis is given to counter the depres-
fused with horse-radish Horse-radish is not sive action on the heart.
very much conical like acdnite root Aconite, 5, Atropine is given to avoid vagal inhibi-
when tasted, causes tingling, numbness of tion of the heart.
tongue, mouth and lips. But horse radish is
6. Artificial respiration and oxygen inhala-
pungent to taste. Aconite, when cut, surface
tion to combat respiratory embarrass-
which is white, slowly reddens, but horse
ment.
radish remains white.
Aconitine is white amorphous powder, Postmortem appearances
Signs and symptoms There are pallor of the mucus membrane of

the mouth, congestion and engorgement of
There are tingling, numbness and buming brain and lungs. Mucus membrane of the
sensation in the mouth, tongue an~ throat, stomach is inflamed and liver and kidneys
It has a bitter sweet taste. Hence its Indian are congested When crushed root is taken,
name is mitha-bish There are f~eling of con. remai:ns of the root may be present in the
striction in the throat, and pain and tender- stomach
ness in the abdomen, There may be nall!'ea
and vomiting. Tingling, numbness and weak- Medicolegal aspeds
ness appear in the limbs aD.d. other muscles,
~. It is a popular homicidal agent. Points in
There is ringing in the ear with impairment
of the hearing cap~ity. There are impai~ favo~r a:ro -
ment of vision, giddiness, indistinct articula- (a) Eas"ily available
tion with ultimate loss of's}leech, Pupils show (b) Cheap

896 I PRINCIPLES Of FORENSIC MEDICINE
(c) Death is certain cidal action. Nicotine content of tobacco

(d) No specific antidote leaves is small in amount.
(e) Decomposes very quickly in the body Lobelia inflata, anothervarietyoft6bacco
(f) No definite detectable chemical test plant, yields lobeline, which is almost' simi-
is there. The sweet-bitter taste of the lar in action to nicotine.
poison can be masked when given Absorption of nicotine occurs by inges-
with a 'paan' or with drink. tion, inhalation and through skin. When
smoked, a good amount of nicotine is lost due
2. Its disadvantages ofbeingused as a homi-
to heat of burning. Mter smoking cigarette,
cidal agent are-
the inhaled nicotine reaches brain within
(a) It causes tingling and numbness of about 10 seconds.
the mouth and tongue
(b) Signs and symptoms start quite early Source of poisoning
and death also ocGurs quite quickly. Usually accidental from commercial prepa-
3. It is not usually used as a suicidal agent ration as fertilizer, insecticide and fumigant.
as it causes painful death. Suicidal cases
are thus only occasional. ACUTE POISONING
4. Accidental poisoning may occur due to After absorption it stimulates adrenaline se-
quackary medicinal use, by mistake it cretion and stimulates both central and pe-
may be taken for horse radish which is ripheral nervous system.
used as a condiment.
Signs and symptoms
5. It is used as an arrow poison.
6. It is also used as an abortifacient agent It causes successive central and peripheral
and may in that way also cause acciden- stimulation. There are nausea, sickness,
tal poisoning. tachycardia, raised B.P., then cardiac irregu-
larity, severe prostration, precordial oppres-
7. It is also used as a cattle poison. sion, cardiovascular collapse, convulsion, de-
lirium, irregular respiration, dyspnoea and
coma.
John Dang and 4 others from Texas
(Baylor College of Medicine in Houston.
Texas), reported in Nature that Nicotine helps
The plant Nicotiana Tabacum grows all over in thinking. It increases transmission of nerve
the world. impulses in the hippocampus, the part of the
brain involved in learning and memory. It
Active principle takes 10 seconds to go from lung to brain and
set to work. Smoking improves cognition,
Active principle is Nicotine, which is a col- according to neurologists, a term used by
ourless liquid. On exposure to light it devel- psychologists. But the ultimate hannful ef-
ops an amber tint. Acute poisoning with nico- fects on cardiovascular, respiratory and neu-
tine is rare. But subacute and chronic toxic- rogenic functions have alarmed the whole
ity is not uncommon. It has strong insecti- world to call for its ban or very restricted use.

chapter 39: CARDIAC POISONS I 897
Prolonged smoking causes strong habit

formation , with withdrawal syndrome.
Fatal dose
40 mgofnicotine or what is contained in two
average cigarettes. Most of the nicotine is
destroyed when smoked. Fatal blood level is
about 1 mgper 100 m1.
Fatal period
A few minutes to a few hours.
Treatment
1. Gastriclavage with ~01 or tannic acid. Fig. 39.5: Cinchona bark Fig. 39.6: Cinchona tree
2. Inj . adrenaline. ' - - - - - -- - - -- - - -- -- - -
3. Artificial respiration and oxygen inhala- CHONINE
tion.
4. Symptomatic.
These alkaloids are available from the bark
P. M. findings of the Cinchona plant (Cinchona cortex, Cin-
Signs of asphyxia. Mucus membrane of mouth chona hybrida, C. ledgeriana). Quinine is a
white, crystalline, bitter powder.
and stomach is congested.
Actions
CHRONIC POISONING
Quinine is a protoplasmic poison. It has
In chronic toxicity, there is involvement of sclerosing and anaesthetising effects. On
nervous system with tremor, weakness and CNS it first causes stimulation and then de-
loss of memory. Due to involvement of the pression. It causes circulatory failure both by
C.V.S. there are cardiac irregularities giv- its direct and indirect actions.
ing rise to, tobacco heart, extrasystole, an-
gina like pain. Due to involvement of respi- Signs and symptoms
ratory system, there is bronchitis. In addi-
tion to all these, there are anorexia, weak- After ingestion, there is GI tract disturbance
ness etc. with abdominal pain and vomiting. After ab-
sorption there are dizziness, headache, dim-
Medicolegal aspects ness of vision, ringing in the ear. There is
ataxia Respiration is rapid and shallow. Pulse
Most of the incidents, both acute and chronic, is rapid, B. P. low. There are cardiovascular
are accidental. Circumstances of the chronic collapse and respiratory failure and loss of
accidental toxicity are as described in source consciousness. After cure, there may be loss
ofpoisoning. Suicide and homicide are unu- of vision and loss of hearing capacity for a
sual. few days, followed by severe limitation of vi-
IF. M. - 571
sion for some period with dilated and fixed 7. In case of coloured urine with oliguria
pupils, central scotoma and pallor of retina and haematuria, treatment for renal fail-
with spasm of retinal vessels, There may be ure and protection ofkidneys should start
oliguria and haematuria. Abortion may oc- 8. All precautions should be taken to pro-
cur in pregnant women. tect vision: (a) In case of spasm of retinal
vessels (arteries), vasodilatation by I. V.
Fatal dose injection or retrobulbar injection of nico-
2-Sgm. tinic acid or (b) .Inhalation of amyl nitrite,
(c) In some cases blocking of stellate gan-
Fatal period . glion is recommended.
A few minutes to a few hours or even 1 or 2 P. M. findings

days.
. Nothing specific. 'Organs are congested.
Treatment
There may be evidence of haemolysis.
L Stomach wash · Medicolegal aspects

2. Purgation Accidental poisoning occurs from medicinal
3. Symptomatic treatment for respiratory overdose. It is used as an abortifacient agent.
and circulatory failure and dehydration Rarely it is taken with suicidal intent. Homi-
4. Special vigilan<;e should be maintained to cide not possible.
watch ifthere is any gross cardiac irregu-
larity .
DIGITAliS
.·q. ' Pro~ainamide may be used . . . . . .
.6. Sympathomimetic circulatory stimulant (Digitalis purpurea, Digitalis lanata, Fox-
may be given but not by infusion glove, Strophanthus gratus)
Fig. 39.8: Oigitqjis (Fo~ glove)

1 ~ • • I ' • • · -, ·

·chapter 39: CARDIAC POISONS l 899
Active principles Postmortem findings
Active principles of these plants are glycosides Nothing specific.

like digitoxin, digoxin, digitalin, digitalein and
digitonin. Medicolegal aspects
From toxicological point of view digitalin It has occasionally been used with homicidal
and digitoxin are i~portant, purpose. It causes occasional accidental death
When pure, .digitalin is fine, white, ac- due to overdose; Suicidal uses are not known.
icular crystals, It is odourless and has a bit-
ter. taste. It is a cumulative.poison._.
CERBERA THEV fA {Yellow Olecmdc
Action
Digitalis prolongs .di~tolic period of the heart. Y~llow oleander plants are ~~ally ~round 10'
In therapeutic.dose, it depresses both excit- in :height. Its le.aves a~e lanceolate. Flowers
ability and conductivity. But in toxic dose, are yellowish and bell~shaped. Fruits. are
excitability is increased with extrasystole. globular, light green, lt" to 2" in dia~~r.
Nuts are biconv:ex, triangular and.grooved
Signs and symptoms on the basal tM.rgin. ·
.T here are nausea, pain in the abdomen, vom-
Ac:tive prinCiples ·
iting, burning sensation, diarrho~a, Pulse is
irregular, 'usually slow' b~t in toxic doses 'there Thev~tin, thevotoxin; cerberin, penivosid~ {a
may be extrasystOle and a feeling of precor- glycoside). · ·
dial oppression. Respiration is slo~. and sigh- . '·
ing. The patient is drowsy or even comatosed. Si~s ·and symptoms

There may be convulsion before death. ·
There are dr:iness, tingling and mimbness
Fatal dose f~eling in mouth, fOngue and oesophagus.
For dried leaves, it is a few grams. For digi- There:are vomiting, headache, giddiness, di-
arrhoea, dilated pupils, rapid, irregular, weak
toxin, it is 2 mg.
pulse, ID\lSCular weakness 1 faintness, low B.
Fatal period
Death occurs within a few hours, Danger
passes off in a day
Treatment
1. The patient should be kep~.wann, at rest
in bed. ...
2. Atropine 0. 6 mg given: s~bcutaneously,
3. Stimulants or sedativ~~:~~
.
·~
given as re-
quired.
4. Potassium chloride ~ay be given by
mouth.
5. I. V. lignocaine may ~~-.bcl~~;i( --

900 I PRINCIPLES OF FORENSIC MEDICI NE
P., collapse, heart block, peripheral circula-

tory failure and death.
Fatal dose
8- 10 seeds or 15- 20 gms of root.
Fatal period
2-3 hours.
Treatment
1. Stomach wash;
2. Infusion of sodium molar lactate with glu-
Fig . 39.11 : Nerium odorum (white oleander)
cose;
3. Atropine - 1 mg;
4. Adrenaline 2 ml. or nor-adrenaline 2 mg.
The plant grows wild in all parts of our coun-
Nothing specific. Fragments of the seeds or try. All parts of the plants are poisonous.
roots may be present in the stomach. Leaves are lanceolate. Flowers are in clus-
ters and are pinkish or white.
Medicolegal aspects
Active principle
Suicidal uses are coinmon in some pockets
of rural areas. Homicidal attempts are unu- Nerin (a glucoside).
sual due to high fatal dose. Accidental poi-
Signs and symptoms
soning is comparatively common in children
by eating the seeds. Root is used as an abor- Abdominal pain, vomiting, salivation, diffi-
tifacient agent. It is also used as a cattle poi- culty in swallowing, difficulty in articulation
son. of speech, diarrhoea. Pulse is at first slow,
Fig. 39.10 :Cerbera thevetia (yellow oleander) Fig_. 39.12:Yew

chapter 39: C ARDIAC POISO NS I 901
then rapid and weak , blood pressure falls , IPECACUANHA

respiration is increased and slow . Later, the
patient has muscular twitching , tetanic
Active principle
spasm and lockjaw . Pupils are dilated . Drow-
. siness and coma precedes death . Emetine , cephaeline . Plant extract causes
dermatitis with vesicle formation . Inhalation
·. · Ftrtal dose of powdered root cause respiratory distress
followed byinflammation and infection. It has ..
·"::: ·. ··: : 15 gms of the root .
direct action on medulla, particularly on car-
... diac centres .
.· fcital period
.' · · :.:. ·· · ..·. :. 24- 36 hours .
· · treatment YEW AND GLOR LILY
· ··. Stomach wash and symptomatic. Cause circulatory embarrassment, collapse

and death .
.Postmortem findings
· Qrgans are congested. Fragments of root may
~e present in the stomach . Petechial h aem-
.. ·orrhage seen on the surface of the heart .
Causes depression of heart , and peripheral
Medicolegal aspects circulatory failure . In high dose also causes
Suicidal use in rural side ; homicidal use is respiratory paralysis .
very rare . It is used as an abortifacient agent.
Accidental poisoning occurs from its medici-
nal use on ulcers . It is also used as a cattle Ref ren
poison .
• Clinical Toxicology - C. H. Thienes, T. J. Haley, 1972.
• The diagnosis and treatment of Acute poisoning -
J.D.P Graham, 1962.
• Treatment of Common Acute Poisonings - H.
Mathew, A. A. H. Lawson, 1975.
• F. E. Camps, Gradwohl's Legal Medicine, 1976.
• C. H. Thienes anT. J. Haley - Clinical Toxicology.
• R. H. Dreisbach - Handbook of Poisoning, 1983.
• Wilma Roberts James- Know your Poisonous Plant
- 1973
• T Acamovic, C.S. Stewart, T. Pennycott- Poisonous
Plants and related Toxicology- 1989.
• David Ellis - Medical Herbs and Poisonous Plants-
2008.
Fig. 39.13: Glory Lily • K. R. Kartikara- Poisonous Plants of Bombay- 2003.

Long quE)stions In addition to question from long and short ques-

Signs-symptoms. Treatment, Postmortem findings tions--
and Medicolegal aspects of H.C.N. and Aconite. Why KCN and NaCN is said to be non-toxic in
achlorohydric persons?
Short notes
Name some t;ardiac poisons, Fatal doses and Fatal
Medicolegal considerations of using nicotine, digitalis,
periods of HCN, KCN, Aconite, Aconitine, Nicotine,
yellow oleander and quinine as poisons. VVhy aconite
Digitoxin, Yellow oleander.
is considered as an ideal homicidal poison ?·
Active Principles of different cardiac poisons, Anti-
dote of HCN. How HCN and its antidotes act? Reac-
tion of pupils in aconite poisoning . VVhat happens
due to chronic tobacco toxicity?
NOTES
... rr~ U.h ..
.. ah£

According to mode and site of action asphyxi- physiological mechanism of control of respi-
ants are classified as follows : ration . But, great excess due to inhalation,
1. Irritating, gases causing spasm of the over-production or failure to excrete C02 from
respiratory tract or larynx, e.g. 802 and the body paralyses the same mechanism.
fumes of mineral acids .
2. Agents which cause paralysis of the mus- Source
cles for mechanical movement of respi- It is a product of complete combustion of car-
ration, e.g. anaesthetics and muscle re- bon . lt is a product of respiration of all veg-
laxants .
etables and animals . Decomposition or fer-
3. Agents which cause failure ofrespiratory mentation of vegetable products in cellars,
centre , e.g. C02 , ~S .
tunnels , wells , caves and breweries produces
4. Agents which prevents diffusion of respi- C02 . It is also produced during an explosion
ratory gases at the alveolar membrane in mines or otherwise.
level, e.g. , Phosgene .
5. Agent which causes failure by the RBC Properties
to pick up oxygen in the lungs and lay it
down at the tissue level, e.g. CO (carbon Colourless, odourless, heavier than air gas.·
monoxide).
Uses
6. Agents which interfere with the trans-
port of oxygenated blood , e.g. circulatory 1. In medicine as a respiratory stimulant,
depressants . used either alone or miXed with oxygen
7. Agents which prevent use of oxygen at in the concentration of 5-7% (carbogen).
the tissue level, e.g., HCN and cyanides • 2. As fire extinguisher.
8. Lack of sufficient oxygen in the inspired 3. Liquid or solid C02 is a powerful refrig-
air, e.g. vitiated atmosphere . erant·
Signs and symptoms
Adion Normal con~entration of C02 in air is 0.04o/o,.

Up to 2% concentration in air thete is n6
Mild excess of C02 in blood or air stimulates physical disturbance . Above 2% cortcentration
breathing and that wa~ !~ acts a_s the c?!ef ~spll:a_~9n <!_e~pen_s and ~P~~P.~U.l?:_~bove 5~

903 CoMC-24
(i.e., above the concentration in the alveolar inflammable , explosive, asphyxiant~ ·

air), there are headache, dizziness, mental It is the product of incomplete oxidation of
confusion, dyspnoea, dimness of vision, even carbon. It is a cheap source of fuel. As a safety
nausea and vomiting. Higher concentration measure some mal-odorus gas is mixed with
stimulates the nervous system and becomes it for detection of its leakage.
intolerable. At up to 10% concentration in the
inspired air, there is vasoconstriction, stimu- Source
lation ofheart, rapid pulse, raised blood pres- Exhaust gas of automobile contains 5% CO
sure and greatly increased cerebral and coro-
Coal gas contains 5 - 15% of CO
nary blood flow . Inhalation of 20 - 30% C02
Blast furnace gas contains 25%
in air causes sudden fall of respiratory minute
volume due to onset ofincoordinated breath- Fuel gas - 30%
ing or convulsion . In 40- 50% concentration, Explosion gas - 60% .
paralysis of respiratory centre occurs very
Domestic source of poisoning
quickly. Higher concentration causes cardiac
irregularity and collapse . Lack of precautionary steps against a leak
from faulty domestic apparatus , old pipes,
Treatment defective joints, tube connections, stoves,
1. Quick removal to a safe atmosphere. cookers, burners, pokers, rig fire , radiators,
2. Removal of any obstruction in the airway. conflagration , exhaust gas of automobiles.
3. Artificial respiration. Maximum permissible concentration of
CO for single exposure in air is 400 ppm. For
4. Oxygen inhalation.
chronic exposure , it is 100 ppm.
Postmortem findings
Mode of toxic action
There are marked cyanosis, prominent post-
mortem staining, extreme dilatation of pu- CO has a greater affinity for Hb than 0 2
pils, presence of petechial haemorrhages, (about 200 to 300 times more ). Carboxyhae-
dark fluid blood, deeply congested organs, moglobin thus formed is also more stable than
venous engorgement, distension of right oxyhaemoglobin. CO-Hb cannot carry oxygen.
chambers of the heart with blood. In presence of carboxyhaemoglobin oxygen
released by oxyhaemoglobin is also poor.
Medicolegal importances COHb combination is reversible . Thus,
though a deadly poison, life can be saved by
Poisoning is accidental in vulnerable circum-
timely efficient treatment. C02 helps the re-
stances like inside mines, dampen pits, wells,
version process and then oxygen under high
leakage of fire extinguisher, outbreak of fire
pressure helps formation of oxyhaemoglobin.
in house etc.
Repeated exposure causes po1ycythemia.
Signs and sy~fltoms

Effects vary according to the physical condi-
A colourless , odourless , slightly lighter than tion of the victim, his health, oxygen need
air gas . It mixes ref,ldily with air to form an and pressure of oxygen in the inspired air.

chapter 40: ASPHYXIANTS I 905
The following signs and symptoms appear 100 ppm in air =up to 10% in blood:; No signs
progressively:
400 ppm in air= up to 20% in blood= Headache,
Headache, a feeling offatigue, weakness,
cizziness
tightness in the chest and head, defect in sen-
sory acuity specially the visual sense, dimin- 600 ~m fnair = up to 30% in l:llood= Throttling
ished mental power which the victim does headaclle
not realize. There lies the danger. In attempt 1,000 ppm in air= up to 40% in blood= CondiUon
to move, there are dizziness, dyspnoea, weak- deteriorates
ness, double vision, unsteady gait, violent 11,500 ppm in ·r= up to 50% in bloocl= Ccilapse
pulse. Then nausea and throbbing frontal
headache develop. There is depression of cer- 60 to 70% in blood = coma, c2a1h
ebration which prevents the victim from tak- Above 80% in blood :; Death is
ing measures to escape and when he is fi- almost certain
nally roused to a state of alarm, any attempt
to move causes collapse. State of mental Treatment
change may vary from intoxication to coma.
1. Removal of the patient from the environ-
In rapid poisoning with 20 - 30% blood con-
ment.
cent::ation there are pinkish discolouration
of lips, reddening of conjunctiva. When J>Oi- 2. Suction of the air passage to remove
soning occurs slowly, face is pale or livid or vomitus and other obstruction.
grey and there is sweating. In moderate poi- 3. Artificial respiration.
soning, respiration is increased and shallow. 4. Carbogen (oxygen+ carbon-dioxide) in-
In severe poisoning, respiration is depressed, halation.
when breathing is shallow, sighing or gasp-
5. 5% dextrose infusion to combat dehydra-
ing and intermittent or occasionally deep, . tion.
slow and stertorous. Pulse is rapid and weak
6. Methyl amphetamine 0.5 ml (10 mg) or
or rapid, full and bounding, and may be ir-
other pressure agent to restore B. P .
regular. Blood pressure is raised. But in se-
vere cases B. P . may be low with peripheral 7. Complete rest.
circulatory failure . Liver may be enlarged 8. Antibiotic cover.
with tenderness. In the early stage limb re-
flexes are brisk and exaggerated. There may Postmortem appearance
be incontinence of urine and faeces in severe
cases. The C. S. F . pressure is increased. The Pinkish postmortem staining. Bright red con-
body temperature varies. In late stages the gested organs. Bright red blood. Petechial
temperature tends to be equal to that of the haemorrhages.
atmosphere . A high temperature is very
Medicolegal aspects
grave . There may be erythematous patches.
Urine contains albumin, blood cells and casts Suicide is more common in men and accident
and there may be glycosuria in severe cases. in women. Death from CO in general occurs
Relation between atmOspheric concentra- at home. Children are more susceptible as
tion, blood concentration of CO and chief are the old people. Suicide is common in win-
symptoms: -· ter, accident in summer. For suicide a tent
is made by covering the head with a towel and stimulation followed by depression 1bradycar-
then placing the tube of the cooking gas un- dia and cardiovascular collapse , unconscious-
der it. Accident occurs due to the reasons de- ness , convulsion , and death due to respira-
scribed under the heading domestic sources tory failure .
of poisoning . Homicidal poisoning may be
caused by placing a gas tube inside the room Fatal dose and fatal period
of the victim when he is sleeping at nig'ht. EX:posure to 1,000 ppm causes unconscious-
ness and death within an hour. Exposure to
2,000 ppm causes immediate death .
HYDROG
HY ROGE Treatment
1. Immediate removal of the victim from the
Hydrogen sulphide is the product of decom- atmosphere.
position of organic materials containing sul- 2. Oxygen inhalation.
phur .Acidulated metallic sulphides also pro-
duce ~S . It has a typical rotten smell · 3. Artificial respiration.
4. Respiratory stimulants .
Sources 5. Maintenance ofcirculation .
.Sewers , brewer's vats , tannery vats , cess-
pools , abandoned wells are the sources of this
deadly gas. Greenish discolouration appears early in the
body, before the R.M. has passed off. Organs
Absorption, fate and elimination are congested with petechial haemorrhage
It is rapidly absorbed through the mucus and areas ofdegeneration .
membrane of the lungs .In the body it changes
Medicolegal aspects
to sulphate ,thiosulphate , alkali sulphide and
metallic sulphide which are excreted through Poisoning is usually accidental due to a fall
lungs , stool and kidneys . in an abandoned well 1while cleaning under-
ground sewers • Chronic exposure may occur
Actions in industries and laboratories •
The gas irritates mucus membrane oflungs,
respiratory tract and eyes. It depresses the
SULPHUR DIOXIDE (502 )
central nervous system and particularly the
respiratory centre · Sulphur dioxide is one of the gas which is
responsible for pollution of air in cities. Acute
Signs and symptoms poisoning may occur at higher atmospheric
Locally it irritates eyes causing lacrimation concentration in industrial and commercial
and photophobia , and the lungs, causing pul- enclosures -
monary oedema . After absorption, in mild
toxicity , there are vertigo, headache, mus- Adiqr.a;;1 signs and symptoms
cular cramps and weakness. In case of se- If i3 ari·'itmllint :W•.the mucus membrane of
vere poisoning , there is first respiratory the respiratory .tract and the eye. Liquid sui-

-chapter 40: ASPHYXIA NTS I 907
phur dioxide acts as a corrosive agent. In sion. Acute respiratory tract symptoms like
low concentration it causes sneezing, cough- pulmonary oedema etc. occur in exposure to
ing, narrowing of the respiratory tract with high concentration in air and other systerllic
difficulty in respiration. At higher air con- effects are common in chronic low-concen-
centration there is sustained laryngeal spasm tration exposure.
causing death. In case of recovery there will
be signs of bronchitis and pulmonary Treatment
oedem a .
1. Removal from the exposure or preven-
Fatal dose and fatal period tion of exposure
2. Safeguarding respiration
400 ppm is dangerous for life and 1000 ppm
in air is fatal in 10 minutes. 3. Symptomatic.
Treatment Postmortem findings
1. Removal of the patient from the atmos- Nothing specific except respiratory tract ir-
phere. ritation and signs of asphyxia with pulmonary
2. Oxygen inhalation and artificial respira- congestion and oedema.
tion.
Medicolegal aspects
3. Subsequently bronchodilators and anti-
biotic cover. Exposure is accidental, mostly in industries
and commercial centres. Both acute and
Postmortem findings chronic exposure may occur.
Signs of asphyxia with congested organs ..
Lungs are congested, oedematous with pe-
techial haemorrhages on the surf~ce (See alsQ References
page 771, Chapter 30).
• Forensic Medicine- A study in trauma and environ-
mental hazards, Vol. II. 1977 by C. G. Tedeschi, W G.
PHOSGENE (COCI1) Eckert, L .G. Tedeschi.
• Haldane J. S. .._ The causes of anoxaemia, in respira-
See page 769.
tion, Newftaven, Yale University Press, 1922.
• Henderson Yand Haggard H. W -Chemical Asphyxi-
PHOSPHINE ants in Noxious Gases and the Pri nciples of Respira-
tion Influencing their Action, 1943.
-Jrt;. ,. J... ' "\ ~'I ~- ,.),,."-\''!'
Phosphine is generated from metallic phos- • lr .:_ Systemic

Lindenberg'
~ :~ ..,~-~-
.. •• . . .-.J
D;'def. in Pathology. of.
'?.I~iL J !
_P..·: j I J
phides and is a respiratory tract irritant gas. Nervo~l(~l"l!~~~,VpL 41 tjf ~inckler. and Dusseldolf,
It causes signs and symptoins ofrespira- - · m\9?J rbst 9u ogmw.t ., tn:sc!, ,
tory tract irritation, dyspn.Qea, oppression in • lt Matbew, A e Ad:l>f tlawsGm:fl lh~ r:treatmenf of
the chest, back-pain, fainine.Sli;;l obiH,'.convu1:: common ac~pbisonsrS!'dil!:dn, 1977.

Questions Oral questions

Classify asphyxiants.
Long questions Sources of CO, C0 2, H2S.
Signs-symptoms, Treatment, Postmortem findings How phosgene is formed, Mode of toxic action of
and M. L. I. of CO poisoning . CO?
Short notes Fatal atmospheric levels of CO, C0 2, H2S.
Poisoning with - C0 2, H2S. Phosgene. Fatal blood level of CO and C0 2.
. . .i
NOTES
..
. '·
.· .
-: ·~· ..
''(
: ...

BOTUUNTO I POl 0 I G FROM FOOD SUBSTANCE
Exotoxin produced by Cl. Botulinum in im- Poisoning from fish (icthyotoxicosis) has been
properly preserved canned or tinned (with- discussed elsewhere (See pages 835, 836).
out proper sterilisation by boiling) food, is Poisoning from vegetable food may oc-
most lethal 0. 00005 mg is the calculated sin-
cur in various ways due to various reasons.
gle fatal dose of the toxin
Some of these are discussed in this chapter.
Action Poisoning through edible oil
It acts at the nerve ends or the myoneural Edible oils are sometimes adulterated by
junction and the action is depression Argemone Mexicana Seed oil that contains
sanguinarine, berberine and protopinewhich
Signs and symptoms affects heart and circulation, causes glau-
coma, abortion in pregnant women, oedema
Apart fro m paralysis type of weakness of
oflegs and GI tract disturbances. Treatment
muscles including muscles of respiration,
is symptomatic and avoiding consumption of
there are dilatation ofpupils, drooping of eye-
doubtful edible oil.
lids, dryness of mouth and impaired vision.
Mushrooms
Treatment
These are fungi Some of them are poisons.
Preventive - Sufficient boiling or cooking of Some are deadly poisonous. In any case ma-
the stored food before use. jority of them are not edible. Movels and
Curative- puffballs are edible. Edible mushrooms are
about 5-10 em long and the diameter of their
1. To safeguard respiration by artificial res- .
cap placed at the top varies between 2.5 - 10
piration,
em When older, with changes in their col-
2. Use of minimum 50,000 units of specific our and appearance they become non-edible
antitoxin, and is poisonous. Some of the mushrooms
3. Symptomatic. are woody which are also not edible.
Poisoning from mushrooms
Amanita Muscaria , Amani~ pantherin8: and-:

Amenita phalloides and some other varieties -
are poisonous for human consumption. O(
these ' Amanita Muscaria arid Panthrma . has ·. ).
muscarine like parasympailiomimetic action. ·_··
There is also some CNS stimulation. Death .
occurs due to respiratory failure . Active·prin~
ciple ofAmanita Phalloides are amanitine and
phalloidin :which cause GI trac~ irritatio~, cir- ..
culatory collapse , CNS excitation and .liver · .
and kidney damage . Treatment for these poi-
sonous mushrooms are symptomatic. Specific
antidote - atropine , only against a part Mus- Fig. 41.3: Destroying Angel
carine type toxin: Care to betaken to protect
liver and kidneys, if there is ahy chance of _ Destroying Angel is a type of mushroom
their damaie. GI tract should be thoroughly which acts as protoplasmic poison and may
washed . Other signs like nausea, vomiting, cause fatality _Hence they are not edible.
abdominal cramp should be taken care of
-· - · Badly stored wheat, barley, rye and other
Fly Agaric is another variety of mush- grains allcw growth of fungus CLAVICEPS
room which also affects neurogenic functio~s, PURPUREA, consumption of which may
when taken by mistake for edible mush~om. cause ergot poisoning (See also page 814).
But users. and traders can identifY them as
LATHYRUS SATIVA (Khesari Dal) has
non-edible.
rieuroto~c agent in .it which causes sclerosis'
-of the lateral colunm of the spinal cor~ re-
sulting in weakness oflimbs 'and progressive
spastic paraplegia. · ·
SOLANINE poisoning may occur due to
consumption of many vegetables including
potato, if the concentration is high.
Hepatotoxicity develops due to consump-
tion of badly stored ground nuts which shows
presence of AFLATOXIN (a metabolic prod-
uct of a fungus) in them.
SOYABEAN has trypsin inhibiting factor
in it. Hence, heavy consumption of soyabean
may cause hypoproteinemia.
Fig. 41.2: Fly agaric-
nerve poison .
A few varieties of PTOMAINES (neurine
Fig . 41.1 : Fly agaric (Autonomic and mydaleine) which are formed due to de-
(Poisonous Muscarine composition of flesh , may cause signs and
mushroom) like)
symptoms like that of atropine.

chaptttr 41: FOOD POISONS I 911
Food Allugy occurs with varieties offood • C. G. Tedeschi, W. G. Eckert. L. G. Tedeschi- Forensic
products in persons who are s~nsitive to the Medicine ~ A stu~y in trauma and environmental
particular food (usually some proteinous sub- hazards. Vol. Ill, 1977.
stance of the food) and may show various al· • Getting V. A. ~ Epidemiologic aspects of food borne
lergic manifestations including appear~ce of disease, N. ENG. J. Med. 228, 1943.
rashes, diarrboe~ vomiting, asthmatic at-
tack, circulatory collapse. • Charles l Fergus - Common ediple and poisonous
mushroom of Northeast - 2003.
Treatment consi sts of use of anti-
Oral questions
allergant, symptomatic treatment. Prophy.
lactic steps to avoid the food responslhle. Name some food poisons, their toxic active princi-
pl~s.cause of death with these agents, other dam-
Ages caused by them. What are the toxic effects
of Argimone Mexicana, Amanita Muscaria .
lathyrus sativa, Solanine, Soyabean, P<omaines,
• R. H. Dreisbach - Handbook of Poisoning. 1983. Botulin?
:i I

NOTES

Drugs by definition are substances having vast majority of the society, get detached from
physiological and psychological effects on the mainstream of the society and become a
human beings and other higher animals. class of their own.
Thus, drugs are used to sustain life and pro- Some of the drugs act as stimulants which
mote health, which should have ideally been give a sense of well-being, hilarity, expansive-
the sole use of drugs. But as actions and pow-
ness which ultimately reduce the users to
ers are misused in all fields, the actions and
non-productive creatures whose only success
powers of drugs are also misused. This mis-
remains limited to procuring the drugs and
use is not limited to therapeutic purposes.
Some use drugs to terminate their frustrated be "happy". The other group of drugs are de-
pressants which sedate a person who feels
or unsuccessful lives.
.mentally overburdened.
Moreover, the discovery of certain
psychodelic drugs has shaken the very root Types of drug users
of social structure at all levels. These drugs
are often misused to get relief from tension, Drug users may be:
to pass 'undisturbed peaceful' time, to be out 1. Occasional or moderate or 'social' drug
of touch from practical aspects of personal, users- related to occasional uses of alco-
familial and social problems and to be in an hol or cannabis in some societies. Soci-
imaginary state of mental happiness and well- ety does not take a serious view of such
being by being care-free from the influence users. However, here also much depends
of the environmental odds. Thus, these drugs on the custom and cultural background
have made its path from the doctor's or chem- of a society. Western society may easily
ists's cabinet to the street, open to the ap- accept occasional use of alcohol but not
proachability of a wide section of vulnerable cannabis, whereas our Indian society,
people of the society, cutting across all so- particularly in some sections, occasional
cial, educational, cultural, economical and use of some specific preparation of can-
ethnic classes of the society. They are the nabis may be acceptable but not alcohoL
poor members of our society who, primarily On the other hand tobacco, which defi-
due to their clandestine attachment to the nitely causes harm, still has a broad-based
drugs and due to unreasonable attitude of the accept ability in almost all societies.
2. Heavy users are addicted or dependent 3. Cannabis

on some drug and cannot do without the 4. Cocaine
same. For them, to stay 'normal', the drug 5. Lysergic acid diethyleamide
should be always present in their blood. 6. Mescaline
To avoid such a state, some users of drug 7. Tobacco
try to avoid a time schedule for the drug.
Drugs which cause both psychological and
Types of abused drugs physical (physiological) dependence -
(detail Ch. 35)
The term drug dependence is used to cover
both drugs of addiction i.e. which cause both 1. Alcohol
psychological and physiological dependence, 2. Barbiturate
as well as drugs which only cause habit for- 3. Codeine
mation i.e., which cause only psychological . 4. Chlordiazepoxide
dependence and no physiological dependence. 5. Diazepam
1. Some of the abused drugs .cause psycho- 6. Heroin
logical dependence. Body physiological 7. Meprobamate
activities of persons who are only psycho- 8. Methadone
logically dependent on some drug is not 9. Methaqualone
disturbed if the drug is discontinued. The 10. Morphine
user only apprehends or experience men- 11. Pethidine
tal distress in absence of the drug. To-
bacco, cannabis, LSD and cocaine are in These dn1gs cause mild, moderate or
this list. high psychological and physiological, both
types of dependence.
2. But some of the drugs cause physiologi-
' Narcotics and depressants cause both
cal dependence. A person used to any of
these drugs, will not have nonnal physi- physiological and psychological dependence.
ological functioning capacity of his body Stimulants and hallucinogens cause only psy-
in absence of the drug. In this group we chological dependence.
have morphine and other opiates like Morphine, Pethidine, Heroin, Metha-
heroin and pethidine, barbiturates, alco- done, Alcoho~ Methaquolone, Short acting
hol, diazepam, chlordiazepoxide and barbiturates are notorious drugs which cause
methaqualone. strong physical dependence as well as psy-
3. Misuse or overuse or self-medication of chological dependence.
therapeutic agents is also in the real sense
Factors which are related to drug depen-
drug abuse.
dence-
Drugs which cause physical dependence
also cause psychological dependence. L P~rson~l factor,
2. Social and environmental factor and
Drugs which cause only psychological 3. Drug factor.
dependence- (detail Ch. 35 except tobacco)
1. Personal factor - . Though the personal
L Ampheta~e factors of the addicts inay be held greatly
2. Caffeine responsible for their dependence on the

chapter 42: DRUG D EPEN DENCE AND ABUSE I 915
drugs , it may often be observed that, 5. Social structure and culture and the in-
there are other factors related alongwith. fluence of his social environment.
Among the personal factors , physical and 6. Balance with the place of work, condi-
mental illness, user's personality, toler- tions prevailing·among the co-workers.
ance, threshold to different odds of life
7. Economic factor.
e.g. failure in achievements, love affairs,
stressful events, sense of responsibility 8. Family structure, cohesion, environ-
to himself, his family and the society, his ment, relationship, culture and status.
emotional trends , habits, likingness, 9. Repeated experimental use out of curi-
mental make-up, compulsive psycho- edu- osity.
cational status and working engagements 10. Status and influence of friends.
all may have to contribute towards in- 11. Environment in school, college or hos-
dulgence to drugs .
tel.
2. Social and environmental factors are no
12. Source and availability of the agent of
less important. These include family sta-
addiction.
tus, family environment, happenings in
the family, family liability, attachment 13. Knowledge about the immediate action
with the family, social and Il_lental status of the drug.
ofhis freinds and associates, environment 14. Cost of the drug.
in school/college, hostel, his capacity to 15. Handling drug as a peddler.
meet social bindings and obligations, resi-
Drugs which cause psychological depend-
dential and working environment.
ence can be discontinued with relative ease
3. Drug factor - This is probably the most in comparison to those which cause physical
important of the factors . As enumerated dependence. However, some of such drugs
earlier , some of the drugs on repeated which cause psychological dependence like
use cause psychological dependence, some LSD are so strong in their action that, they
physical dependence also. are often equated with drugs which cause
When considered in an individual addict physical dependence. Withdrawal of these
factors linked with drug addiction may be one drugs may seem difficult, though they do not
or more of the followings: cause physical dependence.
1. From therapeutic use of some drugs like, On the other hand, some of the drugs which
morphine, pethid~e , which may lead to cause physical dependence, do so very strongly
addiction of any addicting opiates and while others in this group are not so strong in
other drugs which are likely to cause · their such action. Both heroin and diazepam
addiction. · cause physical dependence. But dependence
2. From recreational use - when used too with heroin is very strong and occurs very eas-
frequently, the user may find it difficult ily whereas that with diazepam is not so strong
to do well without it. and does not also occur so easily.
3. From repeated use to get relief from Tolerance is another factor which is more
physical and mental exhaustion. intimately related with drugs of physical de-
4. Used with the desire to be freed from pendence, as in case of their use there will
mental worry or distress. be a tendency to increase the dose gradually

as the body develops increasing capacity to or different voluntary organisations is also

metabolize them. This is true for morphine, not the total solution. The state must adapt
heroin and other opiates. But with alcohol, certain stringent and sensible law for the traf-
the tolerance is mostly psychological with fickers,tpeddlers, possessors and in some cases
increased capacity to maintain semblance and the users of drugs, in a rational way. In this
sobriety with gradual higher doses, without context the federal law of the USA may be
any increase in the capacity to metabolize the referred to. In USA, drugs are classified in
drug. five schedules according to their potentiality
to be abused, potentiality to form dependence
Assessment of the problem and their potentiality to be abused, potenti-
ality to form dependence and their present
35 years back one would be puzzled in Cal-
medical use in that country. The extent of
cutta to get smell of alcohol in the breath of
punishment for possession and use of a drug
a co-passenger in a bus. But today, it is not
varies depending on, to which schedule the
an uncommon occurrence in public vehicles .
drug belongs.
after evening hours. It is inte:r:esting that, at
different periods different categories of the The first schedule includes drug which
population are recorded to be the high con- have high potentiality for abuse and have no
sumers of drugs. It is sometimes the daily medical use, e.g. heroin, LSD, cannabis. The
labourers, sometimes office goers, sometimes second schedule includes drugs having high
the students, sometimes businessmen and potentiality for abuse and create physical or
often unemployed young men. This change psychological dependence, but also have re-
in pattern indicates that there is constant stricted medical use, e.g. opium and its de-
effort among the population in general to do rivatives, amphetamine, cocaine, some bar-
away with the drug habit. But then we see biturates and methaqualone. The third sched-
that, the type of consumers change but the ule contains the list of the drugs which have
consumption continues. For this the state ad- a lesser degree of potentiality for abuse than
ministration has to share responsibility. those i..J.cluded in first and second schedules,
When the general mass becomes conscious a potentiality for developing low to moderate
about the misuse of one drug, sometimes it physical dependence and high psychological
is the nexus between some administrative dependence and also have medical use. This
wings of the state in one side and the drug group consists of codeine , phencyclidine and
traffickers and petty peddlers on the other, some barbiturate preparations. The fourth
who introduce a new drug and continue its schedule includes the list of the drugs which
clandestine supply to the users. The state have low potentiality for abuse and develop-
remains happy by spending money to adver- ing dependence than in schedules I, II and
tise about the danger of use ofdrugs and "edu- Ill, and also have present medical use, e.g.
cate" the people through media while its tranquilizers including diazepam, chloro-
machinery remains undisturbed with the sys- diazepoxide, meprobamate and phenobarbi-
tem of coexistence and allow illegal drug traf- tal. The fifth schedule includes the drugs
ficking. which have minimum potentiality for abuse
Effective dealing of the problem - Only and dependence fon:ruition, have medical use
mass education will not solve the problem. and are available mixed with some other
Running of de-addiction centres by the state medicinal ingredients.

chapter 42: DRUG DEPENDENCE AND ABUSE I 917
The Narcotic Drugs and Psychotropic should be effort to identify the abusers and
Substances Act of 1985 , provides in chapter potential abusers . the factors influencing the
VI , section 71 (1)that , the GDvernment may abuse and effective methods to stop drug traf-
in its discretion, establish as many centres ficking/peddling· There should be adequate
as it thinks fit for identification, treatment number oflaboratories for drug testing, and
education aftercare rehabilitation, social re- treatment centres for the drug dependents.
integration of addicts and for supply, subject There should be meaningful rehabilitation
to such conditions and in such manner as programmes for the de-addicted persons · All
may be prescribed by the concerned GDvern- these wings should act in close cohesion and
ment of any narcotic drug and p sychotropic collaboration.
substances to the addicts registered with the
GDvernment and to others where such sup-
ply is a medical necessity.
Sections 1 (2) of the same chapter pro- Active treatment for de-addiction may be car-
vides that The GDvernment may make rules ried on at home or in an institution - Cases
consistent with this Act providing for the es- requiring constant surveillance and attention
t ablishment of appointment, maintenance, must get institutional treatment.
management and superintendence of and for
supply of narcotic drugs and psychotropic Active treatment essentially involves the
substances from the centres referred to in followings :
subsection (1) and for the appointment, train- 1. Treatment for ill health resulting from
ing, powers, duties and persons employed in chronic use of drug.
such centres. 2. Antidote for prevention of use of the
drug's re-addiction.
Article 38 of resolutions adapted by the
United Nations conference for the adoption 3. . Stoppage of supply of drug of addiction.
of single convention on narcotic drugs , held 4. Treatment of withdrawal symptoms .
in 1961 provides for treatment of drug ad- 5. Constant surveillance (a) to assure non-
dicts that, 1. The parties (i.e., all official con- use of the drug, (b) to pay attention to-
cerned bodies ) shall give special attention to wards possible dangerous withdrawal
the provision of facilities of the medical treat- symptoms, (c) to prevent doing any harm
ment care and rehabilitation of drug addict, to himself and (d) to assure prevention of
2. If a party has a serious problem of drug escape of the person.
addiction and its economic resources permit , 6. Proper nursing care.
it is desirable that it establishes adequate
7. Maintenance of adequate food, vitamins,
facilities for the effective treatment of drug
electrolytes etc.
addicts -
8. Giving proper education (mostly psycho-
For successful drive against drug abuse
logical and supportive to de-addiction).
mass education , though an effective step,
alone cannot eradicate the menace. Along 9. Helping to develop his personality and
with mass education, there must be legisla- self-respect.
tion of suitable acts and their implementa- Usually addicts are self-absorbed, not in-
tion . The state administration should be free terfering, noncommittal and of passive per-
from any influence and be effective. There sonality, only remaining conscious or active
to procure the drug by any means. But in tor in the institution should try to collect the
occasions as such, and during active de-ad- required informations after establishing very
diction treatment in particular, they may of- intimate relationship with the person. When-
ten be dangerous from many angles . ever necessary and possible his statement
should be cross -checked through other
sources , preferably without his knowledge.
DE-ADDICTION Cr:N RES In the institute, service ofPsychologist,
Psychiatrist, and specialist in general medi-
Hence the de-addiction centres should have cine and other speciality should be available.
the facilities to meet up any situation which
The psychologist in the centre may be
may arise in individual case.
recognised as the key man who finds way for
The centre in addition to being airy and indepth study of the addict and successfully
providing all reasonsible comforts and ameni- imparts educational therapy for future reha-
ties for the addicts should be so set up that bilitation and development ofhis personality
the addict cannot leave the centre unnoticed. and his further adjustment in the society,
It should be manned with staff of different family, place of work, school/college, with
categories who have experience and knowl- friends and neighbours . A feeling should be
edge about the problems needs and dangers imparted in his mind that he is not a lost
of and from the addicts. They, irrespective of case. He is not spoiled altogether. He has yet
their service status and qualifications should many a things to contribute to the society.
have sound knowledge about action of drugs There are enough reasons and quality in him
and its withdrawal symptoms and dangers of to have self-respect in himself. He should be
all drugs of dependence prevalent in that made conscious about his dependents, chil-
area: They while being sympathetic towards dren, parents and relatives who would like
the inmates should be rigid in their attitude to see him as a good member of the society
towards their duties and must not act in any and take care ofhimself and his dependents.
way which in turn may act adversely on the
tough task of de-addiction programme.
The institute should maintain thorough
history of each individual addicts , about his
period of add~ction, type and nature of addic- After active treatment is over, and the de-
tion, whether planned de-addiction pro- addicted person returns home, he should be
gramme was tried earlier. Social, familial, advised to visit the centre at short intervals
working, school and economic conditions of regularly. The social worker should visit his
the addict and his position in all these fields place of stay or of work or if that is embar-
should be recorded. If there is any past crimi- rassing for the person th.e n any other place,
nal history, the exact nature and how he over- and assess his future state including whether
came the situation should be known. The he faces any·fresh problem. His rehabilita-
source and mode .of procuring the drug is tion include places like school, college or place
important and must be known as well. or work.
It should be remembered here that drug Treatment at home may have some
addicts are often, notorious liars. Hence doc- slackness and hence may be deficient. But it

has an additional advantage of friendly and No doubt harbouring a sense of "no ac-
sympathetic attitude to him from the family tive punitive" step towards the drug addicts
members which is so much essential and ben- should not inactivate the prohibitory provi-
eficial in the treatment of addiction and with- sions mentioned in the Acts for narcotic and
drawal symptoms of the drug. psychotropic drugs but should promote use-
ful functioning of the concerned institutions
which are vested with the job to limit addic-
tion . For that purpose, prevention of use of
drug shoud be controlled in such a way that
Treatment of mild addiction cases may bet- they really become helpful to the society in
ter be attempted at home, if the family at- all considerations. I intend to say that drug
mosphere is congenial and not repulsive for users should not be taken into task or sub-
the addict or not adverse for the programme. jected to action indiscriminately, but the pur-
Moderate and severe addiction cases should pose involved in the whole affair may better
better be treated in specialised centres . have some modifications with application of
mind and understanding the problem in
depth. Alcohol is also a drug which causes
ROLE OF lAW AND STATE addiction and tobacco causes dependence
which does not amount to addiction. That way
Needless to say, that some trivial offence as stated earlier, some drugs are qualitatively
committed by an addict which are hannless different from others, posing more danger
to others should better be overlooked by the than the others. Some, in low regulated dose
law . The law should also overlook the method may even increase the functioning capacity
of procurement (not the source) and posses- and output of a person though the same may
sion of a drug in small quantity for self-use . be hannful to others. In any case if total ban-
These may be considered as part of broader ning of use of tobacco is not recommended
aspects of treatment though Narcotic Drugs and if use of alcohol in specific circumstances
and psychotropic substances Act of 1985 and as recreational agent is also not prohibited
prevention of illicit traffic in Narcotic drug then why a presently prohibited scheduled
and psychotropic substances act of 1988. Pro- · drug if used privately without harming other
vides for graded punitive measures against members of the society and used periodically
possession and use of drugs. An addict and for recreational purpose or to increase the
for that purpose his family members and so- productivity or efficiency of a person in lim-
ciety all are more benefitted by planned medi- ited dose , should be dealt harshly ?
cal and psychological treatment than harsh There are real contradictions which
police action for trivial offence related with . needs debating as to what should be the yard-
self-use of drugs due to addiction . stick to prohibit a drug. Partial prohibition
The police has a greater constructive role or conditional prohibition, may it be for alco-
to play to prevent proliferation of drug addic- hol or for marijuana or opium keeps the con-
tion. The police and other custodians of law tradiction alive in the sense that it involves
may do good to pay more effective attention discrimination to allow users without .pur-
towards control of manufacture and traffick- poseful and· scientific basis . Not only that if
ing of drugs . narcotic or psychotropic drugs are available

920 I PRINCI PLES OF FORENSIC MEDICI NE
to selective users, their illegal trafficking can- preventive aspect should be taken up more
not be checked due to obvious reasons. On vigorously in which case the deaddiction pro-
the contrary a total prohibition of all such gramme will obviously occupy the 2nd posi-
drugs may be considered, to bring total suction and that way the society will be better
cess but that is impracticable in all consid- served-Author's other contention is that pre-
erations. Different countries at different time ventive programme towards use of narcotic
prohibited and allowed a limited use of drugs and psychotropic drugs must not only be
only to revoke the prohibition of the same, taken as a perfunctory job and should not
years after. Finland and Denmark at differ- consist of only occasional or sporadic drive to
ent periods in the middle and latter half of identify the manufacture, traffickers and the
the last century restricted and prohibited the users of the drug and take them to task as
use of alcohol but the restriction and prohi- per provisions of the concerned Act, to place
bition could not be sustained. Many states of them inside the prison to confiscate or at-
USA at different period promulgated strin- tach their property or such action, as puni-
gent laws prohibiting every thing concern- tive measures against the offenders.
ing manufacture, possession; distribution and Drug policy in my opinion should be
use of some drug sometimes with discrimi- framed in a way for their maximum effectivity
nation towards age, sometimes place of use to serve the purpose maximum and should
of drugs, sometimes with permissible quan- include people who have experience on dif-
tity and sometimes in totality also. But any ferent aspects of drugs and their uses and
such lawful stand did not alter the status of effects.
use of drugs which instead of remaining a
legalised matter turned to be a clandestine
practice . The only loser of such stringent RIGHT TO USE PSYCHOTROPIC DRUGS
measures was the "essential" users or addicts
who have to spend huge money for evading Some arguments are cropping up in some
the prohibitory law. The only beneficiary in comers of the world about the right to take
these cases were the clandestine manufac- drugs. The basic strength of this arguments
turers, traffickers and black marketeers . is said to be the facts that some become ad-
Now then if partial or total prohibition of diet to small doses of drug inadvertently with-
drugs have these bad effects including their out which they cannot carry on with nonnal
partial uselessness then should the society functions and duties and that their perform-
think to allow indiscriminate use of narcotic ance, personality and existence suffer if they
and psychotropic drugs? No human sense can don't take it regularly, may be in low "social
approve this . The purpose of this chapter is dose". If this right is acceptable on principle
definitely not to certify for free and indiscrimi- that so long the consumer does not do any
nate use of drugs and simultaneously to ad- wrong to anybody, or so long he does not com-
vocate the active treatment of addiction and mit any crime, then also another question
rehabilitation steps for addicts. Treatment remains, that many offences are committed
and rehabilitation of addicts are erratic con- after use of drug out of excitation or aggra-
ception in absence of prohibitory provision vated passion without any intent or desire.
for scheduled drugs in law being followed . This apart, danger to the user and to others
What the author wants to impress on is that increase after use of drug. A good example

being that, drivers of vehicles in drunken ture, does not serve the purpose of revenue
state face more accidents in comparison to collection at the expected optimum level.
vehicles driven by non-consumers of alcohol. Difference in policy to sale alcohol etc.,
As such, use ofdrugs and their addiction leads from one place to another, in our country is
to possible commission of offence and harm definitely a hindrance for taking up a com-
to the society. It is well accepted and proved prehensive programme to curb the use of al-
that the tobacco smokers not only cause harm cohol and other drugs.
to themselves but to all others nearby. In
Higher retail price may for some users
U.S.A. each year about 3 lakhs children are be effective but it is not so for all. The theory
born to mothers, who use drugs during preg- of different methods to be adopted for differ-
nancy. This babies may born premature with ent strata of society may be advocated by
lower birth weight, head circumference and some. But this cannot give uniform result. It
body length, having physical, neurological, is also liable to disturb uniformity and mo-
psychological and hormonal problems like, rality of the society in a democratic set up.
early death, morphological abnormality,
Lowering the potency of alcohol and other
mood dysfunction, organisational deficits,
drugs is recommended by some, may be con-
lack of attention: and impaired childhood in-
sidered worthy to try.
teraction. Thus unintentional major harm is
caused to the society. In these cases "Right License to users may also be thought of
to use Drugs" leads to violation of right of for them who cannot do without the drug.
the foetus to born as a normal human being. But then, it needs careful and honest imple-
mentation with a scientific approach for drug
Some steps taken by some of the states to de-addiction· This of course will mean depri-
curb use of alcohol and some other drugs : vation to them who claim to use alcohol or
other drug to increase their personal and
Prohibition of use of alcohol was tried in many social perforn1ance. War against use of drug
countries at different times. Free sale and with the aim of total prohibition is a difficult
distribution of alcohol was a criminal offence task which runs the risk offailure even with
in U.S.A. between 1920 to 1933 and only pri- supportive state legislation as narrated above.
vate use was permitted with certain regl.lla- Cruel punishment, as are prevailing in
tion. In our country also it was on trial in some countries, as well as vicarious and col-
1977-78. This attempts could not be sustained. lective punishment, however, cannot be rec-
Right to use even in privacy means right ommended on moral ground and can also be
to buy, right to possess , sale , distribute and co~ter produc":ve. In some countries use
manufacture. In our country heavy taxation and distribution of drugs have been taken up
on sale of alcoholic beverages prevail. What with model public health programme which
purpose does it serve? Is it to discourage use inherits the idea to control· distribution of
of alcohol or to meet up the financial defi- drugs through medical persons with author-
ciency of the Government? Heavy taxation ity to dispense drugs to addicts With this
may be useful to earn good amount of money marginal improvement may be expected But
by the state but is useless to stop clandestine the disadvantages and limitations of these
sale of alcohol So it does not stop ill effects types ofprogrammes are·
of alcohol on the society and in absence of Non-addicts may increase their use of
proper mailagerial and controlling infrastruc- drugs.

Users who find low dose use of drugs ben- the patient, but also it may develop resist-
eficial (Social users) may find it difficult ance of the patient towards the drug.
to adopt with this method and that may Lastly, it must be remembered by all that
ultimately affect the purpose adversely . drugs are blessed discoveries for the safety and
Further , a good percentage of use being
well being of members of the society and not
for recreational purposes only , medical
to cause any harm to any of its members .
persons cannot have any role there .
Clandestine use cannot be prevented .
The programme may not be of use in the References
long run without accompanying social
education . • R. V. Phillipson : Modern trends in drug dependence
and alcoholism, 1970.
Misuse of medicinal drugs • F E. Camps - Recent advances in Forensic Pathol-
One of the hannful use of medicinal drugs is ogy, 1969.
self-medication . Serious complications occur • Richard Saferstein- Criminalistics.
due to wrong use , hypersensitivity, overdose, • Frank Dawtry- Social Problems of Drug Abuse, 1968.
prolonged use, incompatibility and direct
• Steven B. Karch- Drug Abuse Handbook- 1997.
hannful effects on the body. Dangers are
there with such misuse of any drug, antibiot- • Sandra B. McPherson, Harold V Hall and Errol Yudiko
ics (hypersensitivity, aplasia ofbone marrow); Methamphitamine use- 2008.
aspirin (idiosyncracy, metabolic crisis, dam- • Mahmoud A., Elsohly- Marijuana and Cannabinoids
age of kidney, haemopoetic disorders); -2006.
psychodelic drugs, hormonal preparation,
• Richard Laing and J.A. Seigal- 2003.
pressure agents, antidiabetic and antihyper-
tensive drugs. Almost all drugs have some • . Eric VanWyk- Mind altering and poisonous plants of
side effects which are either serious in acute the world- 2008.
form or when used for a long period .
Other examples of misuse of drugs are
Questiof')S
when used to commit suicide, homicide, crimi-
nal abortion or to commit some other crime
Oral questions
like stupefaction of a person to cause theft or
robbery. What is drug dependence? What do you mean by
Therapeutic misuse of drugs by doctors drug? What are different uses of drugs? What is drug
is also quite cormnon . Its effect is something addiction? (see cerebral poison-opium) . Name drugs
apart from iatrogenic effects of drugs. Fre- of addiction or which cause psychological and physi-
quently, hannful drugs are used for quick cal dependence, Name drugs which cause only psy-
effect, to earn a good name as a practitioner, cho1ogical cependence or habit formation. Name some
though at the cost of the patient's health and stimulating and sedative drugs which causes depend-
safety. This causes not only direct harm to ence. What are the dangers of drug dependence?

NATIONAL HUMAN RIGHTS COMMISSION DESIRES THAT ALL ITS RECOMMENDATIONS BE USED
AND WELL CIRCULATED FOR IMPLEMENTATION OF THE RECOMMENDATION AS FAR AS PRACTICABLE
MODEL AUTOPSY PROTOCOL (a) Experienced forensic pathologists may fol-

low this model autopsy protocol t<J ensure
A Introduction a systematic examination and to facili-
tate meaningful positive or negative criti-
Difficult or sensitive cases should ideally be cism by later observers. While trained
the responsibility of an objective, experi- pathologists may justifiably abridge cer-
enced, well-equipped and well-trained pros- tain aspects of the postmortem examina-
ector (the person perfonning the autopsy and tion or written descriptions of their find-
preparing the written report) who is separate ings in routine cases, abridged examina-
from any potentially involved political organi- tions or reports are never appropriate in
zation or entity. Unfortunately, this ideal is potentially controversial cases. Rather,
often unattainable. This proposed model au- a systematic and comprehensive exami-
topsy protocol includes a comprehensive nation and report are required to prevent
checklist of the steps in a basic forensic post7 the omission or loss of important details;
mortem examination that should be followed (b) C':xeneral pathologists or other physicians
"to the extent possible given the resources who have not been trained in forensic
available. Use of this autopsy protocol will pathology but are familiar with basic post-
permit early and final resolution of poten- ~rtem examination techniques may sup-
tially controversial cases and will thwart the plement their customary autopsy proce-
speculation and innuendo that are fueled by dures with this model autopsy protocol.
unanswered, partially answered or poorly It may also alert them to situations in
answered questions in the investigation of an which they should seek consultation, as
apparently suspicious death. written material cannot replace the
This model autopsy protocol is intended knowledge gained through experience;
to have several applications and may be of (c) Independent consultants whose expertise
value to the following categories of individu- has been requested in observing, perform-
als: ing, or reviewing an autopsy _may cite
923
this model autopsy protocol and its pro- topsy performed in a controversial death
posed minimum criteria as a basis for should meet certain minimum criteria if the
their actions or opinions; autopsy report is to be preferred as mean-
(d) Governmental authorities, international ingful or conclusive by the prosector, the
political organizations, law enforcement autopsy's sponsoring agency or governmen-
agencies, families or friends of decedents, tal unit, or anyone else attempting to make
or representatives of potential defendants use of such an autopsy's findings or conclu-
charged with responsibility for a death sions.
may use this model autopsy protocol to This model autopsy protocol is designed
establish appropriate procedures for the to be used in diverse situations. Resources
postmortem examination prior to its per- such as autopsy rooms, X-ray equipment or
formance; adequately trained personnel are not avail-
(e) Historians, journalists, ~ttorneys,judges, able everywhere. Forensic pathologists must
other physicians and representatives of operate under widely divergent political sys-
the public may also use this model au- tems. In addition, social and religious cus-
topsy protocol as a benchmark for evalu- toms vary widely throughout the world ; an
ating an autopsy and its findings ; autopsy is an expected and routine procedure
in some areas, while it is abhorred in others.
(f) Governments or individuals who are at-
A prosector, therefore, may not always be
tempting either to establish or upgrade
able to follow all of the steps in this protocol
their medicolegal system for investigat-
when performing autopsies. Variation from
ing deaths may use this model autopsy
this protocol may be inevitable or even pref-
protocol as a guideline, representing the
erable in some cases. It is suggested, how-
procedures and goals to be incorporated
ever, that any major deviations, with the
into an ideal medicolegal system.
supporting reasons, should be noted.
While performing any medicolegal death
It is important that the body should be
investigation, the prosector should collect
made available to the prosector for a mini-
information that will establish the identity
mum of 12 hours in order to assure an ad-
of the deceased, the time and place of death, equate and unhurried examination. Unreal-
the cause of death, and the manner or mode istic limits or conditions are occasionally
of death (homicide, suicide, accident or natu- placed upon the prosector with respect to the
ral). length of time permitted for the examination
It is of the utmost importance that an or the circumstances under which an exami-
autopsy performed following a controversial nation is allowed. When conditions are im-
death be thorough in scope. The documenta- posed, the prosector should be able to refuse
tion and recording of the autopsy findings to perform a compromised examination and
should be equally thorough so as to permit should prepare a report explaining this posi-
meaningful use of the autopsy results (see tion. Such a refusal should not be interpreted
annex II, below). It is important to have as as indicating that an examination was unnec-
few omissions or discrepancies as possible, essary or inappropriate. If the prosector de-
as proponents of different interpretations of cides to proceed with the examination not-
a case may take advantage of any perceived withstanding difficult conditions or circum-
shortcomings in the investigation. An au- stances, he or she should include in the au-

chapter 43: NATIONAL HUMAN RIGHT COMMISSION 'S RECOMMENDATION ON AUTOPSY PROTOCOL I 925
topsy report an explanation of the limitations any insects present should be collected
or impediments. for forensic entomological study. Which
Certain steps in this model autopsy pro- procedure is applicable will depend on the
tocol have been emphasized by the use ofbold length of the apparent postmortem inter-
face type. These represent the most essen- val;
tial elements of the protocol. (e) Examine the scene for blood, as this may
be useful in identifying suspects;
B. Proposed model autopsy protocol (f) Record the identities of all persons at the
scene;
1. Scene investigation (g) . Obtain information from scene witnesses,
The prosector(s) and medical investigations including those who last saw the decedent
should have the right of access to the scene alive, and when, where and under what
where the body is found. The medical per- circumstances. Interview any emergency
sonnel should be notifi.ed immediately to as- medical personnel who inay have had·
sure that no alteration of the body has oc- contact with the body;
curred. If access to the scene was denied, if (h) Obtain identification of the body and other
the body was altered or if information was pertinent information from friends or
withheld, this should be stated in the prosec- relatives . Obtain the deceased's medical
tor's report. history from his or her physician(s) and
hospital charts, including any previous
A system for co-ordination between the
surgery, alcohol or drug use, suicide at-
medical and non-medical investigators (e.g.
tempts and habits;
law enforcement agencies) should be estab-
lished. This should address such issues as . (i) Place the body in a body pouch or its
how the prosector will be notified and who equivalent. Save this pouch after the body
will be in charge of the scene. Obtaining cer- has been removed from it;
tain types of evidence is often the role of the (j) Store the body in a secure refrigerated
non-medical investigators, but the medical location so that tampering with the body
investigators who have access to the body at and Its evidence cann.o t occur;
the scene of death should perform the fol- (k) Make sure that projectiles, guns, knives
lowing steps: and other weapons are available for ex-
(a) Photograph the body as it is found and amination by the r esponsible medical
after it has been moved, personnel,
(b) Record the body position and condition, (l) If the decedent was hospitalized prior to
including body warmth or coolness, liv- death, obtain admission or blood speci-
idity and rigidity; mens and any X-rays, and review and
(c) Protect the deceased's hands, e.g. with summarize hospital records,
paper bags; (m) Before beginning the autopsy, become
(d) Note the ambient temperature. In cases familiar with the types of torture or vio-
where the time of death is an issue, rec- lence that are prevalent in that country
tal temperature should be recorded and or locale (see annex ill).

2. Autopsy also include information indicating

which camera took each picture, if
The following Protocol should be followed more than one camera is used. The
during the autopsy: identity of the person taking the pho-
(a) Record the date, starting and finishing tographs should be recorded;
times, and place of the autopsy (a com- (ii) Serial photographs reflecting the
plex autopsy may take as long as an en- course of the external examination
tire working day); must be included. Photograph the
(b) Record the name(s) of the prosector(s), body prior to and following undress-
the participating assistant(s), and all ing, washing or cleaning and shav-
other persons present during the autopsy, ing;
including the medical and/or scientific de- (iii) Supplement close-up photographs
grees and professional, political or admin- with distant and/or immediate range
istrative affiliation(s) of each. Each per- photographs to permit orientation
son's role in the autopsy should be indi- and identification of the close-up pho-
cated, and one person 'should be desig- tographs;
nated as the principal prosector who will
(iv) Photographs should be comprehen-
have the authority to direct the perform-
sive in scope and must confirm the
ance of the autopsy. Observers and other
presE'> (.8 of all demonstrable signs of
team members are subject to direction
injury or disease commented upon in
by, and should not interfere with, the prin-
the autopsy report;
cipal prosector. The time(s) during the
autopsy when each person is present (v) Identifying facial features should be
should be included. The use of a "sign-in" portrayed (after washing or cleaning
sheet is recolnm.ended; the body), with photographs of a full
frontal aspect of the face, and right
(c) Adequate photographs are crucial for
and left profiles of the face with hair
thorough documentation of autopsy find-
in normal position and with hair re-
ings,
tracted, if necessary, to reveal the
(i) Photographs should be in colour ears;
(transparency or negative/print), in
(d) Radiograph the body before it is removed
focus, adequately illuminated, and
from its pouch or wrappings. X-rays
taken by a professional or good qual-
should be repeated both before and after
ity camera. Each photograph should
undressing the body. Fluoroscopy may
contain a ruled reference scale, an
also be performed. Photograph all X-ray
identifying case name or number,
films;
and a sample of standard grey. A de-
scription of the camera (including the (i) Obtain dental X-rays, even if identi-
lens "f-number" and focal length), film fication has been established in other
and the lighting system must be in- ways;
cluded in the autopsy report. If more (ii) Document any skeletal system injury
than one camera'is utilized, the iden- by X-ray. Skeletal X-rays may also
tifying information should be re- record anatomic defects or surgical
corded for each: Photographs should procedures. Check especially for frac-

chapter 43: NATIONAL HUMAN RIGHT COM MISSION'S RECOM MENDATION ON AUTOPSY PROTOCOL I 927
tures of the fingers , toes and other 2. Describe and document the means
bones in the hands and feet. Skeletal used to make the identification. Ex-
X-rays may also aid in the identifica- amine the body and record the de-
tion of the deceased, by detecting iden- ceased's apparent age, length, weight,
tifying characteristics, estimating age sex, head hair style and length, nu-
and height, and determining sex and tritional status, muscular develop-
race. Frontal sinus films should also ment and colour of skin, eyes and hair
be taken, as these can be particularly (head, facial and body);
useful for identification purposes; 3. In children, measure also the head
(iii) Take X-rays in gunshot cases to aid cir cumfer ence, crown-rump length
in locating the projectile(s). Recover , and crown-heel length;
photograph and save any projectile A
Record the degree , location and fixa-
or major projectile fragment that is tion of rigor and livor mortis;
seen on an X-ray. Other radio-opaq-:.:te 5. Note body warmth or coolness and
objects (Pacemakers, artificial joints state of preservation; note any de-
or valves, knife fragments etc.) do,.u- composition changes, such as skin
mented with X-rays should also ba re- slippage. Evaluate the general con-
moved, photographed and saved ; dition of the body and note adipocere
(iv) Skeletal X-rays are essential in chil- formation, maggots, eggs or anything
dren to assist in detennining age and else that suggests the time or place
developmental status; of death;
(e) Before the clothing is removed, examine 6. With all injuries, record the size,
body and the clothing; photograph the shape, pattern, location (related to ob-
clothed body. Record any j ewellery vious anatomic landmarks), colou r,
present; course, direction, depth and structure
(f) The clothing should be carefully removed involved. Attempt to distinguish inju-
over a clean sheet or body pouch. Let ries resulting from therapeutic meas-
the clothing dry if it is bloody or wet. De- ures from those unrelated to medical
scribe the clothing that is removed and treatment. In the description of pro-
label it in a permanent fashion. Either jectile wounds, note the presence or
place the clothes in the custody of a re- absence of soot, gunpowder, or singe-
sponsible person or keep them, as they ing. If gunshot residue is present,
may be useful as evidence or for identifi- document it photographically and save
it for analysis. Attempt to detennine
cation;
whether the gunshot wound is an en-
(g) The external examination, focusing on a try or exit wound. If an entry wound
search for external evidence of injury is, is present an~ no exit wound is seen,
in most cases, the most important por- the projectile must be found and saved
tion of the autopsy; or accounted for. Excise wound tract
1. Photograph all surfaces- 100 per cent tissue samples for microscopic exami-
of the body area. Take good quality, nation. Tape together the edges of
we~l-focuse~, colour photographs with knife wounds to assess the blade size
adequate illumination; and characteristics;
928 I PRINClPLES OF FO RENSIC MEDICINE
7. PhotogTaph all injuries, taking two possible to distinguish microscopically

colour pictures of each, labelled with between burns caused by electricity
the autopsy identification number on and those caused by heat;
a scale that is oriented parallel or 9. IdentifY and label any foreign object
perpendicular to the injury. Shave that is recovered, including its rela-
hair where necessary to clarify an tion to specific injuries. Do not
injury, and take photographs before scratch the sides or tip of any projec-
and after shaving. Save all hair re- tiles. Photograph each projectile and
moved from the site of the injury. large projectile fragment with an
.Take photographs before and after identifYing label, and then place each
washing the site of any injury. Wash in a sealed, padded and labelled con-
the body only after any blood or ma- tainer in order to maintain the chain
terial that may have come from an of custody;
assailant has been collected and
10. Collect a blood sped.men of at least
saved;
50 cc from a subclavian or femoral
8. Examine the skin. Note and photo- vessel;
graph any scars, areas of keloid for-
mation, tattoos, prominent moles , 11. Examine the head and external scalp,
areas of increased or decreased pig- bearing in mind that injuries may be
mentation, and anything distinctive hidden by the hair. Shave hair where
or unique such as birthmarks. Note necessary Check for fleas and lice, as
any bruises and incise them for de- these may indicate unsanitary condi-
lineation of their extent. Excise them tions prior to death. Note any alopecia
for microscopic examination. The as this may be caused by malnutri-
head and genital area should be tion, heavy metals (e.g. thallium),
checked with special care. Note any drugs or traction. Pull, do not cut, 20
injection sites or puncture wounds representative head hairs and save
and excise them to use for toxicologi- them, as hair may also be useful for
cal evaluation. Note any abrasions detecting some drugs and poisons;
and excise them; microscopic sections 12. Examine the teeth and note their
may be useful for attempting to date condition. Record any that are ab-
the time of injury. Note any bite sent, loose or damaged, and record
marks; these should be photographed all dental work (restorations, fillings
to record the dental pattern, swabbed etc. ), using a dental identification
for saliva testing (before the body is system to identifY each tooth. Check
washed) and excised for microscopic the gums for periodontal disease. Pho-
examination. Bite marks should also tograph dentures, if any, and save
be analysed by a forensic odontolo- them if the decedent's identity is un-
gist, if possible. Note any bum marks known . Remove the mandible and
and attempt to determine the cause maxilla if necessary for identification.
(burning rubber, a cigarette, electric- Check the inside of the mouth and
ity, a blowtorch, acid, hot oil etc.). note any evidence of trauma, injec-
Excise any suspicious areas for mi- tion sites, needle marks or biting of
croscopic examination, as it may be the lips, cheeks or tongue. Note any

chapter 43: NA.TIONA.L HUMA.N RIGHT COMMISSION 'S RECOMMENDATION ON A.UTOPSY PROTOCOL I 929
articles or substances in the mouth. wounds. Dissect and describe any in-
In cases of suspected sexual assault, juries. Note any bruises about the
save oral fluid or get a swab for sper- wrists or ankles that may suggest
matozoa and acid phosphatase evalu- restraints such as handcuffs or sus-
ation. (Swabs taken at the tooth-gum pension. Examine the medial and lat-
junction and samples from between eral surfaces of the fingers, the ante-
the teeth provide the best specimens rior forearms and the backs of the
for identifying spermatozoa). Also knees for bruises;
take swabs from the oral cavity for 16. Note any broken or missing finger-
seminal fluid typing. Dry the swabs nails. Note any gunpowder residue
quickly with cool, blown air if possi- on the hands, document photographi-
ble, and preserve them in clean plain
cally and save it for analysis. Take
paper envelopes. If rigor mortis pre-
fingerprints in all cases. If the
vents an adequate examination, the
decedent's identity is unknown and
masseter muscles may ·be cut to per-
fingerprints cannot be obtained, re-
mit better exposure;
move the "glove" of the skin, if
13. Examine the face and note if it is cy- present. Save the fingers if no other
anotic or if petechiae are present; means of obtaining fingerprints is
(a) Examine the eyes and view the possible. Save finger-nail clippings
conjunctiva ofboth the globes and and any under-nail tissue (nail
the eyelids. Note any petechiae in scrapings). Examine the fingernail
the upper or lower eyelids. Note and toe-nail beds for evidence of ob-
any scleral icterus. Save contact jects having been pushed beneath
lenses, if any are present. Collect the nails. Nails can be removed by
at least 1 ml of vitreous humor dissecting the lateral margins and
from each eye; proximal base, and then the
(b) Examine the nose and ears and undersurface of the nails can be in-
note any evidence of trauma, spected. If this is done, the hands
haemorrhage or other abnormali- must be photographed before and af-
ties. Examine the tympanic mem- ter the nails are removed. Carefully
branes; examine the soles of the feet, noting
14. Examine the neck externally on all any evidence of beating. Incise the
aspects and note any contusions, soles to delineate the extent of any
abrasions or petechiae. Describe and injuries. Examine the palms and
document injury patterns to differen- knees, looking especially for glass
tiate manual, ligature and hanging shards or lacerations;
strangulation. Examine the neck at 17. Examine the external genitalia and
the conclusion ofthe autopsy, when note the presence of any foreign ma-
the blood has drained out of the area terial or semen. Note the size, loca-
and the tissues are dry; tion and number of any abrasions or
15. Examine all surfaces of the extremi- contusions. Note any injury to the
ties : arms, forearms, wrists, hands, inner thighs or peri-anal area. Look
legs and feet, and note any "defence" for peri-anal burns;
Parvejn::: ~A - <;Ol Dr. Md. Ahsan Uddin (Nayan) CoMC-24

..
930 I PRINCIPLES OF FORENSIC MEDICINE ·
18. fu cases of suspected sexual assault, 2. Examine the chest. Note any abnor-
examine all potentially involved ori- malities of the breasts. Record any
fices. A speculum should be used to rib fractures, noting whether cardi-
examine the vaginal walls. Collect opulmonary resuscitation was at-
foreign hair by combing the pubic tempted. Before opening, check for
hair. Pull and save at least 20 of the pneumothoraces. Record the thick-
deceased's own pubic hairs, including ness of subcutaneous fat. Immedi-
roots. Aspirate fluid from the va gina ately after opening the chest, evalu-
and/or rectum for acid phosphatase, ate the pleural cavities and the peri-
blood group and spermatozoa evalu- cardia! sac for the presence of blood
ation. Take swabs quickly with cool, or other fluid, and describe and quan-
blown air· if possible, and preserve tify any fluid present. Save any fluid
them ·in clean plain paper enve- . present until foreign objects are ac-
lopes; counted for. Note the presence of air
19. The length of the back, the buttocks embolism, characterized by frothy
and extremities including wrists and blood within the right atrium and
ankles must be systematically incised right ventricle . Trace any injuries
to look for deep injuries. The shoul- before removing the-organs. If blood
ders, elbows, hips and knee joints is not available at other sites, collect
must also be incised to look for a sample directly from the heart.
ligamentous injury; Examine the heart, noting degree
(h) The internal examination for internal and locatio11; . of coronary artery dis-
evidence of injury should clarify and aug- ease or other abnormalities. Exam-
ine the lungs, noting any abnormali-
ment the external examination;
ties;
1. Be systematic in the internal exami-
nation. Perform the examination ei- 3. Examine the abdomen and record the
ther by body regions or by systems, amount of subcutaneous fat. Retain
including the cardiovascular, respira- 50 grams of adipose tissue for toxico-
tory, biliary, gastro-intestinal, reticu- logical evaluation. Note the interre-
loendothelial, genitourinary, endo- lationships of the organs. Trace any
crine, musculoskeletal, and central injuries before removing the organs.
nervous systems. Record the weight, Note any fluid or blood present in the
size, shape, colour and cohsistency of peritoneal cavity, and save it until for-
each organ, and note any neoplasia, eign o"Qjects are accounted for. Save
inflammation, anomalies, haemor- all urine and bile for toxicologic ex-
rhage, ischemia, infarcts, surgical amination;
procedures or injuries. Take sections 4. Remove~ examine and record the
of normal and any abnormal areas of quantitative information on the liver,
each organ for microscopic examina- spleen, p~creas, kidneys and adre-
tion. Take samples of any·fractured nal' gJands. ,Save at least 150 grams
bones for radiographic and .micro- each of:k.idl}ey and liver for toxico-
scopic estimation ·of the age -of .the logiG~l 'evaluation. Remove the
fracture~ ga::;trqj~.testin·al tract and examine

chapter 43: NATIONAL HUMAN RIGHT COMMISSION 'S. RECOMMENDATION ON AUTOPSY PROTOCOL I 931
the contents. Note any food present 8. Examine the neck after the. heart
and its degree of digestion. Save the and brain have been removed and the
contents of the stomach. If a more neck ve~slels have been drained. Re-
detailed toxicological evaluation is move the neck organs, taking care
desired, the contents of other regions not to fracture the hyoid bone. Dis-
of the gastrointestinal tract may be sect and describe any injuries. Check
saved. Examine the rectum and anus the mucosa of the larynx, pyriform
for bums, lacerations or other inju- sinuses and esophagus, and note any
ries. Locate and retain any foreign petechiae, edema or bums caused by
bodies present. Examine the aorta, corrosive substances. Note any arti-
inferior vena cava and iliac vessels; cles or substances within the lumina
5. Examine the organs in the pelvis, of these structures. Examine the thy-
including ovaries, fallopian tubes, roid gland. Separate and examine the
uterus, vagina, testes, prostate gland, parathyroid glands, if they are read-
seminal vesicles, urethra and uri- ily identifiable;
nary bladder. Trace any injuries be- 9. Dissect the neck muscles, noting any
fore removing the organs. Remove haemorrhage. Remove all organs,
these organs carefully so as not to including the tongue. Dissect the
injure them artifactually. Note any muscles from the bones and note any
evidence of previous or current preg- fractures of the hyoid bone or thy-
nancy, miscarriage or delivery. Save roid or cricoid cartilages;
any foreign objects within the cervix, 10. Examine the cervical, thoracic and
uterus, vagina, urethra or rectum; lumbar spine. Examine the vertebrae
6. Palpate the head and examine the from their anterior aspects and note
external and internal surfaces of the any fractures, dislocations, compres-
scalp, noting any trauma or haemor- sions or haemorrhages. Examine the
. rhage. Note any skull fractures. Re- vertebral bodies. Cerebrospinal fluid
move the calvarium carefully and may be obtained if additional toxico-
note epidural and subdural haemato- logical evaluation is indicated;
mas. Quantify, date and save any 11. In cases in which spinal injury is sus-
haematomas that are present. Re- pected, dissect and describe the spi-
move the dura to examine the internal cord. Examine the cervical spine
nal surface of the skull for fractures. anteriorly and note any haemorrhage
Remove the brain and note any ab- in the paravertebral muscles. The
normalities. Dissect and describe any posterior approach is best for evalu-
injuries. Cerebral cortical atrophy, ating high cervical injuries. Open the
whether focal or generalized, should spinal canal and remove the spinal
be specifically commented upon; cord. Make transverse sections every
7. Evaluate the cerebral vessels. Save 0.5 em and note any abnormalities;
at least 250 grams of cerebral tissue (i) After the autopsy has been completed,
for toxicological evaluation. Sub- record which specimens have been
merge the brain in fixative prior to saved. Label all specimens with the name
examination, if this is iD:~jcated; of the deceased, the autopsy identifica-

tion number, the date and time of collec- (b) All clothes and personal effects of
tion, the name of the prosector and the the deceased, worn by or in the
contents. Carefully preserve all evidence possession of the deceased at the
and record the chain of custody with ap- time of death;
propriate release forms; (c) Finger-nails and under nail
1. Perform appropriate toxicologic tests scrapings;
and retain portions of the tested sam- (d) Hair, foreign and pubic, in cases
ples to permit retesting; of suspected sexual assault;
(a) Tissues: 150 grams of liver and
(e) Head hair, in cases where the
kidney should be saved routinely.
place of death or location of the
Brain, hair and adipose tissue may
body prior to its discovery may be
be saved for additional studies in
an issue;
cases where drugs, poisons or
other toxic substances are s~s (j) After the autopsy, all unretained organs
pected; should be replaced in the body, and the
body should be well embalmed to facili-
(b) Fluids: 50 cc (if possible) of blood
tate a second autopsy in case one is de-
(spin and save serum in all or
sired at some ·future point;
some of the tubes), all available
urine, vitreous humor and stom- (k) The written autopsy report should address
ach contents should be saved rou- those items that are emphasized in bold-
tinely. Bile, regional gastro-intes- face type in the protocol. At the end of the
tinal tract contents and cerebros- autopsy report should be a summary of
pinal fluid should be saved in cases the findings and the cause of death. This
where drugs, poisons or toxic sub- ·should include the prosector's cormnents
stances are suspected. Oral, vagi- attributing any injuries to external
nal and rectal fluid should be trauma, therapeutic efforts, postmortem
saved in cases of suspected sexual change, or other causes. A full report
assault; should be given to the appropriate authori-
2. Representative samples of all major ties and to the deceased's family.
organs, including areas of normal and
any abnormal tissue, should be proc-
essed histologically and stained with MODEL PROTOCOL FOR DIS INTERNMENT
hematoxylin and eosin (and other AND ANALYSIS OF SKELETAL REMAINS
stains as indicated). The slides, wet
tissue and paraffin blocks should be A. Introduction
kept indefinitely; This proposed model protocol for the
3. Evidence that must be saved includes: disinternment and analysis of skeletal re-
(a) All foreign objects, including pro- mains includes a comprehensive checklist of
jectiles, projectile fragments, pel- the steps in a basic forensic examination. The
lets, knives and fibres. Projectiles objectives of an anthropological investigation
must be subjected to ballistic are the same as those of a medicolegal inves-
analysis; tigation of a recently deceased person. The
chapter 43: NATIONAL HUMAN RIGHT COMMISSION'S RECO MMENDATION ON AUTOPSY PROT0COL I 933
anthropologist must collect information that This model protocol may be of use in
will establish the identity of the deceased, the many diverse situations. Its application may
time and place of death, the cause of death be affected, however, by poor conditions, in-
and the manner or mode of death (homicide, adequate financial resources or lack of time.
suicide, accident or natural). The approach Variation from the protocol may be inevita-
of the anthropologist differs, however, be-· ble or even preferable in some cases. It is
cause of the nature of the material to be ex- suggested, however, that any major devia- .
amined. Typically, a prosector is required to tions, with the supporting reasons, should be
examine a body, whereas an information ob- noted in the final report.
tained from soft tissues, whereas the anthro-
pologist focuses on information from hard tis- B. Proposed model skeletal analysis protocol
sues. Smce decomposition is a continuous
1. Scene investigation
process, fresh body when bone is exposed or
when bone trauma is a factor. An experienced A burial recovery should be handled with
prosector may be required when mummified the same exacting care given to a crime-scene
tissues are present. In some circumstances, search. Efforts should be co-ordinated be-
use of both this protocol and the model au- tween the principal investigator and the con-
topsy protocol may be necessary to yield the sulting physical anthropologist or archaeolo-
maximum information. The degree of decom- gist. Human remains are frequently exhumed
position of the body will dictate the type of by law enforcement officers or cemetery
investigation and, therefore, the protocol(s) workers unskilled in the techniques offoren-
to be followed: sic anthropology. Valuable information may
The questions addressed by the anthro- be lost in this manner and false information
pologist differ from those pursued in a typi- is sometimes generated. Disinterment by
cal autopsy. The anthropological investiga- untrained persons should be prohibited. The
tion invests more time and attention to basic consulting anthropologist should be present
questions such as the following: to conduct or supervise the disinterment.
Specific problems and procedures accompany
(a) Are. the remains human?
the excavation of each type of burial. The
(b) Do they represent a single individual or amount of information obtained from the
several? excavation depends on knowledge of the burial
(c) What was the decedent's sex, race, stat- situation and judgement based on experience.
ure, body weight, handedness and phy- The final report should include a rationale
sique? for the excavation procedure.
(d) Are there any skeletal traits or anoma- The following procedure should be fol-
lies that could serve to positively iden- lowed during disintemment:
tify the decedent? (a) Record the date, location, starting and fin-
The time, cause and manner of death are ishing times of the disintemment, and
also addressed by the anthropologist, but the the names of all workers;
margin of error is usually greater than that (b) Record the information in narrative form,
which can be achieved by an autopsy shortly supplemented by sketches and photo-
after death. graphs;

(c) Photograph the work area from the same ceased is first placed. If the remains
perspective before work begins and after are then removed and reburied, the
it ends every day to document any dis- grave is considered to be secondary;
turbance not related to the official proce- 4. Undisturbed or disturbed. An undis-
dure; turbed burial is unchanged (except
(d) In some cases, it is necessary to first lo- by natural processes) since the time
cate the grave within a given area. There of primary burial. A disturbed burial
are numerous methods oflocating graves, is one that has been altered by hu-
depending on the age of the grave: man intervention after the time of
1. An experienced archaeologist may primary burial. All secondary buri-
cognize clues such as changes in als are considered to be disturbed;
rface contour and variati in lo- archaeological methods can be used
cal vegetation; to detect a disturbance in a primary
2. A metal probe can be used to locate burial;
the less compact soil characteristics (f) Assign an unambiguous number to the
of grave fill; · burial. If an adequate numbering system
3. The area to be explored can be cleared is not already in effect, the anthropolo-
and the top soil scraped away with a gist should devise a system;
flat shovel. Graves appear darker (g) Establish a datum point, then block and
than the surrounding ground because map the burial site using an appropriate-
the darker top-soil has mixed with the sized grid and standard archaeological
lighter subsoil in the grave fill. Some- techniques. In some cases, it may be ad-
times a light spraying of the surface equate simply to measure the depth of
with water may enhance a grave's the grave from the surface to the skull
outline; and from the surface to .the feet. Associ-
(e) Classify the burial as follows: ated material can then be recorded in
1. Individual or commingled. A grave terms of their position relative to the
may contain the remains of one per- skeleton;
son buried alone, or it may contain (h) Remove the overburden of earth, screen-
the commingled remains of two or ing the dirt for associated materials.
more persons buried either at the Record the level (depth) and relative co-
same time or over a period of time; ordinates of any such findings. The type
2. Isolated or adjacent. An isolated grave of burial; especially whether primary or
is separate from other graves and can secondary, influences the care an~ atten-
be excavated without concern about tion that needs to be given to this step.
encroaching upon another grave. Ad- Associated materials located at a second-
jacent graves, such as in a crowded ary burial site are unlikely to reveal the
cemetery, require a different excava- circumstances of the primary burial but
tion technique because the wall of one may provide information on events that
grave is also the wall of another grave; have occurred after that burial;
3. Primary or secondary . A primary (i) Search for items such as bullets or jew-
grave is the grave in which the de- ellery, for which a metal detector can be

chapter 43: NATIONAL HUMAN RIGHT COMMISSION'S RECOMME NDATION ON AUTOPSY PROTOCOL I 935
useful, particularly in the levels immedi- (n) Before displacing any thing, measure the
ately above and below the level of the indiVidual:
remains; 1. Measure the total length of the re-
(j) Circumscribe the body, when the level of mains and record the terminal points
the burial is located, and, when possible, of the measurement, e.g. apex to
open the burial pit to a minimum of 30 plfuitar surface of calcaneus (note :
em on all sides of the body; This is not a stature measurement);
(k) Pedestal the burial by digging on all sides 2. If the skeleton is so fragile that it may
to the lowest level of the body (approxi- break when lifted, measure as much
mately 30 em). Also pedestal any associ- as possible before removing it from
. ated artefacts; the ground;
. Q) Expose the remains with the use of a soft (o) Remove all elements and place them in
brush or whisk broom. Do not use a brush bags or boxes, taking care to avoid dam-
on fabric, as it may destroy fibre evidence. age. Number, date and initial every con-
Examine the soil found around the skull tainer;
for hair. Place this soil in a bag for labo- (p) Excavate and screen the level of soil im-
ratory study. Patience is invaluable at mediately under the burial. A level of
this time. The remains may be fragile, "sterile"{artefact-free) soil should be lo-
and interrelationships of elements are cated before ceasing excavation and be-
important and may be easily disrupted. ginning to backfill.
Damage can seriously reduce the amount
of information available for analysis; 2 . Laboratory analysis of skeleton remains
(m) Photograph and map the remains in situ.
All photographs should include an iden- The following protocol should be followed
during the laboratory analysis of the skeleton
tification number, the date, a scale and
remains:
an indication of magnetic north;
1. First photograph the entire burial, (a) Record the date, location, starting and fin-
ishing times of the skeletal analysis, and
then focus on significant details so
that their relation to the whole can the names of all workers;
be easily visualized; (b) Radiograph all skeletal elements before
2. Anything that seems unusual or re- any further cleaning:

markable should be photographed at 1. Obtain bite-wing, apical and pano-
·close range. Careful attention should ram:ic dental X-rays, if possible;
be given to evidence of trauma or 2. The entire skeleton should be X-
pathological change, either recent or rayed. Special attention should be
healed; directed to fractures, developmental
3. Photograph and map all associated anomalies and the effects of surgical
materials (clothes, hair, coffin, arti- procedures. Frontal sinus film s
facts, bullets, casings etc.). The map should be included for identification
should include' a rough sketoh of the purposes;
skeleton as well as any associated (C} Retain some bones in their original state:
materials; two lumhar vertebrae should be ad-
equate. Rinse the rest of the bones clean unrelated to medical treatment. Photo-
but do not soak or scrub them. Allow the graph all injuries:
bones to dry: 1. E xamine the hyoid bone for cracks
(d) Lay out the entire skeleton in a system- or breaks;
atic way: 2. Examine the thyroid cartilage for
1. Distinguish left from right; damage;
2. Inventory every bone and record on 3. Each bone should be examined for
a skeletal chart; evidence of contact with metal. The
3. Inventory the teeth and record on a superior or inferior edges of the ribs
•
dental chart. Note broken, carious, require particular scrutiny. A dissect-
restored and ffiissing teeth; ing microscope is useful;
4. Photograph the entire skelet on in (j) Ifthe remains are to be reburied before
one frame. All photographs should obtaining an identification, retain the fol-
contafn an identification number and lowing samples for further analysis:
scale; 1. A mid-shaft cross-section from either
(e) If more than one individual is to be ana- femur, 2 em or more in height;
lysed, and especially if there is any chance 2. A mid-shaft cross-section from either
that comparisons will be made between fibula , 2 em or more in height;
individuals, number every element with
3. A 4 em section from the sternal end
· indelible ink before an y other work is
of a rib (sixth, if possible);
begun;
(f) Record the condition of the remain s, e.g. 4. A tooth (preferably a mandibular inci-
fully intact and solid, eroding and friable, sor) that was vital at the time of death;
charred or cremated; 5. Sever molar teeth for possible later
(g) Preliminary identification; deoxyribonucleic acid fingerprinting
for identification;
1. Determine age, sex, race and stature;
6. A case of the skull for possible facial
2. Record the reasons for each conclu-
reconstruction;
sion (e.g. sex identity based on skull
and femoral head); 7. Record what samples have been saved,
and label all samples with the identi-
3. Photograph all evidence supporting
fication number, date and name of the
these conclusions;
person who removed the sample.
(h) Individual identification:
1. Search for evidence of handedness, 3 . Final report
pathological change, trauma and de-
velopmental anomalies; The following steps should be taken in the
2. Record the reasons for each conclu- preparation of a final report:
sion; (a) Prepare a full report of all procedures and
3. Photograph all evidence supporting results;
these conclusions; (b) Include a short summary of the conclu-
(i) Attempt to distinguish injuries resulting sions;
from therapeutic measures from those (c) Sign and date the report.

chapter 43: NATIONAL HUMAN RIGHT COMMISSION'S RECOMMENDATION ON AUTOPSY PROTOCOL I 937
4. Repository evidence should be preserved for a reasonable time. A

repository should be established to hold the
In cases where the body cannot be identified, bodies for 5-10 years in case they can be iden-
the exhumed remains or other evidence tified at a later time.
Annex- II: PostrQortem Detection of Torture

Torture Technique • Physical Findings
Beating
1. General Scars, Bruises, Lacerations, Multiple fractures at different
stages of healing, especially in unusual locations, which
have not been medically treated
2. To the soles of the feet ("falanga", "fa/aka", "basti- Haemorrhage in the soft tissues of the soles of the feet and
nado"), or fractures of the bones of the feet ankles. Aseptic necrosis
3. With the palms on both ears simultaneously Ruptured or scarred tympanic membranes. Injuries to
("el telefone") . external ear
4. On the abdomen, while lying on a table with the Bruises on the abdomen. Back injuries. Ruptured
upper half of the body unsupported abdominal viscera
("operating table", "e/ quirofano")
5. To the head Cerebral cortical atrophy, Scars, Skull fractures, Bruises,
Haematomas
Suspension
6. By the wrists ("Ia bandera") Bruises or scars about the wrists. Joint injuries
7. By the arms or neck Bruises or scars at the site of binding. Prominent lividity in
the lower extremities.
8. By the ankles ("murcielago") Bruises or scars about the ankles. Joint injuries.
9. Head down, from a horizontal pole placed under Bruises or scars on the anterior forearms and backs of the
the knees with the wrists bound to the ankles knees. Marks on the wrists and ankles
("paffot's perch", "Jack", "pau de arara")
Near suffocation
10. Forced immersion of head in water, often contami- Faecal material or other debris in the mouth, phyarynx,
nated ("wet submarine" , "pi/eta", "Latina") trachea, ~sophagus or lungs. Intrathoracic petechiae
11. Tying of a plastic bag over the head ("dry subma- Intra-thoracic petechiae
rine")
Sexual abuse
12. Sexual abuse Sexually transmitted diseases. Pregnancy. Injuries to
breasts, external genital is, vagina, anus or rectum
Forced posture
13. Prolonged standing ('e/ planton") Dependent edema. Petechiae in lower extremities
14. Forced straddling of a bar ("saw horse" , Peri neal or scrotal haematomas
"e/ cabe/lete")
Contd.
Annex-//: Postmortem Detection ofTorture

Torture Technique Physical Findings
Electric shock
15. Cattle prod ("/a picana") Bums: appearance depends on the age of the injury.
Immediately: red spots, vesicles, and/or black exudate.
Within a few weeks: circular, reddish, muscular scars.
At several months: small, white, reddish or brown spots
resembling telangiectasis
16. Wires connected to a source of electricity
17. Heated metal skewer inserted into the anus Peri-anal or rectal burns
("black slave")
Miscellaneous
18. Dehydration Vitreous humor electrolyte abnormalities
Animal bites Bite marks
(spiders, insects, rats, mice, dogs)

chapter 43: NATIONAL HUMAN RJGHT COMMISSION'S RECOMMENDATION QN AUTOPSY PROTOCOL I 939
COMPARISON OF BODY WITH POSSIBLE DECEDENTS

Name of Decedents
Traits Body
Sex
Age
Race
Stature
Weight
Clothing
Jewellery
Documents
Scars, Tattoos
Old Surgery
Anomalies I Defonn
Dentition
Fingerprints
Other
Rule Out
Possible by Exclusion .
Probable
Positive
Notes:
..
'tl ~
----------------------~
~ --------~------~--------------------------
'

940 I PRJNCIPLES OF FORENSIC MEDICINE
Stab Wound Chart
Name _ _ City or Country _ _ _ _ _ _ __
Wound No.
1· 2 3 4 5 6 7 8 9 10
. 1.. Location of wound: Head
-. .
Neck
Chest
Abdomen
Back
Right
Arm
Left
Right
Leg
Left
2. The skin wound is:- Horiz.
.. Vert. ·
.:!
.: bbliql!e :
3. Centimetres.fromwoundto:: ·.·. )op.eif.head
.,. ;:_·..:; >-__ :·-'. :_·: _Ri~ht~tmi~ine
... .· ·.·: ·: . · Leftofmidli.ne
..
i
4. Wound size in 'miUimetreS: ·. •..- :

Widh
..
•·
Length
Diameter
5. Direction of would: Backward
Forward
Upward
Downward
Medially
Laterally
Photographs made: Yes _ _ _ _ _ No

Remarks:
Examined by: _ _ _ _ __ Date:
•
"" 'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38
chapter 43: NATIONAL HUMAN RIGHT COMMISSION'S RECOMMENDATION O.N AUTOPSY PROTOCOL I 941
Firearm Wound Chart
Case No - - - - - - - - - - - - - - - -
Wound No.
1 2 3 4 5 6. 7 8 9 10
1. Location of wound: Head
Neck
Chest
Abdomen
Back
Right
Arm
Left
Right
Leg
Left
2. Sizeofwound: (centimeters) Diam.

Wdh
Length
3. Centimetres from wound to: Top of head
Right of midline
Left of midline
4. Firearm residue: On skin
Clothing
Absent
5. Direction of missile through body: Backward
Forward
Downward
Upward
To right
To left
6. Missile recovered: Probable Callibre
Shotgun

Photographs: _ _ _ _ _ _ _ _ _ _ __ _ _ X-rays _ _ _ _ _ _ _ _ __
Remarks:
Examined by: _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ Date: _ _ _ _ __ _
IN ADDITION TO THE FOREGOING RECOMMENDATIONS AND CHARTS THE NATIONAL HUMAN RIGHT COM-
MISSION HAS PROVIDED SKETCHES OF FULL AND DIFFERENT PARTS OF BODY IN DIFFERENT PROFILES
FOR POSITIONING OF WOUNDS ETC.

FIRST INFORMATION REPORT
First information of cognizable crime reported under Section 154,
Criminal Procedure Code, at police station ..................................................................... .
SUBDIVISION ....................................... . DISTRICT ....................... .

No................. Date and hour occurrence .................. ............................ .. ....................... .. .
Date and hour when reported Place of occurrence and distance and direction Date of despatch from
from police station and jurisdiction number Police station
[N. B. A first information must be authenticated by the signature, mark or thuml:rimpression of informant and attested by the
signature of the officer recording it.]
Name and residence Name and residence Brief description of Steps taken regarding Result of
of informant and of accused offence with section investigation, expla- the case
complainant and of property nation of delay in
carried of, if any recording information
1 2 3 4 5
[FI RST INFORMATION TO BE RECORDED BELOW]

Note- The signature, seal or mark of informant should be affixed at foot of the information
Signature .......................... ......... ..

Designation ................................. .
FIRST INFORMATION REPORT
First information of cognizable crime reported under Section 154,
Criminal Procedure Code, at police station ....................... ............. ....... ...... ... .. ............... .
SUBDIVISION ....................................... . DISTRICT ....................... .

No............. .... Date and hour occurrence ...... ....... .. .......................... ... ........................ ......
Date and hour when reported Place of occurrence and distance and direction Date of despatch from
from police station and jurisdiction number Police station
[N.B. Afirst information must be authenticated by the signature, mark or thumb-impression of informant and attested by the
signature of the officer recording it.]
Name and residence Name and residence Brief description of Steps taken regarding Result of
of informant and of accused offence with section investigation, expla- the case
complainant and of property nation of delay in
canied of, if any recording information
1 2 3 4 5
[FIRST INFORMATION TO BE RECORDED BELOW)

Note- The signature, seal or mark of informant should be affixed at foot of the information
Signature .. ... ... ........................... ..

Designation ... .... ....... ... .. ........... ... .
'Which of the favours Of your Lord will

0 <1.'1ye deny?'- Al Quran 55:38
INVESTIGATION REPORT UNDER SECTION 174 CrPC

(Regulation- 399)
District .... ........... ...... .................................... Police Station ..................................... U/D Case No.................................... .
FIR No .................................................................. U/S.............. ................... .... .. ........... dated ............................... ...... .....
case reported at.. .............. .....................................hrs.. ... .................................. ..... ... .............. Investigation Commenced
at. ................. :....................................... hrs.......... .......... .... .................... Investigation closed at ........................ ............hrs.
1. Name, Parentage and residence of deceased
2. Place where body was found
3. Description of the corps and position in which found
4. Apparent injuries or marks on the body
5. Manner in which and weapons (if any) by which

injuries appeared to have been inflicted
6. Circumstances if any, which give rise to

suspicion of foul play
7. Accurate list and description of clothes,

ornaments, weapons, and other articles found on
or near the dead body
8. Opinion of witnesses as to the cause of death
9. Opinion of police officer as to the cause of death
10. Signature of witnesses
Signature of Police Officer

APPENDIX I 945
Append"x3
--------------~~----------------~----------~----~--~
Chalan No. .... .............. ..
CHALAN FOR USE WHEN ADEAD BODY IS SENT FOR EXAMINATION
P.R. B. Fonn No. 54- Vide Rule 23
Religion and Sex Residence Where body Date and hour Means of Name of Marks on Cause of Remarks notice
caste of and was found of despatch despatch ldenti- the body death as what clothes
. deceased Age and distance fying far as and articles
.. frbin place of police known · were certified
postmortem officer with the body
'
..
...... .j....:J40 Dj .- 84-85-3,000 C.

946/ PRIN C IPLES O F FORENSIC MEDICINE
Appendix4
West Bengal Fonn Nci. 5372

POST-MORTEM REPORT
(P R. B. Fonn No. 54- Vide Rule 284)
STATION -----~
The · day of 20
Name, sex, age and caste Whence brought-Village Name of constable by whom Date and bour of lnformatior. ~~.,;~ished By whom identified
and Thana brought_ and name of relatives Despatch Arrival at E.'<amina- by Police before the Medical
accompanying dead·house lion Officer
· N.B.-Observe the slate all the organs and when to disease or 1njury is found write 'Healthy'.
1. Condition of subject-stout, emaciated, 2. Wounds---pos~ion , size, character 3. Bruises-position, size and nature 4. Marks of ligature on neck,
w
dissection, etc.
'"'
~
~
""
1. Scalp--Skull and Vertebrae 2. Melljbrane 3. Brain and Spinal Cord-[The spinal canal need not be examined
unless any inidication of disease or injury exists.]
"'~-
"'""
~~~
"'"'""
'"'"'"'
=~
1. Walls, Ribs and Cartilages 2. Pleurae 3. Larynx and Trachea Right lung Left lung Pericardium Heart Vessels
><
"'""
0
;:
-
1.Walls 2. Perrtoneum 3. Mouth, Pharynx and Oesophagus 4. Stomach and rts contents 5. Small intestine and rts contents 6. Large intestine and rts contents
z
w
"'
~ 7. Liver 8. Spleen 9. Kidneys 10. Bladder 11. Organs of generation, external and internal
;!
1. Injury 2. Disease or deformity 3. Fracture 4. Dislocation
i"' ,_
"'
z
~
) '
OPINION OF THE MEDICAL OFFICER AS TO THE CAUSE OF DEATH REMARKS BY CIVIL SURGEON
N.B.-In the case of wounds note whether there is any indication of
the wounds being homisidal, suicidal or otherwise
Civil Surgeon of
A~$-tanf" $11Pjoop of 'Tk, ,. ·· 1.: : .-,.,dsyto{" 20
(Note- in place of civil surgeon th1s part beaFS ther.emarks and signature of senior medi_C'ahifficerWho is in charge of the mortuary)

APPENDIX I 947
Appendix 5
LABEL ON VISCERA PRESERVED
P.M. No............................................................ Date .......................... ,.......... .Ref. .... .. ..... P.S ............. ....................... ..
. G. D. E. No./Case No./U. D. Case No........... .. .. .............. ............................................. dated ......................... ,............ ~ .. .
Name...,...,.. ,............ ,.. ,.... ,., .. ......... ..... ,,., ... ...... ,..... ,..... .. ...... ,.-...... .......... ............... .. ................... ........................ u • •••• • • • • • ••• •
HJMIC, Male/Female, Aged about ..............................................................................................................years.
Preserved: (1) Viscera: Stomach with whole contents and proximal 50 em; of small intestine, portion of liver, Half of each
kidney, Spinal cord, Lungs, Uterus with appendages. Preservative used S.S. of common salt/Rectified spirit (2) Urine,
Blood; Presentative- (3) Nailcuttings and scrappings (4) Scalp hair (5) Blood soaked in blotting paper, Control blotting
paper, (6) Wearing apparels, !J) Foreign bodies, (8) Vaginal, Urethral swab, Smear, (9) Skin around bum, Gunshot
injury; Injection mark. Strike of which are not applicable.
Date....... .. ................ ....... ...... ......... Signature of the Autopsy Surgeon
Appendix 6
FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR

EXTENsiON OR COMMUTATION OF LEAVE
Signature of applicant or thumb impression .. ................................................. ,... .. .......................... ................................... ..

(To be filled in by the applicant in the presence of the Government Medical Attendant, or Medical Practitioner.)
I ..... ............. ..................... ,................. .................................................. after careful examination of the case hereby certify
that .................................................................... ....................................... whose signature is given above is suffering
from .. ........................................................................................ ,. ........... and I consider that aperiod of absence from duty
of ....................................... ......... with effect from ........................................................ ...... is absolutely necessary for the
restoration of his health.
Signature of Medical Attendant Officer

Date .... ................................ ..
Note: The nature and probable duration of the illness should also be specified. This certificate must be accompanied by
a brief resume of the case giving the nature of the illness, its symptoms, causes and duration.
Appendix7
REPORT ON MEDICAL EXAMINATION OF A MALE SUBJECT

Sex Offence and Estimation of Age
Date ................... .... 20 Time ................... .
Ref :
Name-
Brought by and identified by-
Police Station-
Examined in presence of-
Identification marks- 1.
2.
General configuration and deve!opment Scalp hair-
Mental State- Axillary hair-
Height- Pubic hair-
Weight- Beard-
Moustache-
u Gait-
R J. L Voice-
Teeth-
Total-
(Eruption)
Genitals:-
i: : I I I I I - I 1111111 : :
t
Attrition-
Archus Senilis-
Penis- L Cataract-
Glans Penis & Frenum- Skin Creases-
Presence of Smegma-
Urethral Discharge-
Testicles etc.-
Anus-
Injury on the genitals-
Injury on the body-
Any abnormality I Diseases-
X-ray Examination advised.,.-
X-ray taken on-
X-ray Findings -
Opinion-
Date- Signature of Medical Officer

Official Seal

APPENDIX I 949
REPORT ON MEDICAL EXAMINATION OF AFEMALE SUBJECT

Sex Offence and Estimation of Age
Date ................... .. .. 20 Time ... ........ ....... ..
Ref :
Name-
Brought by and identified by-
Police Station -
Examined in presence of-
Identification marks- 1.
2.
General configuration and development
Mental State-
Height -
Weight - u
R .J.. L
~:
Teeth -
Total-
(Eruption) Attrition-
: 111111111111 1 : :
t
AbOOmen - L
Breasts ................... ................... .. ... .. ... .. ............ Areola ......................... ... .. ........... .. ....... .. Nipples ..................... ............. .
Scalp hair - Pubic hair....:... Axillary hair-
Menstrual history as stated-
Genitals: -
Vulvallnj~ ............................. ............. ..................................... Labia Majora .................................. .... .. ...... .. ......... .. ... .
Lct>ia Minora .... ... .. .. ..... .. .. .. .. .. ... ... .. .. .... .. ..... ... .. ... ... ....... .... ..... ... . ·
Hymen -
Vagina -
Uterus -
Vaginal dscharge/oleeding-
Fourchette ............................ .... ... .......................... .. ................... Fossa navicularis .. ........... .. ...... .. ................................. .
Examination (Easy/Painful)-
Injuries on the body other than those on genitals-
X-ray Examination advised-
Materials preserved-
X-ray taken on -
X-ray Findings -
Opinion-
Date- Signature of Medical Officer

Official Seal

Appendix 9
NOTICE OF POISONING OR DISEASE (IN CASE OF AN EMPLOYEE)
1. Name and address of the Employer ................ .................... ....................... .... ........... ... .................................... .
2. Name of the patient and his work No.: if any ... ..................... ............................ .............................. ............................. ..
3. Address of patient ........... .... .............. ............ .... ..................................... .. .. .......... ..... .. ....... ... .. .. ............................. .
4. Sex and age of the patient ... ............................................... .................................................................................. ..
5. Precise occupation of the patient ... ...... .. .;........ .. ... ... ... .................. .......................................................................... .
6. State exactly what the patient was doing at the time of contacting ................................................. ..
•• •• ••• • •••••••••• • •••••••••••• • •• •• •••• •••••••• •••••••••• ••••••••• •• • • • • ; . , ,., , ••• • •••••• •••• •••••••••••••••••••••••• • , ,,,,,, • •••••••••• • •• • ••• • •••• ••• •••• •• ••• 1••••••••••••••
7. Nature of poisoning or Disease from which the patient is suffering ............................................................ ..

,,, ,,,, ,,, ,........,,,,,.,,,,,,,,,,,,,,,,,, ,,,,,,,, ,,.... .......... ,, ,,, ,, ,,,,,,,,,,,,,,.,,, ... ,..................................................f ...... .. ,................. ..
(Signature of Employer)
Date .......................... .. .
Appendix 10
(List of Notifiable Diseases) (OCCUPATIONAL SOURCES)
1. Lead Tetra-ethyl poisoning.
2. Manganese poisoning or its sequelae.
3. Carbon bisulphide poisoning
4. Benzene poisoning, including poisoning by any of its hormologues their nitre or amide derivatives or its sequelae.
5. Anthrax.
6. Pneumoconiosis.
7. Poisoning by halogens or halogen derivatives of the hydrocarbons of the aliphatic series.
8. Primary epitheliomatous cancer of the skin.

Appendix. 9
NOTICE OF POISONING OR DISEASE (IN CASE OF AN EMPLOYEE)
1. Name and address of the Employer .......... ................. ........... ......................................... ................................. ..
2. Name of the patient and his work No., if any .... ................ .................... ........................................................... ............ ..
3. Address of patient .... ........ .. ........................................................ .. ...... .. ................................................ ................. ..
4. Sex and age of the patient .................................................................................................................................... ..
5. Precise occupation of the patient ... :....................................................................................... ...... .......................... ..
6. State exactly what the patient was doing at the time of contacting ......... .. ............. .............. .. ..... ... .. .
I o o o 0 o o o o o o 0 o o o o 0 o I o o o I o o o o o 0 I o o I o o o o o I 0 o I o o I 0 t o o oI o I 0 t 0 I 0 0 I o o oo o o 0 I 0 o 0 0 0 i oJ o I o f o o o o I o t o 0 I 0 I o o o o o o o 0 j o 0 o 0 I o o o o o o oo o o o o o o o 0 ~ 0 0 o o o o 0 0 o 0 0 0 0 o o 0 0 o o 0 o I I 0 o 0 o o 0 0 t t o o o 0 0 0 • 0 o o o 0 o o 0 0 o I 0 0 I
7. Nature of poisoning or Disease from which the patient is suffering ................ ........................... .. .. ............. ..
............................................................................................................................... ..................(............................. .
(Signature of Employer)
Date ....................... .... ..
Appendix 10
(List of Notifiable Diseases) (OCCUPATIONAL SOURCES)
1. Lead Tetra-ethyl poisoning.
2. Manganese poisoning or its sequelae.
3. Carbon bisulphide poisoning
4. Benzene poisoning, including poisoning by any of its honnologues their nitre or amide derivatives or its sequelae.
5. Anthrax.
6. Pneumoconiosis.
7. Poisoning by halogens or halogen derivatives of the hydrocarbons of the aliphatic series.
8. Primary epitheliomatous cancer of the skin.

APPENDIX I 951
Appendix 11
FORM FOR DESPATCH OF EXHIBITNISCERA
Case No............................. ...................... ... ...... . Police Station ............ ....................................... .
Section of Law ..... .. .... ................... ............ ........ .. District ... ...... .......................................... .......... .
Date .......... .... .......... .. ........... .......20 .......... ........
In all cases where the examination of any material is required at the Laboratory, a copy of this from duly filled in should
accompany the exhibit.
I. NATURE OF CRIME
(This should include nature of charge, brief history and any relevant details.)
'\.
II. LIST OF EXHIBITS SENT FOR EXAMINATION
Label No. Description of the How and when found Ownership of the Remarks
exhibits and by whom exhibit
,,
-, I
~J;;ntd..

Ill. NATURE OF EXAMINATION REQUIRED

(Including any information which will assist the examination)
Full Name Occupation Age Sex Date& Time Whether on bail Court
of arrest or in custody
'•
Date ......................................... ..... . Signature of the Autopsy Surgeon
Memo No ..............., ........................ Dated, the ... ,.. ... .. ..... .. ,.... ...... .. ........... 20 .....:: ..... .
Forwarded to the ............................... .................................. .. ... ·
'
....................................................................................................
·· ······ ··· ····· ···· ··· ··· ····· ······· ········· ······· ··· ···l '' '''''''.' '' ''"' ''''''' '' ' '' '' ' ''''' ' '
s.p. 0 ./Magistrate/Deputy Commissioner of Police

DistricVKolkata
Note: In the 'Nature of Crime' and 'Nature of Examination' care should be taken to ensure that all necessary information
regarding individual samples submitted is included.
In the packing of material for Expert Examination it is important that the specimen or sample should be well protected
against contamination from outside sources. The specimen when received at the Laboratory must be a true
unadulterated sample of the material found at the scene of the crime.
The exhibit should be wrapped in either clean white glazed paper, or in'a cellophane, and sh.ould be clearly and
distinctly marked. Small exhibits such as hair, fibres, dusts,.etc. should be packed in glass 'tube if possible or in
cellophane card envelopes.
Liquid should be packed in scrupulously clean, glass-stoppered bottles . and sealed..
Each specimen must be in a separate package, and have a separate label with a distinguishing mark.
Whenever exhibits are required to be returned, a note to this effect may be made in the 'Remarks' column at page
2 under the Head II or else they would be destroyed as usual.
Certified that the Director-cum-Senior Chemical Examiner to the Government of West Bengal has the authority to examine
exhibits sent to him in connection with the case of State versus ... .............,...... .................... under secti~n ......... ., ....... and,
if necessary, to take them to pieces or remove portions for the purposes of the said examination.
Date............. .................... ~ ......... ... . Signature .................................................. .
Place ..... ........................... ...... .. ...... S.D.O./ Magistrate/ D.C
Certified to be signed by a S.D.O. I Magistrate I Dy. Commissio~er of Police ... ;, ...,:.... : ......· Di.stiict t K~lkata , and f~rWarded to the
Director-cum-Senior Chem ical Examiner, Forensic Science Laboratory, Medical College, Kolkata-1'2 witti exhibits ·

APPEN DIX I 953
Appendix 12
SUMMONS TO WITNESS
[No. XXXI, Schedule, V, Act V, 1989]
(Section 68 and252 ofthe Code of Criminal Procedure)
of
WHEREAS complaint has been made before me that
of
(1) State the offence concisely With time and p~ce. has or !s suspected to have committed the offence of (1)
and itappears to me that you are likely to give material evidence for
the prosecution.
you are hereby summoned to appear before this Court on the

(2) Ot half-past live or as the case may be. next at ten o'clock (2) in the forenoon, to
testify what you know concerning the matter of the said complaint,
. and not to depart thence without leave of the Court; and your are
hereby warned that if you shall without just exces.s neglect or refuse
to appear on the aid date, a warrant will be issued to compel your
attendance:
Given under my hand and the seal of the Court, this day
of
Magistrate

954 I PRINCIPLES OF FORENSIC MEDICIN E
AGE-WISE HEIGHT AND WEIGHT CHART IN GROWING CHILDREN
Boys Girls
Age Height/ Length Weight Height/ Length Weight
in em. in kg. in em. '- in kg.
At birth 50 3.5 49 3
1 M 56 ' 4.5 55 3.5-4
2 Ms 60 5 59 4.5
3 Ms 63 6 61 5.5
6 Ms 68 8 67 7
9 Ms 72 9 71 8.5
1 Ms 77 10 75 9
1- yrs. 82 11 80 10
2 yrs. 86 12 83 11
2- yrs. 90 13 87 12
3 yrs. 92 14 89 13
3- yrs. 95 15 92 14
4 yrs. 99 17 98 16
4- yrs. 104 19 102 17
5 yrs. 107 20 105 18
6 yrs. 112 21 110 19
7 yrs. 117 22 115 21
8 yrs. 129 24 120 23
9 yrs. 132 26 130 25
10 yrs. 138 29 136 28
11 yrs. 143 31 141 30
12 yrs. 150 35 146 33
13 yrs. 155 40 150 39
14 yrs. 162 45 156 44
15 yrs. 167 50 160 47

APPENDIX I 955
Appendix 14
AFFIDAVIT
son of
do hereby declare on solemn affirmation that on day, the 20, I served a

copy of the summons on the reverse issued against
son of
, on the said person by making it over to him personally, or by

leaving it with an adult member of his family, named , who lives with him, or by affixing
it to a conspicuous part of his house or residence.
Datoclthis
The truth of the above was sworn (or
solemnly affirmed) by
in my presence.
Magistrate
The 20

FORM N0.4
(See Rule 7)
MEDICAL CERTIFICATE OF CAUSE OF DEATH
(Hospital In-patients. Not to be used for still births)
To be sent to Registrar along with Form No. 2 (Death Report)
----
Name of the Hospital .................................................... ....................................
I hereby certify that the person whose particulars are given below ded in the hospital in Ward No.......................... on .... ............ .
at ................. AM/PM
NAME OF DECEASED For use of
Sex Age of Death Statistical Office
If 1 year or more, If less than 1 year, If less than one month, If less than one
age in years age in month age in days day, age in hours
1. Male
2. Female
CAUSE OF DEATH Interval between
onset and death
approx.
I (a) ......... .. ... .................................
Immediate cause due to (or as a consequence of)
State the disease, injury or complication which
caused death, not the mode of dying such as
heart failure, asthenia, etc.
Antecedent cause (b) ............................................ ...
due to (or as a consequence of)
Morbid conditions, if any, giving rise to the
above cause, stating underlying conditions last
II (c) ...............................................
Other significant conditions contributing to the .... :................................ ...............
death but not related to the disease or ····················································
condition causing it OO OOOo o O o O o o o o o o o o o t o o o n o . . OOOOOOO o OoOoo . . oooUOO . .
Manner of Death How did the injury occur?

1. Natural 2. Accident 3. Suicide 4. Homicide
5. Pending investigation
If deceased was a female was pregnancy associated with the death 1. Yes 2. No
If yes, was there a delivery? 1. Yes 2. No.
Name and signature of Medical Practitioner certifying the cause of death

Date of verification ................................................................................. .
(To be detached and handed over to the relative of the deceased}
Certified that Shri/SmVKum ...... ....... ... .... .... .............. : ................... .. S/W/D of Shri ..... ........... ...... ....... .......... .. ... .
RIO ..........................................................................was admitted to this hospital on ............................................... .
and expired on ......................................... .
Doctor................................................................... .
(Medical Supdt. ·
Name of Hospital)

APPENDIX I 957
Appendix 16
FORMN0.4A
(See Rule 7)
MEDICAL CERTIFICATE OF CAUSE OF DEATH
(For non-institutional de~hs. Not to be used for still births)
To be sent to Registrar along with Form No. 2 (Death Report)
I hereby certify that the deceased Shri/SmUKm ............................................... sonlwife/daugher of ... ........................ .........
resident of .......................................... .. .............................. was under my treatment from ............ .. ............ to .. ................ .
and he/she died on ....................................................at ............ ............ .A.M./P.M.
NAME OF DECEASED For use of
Sex Age of Death Statistical Office
If 1 year or more, If less than 1 year, If less than one month, If less than one
age in years age in month age in days day, age in hours
1. Male
2. Female
CAUSE OF DEATH Interval between
onset and death
approx
I (a) ................................ .. .......... .. .
Immediate cause due to (or as a consequence of)
State the disease, injury or complication which
caused death, not the mode of dying such as
heart failure, asthenia, etc.
Antecedent cause (b) ............. :.................... .. ...........
due to (or as a consequence of)
Morbid conditions, if any, giving rise to the
above cause, stating underlying conditions last
II (c) ...............................................
Other significant conditions contributing to the ................................................. ...
death but not related to the disease or ....................................................
condition causing it ....................................................
If deceased was a female was pregnancy the death associated with 1. Yes 2. No
If yes, was there a delivery? 1. Yes 2. No.
Name and signature of Medical Practitioner certifying the cause of death

Date of verification .................................. ............................................... .
(To be detached and handed over to the relative of the deceased)
Certified that Shri/SmUKm ............................................................ S/W/D of Shri. ..... ........ .. ........ ... .... .. ... .. ...... .
RIO ..........................................................................was under my treatment from ........................... ...... .. .. ........ .. .
to ............................................and he/she expired on ........................................................... at .. .... ... ............... A.M./P.M.
Doctor
Signature and address of Medical Practitioner/
Medical attendant with Registration No.

958 I PRI NCI PLES OF FORENSIC MEDICI NE
Appendix 17
BRAIN-STEM DEATH CERTIFICATE-

(As per Government of India Notification)
(A) PATIENT.DETAILS:
1. Name of the patient M r . / M s . - - - - - - - - - -- - -
S.O./D.O./W.O. Mr. _ _ _ _ _ _ _ _ _ _ _ _ _ __
Sex _ _ _ _ _ _ _ Age _ _ _ _ __
2. Home Address
3. Hospital Number
4. Name and Address of next of kin or person responsible
for the patient (if none exists, this must be specified)
5. Has the patient or next of kin agreed to any transplant?
6. Is this a Police Case? Yes No

(B) PRE-CONDITIONS:
1. Diagnosis: Did the patient suffer from any illness or accident that led to irreversible brain damage? Specify details.
Date and time of accidenUonset of illness

Date and onset of non-responsive coma
2. Findings of Board of Medical Experts:
(1) The following reversible causes of coma have been excluded:
Intoxication (Alcohol)
Depressant Drugs
Relaxants (Neuromuscular blocking agents)
First Medical Examination
1& 2nd
Signatures of
Experts
Second Medical Examination
1& 2nd
Primary Hypothermia
Hypovolumic shock
Metabolic or endocrine disorders
Tests for absence of brain-stem functions
(2) Coma
(3) Cess,ation of spontaneous breathing.
AA Genotyp e of blood/208, 209 legal/660, 668
Abandoning/Abandonment of child/683 method s/66 3
Abdominal colic/783 natural/659
Abduction-see kidnappiug/14 7 pill, use oJ7662
Abetment of commit suicide/33 1, 332 postmortem cxaminat ion/665-667
AB Genotype of blood group/208, 209 preserved materials-after/667
ABA card test/201 punishment fcir/660-661
ABO Group fa ctors/202-209 Medical Termination of Pregnancy Act/559, 560
ABO Gmuping/202-209 medicolegal aspects o£'668
body fluid, from/218 spontaneous/659
dandruff/219 stick/662
dental pulp/219 th e rape uti c/660
faeces/219 type/659
hair bulb/174 Abraded Collar/401, 404, 414
maternity exclusion, and/207-213, 656-657 Ab ra sion/339, 340-346
paternity exclusion, and/207 -213, 656-657 ant bite/342
saliva, from/219 antem orte m/342, 343
semen/218, 694 bite mark/117, 118, 290, 341, 693
serum/202, 206, 207 brush/340-342
skin/218 cause/340-342
vaginal fluid/219 cockroach bite/342
Abnormal haemoglobin/214, 215 crescent sbaped/341 , 531
de finition of7340
Aborigins/93
excoriation and/342
Abortifacient agents drugs/661-662, 665, 668
features of7340
ecbo lics/661
friction burn/341
erucnog ogu es/662
gravel mark/341
local acting/662, 663
grazed/34 1, 346
reflexly/662, 663
grievous hurt and/342
systemic/662 impact/340, 467
Abortion/51, 659 imprint/340-34 1, 346
aC'cidental/660 linear/340
crimina l/660 manual strangulation-in case of7531
cau ses of death in/663, 665 m edicolegal importances/341-342
complications of - see causes of death mode of infliction/340
dangers of - see causes of dea th nail scratch/340-342
duties of a medical man in t·elation to/669 parchmentisation/342, 343
fmdings in livings/665 patterned/34-1
incoruplete/666 postmortem/342-343
induced/659, 660 pre ssure/341
instrumeut/662, 663, 666 road tra.flic accidenk-in case of7467
justifiab le/659, 660 scratch/29o; 340-341 , 531, 555, 693, 700

0.')9 CoMC-24
AA Genotype of blood/208, 209 legal/660, 668
Abandoning/Abandonment of child/683 methods/663
Abdominal colic/783 natural/659
Abduction-see kidna ppiug/14 7 pill, use of/662
Abetment of commit suicide/331, 332 postmortem examiuation/665-667
AB Genotype of blood group/208, 209 preserved materials-after/667
ABA card test/201 punishment for/660-661
ABO Group factors/202-209 Medical Termination of Pregnancy Act/559, 560
ABO Grouping/202-209 medicolegal aspects of/668
body fluid, from/218 spontaneous/659
dandruffi'219 stick/662
dental pulp/219 tllerapeutic/660
faeces/219 type/659
hair bulb/17 4 Abraded Collar/401, 404, 414
maternity exclusion, and/207-213, 656-657 Abrasion/339, 340-346
paternity exclusion, and/207 -213, 656-657 ant bite/342
saliva, from/219 antemortem/342, 343
scmen/218, 694 bite mark/117, 118, 290, 341, 693
serum/202, 206, 207 brush/340-342
skin/218 ca use/340-342
vaginal fluid/219 cockroach bite/342
Abnormal haemoglobin/214, 215 crescent shaped/341, 531
Aborigins/93 definition of/340
excoriation and/342
Abortifacient agents drugs/661-662, 665, 668
features of/340
ecbolics/661
friction burn/341
emenogogues/662
gravel mark/341
local acting/662, 663
grazed/341, 346
reflexly/662, 663
grievous hurt and/342
systernic/662 impact/340, 467
Abortion/51, 659 imprint/.340-341, 346
accidental/660 linear/340
crirninal/660 manual strangulation-in case of/531
causes of death in/663, 665 medicolegal importances/341-342
complications of - see causes of death mode of infliction/340
dangers of - see causes of death nail scratch/340-342
duties of a medical man in relation to/669 parchmentisation/342, 343
findings in livings/665 pa tterned/341
incomplete/666 postmortem/342-343
induced/659, 660 pressure/341
instrumeu1J662, 663, 666 road tra-ffic accident-in Calle o£'467
justiflable/659, 660 scratch/29o; 340-341, 531, 555, 693, 700
0.')0
self inflicted/342, 357 Actions of poisons/725"727

sliding/341 Activated charcoal/?:i8
smothering-;-in casE> of/555 Actomyosin comp lex/255
tP.rottling--in case o£'530, 531 Acts of commission/582
time of ·assault- -from/312 of om ission/582 ·
types of/31-0 related ·to drugs· and poisons!72r-'724
we_apon causing/340 related to medical profession/27, 54, 51
Abreaction/50 1 Actus reas/3a7
Abrin/809 Acuk mania/506
Abrus precatorius/809-810 Acquittal/16
accidenta l poisoning--with/810 Addiction (Physical dependence )/844 , 914
appea r ance of seeds o£'809 addicts/842, 844, 849, 914
fatal dose, fatal period of/809 dcfinition/842 .
homicida l use of/810 drugs o£'844, 849, :914
medicolegal aspects o£'810 Additional sessio~s and district courtlll
postmortem findings /810 Additive action . of drugs/855
signs-symptoms of poisoriing/81 0 Adenosine duaminase/2-12
treatment/810 diphosphate/255
Abscess/195 triphosphate/256
Absolute alcohoV297, 731, 749, 845 triphosphatase/256
Absorption band of light in speciro.sr;ope/193-194 Adenylatu kinase/212
Absorption elution test/207 Adepocere change in dead bodies/241, 274
Absorption inhibition test/205 - causes/275
Acaricide/800 distribution/276
Accident, see individual injuries, factors influencing formatio-n of/276
· individual violent asphyxias .a nd poi&ons · mechanism -of forrn atio nf276
Accidental sterilisation/530 medicologal importance/277
Accomplice/519 properties of; chemical and physicaV271, 275
_Adjuvanis/855 · ·
Accused/1 , 7-9, 15
Admission and detention of mentall y liV611-616
Acet a l de hydu/84 7
AdrenaV236, 876
Aceta rson e/7 7 4, 848
Adrenal hypofunction/235 -
Acetic acid/737, 758-759, 859
Adrenal rncdulla/876
Aceton e/808
Adrenaline/850 , 876
Acetylchol.ine/801 -802, 814, 851, 877, 885, 88D
Adrenergic drugs (sympatbomlmeticl/860 876
Acetyl methadoV840
AD.S./235 '
a Acetyl methadol/840
Adsorbents/7 37 , 7a8
p Acetyl methadol/840 Ad ulteration/723 , 724, 854
Acetyl salicylic acid/755-758
of food/723
Achlorohydric subjects/725, 892
drink/723, 724
Acid/737-738, 741, 745-759
Adultery/40, 627, 544, 587, 691, 705
corros ive/745-759 Ad_vanced snakes/823
haematin/194 Ad vertiserpent/38, . 51
inorganic/mineral/? 45-7 52 Advertising/38, 51 '
organic/752-759 Aerophobia/601
phosphatase/217 Aesclopious/24
Aconine/895 Affective disorders/593
Aconite/895 Affiliation cases/656
extract, l-iniment, tincture/895 .A11atoXinl910 ·
root/895 Agar gel electrophoresis/201 .
Aconitine/895 Agar gel precipitin -test/200
Aconitum ferox/894 Agoraphobia/50
li.eterophyl)mli894 Age
napellus/894 of bleeding/191
Acoustic neurolibroma/197 of burn/435 -436
Acquired lmmuno Deficiency Syndrome/585 -589 · of a.l:iraslon/342
(See also AIDS l/585 -589 of bruise/351 -355
Acrodynia/7 89 of incision/364-3G5
Aero -reaction test/457 of puberty/ 108
Actin fil aments/256 of injury/191, 342, 351-35q·; 435-436

INDEX I 961
of viability/67 2 legal, ethica l and moral aspects of/588--590

from bon e/122- 138 medical problems of/586-587
from teeth/109-11 5 M.T.P . and/588
estimat ion/14 p a renteral drugs/588
after birth/1 07-115 patients ' needs/589
before birth/123- 143 poligamy/588
error, in/145 prosiitutes/587 -588
from bea rds/108, 173-174 visitors of/587
bones/ 122-1 38 quarentine mcasures/588
carpals/124 , 130-131 re medy/587
fe mur/125 -1 27 rules/588
fibula/125-126, 127 sex partners and/587
fonta ne lle/136 sub-saha ran countires· · in/586
gustaffsons formula/112-115 transport ation of/587
treatment of/587-589
hair growth/173-171
Uganda--in/589
long bones/122-131
USA- in/585
mandible/131-132
vaccine againstJ589-590
medullary indices/103
virus/585
menopause/109, 14 7 AIH (Art insemination homologous )/631
pubic hair/108, 173-174 Air blustJ460
pubic symphysis/1:"!2, 133, 145 Air embolism/228, 233 , 383, 584
pupillary membr:.me/142 gun/419
physical (morphological ) Ajoan/819
features/95-96 Akanda/815
sacrum/125 Alcohols/237, 731, 749, 754, 845-854, 914
sternum/124, 126 absorption, distribution, fate , excretion/846-8 47
teeth/109-115 absolute/846
tibia/125, 127 action of/846
Agender/1 04 a ccustomed to/609
Agent/52 acute intoxi cation with/846-852
Agent ora nge/80 7 addiction/849, 9 11
Agglui in ation/204-207 a myl/846
- test for pregnancy/649-650 chronic use of/818-849
Agglutinin/202 comme rcial production/815-846
Agglut inogen/202
Aggressive/603, 608-609
Aggrieve/3 37
Agitated/601, 607, 608
blood
brain
C~F
I
concentration in
846-847
Agric ul t ura l exposure/776 unne
Agricultural insecticides/724, 775, 779, 799, 800 danger of driving (and)/847-848, 852
Agricultural poisons/799 dehydrogen ase/858
Agrofuron/806 distribution/846
A.I.D. (arti fi cia l insemination donor)/631 drinkers/845
AIDs (acquired immuno deficiency ethyV845-852
excretion/84 6-84 7
syndrome)/585-590
fatal dose and fatal period/846
attitude and problems of others/588-590
hang over/848
bisexuals and/587, 589
hazards of/851-852
blood t ransfusion and/558 indulgence to/628
cross infection/589 intoxication/846-852
di a gnosis of/586 isopropyl/816 , 854
dispo sa ble syringe- use of/588 metabolisrn/846-848
DNA study of virus/586 medicolega l importances/851-852
drug abuse and/588 methyl alcohol/852-854
fatility of/586 (see methyl alcohol)
heterosexual practice and/587 nystagmus/84 7, 850
high risk subjects of/588 postmortem examination/851
homosexuals and/587 materials preserved during/851
human immunovirus/585-589 preparations of/845-846
(HlVJ properties of/845
[F. M. - 61]
962 I PRINCIPLES OF FORENSIC MEDICINI~
signs and symptoms after use of/847-848 Ammonium bromide/857

tolerance/84 7 carbonate/734, 759
toxicity of/846 hydroxide/759-760
treatment of intoxication/848-849 sulphide/194
uses/845 Ammunitions/385 , 391, 511
Alcoholic Amnesia/599
anonymous/849 antegradc/599
confusional insanity/84 9 retrogradc/599
drinks/8t16 Amnesty lntcrnational/85
drunkenness/850 Amniotic !1uid/647, 650, 663, 677-678
Alcoholism/848 Ampcrage/452, 456, 459
Alcometer/851 Amphctamine/842, 857 , 859-860, 876, 914, 916
Aldcarb/800, 806 Amphibians-poisonous/834
Aldrine/800, 804 Amphibians, RBC of/193
Algolagnia-see sadism/717 Amphisbaenia/823
Algor mortis-see · cooling of dead bodies/245-249 Amputation/367 , 508
Alimentary causes of sudden death (G.I. causes)/229 Amputation of penis/697, 715, 717
Alkalies/737, 741, 747, 759, 760 Amsania/876
antidote (as)/747 Amyl nitrite/893
corrosive/741, 759-760 Amylase/218, 280
Alkaline haematin/194 Amyotrophic lateral sclerosis/789
phenophthaline/195 Anacardium occidentale/817
phosphatase/355 Anaemia/238, 782
Alkaloids of opium/839-840 Anaerobic spore bearing bacilli/263
Alkyl mercurial compounds/799 Anatomy/!
• organophosphorus compounds/799, 800-804 Anaesthesia/57, 69, 862, 882, 887-890
Allelomorphic genes/209 death during/887
Alliga tor/823 general/887 -888
Allethrin/806 local/889
Alma-ata-declaration/585 planes/887
Aloe/817 spinal/862, 888
vera/817 stages/887
Alopecia/778, 784, 792 su rgical/887
Alpha acetyl methadone/840 types/888
Alphonse Bertillon/157 Anaesthetic agents/855 , 859, 887-889
Alphos/806 Anesthetic; Basal/887
Alpinia Galanga/901 Anal canal-prolapse of/709
Alprazolam/878 Anal coitus (see sodomy)/705 -711
Altered blood/191 Analeptics/740, 857
Alternate current/452 Analgesic/840, 844 , 855
Aluminium phosphide/806 Anaphylactoid reaction to drugs/229, 234-235
Alveolar duct membrane/678 Anaphylaxis/59, 229, 234-235, 757, 769, 791
sacs/678 Androgynae/1 04
wall-rupture of/544 Anencephaly/678
Alvcoli/544 Aneurism/492
Amanita Muscaria/910 Anhalonine/87 4
Amanita Pantherina/910 Anhydrous ammonia/759
Phalloidus/910 Aniline-PM staining/255
Ambivalence/601 Animal irritants/724, 741, 823-837
Ambu bag/740 Anky losis/836
Amenorrhoea in pregnancy/644-645 Annoy/337
Amentia/607 Annoyance/19 , 724
American lnd.ians/92 Anoxia/238
Law lnst. reco=endations/618 type of/239
Amino acid nitrogen (PM)/279-280 Antabuse/848
Amino-oxidase inhibitor/860 Antagonist/855
Am.inopeptidase/355 Ant bite abrasion (PM)/342, 344
Aminophylene/740 Antemortem
3-Aminopthal hydrazide/196 a brasion/34 3
Amplified FLP (DNA studyi/185 hypostasis/253
Ammonia/262, 276, 279, 759 wound/340

INDEX I 963
An ihraqu inone/820 bisulphide/774

Anthropologist1933 chronic poisoning/776-778
Ant hropometry (identifica tion)/157- 158 compounds/7 73
Ant imony/796 di stribution in body/774-775
Antimony sulphide/392 dust1775
Anti A Serum/202 , 204 -206 epidemiology of poisoning/779
Anti abrin/810 excret ion/77 5-776
Anti B serum/202, 204-206 homicidal agent (as)/779
Ant ibody/20 1-202 , 201, 210-211 hydride/773
Anticoagulants/BOO, 829 m edicolegal importance/779
Mee's line/775
Anticonvulant1740, 855
organic compounds of/774
Anti D serum/210-211
ox.ide/773
Antidote for individual poisons/737-739
PM examination/778
Antidepressants/859 salts of/773-774
Antigen/201-205 , 207-212 signs and symptom of acute poisoning/775
Antiglobulin - As in antigen and antibody/ chronic/776-778
technique of blood grouping/203-207 , 809 toxicity/773
AI{ti 1-l serum (antihuman serum )/205-206 trioxide/774
Anti histamine/833 trisulphide/774
Antihuman globulin consumption test/199-201 uses of/773, 774
Anti pyretics/740, 757 whiie/773
Antiseptic/754 Arsenious oxide/773 , 774
Antisera/201-205 Arsenoph agist1779
Anti snake venom sera/789, sao Arsenuret ted hydroge nf77 4
Aniivenin/830 f\rs ine/774
Anus/705 , 706-710 signs and symptoms/774
Anxiety disorder/596 source/773 -77 4
Apathy/601 treatment177 4
Aphrodisiac agents/628, 841, 852, 868 Arson/441 , 765
Apollo/24 Arsphenamine/774
Apomorphine hydrochloride/7 34 Artefact1302
Apoplexy/519, 530 Arteries-tearing of/522
Apparent death/226 Arteriosclerosis/7 84
Arteriovenous communica tion/496
AppeaV17
Artificial insemination/52, 59, 631-633
against State Medical CounciV29
donor (AID )/heterologus/631
Appeal case/17
homologus (AIH)/631
Appendicitis/229
indica tions/632
Appetiie/607
legal and social complications/632
Aquatic animals-gnawing by/270 recommended guidelines/632
Aquous ammonia/759 types/631
Arachnoiditis/888 Artificial phallus/711
Arachis oiV738 " preservation of dead bodies/282-283
Arand/810-811 Artificial respiration/676, 740, 841, 853, 857, 862,
Arborescent marks/459 863, 865, 868, 869, 877
Arch eye/455 respiration, Holger Nielson method/740, 893
Archus senilis/109, 145 respiration, mouth to mouth/740
Areola of breast in pregnancy/645 circulation/740
Arecholine/87'/ Aryl organophosphorus compounds/800-806
Argimone Mexicana/817 , 909 Asafoetida/820
Arrhythm ia/232 Asklcpios/24
Argimone oiV909 Aschheim Zondek test/648
Aristoiocia lndica/821 Asphyxia/238-24 1
Aristolocin/821 causes/238-239
Arousal (sexuall/625 mechanicaV238
ArrestJ7, 9 pa thogene:sis/239-240
Arrow poison/810, 812, 816, 896 pathology/239
Arrow strike/375 PM findings/240
Arsenic/773-780 signs and symptoms (manifestation) of asphyxial
absorption/774 239
acute poisoning/775-776 (stages)

stigmata/241 examination of exhumed body/298

trauma tic/23 9 external examination/289-291
Asphyxiants/741, 903-907 internal examination/291-296
classification of/238-239, 903 preservation of materials/296-298
Aspidium/521 pathological/287
Aspiration inhalation/734, 736 Auto-stress disorder (stress disorder)/598
Aspirin/756-758 Austria/73
Assailant/512 Aviation accident/4 75-4 77
Assault/20, 33, 69, 335 airforce aircrafts/4 75
indecent/74, 687, 712-713 air pockets and/476
Ataicha/894 blazing of planes/4 76
Atavism/656 civil/4 76
Atelectasis/678 cockpit/-177
Atish/894 canopy/4 77
cras hing of planes/476
Ativisha/894
d!!compression syndrome/476
Ativadayam/894
emergency evacuation , in case of/477
Atmosphere influencing
adepocere change/276 factors responsible/4 76
cooling of dead bodies/24 7 hazards of aviation/476
human (pilot) error responsible for
decomposition/269
mummification/273 accident/4 76
rigor roortis/21i8 hypoxia in air journey/476
Atomic absorption spectrophot~roeiry/321 , 417 identification of victims/476
Atoroiser/196 investigation of/4 75
Atrocity/569 lightning stroke-cause of/4 77
Atropa Acuminata/868 parachute, use of/477
Atropa belladona- see Belladona/866 reconstruction, of/4 76
Atropinase/867 Avoidable consequences rule/68
Atropine/867 -868 Avulsion laceration/358
Attention deficit disorder/601 Axillary hair/108, 144, 175
Attorneys/926 Axobenzene/800
Ayurvedic and Unani Drugs
ATS/2a5
Attrition of teeth/112-113 Technical Advisory Hoard/722
Auditory hallucination/594 Ajowan (Khorasani )/866
Auricular librillation/428 Azospermia/107 , 628
Auricular septal dcfl.'ct/516
Auscultation of heart/242 , 671
Australia/71 Bacillary dyscntery/729
Auto-erotic asphyxia/528, 539, 563 , 718 13acteraemia/584, 667
Autolysis/263 13ailable/18
Autolytic decomposition/673 HAL- see British antilewisite/738
Automatic guns/391 Haldness/174
Automatic obedience/605 Ba llistics/316
lJallotmcnt (pregnancy)/647
Automatism
Barbiturate/855 Banded Krait (chart )/829
Postepileptic/606 Bansdolla/533
Somnambulislic/600 Barbaloin/817
Autonomic excitant/875-877 Harbitone/855
Barbiturate/733, 738, 740, 741, 843, 854, 855-858,
reactivity/593
Autopsy/6, 20, 287-302 862, 863, 888
absorption, distribution, fate, excretion/855
acadernid287
medico legal/287-302 action/855
model protocol (N HRC)/923 -942 additive/855
prereq uisites/288-289 duration of/855
procedure/289-3 12 automatism/855, 857
purposes/287 -288 blisters/856
dependence/857, 914
room/924
fatal dose and fatal period (chart)/855
stages/288-298
examination of charred body/299-300 medicolegal aspects/857
examination of multilated or/298-299 PM findings/857
dismembered body parts/298-299 signs and symptoms/855-856

INDEX I 965
treatment/856-85 7 B group factor of blood/202-206

type/855 Bhalia/812-814
uses/855 Bhang/871
Barbituric acid/855 BhilawonoV812
Barium/794 Bicondylar width of femur (chart)/101
carbonate/794 Bigende r/104
chloride/794 Bile/267
hydrate/794 Billiard board ricochet bullet/408
nitrate/794 Biological tests for pregnancy/648-649
sulphate/794 Biological warfare/73
sulphide/794 Biomedical research/74
Barr body/103 Biomedical waste
Barrel of a gun/385, 389-391 (Management and Handling Act 1998 )/80
land and groove of/390, 394 Bipolar disorder (manic depressive prychosisl/607
lead or taper/385 Biometric identificaiion/90, 177
muzzle end of/389 Biopsy/103
Bartholin cyst/629 BiosiHsis/226
Basal ganglion/887 Bird shot/393
basophilic stippling/782 Birth, death, marriHge certification Act/81
Bastinado/93 7 Hirth mark/90
Battered child/baby syndrome/569 Birth trauma/680
a etiology/5 72 Bisexuals, pansexuals , polysexuals/104, 587
dealing of the problem/575 Bismuth/796 ·
factors/572 -573 Bite marks/116
identification of/569 Bitter almond/892, 894
treatment of the child/575 Bitter apple/819
type of injuries in/573-574 Black eye/350, 480
Battery/576 Blacken ing of skin/453
Baygon spray, Bait, powder, aerosaV806 Blackmailing/627, 643, 652, 655, 668
Bayonets/389, 390 Black powder/392
BB-Genotype of blood group/208-209 Black spider/833
Bed sore (Picture)/360, 565 Black widow spider/83 3
BarreV385 Black's law dictionary definition of deHth/222
bore/385 lllade (or Hand) guard/376
end (muzzle )/389 Bleaching/766
fouling/416 Bleeding/364, 514, 764
land/390 Blind snake/823
leed/lead/385 Blister/264, 433, 435, 438, 442, 448 (chart), 812, 814
taper/385 (chart)/856
Beards/108 burn injuries/339, 395, 422, 427, 432-442, 453,
growth/144, 281 457, 460
PM timing/281 chemicals, in/351, 763, 765
Beer/846 postmortem/264
Bees/833 scald/442, 448
Bee's stings/833 vegetable irritant, by/812, 814
Belladona/866 Blood/189-215
Benzene HexHchloride/804 Age from/191
Benzidine solution/194 change in chronic lead poisoning/193 , 78·1, 785
Benzidine test for blood/194 drowning/51!
Benzidrine/876 chemical and biochemical change after/279-780
Benzodiazepines/878 death/279-280
Benzpyrine/808 chemical tcst/194-197
Benzyle benzoate/738 clot/364
Benzyle morphine (chartl/839 antemortem/191
Berberine/8 17, 909 postmortem/191
Bertillon's system of identification/157 dyscrasias/229, 255, 355, 490
Bestiality (Zoophilia)/687 , 712 effu sion/346
Betel nut/877 enzymes
Bevelling/363 acid phosphatase/212

966 I PRINCIPLI:S OF rOI~ E NSIC MLDICINE
adenosene deaminase/212 Takayama/197

adenylate kinase/212 'feichman's/198
phosphoglucomutase/213 physical
Red cell, ol/212-213 luminal/196
extravasation of/346 microscopical/192
group factors and grouping and typing/202-212 staining/193
group 'A'/202-207 wet/193
'AB'/202-207 spectroscopic/193
'B'/202-207 seroimmunological/198
cl umping/203-207 grouping tesU203-214
Duffy's system/212 absorption elution/207
genotype/ absorption inhibition/205
-Tables - 5.5, 5.11, pages 208-211,213 agglutination/199
Gm factor/212 mixed agglutination/206
haptoglobin/212 tile method/203
Kell system/211 tube method/203
Kidd system/212 species identification by
Lutherah system/212 antiglobulin consumption/199
'.MN'/209 diffusion precipitation in gel/200
mutation/208 gel electrophoresis/201
'0'/202-207 mixed antiglobulin/200
phenotype/208-21 Jr passive haemagglutination/200
phosphoglucomutase//213 ring precipitation/199
red cell enzyme factor/212 time lapsed after death, from/179-180
Rh allele/211 time lapsed after shedding of/191
Rh factor (Rh typing J/210-211 trace evidence- -as/189-219
secretor/218 transfusion , hazards of/583
'Ss' system/21 0 air embolism/583 -584
identification from/189-215 civil/189 excess volume/583 -584
medicolegal importances ot/189 :::::criminal/190 haemolysed blood/583-584
nucleated RBC in/193 infected blood/583-584
postmortem/191 279-280 infection due to wrong technique/584
preservation of/296-298, 730-732 mismatched transfusion/583
source of/190-193 serological problems/583
abortion/191 sudden death/228
animal/192-193 vessel decomposition/264, 269
arterial/191, 193 worms (Bristle)/837
avian/193 Blue bottle fly/271
bed bug (crushed)/192 Blue line on gum/783
haemoptysis/191 Blue pill (Abortion)/662
haematemesis/191 Blue vitriol/790
marnmal/193 Blueman Black's class. of race/91
menstrual/191 Bluish PM staining/250, 252, 255
mosquito (crushed )/192 Blunt force injury/339
species/199-201 Blunt weapons/340, 346, 355
venous/191, 193 Boa/823
spectra/194 Boa's tube/734
stain extracU192-193 Hobbit syndrome/715 , 717
tests/193-216 Body (dead)
chemical/194-196 adepocere change/241 , 274
benzidine/194 cooling of/241, 245-249
Kastle Meyer's/195 decomposition of/241, 262-272
leucomalachite green/195 mummification/241, 273-27 4
merits and demerits of/196 pouch/925
orthotoludine blue/195 preservation of/282-284
phenolphthalein/195 primary relaxation ol7241, 243
crystal/197 -198 pugilistic attitude ol7436
haemin/198 rigidity ol7256-262
haemoc h romogen/197 resistance to electricity/452
haemoglobin, for/197 -198 secondary relaxation/262 (table)
microchemical/197 -198 surface area calculation/234

INDEX I 967
Bodily injury (hurt)/329-330, 332-:-133 BrPast

Boidae/823 changes in pregnancy/645
Boidea/823 nodular/645
Bolt breach action of gun/389, :-!91 pendulous/640, 615
Bomb explosion injury/420-424 virgin, of/639
Bone Breath analyser/851
age from/119, 122, 124-145 Breath analysis/851
ages of ossification of/122-138 Brengun/391
changes in chronic lead poisoning/782-784 Bride of bath case/551
changes in old ages/131-138 Bristle worm/836
charring/299-300, 437 British antilewisi te/738
cause of death, from/300-301 British Medical Council/26
destruction of/264 British pharmacopocia/840
examination in arsenic poisoning/300, 779-780 Bronchoscopy/65
fracture of/301, 480-487 Bromide poisoning/857
gwishot wound of skull/482 (picture), 485 Bromoacetone/807
identification from/93, 97-102, 122-138, 143-144, Bromobenzyle cyanide/807
148-151, 177-179 Bromoderma/768
medicolegal importance of skeletal/ Bromomethyl ethyl kctone/807
remains/300-301 Bronchus in drowning/514
Bronzed pigmentation/774
medicolegal questions related to-
Brown spider/833
pearl wax dipping/460
Brucine/881
race from/92-93
Bruise/316-355
sex from/96-103
abraded/346, 351 (table)
stature from/148 - 152
adenosine triphosphatase activity in/355
time of death from/301
age of/351-352
Bone-Pearls/wax dippings/460 alkaline phosphatase activity in bruise/355
Borax/662 aminopeptidase activity in/355
Bore of a barrel/385 bile pigment causing colour change/352
Boyde's formula/115 blood dyscrasias lesions and causes/350
Botulin poison/909 chemical lesions and/351 (table)
Botulin toxicity/909 cholinesterase activity in/355
Boxer's attitude of dead body/436 colour change/352
Brachial index/93 complexion of person/350
Brachy cephalic skull/93 congestion and/351 (table)
Bradyk.inin/834 deep bruise/350
Brain definition of/34
abscess/234, 496 delayed/350
alcohol concentration of/846 echhymosis/348
death/224 elastic fibre proliferation in/355
declaration/225 factors influencing formation of/348, 350
definition/224 false bruise/351
signs/225 features of/346
tests/225 fibrinous network formation in/355
chemical activity/839 fibroblatitic proliferation in/355
decomposi tion/267 haemophilia, and/350
dissection/295-296 haemorrhagic spots, and/350
haemorrhage in/490-4-95 , 843 haematoidin pigment in/352
injury of/4.68, 490-499, 843 in leukaemia/350
laceration of/495-496 macrophages in/355
liquefaction/269 medicolegal importances o!i'350
preservation/296, 731 not fabricated/350
tumour of/4-97 neutrophilic infiltration in/355
structural deffect/604 other lesions like chemical lesion/351
stem injury/382 pattemed/350, 355
Braxton-Hick's sign of pregnancy/64 7-648 postmortem/355
Breach of trust/promise/643 postmortem staining and/254 (table)
Breach end/plate cf barrel/389 (Breach mechanism) pigmentation/352
Breach loading of gun/389 quality of force/348
Breaslau's second life test/679 quantity of force/348

railway track/350 classification of injuries-

sex, and/348 classification on the basis of BSN434
shifting of/350 dupuytren/433
site of application of force and/348 modern/434
time of assault from/351, 355 recent classification/434
tram line/350 Wilson's/433
types of weapon of infliction/346, 350 complication/435
whooping cough and/350 conflagration/439
Buccal coitus/687, 711-712 contracture in/435
t es_.....-cunnilingus/712 cooking gas, fire, from/44-0
yp -.......fellatio/712 Crocodyle flash/454
Buccal squamous cell/103 Curling's ulcer in/4:38
Buck shots/393 deep/434
dermal/433 -441
Bufogenins/834
degree ofi'433, 435
Bufotenidine/834
disfigurement due to/433
Bufothionine/834 ·
due to-
Bufotoxins/834 arson/441
Bufoviridine/834 cooking gas fire/440
Buggery- see sodomy/706 electric current/44 0, 453
Bulbar paralysis/892 fire works/440, 763
Bullae (b lister)-- see also blister flame/440
in heart (PM)/269 free flame/440
lungs/676 hot metal/440
B ullets/393-394 inflammable synthetic clothes/440
back spatter/407 lightning/460
billiard board richochet/408 endogenous burn/457
dumdum/407 exogenous burn/457
frangible/ 408 face, of/509
graze/395 fencing attitude in dead bodies due to/436
injury due to/400-409 heat haematoma in/437
piggy tail/408 heat fracture/437
plastic/393, 419 heat laceration/437
primary markings on/415 heat rupture/437
ricochet/407 homicidal/441
rubber/393, 419 honeycomb haematoma/437
secondary markings on/415, 416 hyperaemic line around/433
shape of nose of/394 Joule burn/1, 457
kidney failure/436
slap/395
medicolegal aspects of/438-442
spinning revolution ofi'390
molotov cocktail bomb/441
striking range of/399 (tablel
neck, over/509
tandem/407 postmortem/441
types of/394 postmortem examination in death due to/436-
Bulky food/736 438
Buoyancy of body/540 postmortem staining in death due to/255, 436
Buoyancy of lungs/677 prognosis in case of/435
Burden/62 factors influencing/434
Burking/562-563 pudendal region, ofi'434 (chart)
Burma/28 pugilistic attitude in/436
Bums/buming/427, 432-442 rule of '9' related to/434
accidental/439-440 scar formation in/435
acid/741, 745-752 signs and symptoms ofi'435
age of/735-736 singeing of hair in/176, 436-437
antemortem/438-439 s uicidal/140-141
arson cases, in/765, 441 superficial/433-434
blister formation in/433, 436 surface area calculation ofi'434
bones ofi'300, 433, 437 time passed after/441
boxer's posture in dead bodies in/436 Bursting of cranium/399, 400 (chart)
causes of death due to/436 Burtonian line/783
charring in/300, 437, 441 Business contract and insanity/621
chemical/432, 745-752 Butacaine/862

INDEX I 969
Butenine/834 Capgrass syndrome/605

Buto-phenon/878 Capillary dilatation/239
Butt of a gun/385 Capillary permeability/239-240
Capillary rupture/240
Capillary stasis/240
Cadaveric rigidity/256-262 Capital punishment (Death Sentence)/10
Cadaveric spasm/260-261 Capsaicin/826
Cafe coronary/56 1 Ca psicin/826
Caffeine/863-864 Capsicum annum/826
et sodi benzoate/863 Caput succedancum/676
Caffey/569 CarbachoV877
Caffey's syndrome/569 Carbamate/806
Caisson's disease/233 Carbameza pine/8 7 8
Calcaneum/125 (Table 13) Carbarson/77 4
Calcium CarbaryV/806
bromide/857 Carbines/389
glucomite/753, 810, 833 Carbofuran/806
hydroxide/759 Carbolic acid/754-756
oxalate/753 Carbolic acid poisoning/754-756, 843
soap/276
Carbolic smelll754
Calculated risk/66
Carbolism/754
Calibre of a gun/394
Carboluria/755
California mussels/837
Carbon-14 (C 14 )/281-282
Calliphora
Carbon dioxide poisoning/741 , 903-904
erythroca phila/2 71
vinia/271 Carbon monoxide poisoning/728, 741, 903, 904-906
CalomeV786 Carbon tetrachloride/729, 741
Calories given by alcohoV84 7 Carbonic anhydrase/739
Calotoxin/815 Carbonyl chloride/769
Ca!otropin/815 Carboxy-haemoglobin/255, 437, 904
Calotropis gigantea/815-816 Cardiac arrest/228, 740
Calotropis procera/815-816 Cardiac causes of sudden death/228
Camel's RBC/193 Cardiac depressant/895, 899, 901
Camphor (C0Cl 2 )/818, 862 Cardiac massage/740
spirit o£1862 Cardiac poisons/891-901
Camalia sinensis/869 Cardiac stimulants/740, 896, 898
Canine tooth/109-112 Cardiac tamponade/383
Cannabis/870-873 CardiazoV868
absorption , fate and excretion/872 Cardiomyopathy/cardiopathy/232, 784
action/872 Cardiotoxic agents/836
active principles/871 Cardiotoxins/829
bhang/871 Cardiovascular causes of sudden death/228
charas/872 CardoV817
chronic use/873 Caressing/711
fatal dose/873 Cariophy llin/820
ganja/871 Carnal
indica/870 Carnivorous/825
medicolegal a spects/873 Carotid artery/366 (table), 499, 519, 522
mexicana/870 Carpal bones/124
plant/871 Cartridge/392-393
PM fmdings in death due to/873 case/392-393
preparations/871-872 content/392, 393, 394
reefer/872 empty case/391, 420
resinous extract o£1872 Tandem/408
sativa/870 Carum copticum/819
signs and symptoms in acute intoxication/872 Carunculae hymenalis/638
treatment of intoxication with/872 Carunculae myrtiformis/638
CannabinoV871 Case
Cannelure/393 civil/9
Cantharides/831 cognizable/10
Cantharidin/831 non-cognizable/10

complaint/10 poisons/226, 238-239, 839-879

criminal/9-10 stimu Jan ts/859-876
police/10 softening (brain)/267, 496
summons/10 Cerebrospinal fluid/280
types ofi'9 time of death from study of/280
warrant/10 Certificatc/14, 32,40, 54-55, 70, 513, 948, 949, 956,
Cashew nut/817 957, 958
Casper rule/270 age/948, 949
fitness/14 , 51, 56, 956, 957, 958
Cassia Augusti folia/820
injury/513
Castor/810-811
postmortem/vide also human right protocol/946
Castration/707, 708 sex offcnce/948, 949
Cat fish/835 sick.ness/14, 54, 56
Catacheu/877 Cervical tear in abortion/666
Catamiten06, 708 Cervical tear in delivery/653, 655
Cataract/109, 289, _454, 472 Cervical tear in parous women/654 (table), 655
Catatonic excitement/605 Cervical vert. fracture/499
schizophrenia/605 judicial hanging/522
stupor/605 strangulation/499, 533
Catecholamines/829, 863 Cervix
Caterpillars/761 abortion, in (os)/666
Catheterisation (intracardiac )/457 delivery, in/653
Cattle poison/741, 810, 900 parous women in/655
Caucasians/Caucasoids/91 pregnancy in/646-64 7
Causes of death/79, 226, 228, 229, 236, 287, 455, Chairman Zilla Parishad/52
518-519, 529-530, and other individual cases Chamber of firearm weapons/385
cone, lead, taper of/385
~elaye~ J Appendix 4 and 4A
Chancre of vulva/629
1mmed1ate
Changes after death/241-284
Caustic al.kalies/741, 759
in blood/277, 279-280
Cellular death/223
in body temperature/245-249
Celphos/406 in CSF/280
Cementum apposition in teeth/113 in eye/243-245
Centipedes/833 in. muscles/243, 256-262
Central Drug Laboratory/722 Character of a physician/32
Central nervous system causes of sudden death/229 Charas/872 .
Central nervous system poisons/741, 839-879, 881-883 Charcoal/73 7-738
Cephalhaematoma/676 Charring/437, 441, 453, 748
Cephalic index/93 Catecholamine/863
dolico cephalic/93 Cheiloscopy (lip print)/168
mesati cephalic/93 Chelating agent/737, 738, 739
bracephalic/93 Chemical antidotc/737 -738
Cepheline/90 1 Chemical burn/449-450
Cerbera thevetia/899 Chemical test for blood/194-196
Cerberin/899 Chemical test for poison/732 and individual poisons
Cere bell um/296 Chemical transmitter/SOl
Cerebral- Cherin/818
abscess/496 Cheese cutter method/530
Chest injuries/500-504
anaemia/519, 530-531
Cheyne stokes breathing/840
apoplexy/519, 530-531
Child labour/575
arteries/497 (Fig.)
Chilli/816-817
compression/490 Chinerariaefoliurn/818
concussion/487 -489 Chinerin, I, II/818
depressan ts/83 9-85 9 Chirukattali/817
depression in general anaesthesia/887 -888 Chitra/816
haemorrhage/490-495, 843 Chloracetaphenone/807
inj ury/492-498 Chloral hydrate/858
ischaemia/519 Chloraluric acid/858
malaria/229, 843 Chlorate of sodium/799
oedema/740 Chlorbenzylate/800

INDEX I 971
Chlordane/800, 804 delivery/652

Chlordiazepoxide/878, 914 insanity/591 -592, 617-622
Chloride level of blood in drowning/541 pregnancy/644
Chlorinated hydrocarbons/804 courts/8, 10-12, 16-20, 55
Chlorine gas/766 mal practice/61-65
Chloroacetylenone/807 negligence/61 -65
Chloroform/861 , 888 procedure, code of/5
Chlorophenothane (DDT)/804 Classification of poisons/7 40-7 41
Chloropicrin/807 according to motive and nature of use/7 40-7 41
Chlorpromazine/842, 848-849 , 878-879 according to site and mode of action/740-741
Chlorothion/800 according to sour~e of poisons/7 40-7 41
China/2 , 871 Claustradium Botulinum/909
Choking (violent asphyxia)/560 Claustradium Welchii/263 , 276
Choking, barrel of gun/390 Claustrophobia/601
Chqking gas/769 Claviceps purpura/814 , 873
Cholinergic agen t/801 , 877 Clavicle/123 , 128 (picture )
Cholinesterase/801 , 829, 861 (ossification of medial end of)
Chondrodendrom tomentosum/885 Cleaning agents (soaps and detergents )/771
Chop wound/367, 373 (picture ), 375 Cleavages/362
heel end of/373, 375 Clinical death (somatic death)/223
MLI of/375 Clitoris/625-626, 638, 711
toe end of/373, 375· · Cloaca/649
Chopped hair/762 Cloning/76, 634-635, 657
Chorea/608 cellular/634
Chorionepithelioma/649 molecular/634
Chromatography (column, gas, organism/635
paper, thin la yer), technique of/316-318, 733 other aspects/635
Chroma tolysis/459 reproductive/635
Chromosomes/103 Chloroform/882, 888
Chromosomal abnormality-(see intersex) Clothes in relation to injury/364, 366, 381, 406 (table),
Chronic nephritis/229 410, 412
Chrysanthemum cinerariaefolium/818 cooling of dead body/248
Cicutoxin/870 decomposition/270
Cinchona/897 identification/182
bark/897 injuries/364, 366, 381, 406 (table), 410, 412
cortex/897 poisoning/728, 731
hybrida/897 rape/694, 695, 702
ledgeriana/897 resistance/694
plant/897 sodomy/709-710
Cinchonidine/897 Cloud to earth lightning/458
Cinchonine/897 Cloves/820
Cinerin U818 Coagulase/436, 829
Cinerin IU818 Co-agulation of blood (PMJ/250
Cinehole/818 Coagulation necrosis/454
Cinnamomum camphora- (camphor)/818 Cobra (snake)/823, 827 (table), 829-831
Circle of Willis/497 bite/827, 830-831
Circulation- stoppage of/242-243 fangs/827
Circulatory depressants/895, 899, 903 treatment/830
Circulatory stimulants/740, 896, 898 venom/827 -829
Circumstance of poisoning/724 Coca/860
Circumstantial disability/497 Cocaine/860-862
Circumstantial evidence/13 bug/861
Circumstantiality/602 Cocainism/Cocainomania/861
Citrated calcium carbimide/848 Cockroach bite abrasion (PM)/342
Citric acid/737 Cocao/864
Civil/2 Code of criminal procedure/5
Civil case/5, 9, 10 Code of medical ethics/23-27, 32-35
Civil procedure code/5 (laid down by Indian Medical ·council)/32-35
Civil and social rights/2 Codeine/839, 844-845
related t~ Coffes Arabica/869
abortion/660, 661, 668-669 .Cogniz<J.nce/16

972 I Pf~INCIPLES OF FOI~ENSIC MEDICINI:
Cognizable offence/9 pregnancy/644

Coitus (see also intercourse)/625, 638, 687, 705, 711 suppositious child/655
anal/687, 706 Competency as witness/622
interruptus/631 Complainant/16
oral/687, 711 Complain case/10
vaginal/687 Complexion/90-91
Coke/852 Compose mentis/618
Colchicum Leutium/819 Composition of Indian Medical Council/27
Cold/255, 427-428 Compression of air/459, 460
blood/429 Compression fracture/480
exposure/427 -430 Compromised exam./924
Compulsive conditions (insanity)/593
features of/428-430
Concealed punctured wound/38 1, 382, 662
general effects of/427 -429
Concealed sex/103
in new born/429 Concealment of birth/655
local effects/429-430 Conceive/626
medicolegal aspe"cts/428-429 Concentration camp/567
PM findings/429 Conception/25-26
PM staining/255, 429 Conch shell/836
stiffening of body- and/260, 261 Conclusive evidence/13
transudation of tissue fluid in Concussion
vasodilatation/430 cerebral/487
vasoparalysis/430 spinal (compression)/4 75
Coliky pain in lead poisoning/783 Conduct money/18
Collapse of lungs/228, 233, 269, 376, 503 Confirmatory test for blood/192-193, 197-198
Colliquative change of dead body/261 Conflagration/436
Colocynth/819 Confusional state/593 , 849
Colocynthin/819 Congenital heart disease/228
Colonic lavage/736 " malformation and infant death/680
Colorimeters/319 Congestion/240
Colostrum/645, 653, 665 asphyxia, in/240
Colubridae/823 bruise, and/351 (table)
Colubroidea/823 PM staining, and/254 (table)
Column chromatography/316, 733 Conine/869
Coma/237 Conium maculatum/869
Consciousness/78, 599, 600
alcoholic/84 7
Consciousness· disturbance:
barbiturate poisoning/856
coma/227
carbonmonoxide (C0)/905
delirium/599
intensity/856
semisomnolence/600
opium poisoning/841 somnambulism/599
types/843 Consent/51 , 52, 56, 58, 59, 76-79
Commercial sources of poisons/724 expressed/76
Commission of crime/60 full disclosure/77
Common house fly/270-271 implied/58, 76
Common knowledge/66, 68 informed/77
Common krait/823, 829 insanity and/77, 78
Common salt as emetic/734 intoxication and invalid/77 , 78
Common salt as preservative/297, 7a1 proxy/72, 73
Commotio cerebri/487 Sec 87 IPC/78
Communicable diseases/56, 58, 60 Sec 88 IPC/78
Communication and transportation injury/465-4 78 Sec 89 IPC/78
Community health/37-38 Sec 90 IPC/7 8
Comparison microscope/322, 417 sexual intercourse, for/146, 688, 690
Compensation/5, 10 surrogate/72, 73, 514
Compensation case related to type/76
abortion/668-669 valid/76
delivery/652 verbal/76
impotence/626-627 where necessary/77-79
injury/SO where not necessary/77 -79
medical negligence/64, 69 written/76
posthumous child/644 , 655 Constipation in lead poisoning/783

INDEX I 973
Constitution of lndia/5 Corneal reflex loss of, in death/225 , 243

Constrictive pericarditis/228 Corneoplasty/332
Consultation in medical practice/36-37, 56, 63, 79 Corona/401
Consumation of marriage/626 Coronary thrombosis/228, 229-231
Consumers' Protection Act (CPA or Copra)/81-84 Coroner/7
different fora/81-83 Coroner's court/7 -8
structure/82 Contempt of/9
<
district !eve I
power/82
structure/82
Co roner's inquest/7
Corporate nC'gligence/66
<
national level
power/82
structure/82
Corporobasal index of sacrum/100 (table )
Corpus delicti/13
Corpus luteum/648, 667
<
state level
power/82
how doctors are related/83, 84
Corrosion/480, 728, 745, 752, 754, 759
Corrosive agents/480, 728, 745-760, 786
acids/741
Contact firearm wound/401, 408 inorganic or mineral/745-752
Contact flattening/241, 243, 258 organic/7 52-7 59
Contact Pallor/241, 243, 252 alkalies/741, 759
Contamination/50 sublimate (see mercuric chloride)/786
Contempt of Coroners' court/9 Cortex of hair/171-172
Contempt of court/9, 18 Cortical hypoxia/240
Contracts and insanity/621 Cortisone/830
Contracture/153, 433 Cosmetics/90
Contravention of Drugs Acts/51 Cot death/683-684
Contre-coup fracture/485 Country liquor (co=on alcoholic drink)/853, 868
Contracoup lesion/468, 495 Coup-contre coup phenomena/467-468, 495
Contre-coup lesion to brain/468, 495 Court/8, 10-12, 16-20
Contributory negligence/63, 67 additional sessions/11, 16
Contused collar/401, 406 (table), 415 asstt. sessions/ 11, 16
Contusion--see bruise chief judicial magistrate/11
Contusion of meninges/495 metropolitan magistrate/11, 12
Convict prisoner/58 coroner's/8-9
Conviction of doctor/40 criminal/10, 12
Con vulsan ts/7 41 High/10, 17, 19, 20
Convulsion/740, 774, 783, 797, 802, 805, 811, 818, inquiry of/7, 9
849, 861-862, 865, 881, 896, 9().1 judicial magistrate, 1st class/11
Cooking gas/906 judicial magistrate, 2nd class/11
Cooling chamber/288 juvenile offenders'/11
Cooling of dead bodies/245-2~9 of law/1, 60
factors influencing/247 magistrate/Ill
exponential curve of rate of/246 metropolitan magistrate/11
Marshal and Hore formula of rate of/247 sessions/11
medicolegal aspects of/249 special judicial magistrate/11
process of/245-246 special metropolitan magistrate/12
rate of/247-248 Supreme/10, 17
sigmoid curve of rate of/246 trial, of/11, 16-20
Copper/790-791 Covert incest/705
acetoarsenite/773 CPA/70, 80, 81-84
arsenite/773 CPC/5, 80
chloride/790 Crab/837
subacetate/790 Crab's eye/809
sulphate/790 Crack/860
COPRA (see also CPA)/70, 81-84 Crack burn/454
Coproporphyrine in Cranial cage/479
arsenic poisoning/77 5 Creatine/280
lead poisoning-porphyrinuria/784 Cresol/754
Copyright/38 Crib death/683-684
Coral/836 Cricohyoid Jigament/522
Cord degeneration/862 Cricoid cartilage/530
Corneal hazziness/243 Crime and cruelty at home- see cruelty at home/
Corneal opacity/342 569-581 .

974 I PRINCIPLES OF FORENSIC MEDICIN[
Criminal Custody/6
abortion/659-669 Cut laceration/358
breach of trust/591 , 627, 643, 655 Cut test/243
case/5-6, 16-17 Cut-throat injury/366 (table)
cases in pregnancy/643-644 Cuticle-denudation of/264, 340, 341
courts/10-12 Cuticle of hair/170-171
delivery/652 Cutis anserina (goose skin appearancel/257, 547
force-application of, on/699 Cyanate of potassium/799
intent/330 Cyanides (cyanogen )1728, 892, 903
negligence/61-64 Cyanogen/833 , 892, 903
procedure code/5, 20 cytochrome com bin a tion/893
responsibility/617 -620 Cyanogen and methaemoglobin combination/893
slander/627 Cyanosis/239-240
Crocodylia/823 Cycloneosamandaridine/834
Crochodile flash burn/454 Cycloneosamandione/834
Cross examination in a court/19 Cyclopropane/888
Cross matching of blood-see also disputed paternity/ Cylindrical bore of gun/385, 389
213 Cypermethrin/806
Cross section of hair/171-173 Cytochrome oxidase/893
Crotin/811 Cytrulus colocynthis/819
Croton oiU811
Croton seed/811
Croton tiglium/811 'D' antigen/210-211
Crotoniside/811 Dacoity/335
Crown heel length/138-143 Dacty logra phy/Dactyloscopy/15 8-163
Cr. P.C./5, 6, 80, Chapter 9 and other concerned DaffodiU820
Chapters Damages/10
sec 174 of76 Damage related to professional negligence/61-63 , 65-
sec 176 of76 68
CrueU580 Damage to reputation/329
Cruelty/569-581 Dandruff/218
children, on/569-576 Dangerous Drug Act/722
home, at/569-581 Dangerous injury/332-333
husband, on/580 Dangerous lunatics/610
old and disabled/580 Restraint of/611-616
others/580 Dangerous weapons/383 -334
servants/580 Dangerous wound (see dangerous injury)
wife/576-579 Date-rape-drugs/688
Crural inde;u93 Datura/866
Crush injury/357, 485 alba, fastuosa, niger/866-868
Crushing of chest/500 stramonium/866
Crustacians/835 Davidson body/103
Cryptobiotic/226 DDT/800, 804-806
Cryptorchidism/627 (dichloro-diphenyl-trichloro-ethane)
Crysanthemum cinerariaefolium/818 Dead birth/673
Crystals of oxalate in urine/753 Dead born foetus/672-673
Cuboid/125 signs of7673
Culpable homicide/330-331 De-alkylation/855
amounting to murder/330-331 Death
not amounting to murder/331 adepocere change after/241, 274-277
Cuminum cyminum/819 apparent/226
Cumulative poison/727, 782 brain/224-226
Cunnilingus/712 causes of cellular/223
Cupping/662 certificate of714, 56, 956-958
Cuprimine/739 changes after
Curare/239, 741, 829, 833, 885 chemical and bio-chemicaU278-280
Curetting/663 early/241, 243
Curariform drugs/833, 885 eye, in the/241, 243-245
Curling's ulcer/438 immediate/241-243
Curren's rule/617 late/241, 262-277
Current pearls/460 temperature of body/245-249

INDEX I 975
Defi ciency-men tal/607

Deficiency syndrome/567
cotJcn Definitious of death/222-223
declandiao ~1-224 medicolegal/222-223
definiti ~ others/222
d0011111p15 - after put.refaction}/241, 262-273 Deflorated women/637 -641
electrocution, due tof251-258 Deformity/90
event oll'221-223 Degeneration of intima of vessels/615
infant/671-684 Degenerative condn. of heart/232
instantaneous/892 (HCN) Dehydration/848
lightning/458-46 1 Dehydrobufoienine/834
lividityflS0-256 Dehydrocodeine bitartrate/840
misdiagnosis of/221 Dehydrogenase (lactic)/280
modes of!237-241 Delayed bruise/350
molecula r/223 deaih/240
mummification change after/241, 273-274 meningitis/496
natural/226-229 traumatic apoplexy/494
pH of muscles after/261 (tables), 262 Delirients/741, 866-868
presumption ofdeath/285 Delirium/599, 867
survivorship, in cases of/284-285 tremens/599, 849
primary flaccidity or relaxation aftcr/241 , 262
Delirius mania/606
secondary flaccidity or relaxation/241 , 262
Delivery/652-655
sentence/10, 12 and Chapter 9
forceps/676
somatic/223
lab. investigations/653
suddcn/228-229
signs of recent -in dead/653
suspicious (circumstances, in l/6
-in living/652-653
suspended animation and/226
remo te-in dead/655
systemic/223
time passed after, (estimation of}/277-282 -in Jiving/654-655
trance/226 De lnav/801
types of/223 Deltamethrin/806
Death and postmortem cha nges/221-284 Delusion/594-596
Decapitation/499 MLI/596
Decedant/925 , 929 types/594 -595
Declaration (dying)/15 Delusional disorder/605
Declaration of Dementia/608
Helsinki/74-76 senile/608
Geneva/25 Demerol/845
Medical graduate during registration/53 Demulcents/737
Decamethonium iodide/889 Demyelinating disorder/593
Decomposition of dead bodics/262-273 Demyeli nation/802
cause of death and/272 Dental surgery
changes due io/263-269 gagging/561
colliquative changes in/264 Dentition (See teeth )/109-115 , 476
definition of/268 for identification/115-117, 4 76
destruction of bones in/264 as cause of gagging/561
factors influencing/269-273 Denture/116, 476
gases evolved in/263 Deoxyamphetamine/859
medicolegal importances/273 Depersonalisation/60 1
micro-organisms re sponsible for/263 Depilatory/773, 792
modified/263 Deposition in court/13 , 18-19
onset of/263-264 Depressed comminuted fracture of skull/484
skeletonisation after/261 Depression (mental )/606-607
time of death from/263-273 acute (simple)/606-607
water, (in )/272-273 chronic/607
Deep X-ray/631 seasonal or periodical/607
Defamation/627, 637 simple/606-607
Defective vision/60 Depressive drugs/84-4, 846, 913
Defence counsellor/122 Depressive psychosis/606-607
Defence cuts/365 Derealisation/60 1
Defence wounds/365 Dereliction of duty by a doctor/62

Dermal nitrate test/417 nulliparous and parous uterus/654

Dermatitis due to physical/morphological difference between
chemical agent/771 males and females/95
radiationl761 primary and secondary relaxationl262
vegetable extract/812, 816-817, 820 professional negligence and misconduct/64
Desferrioxamine/739, 792 respired lung and unrespired lung/679
Destroying angel/910 rigor mortis and cadaveric spasm/261
DesquamationJ728, 764, 768, 770 rigor mortis and heat stifft:ming/262
Detergents/771 strychnine poisoning and tetanus/882
Defraction pattern of X-ray/322 suicidal cut throat & homicidal cut throat/366
Dexamphetamine- (Dcxidrine)/859-860 suicidal, homicidal and accidental
Dextrohyasciamine/867 injuries/381-
Dhatura (see Datura )/866 temporary and permanent teeth/110
Diabetes/659 true insanity and feigned insanity/611
Diabetic coma/843 true virgin and fal se virgin/611
Diacetyl morphine/839, 844, 857 virginity and defloration/640-641
Diagnostic misadventure/55 wound of entrance and exit (bullet)/406
Dialysed ironJ776 Digitalis/898
Dialysis/7~7, 788 lanata/898
Diamond powder (dust)/761-762 purpura/898
Diamox1740 Digitalein/899
Diaphanous test/242 Digitalin/899
Diaphoresisl737 Digitonin/899
Diaphragm/802, 829 Digitoxin/899
decomposition of/269 Digoxin/899
Diaphragmatic hernia/383, 516 Dihydroergotamine/814
Diatoms/545-546 Dihydro-diphenyl -trichloroethane (DDT)/800 , 801
test for/546 Dihydromorphine/839, 815
value and fallacy of/546 Dilatation and curettage (abortion)/663
Diazepam/863 , 876, 878, 914 Diluentsl737
Diazinonl800-801 Dilution of poison/733, 736
Dibucaine/862 Dimefox1799
Dieldrinl804 Dimercaprol/738-739
Die thy laminoethanol/8 62 2-3 dimercaptopropanol/738
Difference between: 2-3 dimerca'pto-1-propain sulfonic acidl789
antemortem and PM abrasionl343 Dimercaptopropyl ethyl ether/774
arsenic and cholera/gastro-enteritisl780 2-3 dimercaptosulphonic acidl789
bruise and chemical or vegetable juice Dimethyl tubocura rine/885
lesions/351 Diminished responsibility of insane/498 , 596, 622-623
bruise and congestion/351 Dinitrocresol/799
bruise and lesions by semicarpus anacardium Diphenyl-phylene/418
juice/814 Dipsomania/5 98
bruise and PMS/254 Dipterex1799
burns and scalds/448 Diptheria/228
civil negligence and criminal negligence/64 Direct agglutination test for pregnancy/65 0
cobra and viper snake/827 Direct evidence/13
congestion and PMS/254 Dirt collar/401 , 415
coroner's court and magistrate's court/8 Disability/SO ·.
dying declaration and dying deposition/16 benefit/SO
incised, punctured and lacerated woundl383 degree of/80
magistrate/coroner's inquest and police Dispensation of justice/1
inquestlinvestigation/8 Discharge of froth from mouth and nose/543
male amd female bones- Discharge of patient/79
articulated pel vis/1 01 Disciplinary action on registered medical
femur/101 practitioners/52
hip bone/99 appeal against/30
mandible/98 Diseases causing sudden death/228-229
sacrum/100 Disfiguration amounting to grievous hurt/333
skull/97 Disinfectant/724, 754, 766

INDEX I 977
Disintemment/298, 932-933 antemortem/54 7

Dislocation of bone/333 blood chemistry in/545
Disodium calcium edetate/739 bronchus in/544
(versenate) causes of/548
Dispersion of pellets/396 causes of death in/542
Disposal of dead bodies/283-284 diatoms/5 45 , 546
burial/284 dry drowning/540
cremation/284 fresh water/541
Disproved evidence/13 homicidal/549, 551
Dispute/5 identification of drowned dead bodies/553-554
Dispute and brutality or· cruelty/576 immersion syndrome/541
Disputed matern.ity/190, 207-213, 656-657 lab. findings in/545
Disputed paternity/190, 207-213, 656 larynx in/544
Dissecting aneurysm/496
lungs in/544
Distraction/602
medicolegal questions in/54 7
District Magistrate/7
microscopic tests in/545
Disulfirum/848
mode of (process of)/540
Diuresis/736-737, 857
Dive, divers/541, 549 place of/554
scuba/549 post mortem/54 7
Divorce/626, 637, 644 post mortem fmdings in/542-545
impotence and/626 prevention (of causes)/542
insanity and/621 process of/540
pregnancy and/644 prognosis/542
virginity and defl.oration/637 salt water/540
DNA Card system/186 secondary/541
DNA study and AIDS/586 sequelae of type I/540
AFLP (amplified fragment shallow water/541
length polymorphism)/185 black out/541
Basing on PCR/185-186 signs/542-545
STR/185 stomach in case of/544
DNA study for identification/76, 117, 183-186 suicidal/549
siblings/186 symptoms of/542
by AFLP, PCR technique/185-186 time of death/551
from blood/214 time of drowning/551
other fluid/215, 217, 218 trachea in case of/544
DNA profiling/90, 183-186 treatment/542
tissue/183-186, 218 type-l/540
Doctor type-II-A/541
duties of/32-60 type-Il-B/54 1
in the court/17 -19 types of/540
patient relationship/55 wet/540
Documentary evidence/12, 13-14, 16
Dr. Stanford Emersion Chille/2
Documentary medical evidence/14
Drug(s)/721 , 913
Dogs scent identification/1HZ
abortifacient/66 1-663
Dolichos biflorus/203
Dolicocephalic skull/93 abuse, of/914
"Dolly the sheep"/635 abusers of/913-914
Domestic source of poisoning/724 types of/913-914
Dopa/876 accident (poisons and)/724
Dopamine/862 act/80, 721-724
Dowry and cruelty/331, 578 addiction (physical dependence )/914
Dowry death/331 analyser/851
Dowry harassment/331, 578 anaphylactoid reaction to/229, 757
system/578 and cosmetics Act 1940/51, 80, 722
ng of saliva/520-521 and cosmetics rules of 1945 and 1940/722
Drin k ',"'l.Pisoning/896 and magic remedies Act/723
Drinks-ak'<Jholic-see alcoholic drinks/845 consultative coromittee/722
Driving cap. city in alcoholics/471, 847 control Act 1950/723
Drown ing/540-554 dependence/914
accidenental/548-549 assessment of the problem/916-917
(F. M.- 62]

dealing with the problem/716, 920 Electric amperage/452, 455

factors related to/914-916 Electric current1452
physiological/914 alternative/452
psychological/914 cycles/452
dependent/917 direct1452
peddlers/915 intensity/452, 455
technical advisory board/722 nature of/152
toxicity/659 passage of/152 , 455, 456
traffickers/916 resistance/452, 455, 456
types of users ofi913 wave/459
Drumstick/103 Electrical coagulation necrosis/453 , 455
Drunk/859 Electrical discharge/459
Drunkenness/850 • energy/451
diagnosis/850-852 field/459
haxards/852 force/451
Drunkometer/851 lesions (n ecrosis)/452, 453
Dry submarine/937 at the site of entrance/452
d-tubocurarine/885 at the site of exit1452, 453
Ductus arteriosus/680 Electricity
Ductus venosus/680 amperage/452, 455
Duffy's system of b load grou p/212 distribution system/451 , 452
earthing/452 , 156, 459
Dumdum bullet1108
resistance to/452, 455-156
Duodenal fistula/383
source/451
Duplex cartridge/407
vo ltage/45 1
Dupuytren's classification of burn injuries/433
Electrocution/152-458
Dural venous sinuses/490
acroreaction/157
Durham's rule/617
causes of death/4 55
Duties of a doctor/32-38, 62-63
coagulation necrosis/453-454
to the public and paramedicals/37 eye changes/454-455
consultation/36 arch eye/455
dereliction ofi62 cataract due to/454
in emergency/31 factors influencing action of/455
prescribe medicine/31 features of/156-457
Duties of a patient/66 fmdings in brain in case of/456-457
Dying declaration/14-15 joule · burn/457
Dying deposition/14, 16 judicial/158
Dysarthria/878 homicidal/4 57
Dyspareunia/629 medicolegal aspects of/15 7-158
precautionary measures against (lightning)/161
postmortem findings/456 -457, 460
Earprint identification/157 respiratory arrest in/454, 455
Earthing (of electric current)/452, 456, 459 retrograde amnesia in/454
Ecbolics/661 signs, symptoms of/452-455
Ecchymosis/348, 831, 833 ventricular fibrillation in/454, 455
F.:CG/243 J:<;lectron/323
Echis viper/823 Electron capture detector/317, 733
Echolalia/602 microscope/323
Echopraxia/602 Electrophoresis/318
Ectopic pregnancy- rupture ofi229 gel/318
F.ciogenous burn/457 paper/318
ED'rA---see ethylene diamine lPlra-acctic acid/739 Elephantasis/627
EEG/225, 610, 791 Elimination of poisons/736, 737, 738-739
Effect of gunpowder, smoke, hPat, fire/399, 400-101 , !';lisa test/650
415 el cabellete, saw horse/937
Effusion of blood/346 Electra complex/705
Egg a lbumin/737, 787 el planton/937
Ejacula tion/625-626 el telefone/937
Elapidae/Elapinae/823 el quirofan/937
Elastic fibre/355 Emasculation/332
Elasticity of the skin/241 , 243, 362 Embalming/282

INDEX I 979
bulb pump/282 seizu re/606

Emba lming injection/282 , 283 types/606
a ricrial/282 Epinephrine/83:3
gravity/282 Epiphyseal centres of ossification/1 22-131 , 111 - 14 :l
Embolism/228, 237, 239, :l83 , 501 , 515 8pispadiasis/627
air/228, 239, 583-584 , 666 Epithelial cells
faV239, 388, 505, 508, 516, 663, 666 buccal, for barr hodies/103 , 218
pulmonary/228 , 289 vaginal/1 08
thrombu s/516 for barr bodies/103 , 218
J:o~mbry o/6 3 3, 643 on penis as evidence of sexual
Embryo (hybrid )/635 intercourse/218, 699-700
Emergency/55, 57 Epsom salU461
Emesis/734 EquipmenU68
contra-indications of/734 Erasure of names
Emetics/734 penal/31
tartar/734, 796 of registered medical practioners/31
Bmetine/90 1 Eratomanic/595
Emission spectrograph/320 Erection of
Emmenagogues/662 clitoris/625
Emotion/596 pcnis/625
Emphysema aquosum/544 Erector pilae musclcs/257
Emphysema tous change in lungs/531, 544 Erethism (mercuriall/789
Emph rosthotonus position of tbe body/882 Ergobasine/814
Employees State Insurance AcU55, 80 Ergocornine/814
Encephalitis/229 , 843 Ergocryptine/814
Encephalopathy- Ergocrystine/814
arsenic/778 Ergometrine/814
lead/783 -784 Ergonovine/811
mercury/789 Ergot/814 , 873
thallium/792 abortion, to causc/661
Endocarditis/663 poisoning/811 -815
Endogenous burn/457 Ergotaminc/814
Endometri t is/629 I<:rgotism/814
Endot racheal intubation/739 Ergotoxin/814
Endrin e/800, 804 Error of judgemenV68
En glish law relating to Erythema(burn )/433
infa nticide/336 f<:rythematous patcbt>s/856
mans laughter/337 Erytbroxylum coca/860
murder/336 Esterasc/801
Entomology (Forensic)/270-271 Estimation of time of death/277-282
Environmental Protection AcU80 J<;thanol (Ethyl alcoholl- see alcohol//845
Enzymes/231, 280 Ether/888
Enzymatic study/280 Etheral odour/858
blood, to estimate time of death/280 Ethical contradiction/71
myocardial infarction , for diagnosis of7231 malpractice/52
Eonism/716 Ethics/1-2, 24, 26-27, 32-34, 52, 53, 76
Ephedra aequesetina/876 J<;thics medical/2, 24, 26-27, 32-34, 53
Amsania/876 Ethics and negligence/1 , 62
gerardoama/876 Ethics of research on animals/74, 76
vulfaria/876 !<;thics- medical-code of72, 24
Ephedrine/862, 876 human/631-635
pseudoephidrine/876 Ethiopians/91
Epidemic dropsy/817 l<:thnicity/89, 91 -92
Epideroiological/74 in lndia/89
Epididymis/627 ~':thy! alcohol (see alcohol )/845
Epilepsy/606 Ethyl -amyl-ketone/808
Epileptic insanity/606 Ethyl-bromo-acetate/807
automatism in/606 ~~thylene diamine tt>tra acetic acid/739

980 I PRINCIPLES OF FOI~ENSIC MEDICINE
Ethylene dibromide/800 Eye brow/175

Ettiquate/23-24, 53 Eye change , in
Eucalyptus globulus/818 alcohol intoxication/84 7
Eucalyptus oil/818 aconite poisoning/895
Eugonea caryophyllus/820 morphine poisoning/841
Eunach/104, 707, 708 pos tmortem/243- 245
Eunachoidism/107 Eye features for identification/175 , 177
Euphoria/601 ~~ye lash/1 7 5
Europian community/74
Euthanasia/70-72
Active/71 Fabricated wound/367
Ethical contradiction/71 Facial pallor/243, 782
Involuntary/71 Factors influencing action of poison/725-727
Method of Practice/71 Factory act/81
Non-voluntary/72 Faeces/218
Passive/71 Faecal stain-
Philosophical/71 as trace evidence/218
Position in different countries/70, 71 tests for/218
Religious/71 Edelman's reagenW'218
Voluntary/71-72 vegetable cells in/218
Evacuation of uterus/666
Foetus papyraseous/651
Evaporation/245, 270, 273
Foetus compressus/651
Evidence/7, 12-16
F a laka/957
repository/937
Falanga/957
types/12-13
Falconi syndrom/789
value/13
Fallopian tube/628
Evidential/15
False certificate/32, 61
Ewald's tube/734
False virgin/641
Examination of dead bodies at the scene of
crime/20, 303-312 Fangs of snake/827-828, 830
Examination-in-chief/IS Fat embolism/383, 508, 616, 663
Excavation/932-933 Fate of poisons in the body/725
Excoriation and abrasion/:H2 Fatigueability in pregnancy/645
Excuse to kill/330 Fatty acid in adepocere/276
Execution- judicial/458, 528-529, 536-538 Feather tellt/242
electrocution- by/458 F ecunda-ab-extra/627
hanging, by/528-529 Fecundation ab extra/632
Exhi bi tionism/715, 718 Feeling/595
Exhibitionist/718 Fees/31, 34
Exhumation/8 (table), 298 Feigned insanity/610-611
Expectorant/740 Fellatio/712
Experimental misadvanture/65-66 Felony/337
Experimental treatment/65, 69 Feminist movement/576
Expert witness/12 B'emoral vessel/928
Expiry date medicine/69 Femur-
Explosion injuries/421-425 age from/125
effects of n:Ussile/421 sex from/101 (table)
gross mutilation due to/425 stature/149-152
secondary injuries due to/425 Fencing attitude/436
bullet/393 Fern/821
Explosives/421, 425 Ferric arsen ate/738
Exposure Ferric chloride test/756
to cold/427 -432 Ferric oxide/738, 776
- infant/429 Ferri-et-amon-citroull/791
features/428 Ferrous sulphate/791
local effects/429-430 Fertilisation/643
to heat/430-4-50 (see heat effect of) Fetichism/Fetishism/715, 716
Extortion of confesions or property/334 Fibres/170
Extradural haemorrhage/490 Fibrinogen/7 57
Extradural haematoma due to burn/437 Fibrinolysin/250, 829
Extravasation of blood/346 Fibrinous network/365

980 I PRINCIPLES OF FOf~ENSIC MEDICINE
Ethylene dibromide/800 Eye brow/175

Ettiquate/23 -24, 53 Eye change, in
Eucalyptus globulus/818 alcohol intoxication/847
Eucalyptus oil/818 aconite poisoning/895
Eugonea caryophyllus/820 morphine poisoning/841
Eunach/104, 707, 708 postmortem/243-245
Eunachoidism/107 ~::ye features for identification/175, 177
Euphoria/601 ~~ye lash/175
Europian community/74
Euthanasia/70-72
Active/71 Fabricated wound/367
Ethical contradiction/71 Facial pallor/243, 782
Involuntary/71 Factors influencing action of poison/725-727
Method of Practice/71 Factory act/81
Non-voluntary/72 Faeces/218
Passive/71 Faecal stain-
Philosophical/71 as trace evidence/218
Position in different countries/70, 71 tests for/218
Religious/71 Edelman's reagenlf218
Voluntary/71-72 vegetable cells in/218
Evacuation of uterus/666 Foetus papyraseous/651
Evaporation/245, 270, 273
Foetus compressus/651
Evidence/7, 12-16
Falaka/957
repository/937
Falanga/957
types/12-13
Falconi syndrorn/789
value/13
Fallopian tube/628
Evidential/15
Ewald's tube/734 False certificate/32 , 61
Examination of dead bodies at the scene of False virgin/641
crime/20, 303-312 Fangs of snake/827-828, 830
Examination-in-chief/IS Fat embolisrn/383 , 508, 616, 663
Excavation/932-933 Fate of poisons in the body/725
Excoriation and abrasioni:H2 l<'atigueability in pregnancy/645
Excuse to kill/330 Fatty acid in adepocere/276
Execution- judicial/458, 528-529, 536-538 Feather test/242
electrocution- by/458 Fecunda-ab-extra/627
hanging, by/528-529 Fecundation ab cxtra/632
Exhibitionism/715 , 718 Feeling/595
Exhibitionist/718 Fees/31, 34
Exhumation/8 (table), 298 Feigned insanity/610-611
Expectorant/740 l<,ellatio/712
Experimental misadvanture/65-66 Felony/337
Experimental treatment/65 , 69 Feminist movement/576
Expert witness/12 Femoral vessel/928
Expiry date medicine/69 Femur-
Explosion injuries/421-425 age from/125
effects of missile/421 sex frorn/101 (table)
gross mutilation due to/425 stature/149-152
secondary injuries due to/425 Fencing attitude/436
bullet/393 Fern/821
Explosives/421 , 425 Ferric arsenate/738
Exposure Ferric chloride test/756
to cold/427-432 Ferric oxide/738, 776
- infant/429 Ferri-et-amon-citrous/791
features/428 Ferrous sulphate/791
local efiects/429-430 Fertilisation/643
to heat/430-450 (see heat effect of) Fetichism/Fetishisrn/715, 716
Extortion of confesions or property/334 Fib res/170
Extradural haemorrhage/490 Fibrinogen/757
Extradural haematoma due to burn/437 Fibrinolysin/250, 829
Extravasation of blood/346 Fibrinous network/365

INDEX / 981
Fibroblastic prolife ration/365 card board disc/390

Fibula/125, 149-152 cartridge/385, 391-393
Fiduciary duties of doctors/60 case/392, 393
Filicin/821 tandem/408
Filigree marks/460 chamber/385
FINDER/162 cone/385
Finger-nail injuries on neck/342, 531 pressure/395
Finger prints/158-163 choking/390
advantage as identification marks/16;{ classification of/389
chance/161 cylindrical bore/385
comparisons of/162-16:-1 dumdum bulleU408
core/160 dermal nitrate test to identify user of/417
delta/159 disc inside cartridge of/392
description/159, 165 (Figs.) firing of a round from/395
development of/161-162 gauge of/394
identification from/158 gun powder of
invisible/161 black/392
history of/158 semismokeless/392
latenU161 smokeless/393
lifting of/161 gyrojeU420
maintenance of records of/.160 hammer of/389
methods of taking/160 hand resU385
patenU161 identification of user of/417-418
plastic/161 improvised/389
points of comparison/162-163, 165 (Fig.) loading of/389, 391
preservation of/161 long barrelled/385
primary classification/160 maga zine/391
study by computer/162 muskets/390
type lines/159 muzzle/389
types/158 choking of/ago
Fire ants/833 velocity/390
Fire arms/385 paradox gun/390
air gun/420 parts of/385
ammunitions of/391-394 pellets/390, 392
automa tic/391 percussion cap/392-393
ball of shoU389 pin/392, 394
barrel of guns/385, 389-391 pistols/391
choking of/390 point blank firing of/412
grooves of/390 primer (Pr iming mixture)/392-393
lands of/390 projectiles/385
bayoneU389-390 propellant chargc/392, 393
breach end of guns/389 ricochet bulleU408
bren gun/391 rifled slugs/393
black powder/392 repeating/391
bolt action/389, 391 rifled/390-391 , 393
bore of/385 revolver/3 9 1
bird shots/buck shots/393 safety catch of/389
bulleU394 semi-automatic/391
billiard board ricochet bulleU409 single shot/391
dum dum/408 short barrelled/389, 391
piggy tailed/408 sho tgun/389
frangible/409 shoulder resU385, 389
plastic/393, 419 smokeless gunpowder/393
ricocheU408 smooth bored - see shot gun/389
rubber bulleU393, 419 stalk of/385
tesU416 sten gun/391
tandem/408, 409 structure of/385
butU385 suspect gun/316-317
calibre/394 taper of barrel/385
cannelure/393 trigger/385, 389
carbines/389 guard/389

982 I PI?INCIPLES OF FORF.NSIC MLDICINE
types of/389 Florence test for semen/216

wad in cartridge of shotgun/392 Fluorescence test/231
wobling of bullets of/390 Fluorescent microscope/322
wounds/395-413 Fluoride/BOO
accidentaV414 Fluorine poisoning/767 -768
bullet injUJy/401-·113 Fluoroacetate/800
abraded collar/401 Fl uoroma r (anaesthetic)/888
contused collar/401 l<'luorosis/768
corona/101 Fluothane (anaesthetic)/888
depth and track of/401, 406 Flushy skin/431
direction of firing/401 , 414-415 Fly agaric/910
dirt collar/401 Flying missiles/421
distance of firing from/401, 415 Fly paper/773
features of/401-413 Foamy liver/267
medicolegal aspects of'l41::!-416 Foetal haemoglobin/214
place of firing/410 l''oetal heart sound/650
post mortem findings/412 Foetal movement/650
primary marks on bu llets/4 I 6 Foetal parts/650
punched in hole/408 Foetus/643
punched out hole/408 appearance at different ages/138-143, 667-668
secondary marks on bullets/4 I 6 dead born foetus/673 -674
spectrophotometric examination of/1 I 8 live birth of/674 ·680
yawning of/395 ·
postmaturity/652
bursting of cranium in case ofl40 I
prematurity/652
HRC chart/94 I
separate existence of/674 -680
contact/408
still born/672-673
depth o£1401, 406
viability of/652
dispersion of pellets on body in shotgun/396
l<,ontanelle/136
effects of gunpowder, fire, heat, smoke around
entrance - see chart in/399-400 Food allergy/911
Food poisoning/909-911
corona at/401
examination of victim of/396, 399, 401, 4·06 Fool's Parsley/869
409-410 Foot print(s)/164-168
PM examination/412-413 comparative study/164, 166-168
exit/406, 408 identification from/166-168
features of preservation of/167-168
homicidaV414 recording/167 -168
medicolegal questions/413-418 Foramen ovale/680
radiological examination of/410, 412 Forced diuresis/857
rifle, wound by/412 Forceful intercourse/691 , 715
shot gun, by/410 Forceps delivery/676
shored/4.06 Foreign body in respiratory tract/228
suicidaV413 Forensic/1
track of/401, 406 Forensic entomology/270-271
Fire works/440 Forensic Medicine/!
Firing of a round/395 - and state medicine/2
Fish berries/870 - and toxicology/2
Fish, poisonous/835-836, 909 defmition/1
Fish RBC/19::! history of/2
Fish tailing/380 China/3
Fissure fracture of skull bones/484 Egypt/2
Fist blow/479 France (Paris)/3
Flaccidity of muscles (f'M) (relaxation ) Cermany/2-3
primary/241, 256, 262 (table) Great Britain/2
secondary/257, 262 (table) Lndia/2, 4
Flame ionisation/317, 733 J·ustinian code/2
Flameless atomic absorption/317, 7 33 Orfila/3
Flash burn/442, 459 Persia/2
FlaxediV885 Rome/2-3
Flight accident/575-577 .. pathologist/$23-924
Floatation of dead bodies/272 pa thology/923

INDEX I 983
Forensic-Psychiatry/591-623 Frenulum (Frenum)/700, 709

Forensic-Psychia trist/591-623 Freshly prepared ferric oxide/738, 776
J<~orensic-Science La bora tory/315-327 Friedman test/648
J<~orensic Medicine-Tox.icology-and/2 Frigidity/629-630
Formaldehyde/853, 864 causes/629-630
Formalin/864 psychological causes/629
J<'ormic acid/853, 864 J<~rog/834
Fomica tion/24 Frost bite/430
Fossa navicularis/639 J<'rost nip/430
Fourchette/638-639 Froth/543, 803, 843
Fowler's solution/773 Froiteurism/715, 719
Fox glove/898 Frozen dead bodies/282
Fracture- Fruit spray/773
a-la-signaturea/484 Fulminating poisoning/752
anterior fossa/487 Fumes of mineral acids/745-747
avulsion/522 Function of lMC/28
base of the skull/487 Function of nervous system/241
bullet-du e to/413, 485, (also sec Chap. 10) .Function of State Medical Council/30-31
cervical/499, 533 l<'ungi--poisono us/909-9 10
clavicle/500 Fungicides/799
cricoid/530 Furore uterinus/718
comminuted/484
compound/484
Gagging/554, 561
compression/480
Gait/182
contre-coup/468, 485, 495
alcoholic/850
coup fracture , 467, 495
Gallamine (triethiodide)/885, 889
crush/485
Gall bladder
cut/485 decomposition of/267
depressed comminuted/484 in starvation/567
dislocation/332-333 Galli Mainini test/649
femur- neck of/508 Galton/158
fissured/484 Gammexane/804
frontal bone/681 Gang rape/689
gutter/481 Gangrene/814, 831, 862
heat/485 Gangrene in ergot poisoning/814-815
hyoid/522, 631 Gangrene in snake bite/831
malunited/30 1 Ganja/871-872
mandible/487 Garroting/529, 533, " l6, 538
maxilla/487 Gas chromatography/317, 733
mechanism of skull fracture/480 Gas stiffening/262
middle fossa/487 Gastric lavage (see stomach wash)/734-736
nasal bone/555 Gastrointestinal causes of sudden death/2 29
parietal/681 Gastro-jejunostomy/726
padicles and articulation process/508 Gauze of a gun/394
perforating fracture/180 Gavial/823
pond/484 Gay/104, 706-707
posterior fossa/487 Gell Card Technology (ARA)/201, 203-204
ribs/559 - also see DNA Gene Card Technology
ring/485 Gel diffusion precipitation test/200
simple/484 Gel electrophoresis/201, 318
skull/480 Gender intennediate/104
spine/475 Gender queir/104
stemum/500 Gene card/186
sutural/485 Gender fluid/104
temporal/681 General anaesthesia/887 -888
thyroid/533 General aspect of medical practice/55
France/2 General debility/226
Francis galton/158 General paralysis of insane/628
Frangible bullet/409 Genetic testing/183-186, 203-214
Free flame/432 Geneva/23, 25, 56
Freezing of dead bodies/282 Gene.va convention/56

Geneva declaration/25-26, 56 Grounded house (against lightning)/459

Genital union/625 Group specific substance/203
Genito-urinary system Grouping of blood/202
causes of sudden death/229 Grouping of blood from hair/174
Germany/2, 71 Grouping with DlAMED gel card/204
Geron top hilia/7 06 Gmirdian/77-78, 146, 692
Gettler's tesU545 Guardianship of courU147
Gheekumari/817 and insanity/611, 613-614
Ghreetakumari/817 Gui saap/834
Gigantin/815 Guideline to doctor- witness/20
Gun/385-395 .
Gila monster/834
automatic/391
"Giving lip" (buccal coitus)/712
culture/385
Glacial acetic acid (see acetic acid)
paradox gun/390
Glaister, John/3 semiautomatic/391
Glans penis/700, 709 spiralling of inner surface/390
Glass powder/761-762 Gun powder/392
Glenoid cavity of scapula/103 Gun shot wounds (see firearm wounds)/395-416, 420
Glorified male vimpirism/712 Gustafson's formula/112
Glory lily/901 Gustatory hallucination/594
Glucoronides/878 Gutter fracture/484
Glycogenolysis- PM/248, 279 Gynaecology/1
Glycolysis/279 Gynaecomastia/107
Glycopolypeptides/829 Gyrojet/420
Glycoronates/755
Glycuronic acid/858
Glycyrrhiza/820 Habit- drug (Psychological dependence )/414-415
Glycyrrhizic acid/820 Habitual sodomite , active/706, 707, 711
Gm blood group factor/212 Habitual sodimite, passive/706, 707, 711
Gold/796 Haemagglutination test for pregnancy/649
Gold-antidote of/796 Haemastic test for blood/197 (table)
Gonadal- Haematemesis/191
agenesis/104 Hema test strips/201
dysgenesis/104 Haematoidin/352
Gonads/103-104, 106 Haematoma/348
Gonadob Ias toma/1 06 Haematoxylin-eosin staining/230
Gonococcus/694, 700, 710 Haemin crystal test for blood/198
Gonorrhoea/694 , 700, 710 Haemochromogen crystal test for blood/197
Gonzales/3 Haemochromogen spectra/194
Good faith/146 Haemoconcentration/541
Goodell's sign/647 Haemodialysis/788, 857
Goose skin appearance-see cutis anserina Haemodilution/541
Gored (by animal horn)/382 Haemoglobin- abnormaV214
Goulards solution/780 adult/211
"G" point/625, 712 A, ~. Barts, C, H, E , S/214
Graffian follicle/648 Dpunjab/214
Gratification (sexual)/716-718 foetaV214
sickle cell/215
Grazed abrasion/341-342
carboxy/193
Grazes/341, 342
cyan -meth/893
Gravel ra sh/341 oxy/193
Grease collar/401 reduced/193
Grease mark/466 spectroscopic test for/193
Great Britain/2 Haemolysed blood/583-584
Green bottle fly/270 Haemolysin/829, 834
Green pit viper/829 Haemolysis/235, 583-584
Grenades/425 drowning in/541
Grievous hurU119, 332 transfusion/235, 583-584
Grinding compression/358 Haemolytic condition/disease/680, 830, 833

INDEX I 985
Haemopoetic disorder/191, 922 medulla/172

Haemoptysis/191 morphology of/170-172
Haemorrhage moustaches/174
cause of death/365, 383, 515 nasaV175
epiduraV490 naturally fallen off/175
externaV362, 515 nature of death/176
extraduraV490 occupational marks in/174
internal/381, 515 pigment of/171
intra-abdominaV504 poisoning/175
intra-cere braV192-495 pubic/175
intra-craniaV490 race from/173
atraumatic/490 root of (bulb)/170, 175
traumatic/490, 494 scale index of/171
petechiaV24 0 scalp/174
pho phorus poisoning, in/764 sex from/173
· pontine/515 shaft of/170
primary/492-494 sheath of bulb of/175
secondary/492, 495 singeing of/176
stomach in/229, 448 time of death from growth of/176
subarachnoid/490, 492 tip of/172
subconjunctivaV350, 4 79, 530 trace element in/174-176
subduraV492 type of injury/176
natural/492 type of weapon used/176
pathologicaV492 Half life of radioactive substances-/282, 462
subendocardiaV667 biological, effective, radioactive/462
Hallucination/594
ventricular/490, 495
types/594
Haemorrhagic pancr eati tis/229
Hall ucinogens/8 70
Haemorrhagic points/240
Hallucingenic mushrooms/875
Haemorrhagic spots/240
Halogenated hydrocarbons/800, 804-806
Haemorrhoids/711 Halogens/766-769
Hae mosiderin/352 Haloperidol carbamezapine/878
h aemothorax/383, 500 Hamilton, AM/3
Haematoxic venom of Hammer of gun/389
cat fish/835 Hand geometry/90, 177
scorpion/832 Hand rest gun/389
sna.k.e/829 Handwriting/182, 316
Hafikine's Institute/829, 830 Hang-over/848
Hair/169-176 Hanging/517 -529
age from/173-1 74 accidentaV526
anal/175 atypical/517
animal/169, 172-173 bending of neck in/520
arsenic poisoning, detection from/176 causes of death in/518-519
axillary/175 complete/518
blood grouping from/174 degree of suspension in/518-520
bulb/170, 174 dimensions of neck in/520
colour/171-172 dribbling of saliva in/520
cortex/171-172 fatal period of/519
crushing/176 force of constriction in/519
curly/172-173 homicidaV523-524
cuticle/! 70 judicial/522
dye/172, 174 kneeling position, in/518
eye brow/175 knot of ligature of/518
eye lash/175 ligature mark of/519
facial (bea rd s)/174 ligature material for/518
forcefully taken out/175 lynch ing/524
frayed/175 masochistic/528
greying/174 medicolegal aspects of/523
growth in foetal life/173 partiaV518
growth rate of/170 • point of suspension in/518
human/171-172 post mortem appearance/519
identification from/169 fmdings in/519-523
lanugo/173 staining/52!

signs and symptoms ofi'51S Hemp/S70-S71

suicidal/523 Henry- Galton/15S
tardieu's spots in/520-521 Heparinase/S29
tongue in/520 Hepatotoxic/SSS
types of/51 7-5 1S f leptach lor/SOO
typical/51 7 Herbicidal agents/799
Haptoglobin/212 Hermaphroditisrn/106-107
Harakiri/3S2 female harmaphrodite/107
Harrison and Gilory tesU41S male harmaphrodite/106
Hashish/S71 pseudo harmaphrodite/106
liquid/S72 true herm aphorodite/ 106
oil/S72 Hernia (strangulated)/229
Hasse's rule/143, 667 Herniation of intestine/372 (Fig.)
Hatter's shake/7S9 Heroin/S40, S44
Hazard- Hesitation cuU363
alcohol, of/S52 Hesitation wound/363 , 3S1
occupational/SO Heterosexual experience/705-706, 711-712
HCG/649-650, 653, 665 Hexabarbitone/S55
HCN- see hydrocyanic acid/S91 , S92-S91 Hexachlorocyclohexane/S04
Head injury/479-49S Hexa ethyl tetra phosphate/799
legal responsibility, and/487, 490, 49S Hibernation/S26
Healing- stages ofi'364 HilU376, 3SO
(incised wound) Hilt mark/376, 3SO
Hear-say evidence/13 Hing/S20
HearU22S-232, S91-901 Hingu/S20
Heat (effect ofl/430-450 Hip bone/99-100, 125
burn/432-44S Hippocrates/2
cramps (miner's cramps )/432 Hippocratic oath/23-24
dry-effect of (see burn J/432 Hiran Tutigu/S19
endogenous/457 Histamine/S15 , S33
energy/451 Histochemical (microchemical) test for blood/197 -19S
exhaustion (collapse)/431-432 Histological examination of organs and tissues/732
explosion/421-425 "Hizra"/104
exposure to Hit and run/471
general effect of/430 Hofmann, AlberUS73
local effect of/432 Holger Nielson method of artificial respiration/740
fracture/437 Homicidal impulse/59S
haematoma/437 Homicidal poison
hyperpyrexia, stroke (heat stroke)/431 , 437 ideal/742
laceration/437 Homoeopathy/S95
liquid/442-450 Homicide/330
miner's cramps due to/432 culpable/330
moist- effect of (see scald) amounting to m urder/330
rash/432 not amounting to murder/331
regulating centre/431 (heat stroke) excusable/300-301 (exceptions)
scald due to/442 lawful/300-301 (exceptions )
stiffening/261 Homosexual practice/705-707, 711-712
syncope due to (heat stroke)/431 Homosexuality
stroke/431 , S43 female/705 -706, 712
systemic effect ofi'431 male/705-707 , 711-712
viscid/442 (see scald) Homosexuals/705-712
Heated air-expansion and regression of/459 Homozygous blood group antigen/207 , 208, 209
Heavy metals/4 73-497 Hormonal deficiency/107
Hebephrenia/605 Hormonal disorder/107
Heger's sign/646 Hormonal imbalance/107
Helixometer/394 Horn shark/835
Helmet- use of/469 HorneUS33
Helpern/3 Horse-radish/S95
Helsinki declaration/74-75 Horticultural poisons/724
Hemiplegia/50S , 62S Hostile witness/12
Hemlock/S69-S70 Household poisons/724

INDEX I 987
Human Chorionic Gonadotrophin test for Hyosciamine/866-867

p regnancy/648-650 Hyosciamus niger/866
H uman experimeotat ion/72--76 Hyoscine/866-867
Human Genome P roj ect/75 Hyperaemic line/433, 436
--- Researchf72, 73, 74, 75
Rules forn3-75
Hyperemesis gravidarum/645
Hyperkeratosis- in chr. arsenic poisoning/777
P roxyn2-73 Hyper-pigmentation in chr. arsenic poisoning/777
Surrogatef72-7 3 I [ypersensitive (Idiosyncrasis) to drug/69, 727
Nuremberg code of/7 4 I Iypersensitivity to milk/684
Human Rights Co mmission I i ypersexuality/718
Act/84 and Chap. 43 lTyperthermia (hyper pyrexia l/431
H u mcro-femoral index/93 Hypnotics/854
Hume rus, a ge, stature/124 , 149-151 Hypnotism/622
Hunger strike/568 Hypocalcemia/753
Hunter's prey/3 82 Hypochondriacal delusion/595
Hyali.D.e membrane disease/678 , 680 I-lypoglycemia/848
Hyaluronida se/829 .Hypomania/606
Hydat idiform mole/650 Hypothermia/4 27-430
H ydramnios/650 signs, symptoms/428
Hydrazine/770-771 factors/428
Hydrocarbons/BOO , 804-805 , 888 MLI/428
Hyd rocele/627 Hypothyroidism/629
Hydrobromic acid/768 H.ypoventilation/887
Hydrochloric acid/7 45-7 50 Hypovolumic shock/436
Hydrogen chloride/766 .Hypoxia/887
Hydrocodone bitartrate/840 Hysterectomy/629
Hydrocyanic acid/491-494 Hysteria/593
Hydrogen peroxide/194-196, 770 Hysterotomy/663
Hydrogen sulphide/263, 264, 906
Hydromorphone/839
Hydrophinae/823 Iatrogenic conditions/diseases/55
Hydroquinone/755 Iatrogenic effects of drugs (Medical maloccurrence)/65
Hydro st atic test/677 Icard's test/242
fallacies of/677-678 fCD -10/79
a-H ydroxy-buteric-d eh ydrogenase/231 lCMR/52
11-Hydroxy corticost eroid/863 lcthioacanthotoxic fish es/835
Hydroxy pe thidine/839 lcthiotoxicosis/909
5-Hydroxy t ryp tamine/836 ldentification/89-187
Hymen/628, 637-638, 640, 641 , 694 acquired and congenital peculiarities , from/90,
180 (Fig.)
after inte rcourse/638-639
age/89, 107-115, 119-147
annular/637
anthropometry for/90, 157
carunculae hymenalis/638
bite mark/90, 116-117
myrtiformis/638
body built, from/89
cribriform/637
blood, from/189 -215
deflorated women , of/637-638, 641 group, type, test, RBC, Hb/202-215
deflora tion/637 bones, from- see for age, sex, stature and face
false virgin, in/641 and autopsy ·
funbriated (elongated verticall/637 complete (tota l)/89
imperforate openings/637 -638 complexion, from/90, 91, 92, 93
impotence a nd/628 cosmetic/90
infantile/637 dactylography or dactyloscopy/fingerprint/90,
multipara, in/638 158-164, 165
rupture of/637 decomposed body, of/94, 264, 269, 273
semilunar/637 deformities , from/90, 533, . 554
septate/637 diary/90 ..
tear of/637-638 -DNA gene card (smart card/secure card)/186
true virgin, in16f:!7, 640 DNA, study, by/90
type of/637 Dogs scent/90
Hyoid/125 dress/90
fracture of/499, 522, 530, 531, 538 ethnicity/89, 91-92

eyes/90 Imbeciles/607
ms, retina/90, 177 Immersion foot/430
facial sketching/90, 179 l=oral trafTlk.ing/688, 814
finger print, from/90, 158-164, 165 Immunity/69
gait, from/90, 182 Impact injury/666-668
general development, from/89, 95, 96, 138-145 primary/666-667
hand writing/90, 182 secondary/666, 667, 668
hand geometry/90, 177 Impersonation/697
hair/90, 169-176 Impotence/332 , 625-629
Henry-Galton system of/158-164, 165 causes
incomplete (partial)/89 female/628-629
total or complete/89 male/627 -628
intelligence and/90, 182 psychological/628-629
frigidity/626 , 629-630
intersex and/1 04-1 07
quode hanc/628
Keloid and/152 .
sterility/625-629
language, from/90 , 94
Impotent/626, 627, 628
letter/90 Imprint abrasion/340, 341, 342, 346 (sketch)
lip print, from/167-168 Imprisonment
manner, from/90, 182 life, regorous, simple/10
memory, from/90 , 182 Improvised gun/389
moles/90, 157 Impulse/598
mutilated dead bodies, of/94, 298-299, 476 Incendiary bombs/425
nail print, from/90, 168 Incense smoke/808
nationality from/90, 94 Incest/705
occupation marks, from/90, 176-177 covert/687 , 705
offender/89 electra complex/705
offender in strangulation (manual)/533 oedepus complex/705
ornament/90, 182 pharoan complex/705
palato-p rint, from/90, 168 Incestual relationship/632
palm vein authentication/90, 177 Incompatibility of drugs/922
partial (incomplete)/89 Incremental line of teeth/115
passport/90 Incised wound/362-375
patemity/213, 656 age of/364
pocket articles/90, 182 bevelling/363
poroscopy, by/163 -164 capillary network formation in/365
photography/90, 182 causes of death due to/365
physcial features (sex and age), from/89, 94-114, chop/367
119-145 cleavages, effect of/362
race, of/89-90, 92-93 defence (cuts)/365
elasticity of skin and/362
religion, of/89, 93-94
fabricated/367
scar mark, from/90, 152-154
false charge of assault, and/365
sex/89, 94-107
feature s of/362
secured card technology/90 , 186
self-inflicted/363
specific/158 fibroblastic infiltration in/365
signature, from/90, 182 healing of/364
stature/89, 148-152 haemorrhage in/362
superimposition technique of/90, 177-179 hesitation (cuts)/363
tatto marks, from/90, 154-157 homicidal/364
teeth, from/90, 109-119 leucocytic infilt ration in/364
total/89 looking laceration/357
wearing apparels, from/90, 182 margin of/362
Ideal homicidal poisons/742 marks of resistance in/364
Ideal suicidal poison/742 medicolegal importance of/363
Idiomuscular contraction or bulge/224· mode of infliction of/362
ldiosyncracy/727 neck, of/363
ldiots/608 neo-vascularisation in/365
Illegal operation/51 postmortem/365
Illegitimacy/213-214, 255-257 secondary/366 (table) ./'
Illegimate child/656 self-inflicted/363 /
Ill usion/593-594 teey
international system of numbering

INDEX I 989
shape of/362 chest/500-504

slope of cut throat/366 (table ) classifications ofl339-340
spurting of blood frorn/362 communication and transportation/465-4 77
tailing of/362 complications of (craniall/496-497
tentative (cu t)/363 concealed punctured/382
time of assault or infliction ofl364 corrosive/745-760
Incisor teeth/! 09-112 crush fracture/485
Incriminating/19 cut laceration/358
Indenture/24 dangerous/333
Indicator red cells/207 defence/365
Indian Belladona/868 diaphragm, ofl501, 509
Indian Constitution/5 ear to/479
Indian evidence Act/5, 80 eyes to/479
Indian Factories Act/81 electrical/451-458
Indian Hemp/870 electricity, lightning and radiation/451-463
Indian Liquorice/820 electrocution/451
Indian Medical Council/23, 27-29 external , head/4 79
Indian Medical Council Act, 1933, 1956/27 fabricated/367
In dian Medical Degress Act, 1919/27 factors influencing healing of laceration/357
Indian Pen al Code/5 fire arrn/385 -418
Indian Plantation Act, 1951/81 grievous/332-:i33
Indian wintergreen/820 • gunshot/385 -418
Indecent assault/687 , 712-713 head/479
lndrayan/819 heart, of/503-504
Industrial methylated spirit/853 homicidal/330-331, 340
Industrial poison/724 incised (see incised wound)
Inel:n-ient poisons/845 internal (Head )/487-498
Inertia of motion/470 intra-abdominal/504-507
Inertia of rest/471 intra-cran ial/487 -498
Infamous conduct/39-52 lacerated/355-358
Infant death/680-681 laceration/355-360
causes/680-682 LASER/462
Infanticide/671 , 682-683 legal aspects/329-337
acts of commission/682 lightning/458-461
acts of omission/682 liver/504
defmition/671 lucid interval/498
methods/682 lungs/501-502
Infarction/228 rnechanical/309
lnfection/228 , 583-584 medicolegal aspects of/see individual injuries and!
Infectious Disease Act/55, 59 511-516
Infective heart conditions/228 nature-medicolegal of/(see as above) and/340
Infidelity/595 neck, of/498-500
Influenza/228 nerves, of/509
Infra-red s pee trornetry/3 20 nose to/479
Inheritance of property in pregnancy, delivery and oesophagus/499, 501
other cases/644 organs, of abdomen/504
Injection mark/728, 844 pancreas/507
Injury place of sustaining (As in examination of dead
abrasion/3a9-343, 348 (table) body and medicolegal cases at the scEae of
accidental (also see individual injuries)/340 crime in Chap. 7)/303-3 12
adrenal gland/232 private parts, on/508
antemortern/340, 343, 355, 358, 364 (from healing) punctured/339 , 375-383
bladder/504 radiation/461 -463
blast or explosion/421-425 rcgional/4 79-509
blood vessels/357, 362 self inflicted/363 , 504
bruise/339, 346-355, 362 shape of/363-364
burn/509 (see also Chap. 11 - Thermal injuries) simple/363-364
causes of death due to (see individual injuries) site of/363-364
chemical/7 45 -760 size of/363-364

990 I PRINCIPLES OF FQI(ENSIC MI:DICINf
spinal cord, of/508-509, 533, 628 animal, with (bestiality )/712

spleen/504 buccal or oral/711-712
stab/339, 375-383 consent for/146, 688
suicidal/381-382 deceitful and other types (punishable but not
teeth/119, 332, 333, 480 amounting to rape)/704-705
thermal/427 -450 Interference/53
type of/339-340 Intergender/104
vessels, of/509 Intermembral index/93
vital organs, of/487-507 Intermission of penis/626
whip lash/509, 573 Intemational code of medical ethics/26
X-ray and radiation/461-463 Intersex/104-107, 190
Inquest/7 herma phroditism/1 06
coroner's 17 True/106
coroners act/7 Pseudo/106-107
magistrate/7 Klinefelter's syndrome/107
medical examiners system of/9 Tumer's syndrome/107
police/7 Intestinal obstruction/229
types of/7 Intestine, decomposition of/267
Insanity (mental illness)/591-623 Intocostrin/885
amentia/599 [ntoxication/513, 696, 847
business contract, and/621 Intoxicometer/851
causes of/593 Intracloud lightning/458
civil responsibility, and/620-622 Intracranial injuries/487-498
classification of/593 age of/497
criminal responsibi lity, and/617 -620 Intra-uterine death/673
competency as a witness, and/622 maceration/673
consent, and/622 mummification/673
dementia/608 Investigation/5-9, 55, 70
depressive psychosis/606-607 In-vi tro-fertilisa tion/633-634
diagnosis of/608-610 also see IVF below
diminished responsibility, and/596, 622-623 Involution of uterus/653
epileptic/606 Iodine/768-769
feigned/610 lodism/769
guardianship, and/622 lpecacuanha/73-1, 901
hypomania/606 lPC/5, 80
law, and/610-623 Irish scan/1 77
lucid interval in/602 lron/776, 791-792
management of property, and/621 Irritants
mania/606 animal/823-837
marriage contract, and/621 chemical/741 (see also individual chemicals)
melancholia/606 glass powder/761
mental health act/610-616 inorganic/763-771
deficiency/607 -608 metal/773-797
handicap/607 -608 nonmetal/7 63-7 71
retardation/607 -608 organic/799-808
subnorma lity/607 -608 vegetable/809-822
psychopathic disorders/603-604 weak acids/741
schizophrenia/604-605 weak alkalies/71 t
terms used in psychiatric disordcrs/593 -602 ISBT Nos. of Rh/211
testamentary capacity, and/621-622 Ischaemia of heart/228
Insecticida l agents/799-806 Ischial lubt•rosily/H9, 125
lnsecticides/799-806 lsomethadon/839
Insornnia/597 , 599, 607, 843 lsopestox/799
Instantaneous rigor/260-261 (table) Isopropyl alcohol/846, 854
Insufficiency of heart valve/228 Isoquinoline group of opium alkaloids/840
Insulin/739 IVF (in vitro fertilisation)/633-634
In telligence/603 ethical issues/634
Intentional sterilization/630 legal issues/634
Intercloud lightning/458 methods/633
Intercourse/625 , 626, 637-641, 687-712 sociological issues/634
anal/705-711 Ivy (Poisonl/820

INDEX / 991
Jack Kevorkin/70 Kirambu/820

"Jack", "Pau de arara", "Parrot's pe rch"/937 K.leptomania/598
Jackquemier's sign/646 Klinefelter's syndrome/107
Jack the ripper/717 Knock-out drop/858, 870
Jacobson's sense organ/824 KnoU518, 529
Jar to brain/487 Kohn's test for blood (Kohn and O'Kelly)/195
Jara/810 Korsakoffs psychosis/849
J asthimadhu/820 Korsakoff-Wernicke syndrome (psychosis)/849
J av/820 KraiU823, 829, 830
Jeerige/819 Kraurosis vulva/629
Jelly fish/835-836 Kretschmer's t h eory/604
Jequirity bean/809 Kuchila/881
Jira/819 Kulanjan/901
Jiraka/819 Kumarpathu/817
Joule burn/457 Kunch/809
Journal (medicolegal)/3
Jowan/819
Judge/9, 10, 11, 19 La bandera/937
Judicia l e lectrocution/158 Labanga/820
Judicial execution of death sentP.nce/1:18, 528-529, 536 Labia majora/639 , 641 (table)
Judicial hanging/528 Labia minora/639, 641 (table)
Judicial inquisition/621 Laboratory findings in drowning/545 , 846
J udgeme nU24 Laboratory tests for poisons/57, 68, 732-733
Judicial Magistrate/6, 11, 12 Lacerated wound OacerationY355-360, 467, 475, 479, 496,
Judgeme nt--error of/63 500, 504
aquatic animals causing/358
Jugular vein/519
avulsion/358
Julap/662
carotid sheath, of/499
J uniperus sabina/819
cerebrum, of/496
J urisdiction/15
cuU358
Jungle roU430 eye brows , on/479
Juror/9 features of/355-357
Jury/9 grievous hurt, amounting to/358
grand/9 grinding compression/358
petiU9 lungs, of/500
Justinian code/2 malar prominence, on/479
Justice--dispens a tion of/2 medicolegal importance/358
meninges, of/495-496
pleura, of/500
Karyotype (XX, XY)/103 , 106 postmortem (laceration)/358
Karl-Pearson 's formula/149 spliU357
Kasauli/830 stretch/358
Kastle-Meye r's tesU195 tear/357
Kath Bish/894 types/357
Kathocy/106 Lacrymatory gas/807
Kawasaki disea se/789 Lactation period/671
Kayamllnguva/820 Lactic acid level in muscles (PM )- break down of
Kayi/819 ATP/256-257
KCN-see Pot. Cyanide Lactic dehydrogenase/280
Keloid/152, 155 (Fig.) Lady Godiva, Godgifu/716
Kerosene. '865 Landstein/207
Ketone bodies/808 Lal chitra/816
Khesari Dall910 Lalisara/817
Khorasani Ajowan/866 Laminae fracturs/508
Kick over scrotum/508 Lanugo hair/139 (Fig.), 142, 668
Kidd's system of blood group/212 La parotomy/65
Kidnapping/146, 147 La picana/938
Kidneys---decomposition/267 Largactil (chlorpromazine)/842, 848, 849, 878, 879
King Cobra/823, 826, 829 Laryngeal spasm/540
Kinetic energy/395 Larynx-
Kininl833 decomposition/26 7

in drowning/544 Librium/878
in hanging/521 Licking/711
LASER beam injury/462 Lidocaine/862
Last clear chance/67 Life imprisonment/10
Late paraphrenia/605 Lie detector/323-327
Law and Medicine/1, 90 tests/324-327
Law and Administration/1 Ligature mark/519-520, 530
Lathyrus sativa/910 factors influencing appearance of/520, 530
Law and statutes related to medical practice/80 Ligature materiaV5 18, 520, 529
Law enforcement agencies/924 Lightning/458-461
Lawyer/18 arborescent marks in stroke by/459
Lay channels press/51 blast effect of/460
Lead/780-786 causes of/458-459
acetate/780, 781 circumstances of/460-461
acute poisoning/781 death due to/459-460
carbonate/780 effects of/459-460
chloride/780 . electrical discharge from/458-459
chroma te/7 80 . field/461
chronic poisoning/7 82-786 filigree marks in stroke by/460
effects on diif. systems (signs-symptoms)/782-784 fire due to/459
encephalopathy/783, 785 flash/459
goulards solution/780 grounding of house against/459, 461
luminosity of/458
iodide/780
mechanical injuries caused by/460
laboratory invest. in poisoning with/784
phenomena of/458-459
line (Burtonianl/783
postmortem findings in/460
medicolegal aspects of poisoning with/786
preca utionary steps against/461
monoxide/780
return stroke in/459
osteopathy/783
stepped leader in/459
palsy/783 streamer in/459
peroxide/392 thunder storm and effects of/459-460
postmortem findings/785 types of/458
reproductive system, action on/783 Linea nigra/645, 652
styphnate/392 Linear abrasion/340, 345
subacetate/780 Lindane/804
sulphate/780 Lip print/168
sulphide/780 Lips/168
tetraethyV780-781 Liquid hashish/872
tetraoxide/780-781 Liquid sulphur dioxide/906-907
toxicity (see signs symptoms) Litigation
treatment of poisoning/781-782, 784-785 Live birth/674-680
Leading questions/IS measurement and shape of chest of foetus/674
Le facie sympathique/521 signs of/67 4-677
Legal advisory fora/579 Liver-abscess, rupture of/229
Legal definition of death/222 Liver damage/740
Legal medicine/! Liver decomposition/267
Legal procedure/5-20 Foamy/267
Legal test for insanity/618 Living skeleton/567
Legislation/23, 27 Living cadavar/224
Legitimacy/643 , 655-656 Livor mortis- see postmortem staining
questions related with/656 Lizard/823
Lens, dislocation of/479 Loading of gun/389, 391
Leptodactyline/834 Lobelia inflata/896
Lesbian girls/104, 711 Lobelin/896
Lesbianism/687 , 711 Local anaesthetics/860-862, 889
Lethargy/626 Local acting anaesthetics/860-862, 889
Leucomalachite green test for blood/105, 195 Local acting poisons/741 , 745-752, 759-760, 761-762
Leukaemia/350 Locard's principle/189
Levohyasciamine/867 Lochia/653
Levorphanol tartrate/840 Lochial discharge/653
Libido/607 , 832 , 878 Loco weed/822

IN!)EX /993
Londonl23 inquest by/6-7, 9

Long/820 judicial/6, 11, 16
Loop of Henle/232 chief/11, 16
Lophophora Wiliamsii/874 second class/6
Lorazeparnf878 subdivisional/6-7
Loss of body heat after death/245-249 Magnan's syndrome/861
different ways of/245 Magnesium level (plasma) in drowning/515
exponential curve of/246 Magnesium oJtide/738
factors inf1 uencing/24 7-249 Magnesium sulphate/662, 754, 842
Marshal and Hore formula ofi'24 7 Magnus test/242
Medicolegal importances/249 Main lining/842
rate of/24 7-248 Maintenance of circulation (in poisoning)/740
sigmoid curve related to/246 Majunl871
Loss of a member or a joint/332-333 Makal/819
L. cericata/271 Mal-absorption syndrome/568
L. cuprina/271 Malaria/229, 237, 584
LSD-see lysergic acid di-ethylamide/873-874 cerebral/229, 237
Lubricant/709-710, 719 Malathionl799-801
Lucid interval/498, 602 Malayanf91
Lucilia caesar/271 male prostitute/707
Lucky beanf809 Male toad test for pregnancy/649
Luminal test for blood/196 · Malena/759
Lunate/124 Male vimpirism/712
Malic dehydrogenase/231
Lungs-
Malignant glioma/497
abscess/228, 233
M alingering/70
collapse of/228, 233
Malnutritionf566
decompositi.o nf269
Malleril/878
drowning, in case ofi'544
Malonyl urea/855
infection (dead newborn)/678
Maloccurence/63, 65
live birth, in!676-678
- (Medical , Therapeutic, Diagnostic)
histological examination of/678 Malpractice-{medical)/61
marbled appearance of/676 civil/61
oedema of/225, 233, 678
criminal/61
respired/676-678 ethical/62
unrespired/676-678 Maltreatment/569
Lust murder/717 Maltreatment syndrome in children!569-576
Lutheran system of blood group/212 (See also battered child syndrome)
Lycorine/820 Mammalian RBC/193
Lynching/524 Management of property of insane/621
Lysergic acid/873 Mandible/98, 123
Lysergic acid diethylamide/873-874 Mango/820
Mangifera Indica/820
Mania/606
Maceration-intrauterine/673 Maniac/726
Macrophage/355 Manic depressive psychosis/606-607
Macula/245 Manner/609
Madar/815-816 Mannerism/602 , 609
Magazine/391 Manslaughter/336-33 7
cylindrical/391 Manual strangulationl531-533
Maggots Manubrium/96, 103, 124
blue bottle fly, of/270-271 Marbled appearance of skin!264
common house fly, of/270-271 Marihuana/870-873
green battle fly, of/270-271 Marijuana/870-873
Magistrate/11, 16-17, 19-20 Marking nut/812
chief metropolitan/11 Marquis test/844
district/6 Marriage contract and insanity/621
executive/6, 7 Marsh's test/779
flrst class/6, 7, 9 Masochism/718
[F. M.- 63]

Masochistic asphyxial death/528 , 539, 556, 718 Melancholia (depressive psychosis)/606-607

Masochistic hanging/528 danger/607
Masochistic smothering/556 signs and symptoms/606-607
Masochistic strangulation/539 MelleriV878
Mass spectrometry/320 Membership of Medical Society/33
Masturbation/719 Memory intelligence (for identification}/182
Material evidence/12 Meningioma/497
Materials preserved in poisoning death cases/57, 730-732 Meningitis/496 , 516, 663, 843
Maternal and birth factor/207 -213 Menopause/60S, 629, 651
Maternity benefit/SO Mental confusion/593 , 849
Maternity dispute/207-213 , 656-657 Mens rea/337
Menstrual blood/191
Maternity dispute circumstanccs/207-213, 656-657
Menstrua l cycle/625-626
Maximum duration of pregnancy/652
Menstrua tion/64 5
McEwen's sign/84 7 Mental health- Act, 1987/80, 610-616
McNaughten's Rule/617 Mental retardation/607
Mechanical antidote/737 Mental subnonnality/607
asphyxia/903 grades of/607
energy/451 Mental unsoundness-diagnosis of/608
injuries/339-425 Meperidine/84 5
irritants/761-763 Mephentermine/876
ventilator/7 40 Meprobamate/849, 914, 916
Meconium/679 Mercaptans/263
Mediastinal structures, contusion , laceration of/500 Mercurial diuretics/786
Medical certificate/14 , 54 Mercurial erethism/789
Council of India/27, 32, 40, 53 Mercurial insecticides/799
Council of states/29-31 Mercuric albuminate/738
Council register/28, 30 Mercuric chloride/786
curriculum and examination/28-29 Mercuric cyanide/786
ethics/2 , 24 Mercuric oxide/786
evidence/14-16 Mercuric sulphate/786
examiners system of inquiry/9 Mercuric sulphide/786
expert witness/12 Mercurolentis/789
jurisprudence/! Mercurous chloride/786
maloccurrence/63, 65 Mercury/786-790
practitioner/23 absorption, fate and excretion/786
bioaccumulation/788
Medical records/33, 54, 79
chemical test for/789
maintenance/33, 79
chronic poisoning by/788
proforma/54
lamps/789
society/33 medicolegal aspects of/789-790
indemnity/insura nce/69 postmortem findings/788-789
termina tion of pregnancy- salts of/786
Act (MTP. Act)/32, 40, 69, 660 source of poisoning compounds/786
centres/660 treatment of poisoning cases/787, 789
consent for/660 vapour/786
contravention of the Act/660 Mercy killing (see also Euthanasia)/70-72
indications of/660 MersalyV786
length of pregnancy and/660 Mescaline/87 4
Medicinal and toilet prepn. Act, 19551723 Mesmarism/622
Medicine and lawll Metabolic disorder (cause of impotence and sterility
Medicolegal aspects of injuries/511-516 in men)/628
" autopsy/287-302 Metal fume fever/794
journaV3 Metallic balls/393
reports/14 irritants/773-797
system/924 lustre/768
Medicologist/14 phosphides/907
Medulla/523, 887 pieces/763
Medullary indices/103 Metals/741, 761, 773-797
Mee's line/775 Methacholine/877
Mekka, Kayi/819 a Methadol/840
Medicine/1 Methadon/839 , 845

INDEX I 995
Methaemoglobin/893 MN 2 blood group/209

Methamphetamine/859, 860 Modem classification of bum inj uries/434
Methanol-see methyl alcohoU852-854 Molar teeth/109-112
Methaqualone/91 4, 916 Molecular death/223-224, 256, 261, 262
Meth.i/662 Moles/90, 157
Methionine/7 40 Molluses/836
Methoxamine/87 6 Molotov-cocktaiU425
Methoxychlor/804 Mongolians or Mongoloids/91
Methyl alcohoU852-854 Monk's hood/894
absorption, distribution/853 Monomania/617
action/853 Mons veneris/290
fatal dose/853 Montgomery's tuberclcs/645
fatal period/853 Mood/593 , 606, 609
hang-over/853 Morning .sickness in pregnancy/645
medicolegal aspects of/854 Morons/607
metabolism of/853 Morphine/839, 810-844
· postmortem findings/85 1 acutc> poisoning/839- 841
preparations of/852-853 addiciion/842-84 :!
signs and sym ptoms/853 chronic use/842
treatment/853
dangers/843
Methyl amphetami ne (see also/
differential diagnosis of coma due to/843
metham ph eta mine )/84 2
derivative of/839-840
Methyl isobutyl ketone/!308
medicolegal aspects/844
Methyl morphine/844
withdrawal symptoms/84 2
Methyl-n-amyl ketone/808
Methyl parathion/800 Morphinomania/842
Mortua.ry/288
Methyl salicylate/820
Methyl salicylic acid/757 Motive/70
Methylated mercury (methyl mercury)/786-787 Mouth to mouth respiration/542, 740
Methylated spirit/852-854 MTP Act/660
Methylated xanthine/863 Indication of/660
Methylene blue/893 Muff diving (buccal coitus)/712
MetrazoV868 Mugging/529, 538
Metropolitan Magistrate/6, 11 M ul tigender/1 04
Microbiological tests/733 Multipara/654
Microeocci/263 Multisexuals/104
Microscopes/322-323 Mummification/273-274
Comparison/322, 417 factors helping/273
electron/323 intrauterine/673-674
fluorescent/322 medicolegal importances/27 4
polarising/322 Mumps/627
stereoscopid322 Munchensens syndrome by proxy/574
Middle ear/543, 680 Murcielago/937
Millipeds/833 M urder/330-331
Mines/425 Muscarine/802, 877, 910
Mineral acids/745-752 Muscarinic action/SO 1
Chronic exposure to/750 Muscle relaxants/889
Mineral alkalies/7 59-760 Mushroom bullet/395
Mineralised methylated spirit/852 M ushrooms/909
Mines maternity benefit Act/81 Mussels/835, 836
Minimum duration of pregnancy with viable child/662 Mustard powder/734
Mirror test/242 gas/807
Misadvanture-diagnostic, therapeutic/53, 65 Mutation of blood group genotype/208
Miscarriage (see abortion)/659-669 Mutilated body parts/298
Misconduct/39-52 Mutilation/4 73
Misdemeanour/3 37 Mutilomania/598
Mismatched transfusion/583-584 Mutism/609
Misuse of medicinal drugs/922 Mutual rubbing for masturbation/711
Mitochondria/186 recognition of medical degrees/29
Mixed agglutination/200, 206-207 Muzzle of gun/389
with squamous cells/207 Muzzle velocity/390, 395, 399 (table)
MN antigen/209-210 Myda)eine/910

996 I PRINCIPLES OF F-OI~ENSIC MEDICINE
Myelin sheath/789 Negligence (professional medical)/35, 61-63, 66, 67

Myelin sheath, ballooning of/456 burden of proof/62
Myocardial infarction/228 charges of/66
death due to/228, 229 civil/61
medicolegal importances/232 contributory/57
post mortem diagnosis/230-232 corporate/66
(macro and micro staining methods ) criminal/61
in scorpion stinging/833 defence of doctors against charges of/63-64
Myofibrils/256 ingredients of/62
Myosin/256 precautions against/68-69
Negligent/1, 68
Myristica fragrans/874
Negroes, Negroids/91
Myristicin/874
Nematicide/BOO
Neologism/602
Neonatal infection/680
N -acetyl-D-penicillamine/7 88 Neoplasm/228
Nabbing fracture/573 Neostigmin/737, 833, 861, 877
NaCN/see sodium cyanide/892 Neovascula risation/365
Nail print/168 Nephritis (chronic)/428, 659, 784
Nail scratch abrasion/341 Nephrolithiasis/229
Nails/90, 142, 168, 341, 775-776, 778, Nephrotoxic agents/752, 831
Nalline/84-5 Nerin/900
N -allyl-Normorphine/845 nerium odorum/900
N alorphine/841-842, 845 Nervous system- stoppage of function of/24-1
N aloxone/841 N eurasthenia/602
Narceine/840 Neurine/910
N arcism/719 Neurogenic shock/436, 515
N arcissus/820 N eurosis/602
Narco-analysis/602 Neurotoxic venom of
N arcolepsy/600 fish/835
Narcosis/840 kerosene/865
N arcotics/840 scorpion/832
Narcotic Drugs Acts and/80 scorpin fish/835
Psychtropic Substance Act 1985/80 snake/829
N arcotine/840 Neurotoxin/829
Neurotransmitters/860, 862
Nasal hair/175
N euters/101
Nascent oxygen/772
Neutron activation analysis/321, 418
National Human Right Commission Neutrois/104
Recommendations on Autopsy
Neutrophil/103, 281
protocol/923-942 NHRC/84-85, 923-942
Nationality/90 Nicotiana Tabacum/896
Natron/283 Nicotine/896
Natural death/226 Poisoning with/896
Natural opiates/839-840 Nicotinic action/80 1
Natural sex offences/687-705 Nihilistic delusion/595
adultery/687, 705 Nitric acid/845-850
deceitful cohabitation/688 Nitrocellulose/392, 393
gang rape/689 Nitrogen oxides/770
incest/705 CN0 2 , N 2 0 4 )
intercourse by management staff Nitroglycerine/392, 393, 421
in a hospital/704 Nitrous oxide/888
intercourse by public servant with N -methyl serotonin/834
woman in custody/704 NN blood group/21 0
intercourse by suptdt. of a jail or a remand Nobbing fracture/573
home/704 Non-accidental injuries in childhood/569-576
intercourse with wife during (see also battered child syndrome)
separation/704 Non-Bailable/18
N aturist/717 N.on-consumation of marriage/626
Necrophagia/715, 718 Non-detection of poison in viscera-causes of/732
Necrophilia715 , 719 Non-infectious disease/628, 629
Negativism/602 Non-metallic irritants/76\-771, 809-822, 823-837

IND eX I 997
No radr en aline (Nor-epinephrine )/S34 Oral coitus (see buccal coitus )

No rm et h adon/S4 0 evidence/12, 14
Notifiable disease/5 1 Orfila/3
Not proved evidence/13 Organ Tran splantation AcVS5
N ovuis-Actu s-Iner ve nins/66 Organic chemical irritants/769-770, 799-SOS
Nuclear explosion/45S Orga n.ic polyphosphates or organophosphorus
Nucleotid a se/S29 com pounds/7 99-S04
Nucleoti des/1S5 a bsorption , fate , excretion/SOl
Nudist/717 action/SO 1-S02
Nullity of marriage/626, 644 medicolegal aspects of/804
Nuremberg code of/7 4 postmortem appearance/S03
Nutmeg/S74 signs and symtoms/802
Nymphomania/625, 71S treatment/S02-S03
OrgasrrJS25 -826
Orientation/599
0-acetyl samanda rine/S34
Orpiment/774
Oak/821
Orthotolidine test for blood/195
Oath/12, 18, 24, 32
of hippoc rates/2, 24 Os uterus/653 -655
Observation of m ental patients/610 Ossification centres of bones/123-138
Obscene/688, 71S Osteopa thy (lead)/7S3
Obsession/593, 599 Ovarian cyst-twisting of/229
Obsessive compuls ive disorde r/5 97 Ov a riectomy/629
Occupational marks/ 176' Ova ry- cystic, fibrous/62S
Octomethyl-py rophospho ramide ( OMP AJ/799 Ove rdose of medicine and drug/724
Octopus/836 Ove rlying/56 1
Ocular tension/244 Ove r sexed/6 25
Odon tologist \Fore nsic J/928 Ov ipa rous (snakes )/S26-S27
Oedema a quos urrJ544 Ov ula ti on/643
Oedema glottis/7 40 Owlish fa cc/84 7
Oedema lungs/541, 544, 740 Oxa lic acid/752-754
Oedepus complex/705 Oxaluria/753
Oesophageal stricture/56S , 747 Oxazeparn/S7S
Oesophagea l var ices/736 Oximes/S02-S03
Oestrogen/662 Oxyhaemoglobin/193
ofTence/9 Oxymorphone/S39
cognizable/9 Oxytocic AgenVS14
non-i:Ognlza ble/9 Oxytocin/663
Oil of tansy/662 Ozone/770
Oil of turpentine/662
Oil of winte rgreen/S5 3
O'kelly test for blood/195 Pace maker/457
Oleanders/89 1 (Fig. ),S99-901 Pachymeningitis Haemorrhagica Inte rn a/492
Oleoresin/821 Paederasty/706, 716
Olfactory hallucination/594 Paedophilia/716
Oman/S19
Pakistan/2S
Oman-U/819
Palatoprint/16S
Omentum-decomposition of/267
Palm vein authenticity/177
Operation/56-57, 69
Omn.isexual/104 Palma christi/810-811
Oozing/S30 Palmar strangulation/533
Opiates/839 Pancreatitis/229, 3S3
Opisthotonus position of body/8S2 Panacea/24
Op.ium/839-844 Panic disorder/600
Acts of 1857, 1S78, amendment of 1957/721-722 Pansexual/ 104
acute poisoning/S40-S42 Papaver somniferurn/839
addiction/S42 Papaverine/S40
chronic u se/S42 Paper electrophoresis/31S
danger/S43 Papra/817
differential dia gnosis of coma due to Papri/S17
opiu rn/S43 Para -amino-ben zoic acid/S62
medicolegal aspects of/S44 Paradoxical unde ressing/42S-429
withdrawal symptoms of/S42 P araldehyde/S63 , SS2

998 I PRINCIPLES OF r:GI~ENSIC MEDICINE:
Paranitrophenol/SOl Periodic Acid Schiff reaction/231

Paranoia/605 caLatonia/605
Paranoid schizophrenia/605 PeriodonLosis of teeth/113
Paraphilia/716 Peripheral nerve poisons/885-886
Paraoxon/SOO-SO 1 Peritoneal dialysis/737
Paraphimosis/627 Peritonitis/3S3, 516, 663
Paraphrenia/605 Perjury/12
Paraplegia/50S, 516, 62S Pearls current/460
Paraquat dipiridyl/SOS Perl wax dipping/460
Parasympathetic/S77 Permanent sterilization/631
parasympathomimetic/SO 1-S02, 910 Permethrin/806
Parathion/SOO, S01, S02 P eroxidase/194
Para urethral glands/S22 Perpetrator/691, 714
Paravaginal muscles/629 Perseveration/602, 609
Paris green/773 Persia/2
Parkinsonism/49S, S7S Personality/596, 597, 604, 605
Partial responsibility ('see diminished Personality disorder/593 , 604, 605
responsibility)/49S, 596, 622-623 Peruvoside/899
Passive algolagnia/71S Perversions/687, 714-719
" haemagglutination test for blood/200 sexual/714-719
Passport/55, 90 Pessary/24
Pasteur pippette/203 Pesticide/799-807
Patent/3S Pestox/799
Paternity- Petechial haemorrhagic spots/240, 530, 533
dispute/190, 207-214, 656 (see also Tardieu spots)
exclusion/190, 207-214, 656 Peth idine/839, 845, 914
fixation/190, 207-214, 656 Peurperal agony/671
Pathologist/923 pH of blood after death/279
Pathology/1, 923 Phagocytes/831
Pathology of traumatic shock/232 Pharmacological ·antidote/737, 738
PaLterned abrasioni:H I Pharmacist Act/80
Pava/S19 Pharoan complex/705
Payment for professional service/34 Phenanthrine group of opium alkaloids/839
P. Baeocystic/S75 Phencyclidine/875
PCR (Polymerase chain reaction)/3, 1S5 Phenobarbitone/855
Peeping Tom/716 Phenol (Carbolic acid)/854
Pegan, J ohn/3 Phenolic compounds/BOO
Pellets Phenolphthalein test/195
striking range of/399 (table) Phenothiazine derivatives/878
Pelvis-sex from/101 (table) Phenyl ephidrine/876
Penal erasure of name of doctors/30 " mercuric acetate/786
Penetrating wound/375, 501, 503, 504, 507 , S01 Pheochromocytoma/789
Pengu n/420 Pherula narthex/820
Penicillamine/739, 77S, 7S5, 7S9-790 Phimosis/627
Penicillin/739 Phobia/597
Penetration/507 , 62S, 6S8, 694, 707 Phobic state/593
Anal/706 Phosdrine/801
Sexual/688, 706-707 Phosfume/806
Vaginal/68S , 694, 707 Phosgene(COC1 2 )/769, 903 , 907
Pentachlorphenol/SOO Phosphate/256
Pentadecyl catechol/S20 Phosphatase/280
Pentathylene tetrazol/S68 Phosphine/770, 907
Pentobarbitone/855 Phosphoglucomutase/2 12, 213
Pentothal/887 Phospholipase-A/829
Peptides/835 Phosphoric acid/279
Percussion cap/389, 392, 393 Phosphorus/761 , 763-765
pin/389, 394 acute poisoning/763-764
Pericardia! sac/3S3 .. post mortem staining in/255
Perforation of stomach/229 , 234, 739 , 74 7 chronic poisoning/764-765
intestine/229, 234 red isotope of/763

INDEX /999
Phosphotek/806 actions of/725-727

Phosphotungstic acid stain/231 antidote of/737 -739
Phossy jaw/765 classification of/7 40-7 41
Phostoxin/806 drugs and criminal laws (see also drug Acts)/
Photoelectric detector/319 722-723
Photograph/90, 182, 934 elimination and removed from body/733-740
Photograph of face/90, 182 factors influencing actions of/725-727
Photosensitisation/821 laboratory tests and analysis of/732-733
Photoscru;itive dermatitis/771 nature/724.
Physical dependence on drugs/914 rate of absorption/725
Physical form of poisons/725-726 routes of administration/724
Physician's conception of death/222 sources of/724
responsibility/32-62 uses of-criminaV724
Physician's Law (Codes of ethics)/21 -27 Poisoning/57 , 70
Physicochemical tests for poisons/732 accidental/724
. Physiology/! diagnosis/727 -733
Physiological antidote/737, 738 from edible oil/909
Physostigma venenosum/877 food substance/709-711
Physostigmine/877, 889 mushrooms/709-711
Phytotoxid809, 833 postmortem findings/728-730
Picrotoxin/870 preservation of viscera and other materials
Piggy tail bullet (s~e tandem bullet)/408 after death due to/730-732
Pigmalionsion/716 treatment of/733-741
Pigment of hair/171-173 Poisonous
Pigmentation in pregnancy/645 amphibians/834
Pilocarpine/737, 868, 877 fish/835 -836, 909
Pilocarpus Jaborandu877 food/909 -911
Pinene-d and V819 mussels/835, 836
Pinus palustris/819 salamanders/834
Pistols/391 snakes/823-831
Pit viper/823, 825, 828, 829 Poland/71
Pituatary extract/661 Police case/10
Placenta/659, 667, 668, 680, 681 Police custody death/6
medicolegal importance of/668 Police investigation/inquest/6
Placental barrier/792 Police officer/6
Plaintiff/68 Polyacry lamide/85
Placibo/73 Polycyclic aromatic :wdrocarbons/808
Plankton/837 Polygraph/323-327
Plasma/740, 801 Polymers/283
Plasmodium falciparum/237 Polyphosphates/799, 800-804
Plantation labour Act/81 Polysexual/104
Plastic bullet/393, 420 Polyvalent antivenom serum/830
Plastination/283 Popliteal line/101 (table)
Platysma/522 Poppy capsule/839, 840
Pleural effusion causing sudden death/228 Poppy plant/839-840
Pleurosthotonus position of the body/882 Poppy seeds/840
Plouquet's test/677 Pornography/7 14
Plumbagin/816 Poroscopy/163-164
Plumbago- Porphobilinogen/7 82
rosea/816 Portuguese man-of-war/836
zeylanica/816 Positive signs of pregnancy/650
P. Mexican/875 Post-anaesthetic myelitis/862
Pneumothorax/383, 500 Posterior commissure/639
Pneumonitis/862 Posthumous child/655
Podophylin/817 Post-maturity of foetus/652
Podophyllum/817 Postmortem abrasion/342-343
Podophylotoxin/817 Postmortem caloricity/248-249
Poison(s) Postmortem examination/287 -312
Act of 1919/722 basic technique/288-30 1

changes Potency/625-630
in blood/277, 279-280 Potentiation/855
CSF., in/280 Practice of medicine/23-85
early/241, 243-252 - Ethical/23-85
eyes, in/241, 243-245 - LegaV23-86
enzymatic/280 Pralidoxime/803
immediate/241-243 Prawn/774
late/241, 252-277 Precatory bean/809
pbysicaV241-279 Precipitated laboUJ"/581
drowning/54 7 medicolegal importance of/581
examination/57, 287-308 Precipitation tube/199
findings in poisoning deaths/728-730 Pre-eclamptic toxemia/680
glycogenolysis/248 Pregnancy
banging/528 biological test for/548-549
bypostasis/241 , 250-255 civil cases, and/644
(see postmortem staining) criminal cases, and/543
laceration/358 diagnosis of/644
lividity (see postmortem staining)/241, 250-255 maximum and min imum period of/552
plastination/283 medicolegal aspects of/543-544
puncture/382 pigmentation in/545
rigidity/241 , 255-252 positive signs of/550
Actin fllaments/255 presumptive signs of/544-545
ADP/255 probable signs of/545-550
ATP/256-257 serological tests for/549-550
Calcium/255
signs of, in dead/551-552
Glycogen/255
Premolar teeth/109-112
Myosin filaments/255
Prenatal Sex Determination Act 1994/80
Pbosphate/255
Prescription/31, 53 , 59
staining/241, 250-255
Preservation of-
bruises, and/254
colour changes in/255 blood/? 30-731
congestion and/254 dead bodies/282-283
cause of death/253, 255 materials from dead bodies/730-732
definition/250 method of/731-732
in hanging/253-254 preservative used for
in different poisoning/255 Urine/73 1 .
factors influencing/253 Presumption of death/285
fixation o£'250 Presumption of survivorship/284-285
formation of/250 Presumptive signs of pregnancy/644-545
haemorrbagic spots in/253 , 255 Pressure abrasion/341
medicolega l importances ofi'253 -255 Pressure in chamber of a gun/392-393
time of dPath/253, 255 Pressure test for circulation/242
Post-operative/59 P rimafacie evidence/13
Post-traumatic amnesia/497 Primary evidence/12
encephalopathy/4 98 " flaccidity/243
epilepsy/497 impact injury/455-457
psychosis/497 -498 relaxation/243
tumours/497 shock/436, 515
Posture/509 Primer (priming mixture)/392-393
Potassium/795-796 Primipara/54 5
a rsenite/773 Primitive snakes/823
bromide/857 Primordial follicles
carbonate/759 Principal, Medical College/52
cyanate/799 Privileged communication/59-50, 78
cyanide/892 Probable signs of pregnancy/545-550
hydroxide/759 Procaine/851 -852
iodide/795 Proceeding/!
iodate/795 Procreate/525
level in drowning/545, 547 Proctoscopic examination/709
nitrate/392 . Product liability/58
permanganate/738, 795, 830, 842 Product of conception/565, 555

INDEX I 1001
Professional abuse/40 Psychotherapeutic counselling/576

Professional con ducU26, 40 Psychotropic drugs/51
Professional death sentence/30 Ptomaines/910
Professional meeting/33 Pubic hair/108, 144, 175
Professional misconducU39, 40, 52 " symphysis/132-135
Professional secrecy/58-59, 61 Pubis/125
Professiona l service to each other/37 Public nuisance/688
Progesteron/659 Public prosecutor/12
Progressive spastic paraplegia/910 additional/12
Prohibitory sexual relationship/705 assistanU12
Projectiles/385 Publicity/38
Prolapse of the cord/681 Puffer fish/887
Prolonged labour/681 Pugilistic attitude/436
Proof spiriU846 Pulmonary oedema/541, 862
Propellant charge/392-393 (in) drowning/540-541
Propoxur/806 (in) sudden death/228, 233
Prosecution/16-17 Punched in hole/408
Prosecutor/12, 16, 18, 64 out hole/408
Prostaglandin/663 Punctured wound/375-383
Prostate-decomposition/269 abscess in/383
Prostitute accidental/382
male/707 air embolism in/383
Prostigmin/868 arrow injury/375
Protection of Human Right AcU84 blade guard impression on/380
bullet, by/375
at national level function/84 -85
cadaveric spasm and/381
at state level function/8 4-85
cardiac tamponade/383
Protection threshold for head/4 79
cause of death due to/382
Proteolysin/829
cerebral compression resulting from/383
Prothrombin deficiency/350
choking resulting from/383
Protopine/817
concealed/381 -382
Protoporphyrine/782 defence/382
Proved evidence/13 depth of/376
Proxy consenU72-73 diaphragmatic hernia due to/383
Prussic acid/892 direction of/380
Pseudo-aconitine/895 entrance, of/375
Pseudo-cholinesterase/80 1 examination of/381
Pseudo-cyesis/651 exit, of/376
Pseudo ephidrine/876 fat embolism in case of/383
Pseudo-neurotic schizophrenia/60S features of/375
Pseudo strangulation/539 fish tailing/380
Psilocin/8 75 gored/382
Psilocybin/875 haemorrhage in/381
Psychiatric hospital and nursing homes/611-616 haemothorax due to/383
admission to/611-615 harakiri/382
discharge from/615-616 hesitation in/381
readmission to/616 high velocity projectile causing/375
removal from one to another/616 hilt mark on/376, 380
PsychiatrisU610 homicidal/381
Psychiatry (Forensic)/591 hunter's prey, on/382
P~ychoanalysis/575 injury to internal organs in/381
Psychodelic drugs/628, 913, 922 intracranial haemorrhage due to/383
Psychological/15 length/375
P sychological aberrations/705 margin/380
" dependence/914 medicolegal importances of/381
Psychomotor hallucination/594 pancreatitis resulting from/383
Psycho-sexual defect- pellets causing/375
disorder/593, 608, 628-629, 711, 714-719 penetrating/375
Psychos is/602 perforating/375
post traumatid497-498 , 574-575, 598 peritonitis resulting from/383
Psychosomatic disorder/593 pneumothorax resulting from/383

1002 I PRINCIPLES OF FORENSIC Ml:DICINE:
pointed weapon causing/375 mongoloid (see Mongoloids and MongoliansY91,

postmortem/382 93, 173
pyothorax resulting from/383 negroids (see Negroes and Negroids)/91, 93,
septicaemia developed from/383 173
shape of/379 inter membra! index, from/93
sharp cutting weapons responsible/379 other indices, from/93
suicidaV381 skeleton, from/92-93
therapeutic/382 primary types of
types of/375 coccasian/91
vagal shock due to/383 monglolians/91
varieties of/375 negroes/91
volitional act/382 Radiation effect/461-463
Punishment (allowed by IPC)/5, 10 cataract/462
congenital abnormalities/462
Pupillary membrane/142, 668
factors influencing/462
Pupils---{fiameter/243
harmfuV462
shape/244
injury due to/462
Purgative/662, 736, 785-786, 857 LASER beam injury/462
Purging croton/811 malignant changes due to/462
Purpura/350 manifestations/161-462
Putative father/190, 207, 213, 656-657 acute/461
Putrefaction (see decomposition ) chronic/461-462
Pyemia/663 medicolegal aspects o£/163
Pyloric stenosis/726 sterility due to/462
Pylorus/544 types of/461
Pyothorax/383, 500 warfare/73
Pyrethrine Radioactive half life/462
" V818 Radioactive iodine/769
"IV818 Radioactive wastes-{fisposal of/463
Pyrethroids/806-807 Radioactivity/55
Pyrethrum/818 Radio-diagnosis/794
Pyridine/197 Radiograph/935
Pyridine 2 aldoxime methane sulphonate/803 Radio-i=uno assay for pregnancy/650
Pyridine 2 aldoxime methodide/803 Radius/122, 124
PyrocatechoV755 Railway-
Pyrogram/318 Act/146
Pyromania/598 accide.n t/4 73-4 75
Python/823, 825 (due to) collision/4 75
derailment/4 75
injury
Quackary medicine/812, 816 causes of/473-474
Quarantine Rules/55 identification of victims/475
Quartz cells/320 postmortem run over/4 75
Questions by Judges or Magistrates to witness/19 primary impact/473-475
spine, o£/475
Quick Phos/806
Rancification/277
Quickening/646
Rape/687
Quinidine/897
by woman on a man/691
Quinine/897
children victims below 12 yrs. of age/689
anaesthetising effect of/897 complications of/698
sclerosing effect of/897 corelationship between accused and victim ofi'701-702
Quinone/833 date rape drugs/688
defmition/688 (u/s 375 IPCJ
defloarated women, on/694, 696
Race/6, 89-92 examination of~
Blumenblack's classification ofi'91 accused/698
bones, from/96-103, 119-138, 148-152 clothings (garmets )/694, 702
brachial index, from/93 materials to be preserved during/695
cephalic index, from/93 private parts/699
complexion, from/90-91 requisition for/691
hair, from/90, 169, 173 victim o£/691
coccasoid- see cocasoid and cocasian/91, 92, 173 impact of/702-704

INDEX I 1003•
gang/689 Reinsch's test/780

general considera tion of a case ofm90-691 Relaxants (muscle )/889
hymen after/693-694 Religion- for identification/93
injuries sustained by victim of/693 Remote acting poisons/725
intoxicated women, on/696 Removal , name of doctor from register/29, 30
investigation of a case of/691 -702 Removal of organ/224
other natural sex offences - IPC Sec. 376A, Repeating shot/391
3768, 376C and 37601704 Reports/40
Adultery (Sec. 497 IPCJ/705 Reptiles/823
cohabitation caused by deceitfully inducing a Reptilia/823
belief of lawful marrige (Sec. 193 IPC)/705 Reri/81 0-811
- incest/705 Res -ipsa loquitur/62
- covert incest/705 Research right to/52 , 74
personal and socio-phychological impact on the Res-judicata/63
victim/698, 702 Resinous extract of cannabis/872
punishment for (u/s 376 IPC)/688 Resistance marks, offering of/693
report prepared after examination of victim/695 Resolution (in intercourse)/625-626
resistance offered during/693, 697 Respiration-stoppage of/241-242
sexual offences not amounting to/704-705 Respired lungs/676-679
sleeping women, on/696 Respondent superior/68
st.atuitary/690 Responsibilities of-
trauma syndrome· after/698 physician to each other/3 7
vagina after/694-695 insanes/617 -622
venereal disease, and/697 civiV620-622
virgin, on/696 criminaV617-620
valva/693 intoxicated persons/622
when the perpetrator is a woman/691 Reticular elastic fibre/355
women on a man, by/691 Reticulocyte/109, 680
young children , on/696 Retinal-
Rapid rat test/648 changes after death/244
Rareca catacheu/877 detachment/573
Rash and negligent act/331 scan for identification/177
Rat poison/800 stippling/783
Rati/809 Retroverted uterus/4 79, 661
Rate of absorption of poisons/725 Return stroke/459
Real gur/774 R.F.L.P. (DNA fingerprint)/183
Rebate of fees/39 Rh allele/211
Recognition of Medical degrees/28 cv, cw, ex. rm and others/211
Rectified spirit/846 Rh incompatibility/632 , 659
Rectovaginal fistu la/698 Rh typing of blood/210
Red ants/833 Cc, Dd, Ee/210
Red blood cells- test (tube technique)/203
amphibian, avain, camel fish and Rhipicephalus sanguineus/835
mammalian of/193
Rhodanase/893
basophilic stippling in/783
Rhubarb/752
clumping of/203-206
Rhus Toxicodendron/820
clumps of/203, 207
Ribs/103
nucleated/193
Richard Galting/391
sickling of (sickle cell)/215
Ricin/810
tanned/201
Ricinus communis/810-811
Red cross emblem/32
Ricochet bullet/408
Red phosphorus/763
Rifled guns/90-91, 390
Reefer/8 72
Re-examin ation/19 Rifled slugs/393
Reflux boiling/195 Rights and privileges of registered medical
Regional injuries/4 79-509 practitioners/3 1
Register/28, 30, 40 Rigor mortis/256-262
Registered medical practitioner-duties of/32-52, 55-57 age and/258
Regulation of standard of UG and PG Medical cur· contact flattening in/258
riculum/28-29 exhaustive disease deaths and/258

1004 I PRINCIPLES OF FOI<ENSIC MEDICINE
factors uifluencing formation of/258 Saliva stain/217

instantaneous rigor (cadaveric spasm)/260 amylase in-test for/217 -218
mechanism of formation/256 buccal squamous cells in/217
medicolegal importances oll258-262 barr bodies in/218
onset of/257 digestion test for- amylase/217 -218
period of stay/257 dribbling of/520, 521
strychnine poisoning death and/258 Salt of saturn/780
wasting disease deaths, in/258 Samandanine/834
Ring test/199 Samandaridine/834
Risk (unavoidable )/63 Samandarine/834
Samandarone/834
Risus sardonicus/882
Samandenone/834
Road accidentlinjury/665-673 ... .
Salmanders/834
bicycle occupants, to/468 Samanine/834
causes of/465 ..
Sanguinarine/817
contre-coup/468 Saponification/276
coup/467 Sarcomere/256
epilepsy and/473 Sarcoplasm/256
exhaustion and/4 72 Saturday night paralysis/852
front seat occupiers/4 70 Satyriasis/607, 625, 718
hearing defects of drivers and/4 72 Sauria/823
heart disease of drivers and/4 72 · Savin/819
intoxicating state of driver and/471-472 Saw like movement of weapon/362
investigation of/465 Scalding/442-450
motor bike related to/469 Medicolegal aspects/448-449
offended vehicle/469-4 71 Scale index of hair/171
offending vehicle/4 71 Scale of snakes/828
place of occurrence/471 Scalp hair/174
pedestrian/467 -468 Scaly reptiles/823
postmortem examination/466 Scapula/103, 128 (Fig.), 133
primary impact injury/466-467 age changes/128 (Fig.), 133
rear seat occupants, to/470 glenoid cavity/103, 123, 128 (Fig.), 133
reconstruction of circumstances of/466 Scar/152-154
responsibility of/465, 4 71 Medicolegal importances/152-154
scooter related to/469 Schedules .o f Indian Medical Council/28
secondary impact injuries/467 Scheduled poisons (drugs)/51, 722-723
secondary injuries/467 Scheele's acid/892
Scheele's green/773
three wheeler vehicles related to/469
Scene investigation/20, 303-312
two wheeler vehicles related to/468-469
Schizo-affective disorder/605
Robbery/3
Schizophrenia/604-605
Rockets/425
causes/604
Rome/2 general features/604-605
Run amock/873 spectrum disorder/605
Russel viper/823, 829 (table) legal and social aspect/605
types/605
Scopolamine/866
Sacral index - see table page/100 Scopophilia/717
Sacral promontory - see table page/100 Scoptophilia/717
Sacral vertebra - see table page/100 Scorching sun/431
Sacrophagus/283 Scorpion/832
Sacrum - see table page/100, 125 Scorpion fish/835
corpora basal table, page of/1 00 Scorpion stinging/832-833
Sadism/717 Scotland/2
Safeguarding profession honour and dignity of/33 Screening test for blood (presumtive)/194-197
Safeguarding respiration/739 Scrotum-retraction of/543
Safety catch/389 Scuba divers/549
Salamders (poisonous}/834 Scurvy/350
Salicyl salicylic acid/757 Sea anemone/836
Salicylates/757 blubber/836

INDEX I 1005
fish/835 Seminoma/106
snakes/823, 828 (Fig.), 835 Semi-smokeless gun powder/392
urchins/836 Semi-somnolence/600
wasps/833 Semi-synthetic opiates/839 , 840
Secondary- Senescence/lOS
accident (collision)/4 70 Senna/820
dentine formation/113 Sensitivity test/69
drowning/541 Septicaemia/516, 663
evidence/12
Seroimmunolgical test of blood/198-218
impact injuries/466, 467
medicolegal purposes/198
injuries/466-467
Serological antidote/737, 739
rela.xation/262
sex fe atures/95-96 Serological test for p regnancy/649-650
wounds/466-467 Serology/315-316
second collision/4 70 Serotinine/833 , 834
Secrecy/20, 26, 35, 51 , 57-59 Serpentes/823
Secret medicine/39 Serum protein polymorphis m/212
Secretor/2 18, 694 Sex
Secrets of patients/57-61 Sex chromatin/103-107
Section 174 CrPC/6 Sex chromosomes/103-107
Section 176 CrPC/6 Sex determination/94
Sections of IPC 376 376 Sex determination by biopsy/103
375/688 • from bones/94-103
~)
376/689 • blood/103, 193
3771705
689 ADBC) 704
• chromosomal study/103, 193·
• hair/173
Sedatives/726, 855, 859 • hormonal study/107
Seduction/643, 652 • morphological features/95
Seet belt effect on injury/471 • mucus membrane of mouth/103
Segmented retinal vessels/244
and vagina/218
Self-advertisement/38
Self-inflicted abrasion/342 Sex determination from teeth/116
Self-inflicted incised wound/363 Sex linked offences/687
Self-strangulation/538-539 (under) immoral traffic/714
Semi-automatic gun/391 indecent assault under/712
Semicarpol/812 Sex offences (see sexual offences)
Semicarpus anacardium/812 natural (see natural sex offences )
Seminal fluid (semen)/215-217, 521 , 530, 625, 627, punishment for/ (See Sec. 376, 377, 497 of IPC and
693-695, 699, 701, 702, 709, 710, 712 other individual sex offences)/688-689, 705-711
ejaculation/521-522, 625, 626, 627 unnatural (see unnatural sex offences)/687-688
examination of (diff. tests) Sex performance/625-626
chemical passive partner/628, 709-710
acid phosphatase/216 Sex perversions
ammonium molybdate/216 types/687, 714-719
barbarios/216 Sexual abuse/575, 714, 937
creatine phosphokinase/216 Sexual arousal/625
florence/216 assault (see sex offence abused )
microscopic d eviations (perversons )/687, 714-719
demonstration of spermatozoa/217 drive/625
staining test/217
fantasies/714
wet test/217
impulse/598
physical/215
physicochemical/216 intercourse/625, 628, 629, 631, 687, 688, 690,
gel electrophoresis/216 691, 693, 696, 700, 70~ 70~ 712, 715, 719
se rological- for group factors/199 -202 interest/626
. agglutination tes.t /217 gratification/626 , 716, 719
mixed agglutination test/206-207 intermediate/104
medicolegal importance of/215 penetration/688
civil/215 Sexually transmitted disease/59
criminal/215 SGOT/230
Seminal vesicle/95, 625-626 SGPT/230

Shallow water black out/541 medicolegal aspects/831

Shells/835 , 837 signs and symptoms/829-830
Ship wreck/56 postmortem findings/830 -831
Shock treatment/830
(to) brain/487 body tem perature/826
hypovolumic secondary/436, 515 charmer/831
neurogenicor primary/436 , 515 features of poisonous snakes/828-829
traumatic/232 food habit/825 -826
neurosis/602 reproduction/826-827
vagal- see vagal shock/236, 515, 519, 531 sense organs/824-825
Shored exit wound/406 venom/828-829
Short barrelled gun/385, 389, 391 absorption/829
Shot gun/389-390, 392 actions of/829
Shoulder rest gun/385 , 389 constituen ts/828-829
SHRC/84-85, 923-943 fatal dose/829
Shrimps/837 . Snake free countries/828
Sickness benefit Act/55 Soaps and detergents/771
Siddhi/871 Sodium
Side effects of drugs (iatrogenic effects)/65-66 arsenite/799
SIDS/683-684 benzoate/863
Sigmond Freud/860 bicarbonate/7 40
Seminoma/106 bromide/857
Signature for identi.fication/90, 182 carbonate/759
Silver chloride/749 chlorate/799
Silver nitrate/749, 797
chloride-common salt/731, 738, 858
Simple injury/340, 341, 342, 350
cyanide/726, 728, 741, 892
Sin of Gomorrah- see buccal coitus/711
hydroxide/7 59
Singeing of hair/169, 176, 433
level in drowning/545
Single shot gun/391
nitrite/876, 893
Skene's glands/625
thyosulphate/893
Skeletonisation/264
Sodomite/706
Skin- creases and wrinklings/145
(as) trace evidence/218 active/706
Skin popping/842 castration/707
Skull vault/136 examination of anorectal region/710-711
sutures/136 , 138 habitual active agent/711
Slashes/362 non -habitual/708
Sleep/600, 607 occassional non -habitual/708
Slander/650 passive/706, 707 , 709, 711 -712
Sleep drunkenness/600 types of/706
Slice wound/362 Sodomy/687 , 705-706
Slurring of voice/850 active agent of (presented non-habitual)/709
Smegma/700, 709 ano-rectal region of passive agent (non-habitua!Y
Smoke/771 , 807 709
screen/765 Definition/705
Smokeless gun powder/393 heterosexual/705-706
Smothering/554-558 homosexual/705-706
accidental/554-556 passive agent/706
causes of death/554 Solanine/910
circumstances of7554-555 Solenopsin - N833
(in) cot death/683 Soliciting practice/51
homicidal/555 Solid blast/421-423
masochistic/555 Solitary confinement/tO
postmortem findings/555-558 Somatic death/223
suicidal/555 Sornnambulism/599-600
Smooth bored gun/389-390 Somniferous drugs/741 , 839-845, 859
Snake/823-831 Somnolentia/600
activities/826 Sonamukhi/820
antivenom/830 Sonography/650, 674
behaviour/828 Sorbital/740
bite/828-829 Souvenir bullet/421

INDEX / 1007
Soyabean/910 penal and ethical committee/30

Spalding sign/673 function of them/30
Spanish fly/831 registration/3D
Sparrow fooU470 State Medicine/2
SpecialisU52 Static tesU677
Speciality/51 Stature/89, 148-152
Spectra of blood- Karl Pearson's formula/148-149
carboxyhaemoglobin/193 Nat, Pan and Siddiqui's formulae/151
cyanhaemochromogen/191 Trotter and Glesser's formula/14 9-151
haemoch romogen/194 Status epilepticus/606
oxyhaemoglobin/193 Status thymolymphaticus/229, 236
reduced haemoglobin/193 Statutary rape/690
Spectrograph/320 Stepped leader (lightning)/459
Spectrometry/319-321 Stereot ypy/602
Spectrophotometry/319, 321 Sterile/626-629
Spectroscopy/319, 321 Sterilisation/630-63 1
Spermatozoa/215, 217, 627, 632, 691 , 694, 696, 929 acciden tal/630
motility of/217, 627 compulsory/630
Spinal anaesthesia/888 intentional/630
danger of/888 medicolegal aspects/631
cord/296, 297, 533 mcthods/631
therapeutic/631
poison/881-883
types/630
Spinous process facture/508
voluntary/630
Spirit of camphor/862
Sterility/52, 626-629, 632
Speech/609, 850
Sternal injury/500
Spleen- rupture of/504
Sternum/96, 124
Split laceration/357
Sternomastoid muscle/622
SpoU7 Steroidal alkaloids/835
Spurting of blood/191 Steroids/51
Squamata/823 Stengun/391
Squ.id/835 Stenosis of heart valve/228
SquinU84 7 Still born foetus/672-673
Ss group factor in blood/210 medicolegal aspects of/673
St. Anthony's fire/815 putrefaction of/872
Stab wound (also see punctured wound)/375-384 St. Anthony' fire/815
accidental/382 St. John's worU821
suicidal/381-382 Sting ray/835
tentative/381 Stock of a gun/385
volitional act and/382 Stomach-
Stack's method of ageing from teeth/115 decomposition/267
Stain for seminal fluid/217 (in) drowning/544
Stam.mering/608 tube/734-736
Stampede/5 59 contra-indication of use/736
Standard knowledge/63 Stone chips/761, 762
Stanford Emersion Chaille, Dr./2 " fish/835
Starvation/566-568 Stoppage of-
acciden tal/568 circulation/241 , 242-243
acute/565-566 nervous function/241
causes of death/566 respiration/241-242
chrome-or malnutrition/565-567 Sto rm-dusU458
complete or total/565 snow/458
fatal period/566 Stoversol/774
medicolegal aspects/568 Stramoni um/866
postmortem appearancc/567-568 Strangulated hernia/229
S!gns and symptoms/566-567 Strangulations/529-539
types/565 accidental/539
State Human Right Commission/84-85, 923-943 bansdolla, by/533
State Medical Council/29-32, 53 force of constriction in/529
structure/29-30 garroting, by/529, 533, 536, 538
function/3 0 homicidal/538

ligature by/529-531 Suicidal impulse/598

causes of death/529-530 " note-see suicidal death
ligature materiaV529 poisons/7 41
knot of/529 ideaV742
postmortem findings/530-531 Suicide- Railway/4 74-4 75
manuaV531, 533 Sulfotep/799
cause of death/531 Sulphur dioxide/771, 906
postmortem findings/531-532 Sulphuretted hydrogen/906
Masochistic/539 Sulphuric acid/745-750
medicolegal aspects of/538-539 Sumac/821
mugging, by/538 Summary triaV19
other means , by/533 Summons/9, 10, 17-18
palmar/533 Sun burn/432
postmortem/530-532, 538 Superfecundation/651
self/538 Superfoetation/651
throttling (see also manual strangulationl/531, 533 Superimposition technique of identification/177 -179
types/529 Superintendant, hospitaV52, 69
STR (DNA study)/185 Superior cerebral vein/492
Streamers (lightning)/459 Superior longitudinal sinus/492
Stretch laceration/358 Suppositious child/657
Supreme Court/10
Stress/598
Surgery/1
Striae gravidarum/645
Surgical methylated spirit/853
Stricture of oesophagus/516, 568, 747
Surrogate consent/72, 73
Strophanthine/858
Surrogate mother/633
Strophanthus gratus/898
Survi vorship/284-285
. " plants/898 Suspended animation/226
Structure of Indian Medical CounciV27 Suspicious/6
· " of State Medical. Council/24-30 Sutural separation/485
Struggle, signs of/384 (table) (also see individual Sutures-age from/136-138
injuries) basi-occiput and basi-sphenoid/138
Strychnine/881-883 coronaV138
Strychnos nux vomica/881 lambdoid/138
Study of X-ray defraction/372 metopic/136
Stupefaciants/741, 868 parieto-temporaV138
Stupefaction/724 sagittaV138
Stupefy/668, 873 Swallow tail/358
Stupor/605, 609, 841 Sweeden/71
Stuporous/428 Sympathetic excitant/875
Subconjunctival haemorrhage/530, 843 Sympathomimetic action of ether/888
Subdural abscess/496 Sympathomimetic drugs/875 -876
haemorrhage/490, 492 Syncetcal pattern of tubular cells/789
Subendocardial haemorrhagic spots/730 Syncope-death/238
Subgroups of blood group "A"/202-203 causes/238
(A 1 , A2 , A3 , A4 , A 5 and ~) postmortem findings/238
Submersion/241, 256, 540, 551 signs and symptoms/238
Subsoil water/774, 776 Syncurine/885
Subspecies/91 Synergists/855
Succinic dehydrogena/231 Synthetic opiates/839-840 , 845
Succinyl choline/chloride/885, 889 Synthetic pyrethroids/806
Sudden death/226, 228-237 Syphilis/73, 584, 587, 659
involvement of different systems/228-237 Syphilitic chancre/627, 629
Sudden infant death syndrome/683-684 Syphilitic warts/711
causes/683-684 Syringeing (abortion)/663
· medicolegal importances/684 Syringomyelia/428
Suffocation deaths/554-563 Systemic acidosis/757
types/554 Systox/799
Sugar of lead/780
Suggilation (see post mortem staining)/250
"Sui"/810 Taches Noire scleroitiques/244
Suicide/70 (also see MLI of all unnatural deaths) Tachycardia/847, 859, 860
Abetment/331-332 paroxysmal supraventricular/862

INDEX I 1009
Tachypnoea/888 Tera tom a/106

Tactile hallucination/594 Terresterial snakes/823-831
Tail gating/469 Testimony/1
Tailing of incised wound/362-363 Testamentary capacity/621-622
MLI/363 Testicles/627, 668
Takeyama reagent/197 Tests for-
Talus/125 circulation/242-243
Tandem bullet/408 Harrison and Gilroy/418
cartridge/408 respira tion/241-242
Tannic acid/200, 738 Testudines crocodylia/823
Tannin/820 Tetanus/882 (table)
Taper/385 Tetracaine/862
Tetrachlorethylene/729
Tardieu/2
Tardieu's spots/240, 520, 530, 531 , 544 Tetra ethyl lead/780, 781
tetra et hyl pyrophosphate/799
Tartar emetics/796
Te t rahydro cannabinol/871
Tattoo marks/154
(~1> ~8 ' ~ g)
1'attooing/151 , 842
Tet rahydro -cannabinolic acid/871
ingrediants/154
Tetrametbyl ben zedine test/197
medicolegal importan ces/ 156
Tetrodotoxin/83 7
removal/156
Thallium/792
Tea plant/869
acetate/792
Tea r gas/807
sulpha tP1792
Tear of intima of carotid artery and
Thanatology/221
sheath/522
'l' ha natophobia/221
Tears (iaceration )/357 -358
Tha natos/221
Teeth (dentit ion and den t ure )/l09- 119
T hebaine/839
ABO grouping from/11 6
dislocat ion of/119 Theft/5
Theobroma cocao/864
identification from
Theobromine/864
eruption ofil09-112
'l'heophylene/864
estimation of age of an adult person/112-115
Therapeutic abortion/660
Boyde's formula/115
Therapeutic misadventure/650
chronological appearance/109-111
" misuse/724, 922
decaying changes/112-i15 (Fig. ), 120-121
falling of/112 puncture/382, 508
germination/109 sterilisation/630-631
gustafson's formula/112-115 Therapeutic wound/382, 508
point furmula/112-115 Thermal injury/427-450
in ternational system of numbering of/112 Thevetin/899
medicolegal importances/117 -119 Thevotoxin/899
mixed dentition/Ill Thiocynate/893
perm a nent/110 (table ) Thiopentone sodium/85 5
pulp/116, 119 Thioridazine/878
tempo rary/110 (t abl e ) Thioryl/878
race from/116 Thiosulphate/893 , 906
sex from/116 Third gender/104
stack method/115 Thorn apple/866
Teic hmann's test for blood/198 Throm bophlebi tis/811
Tempe rature- Thrombokinase/82 9
rate of fa ll in dea d body/247 T hrom bosi s/~28 -2 29
inner core/246 Throttling (see also strangulations)/531 -533
Te mporary Thu nderstorrn/459
impotence/627-630 Thymo l/662
sterilisation/631 Thyrohyoid ligament/5 22
sterility/627 -630 Thyroid cartilage/522, 530
Temposil/848 Tibia/103
Te nderness/5 13 Tick paralysis/835
Tendon reaction or Zoskos phenomenon/224 Tics/609
Tentative cuts/363 Tigritol/878

1010 I PRINCIPLES OF FORENSIC MEDICINI:
Time of death/27.7-284 Tracheotomy/740

from adepocere change of body/276 Track of firearm wound/401
" biochemical, chemical, enzyme study of Trancendental calm/873
blood/279-280 Tranq uilizers/87 8
bone. marrow/281 Transaminase/280
content of bowel/281 Transfusion/583-584
intestine/281 Ttansgender/104
stomach/280-281 Transillumination test for circulation/242
urinary bladder/281
Translucency or transparency of teethlil4, 115, 120-121
circumstantial evidences/281
Tra!i.splantation/56, 79
cooling of body/247
Act185-86
CSF/280
decomposition (putrefaction)/264-267, 269-270 organ/85-86
eye changes/243-245, 278 . tissue/85-86
facial hair/281 Transvestism/715, 716
mummifica:tion/273 Trapezium/124, 144
pericardia! fluid/282 Trapezoid/124; 144
·postmortem staining/250, 253, 279 Trauma'tic asphyxia/558-559
radioactive carbon/281 -282 circumstances/559
rigor mortis/25 7-258 postmortem findings/559
synovial fluid/282 Treatise/14
vitreous humour/278 Treatment of poisoning cases/733-740
Tissue bridges/357 -358 antidote- use of
Toads/648:649, 834 chemical/737 -738
granular glands of/834 physical/737·
mucous glands o£'834 physiological/738
parotid glands of/834 serological/739
Toad fish/836 universal/738
Tobacco/89 6-897 chelating agent, use of/734, 737-739
heartJ897
diluting poison and delaying its
Tolerance to drugs/727
absorption/733, 737
Tooth pulp/113, 116
elimination of absorbed poison/736-737, 738-739
Torture at home and
torturing a'gents/569-58 1 removal of patient from exposure/733
Touts/52 removal of unabsorbed poison/733-736
Toxalbumin/809, 810-811 from injection site/736
Toxaphane/804 intestine/736
Toxemia in pregnancy/229 stomach/733-736
Toxic causes of asphyxia/238-239 vagina/736
Toxic fishes/835-836 , 909 symptomatic/739-740
Toxic nephritis/753, 785 Trench foot/427, 430 -
Toxicological examination evaluation/930 Trial of a criminal case/16-19
Toxicology Tribadism (see lesbianism)/711
Forensic/721-922 Trichloracetaldehyde hydrate/858
Trace elements in Trichloroa/:etic acid/858
blood/189-215 Trichlorethanol/858
dandruff/218 Trichloroethy lene/888
faeces/2 18 Trigger/389
hair/174 guard/389
saliva/217-218
Trick, manner, habitJ182
semen/215-217
Trimethoxy-phenyl ~eth'ylathine/87 4
skin/218
urine/218
j .)
Trimethyl xanthine (see caffeine)/863
vaginal fluid/218 Tripod of life/223
Trace e~i'dEmce/189-218 Triquetra! bonP/124:; 'f4'4'. ·
Trachea-· Trithion/801
in decomposition/267 Trochanteric ohlique length/101 (table)
(i n ) drowning/544 '· Trotter and Glesse·t~fon'r\.tii~ (or stature/ l49-151
(in) hanging/521 · ') 1'rypersamide/774 'i '::' :·: :.'·J ·,
(in ) strangulation/530, 531 ·'• · Trypsin inhibiting fa~t~ii9iti ..

INDEX I lOll
Typhlopoidea/823 jaffe test/218

Tubectomy/63 1 t' rease/218
Tuberculosis of testes/627 tl•st for/218
Tubocurarine/885, 889 Urobil in/236
Tungsten bulb/3 19 Urobilinogen/236
Turner's syndrome/94 : 107 Urocanyl choline/836
Turpentine/819 OSN2, 70
Tuskegee syphilis/73 - Federal court/70
Twisting of cord around neck of ncwborn/68 1 Oscharin/815
Typhlopoidea/823 Uterine !:aemorrhage/663
Tyramine/814 fibroicl/659
hyperplasia/659
soufle/647
Ulna/124, 127-129 (Fig.) Uterus
ffitra-sonography/650 anteroversion of/646
Umbilical artery/679 appendages o£1666
cord/676, 678, 681 decomposition/269
prolapse of/681 double/651
twisting of/681 height of llterus in pregnancy/646-647 (Fig.)
vein/680 involution/654 (table)
Umbilicus/676 malformed/r359
Ummatta/866 nulliparus/6()1 (table)
Unde r-sexed/625 os/654-655
Under riding/469 parous/654-655
Undertrial prisoner/58 perforation oti'666
Under water blast prolapse of/62~l
Undinism/717 retroverted/659
Unethical acts/38 septa te/628 ·
practices/27 tumour of/629
Ungrounded building (lightning)/160 Utus paste/662-663
Unit in charge/68 UV absorption curvc/:120
Unn atural sex offences/687 , 705-712 light/733 (chart)
bestiality/712 spcctroscopy/319
buccal coitus (oral coitus/sin o£1
Gomorrah )/711-712
definition/705 Vacuum aspiration/663
cunnilingus/711-712 Vagal inhibition of heart/236, 238
definition/705 shock (sec vagal inhibition of heart)
fellatio (buccal coitus)/711-712 stimulation/236
heterosexuaV705, 711-712 Vagina
. hornosexuaV705, 711-712 blood in/218
indecent assault/712 constriction of/694
lesbianism (tribadism)/711 criminal abortion, in/66G
sodomy (anal coitus)/705-711 im potence/62 9
types - see page 687 perforation/666
Unqualified persons/51 semen in/218
Unrespired lungs/676-678 stricture of (narrowing et-:.)/628-629
Universal antidote/738 Vaginal-
Uraernia/753 discharge/218
Uranism (see sex perversions)/714 fluid/218
Uremic corna/843 epithelium cells/218
Urethral swab/700-70 1, 709 glycogen in, cells/218
Urinary bladder-decomposition/269 group specific substance in flnid/218, 694
dialysis/737 , 857 Vaginisrnus/629, 630
prolapse/629 Vagitus uterinus/674
Urine as trace evidence with presence of Vagitus vaginalis/674
group factors in secretors/218
group specific subst<;nce/218
Vagus nuclei/237
Vance/3
...
Parvej ·' Ahsan Uddin (Nayan)
Dr. Md. CoMC-24
1012 /PRINCIPLES OF FORENSIC MEDICINE
Varieties of punctured wounds/375 Vitiated air/903

vasectomy/631 Vitreous humor/278
Vasoconstriction/430 Vitriolage/7 50-752
Vasoconstrictors/7 40 Viviparous/82 7
Vasodilatation/430 VNTR (DNA study)/185
Vasoparalysis/430 Voice/182
Vasospasm/782 Volatile poisons/239
Vegetable acids as antidotes/7:n Volunteering sta tement/20
irritants/741, 809-822 Volcanic eruption/458
poisons/809-822, 839, 869-87:i, 876-877, 881, Volitional act/382
885 , 894-904, 909-911 power of, with fatal wound/382
Vegetative existance/224 Vomiting in pregnancy/645
Vehicular accidents (see Road accident/injury )/465-4 77 Voyeurism/715, 717
Voyeurists/716
Venerea!...disease/700, 710-711
warts/711
Venom - See snake, venomous fish and other
Wad/389, 392-:-!93
aquatic and land animals Warfarin/800
Venomous aquatic animals/835-837 Warning notice/30
• fish/835-836 Warrant Case/10
snake/823-832 Warrant of arrest/7, 9
weever-fish/836 Washer woman skin/543
Ventilator/740 Wasps/833
Ventricular fibrillation/541 , 542, 888 Water Hemlock/870
Verdegris/790 Waxy flexibility/609
Verdict/1 0-11 Weapon
Verenda/810-811 blunt/340, 348, 355
Vernix caseosa/142, 674 double edged/365, 379-380
Vertebra/103, 125, 415, 508-509, 522, 533 , 668, 935 fire arm-see firearm weapons
Vertebral fracture/508-509, 522, 533, 609 hard blunt/340, 348, 355
Vertical diameter of head of femur/101 (table) pointed/375
Vervigeration/602 sharp edged/362
Vestibule--occular reflex in d·e ath/225 sharp edged, heavy/862-363, 367
Viable foetus/146, 652 sharp edged pointed/375
Viability of foetus/668, 672 single edged/:-!65, 379
Vicarious responsibility/68 type ofl340, 348, 355, 362, 363, 365, 367 , 375, 379
Victim: weight of/340, 345, 362, 363, 367
of rape/690-698, 701-704 Wedlock/656
of sexuai assault in custody/689, 704 W('ed killers/799
sodomy/707 -711 Wernike-korsakoff syndrome/849
Viena/73 Wet microscopic test for blood/193
Vimpism/712 Wet submarine, pileta , latina/937
Wife battering/576-579
Vinegar/758
Wilson's modified classification of burn
Violence at home
injuries/433
physical/569-58 1
Whiplash injury/509, 573
sexual/575 White Oleander (see nerium odorum)/900-901
Violent asphyxial deaths (Mechanical )- White phosphorus (see phosphorus)/7 63-765
causes of/238 , 517, 529, 540, 554 Whooping cough/350
types/517, 529, 540, 554 Winslow's te-s t/242
Viper snake/823-825, 827-829, 831 Wisdom teeth/110
bite of/823-825, 827-831 Withdrawal syndrome:
Viperidae/823 alcohol/84 9
Virgin - true/637-641 morphine/842-843
false/641-642 Witness/12, 15, 17-18
and defloration/640-642 common/12
Virility/627 expert/12
Viscera analysis/732-733 hostile/12
Visual hallucination/594 release of/19
Vital organs- injury to/342, 515 type of/12
Vitamin B complex/740 Woblir.g of bullet/390
K deficiency/350 Wood naptha/853

INDEX / 1013
-"'
Workmen 's compensation Act/55, 80 X-ray and other radiation injury/461-463
World Medical Association/25-26, 74 diffni.ction pattern- study of/322
Worm lizard/823 radiation-epithelioma- in long exposure to/462
Wound (al~o see injury) early/462
antemo rtem/340 late/462
caused by broken glass/358
certificate/513
chart (NHRC) (stab}/940, 941 Yawning/674
classification/339-340 Yawning bullet/395
dangerous/34 0 Yellow oleander (see cerbera thevetia )/899
defence/3 65 Yew/901
fabricated/367
fire arm (see wound under 'firearm ')
healing/312, 351, 357, 364 Zebra fish/835
lacerated/355-360 Zenana/707
self inflicted/342, 363, 367 Zenkers ·degeneration/460
stab (see punctured wound) Zinc/793
Wrong medication/724 chloride/793
granule/195
oxide/793
Xanthines/863 phosphide/793
Xantho proteic· reaction/7 45 stearate/793
Xenograph/358 sulphate/793
Xenopas· toad/648 Zoskos phenornenon/224
Xiphoid process/124, 126 (Fig.), 145 Zoophilia/712
X-ray/3 19, 322-323, 461-462, 673 , 926-927, 935 Zipgun/420
dangers of/462 · Zygote/643

Appendix 18
SEXUAL OFFENCES AND
SEX PERVERSIONS
THE CRIMINAL LAW (AMENDMENT) BILL 2013 relating sexual offences, (BILL No. 63
.- C of2013), passed in the Lok Sabha on 19.03.2013 and Rajya Sabha on 21.03.2013 with
alteration/inclusion of provision amends the related parts of IPC, CrPC of 1973 and In-
dian Evidence Act ofl872. The bill received President's assent on 03 .04.2013.
(1) TID~
ACT MAY BE CALLED THE CRIMINAL LAW (AMENDMENT) ACT, 2013, (2); IT SHALL
BE DEEMED TO HAVE COME INTO FORCE ON THE 3RD DAY OF FEBRUARY, 2013.
SEXUAL OFFENCES ing a belief in the victim, of future mar-

riage which in a few circumstanc~s in a
Sexual offences can be defined as sexual or
few countries may ;:unount to an offence
sex oriented acts or assaults including sexual
intercourse performed, which are against the but not rape.
provisions of the law of the land. The~e are: (b) Unnatural sex assaults or offences -
(a) Natural sex assaults or offences These are sexual offences where inter-
course is performed against the order of
(b) Unnatural sex assaults or offences
nature i.e., when the act does not involve
{c) Sex _linked or sex oriented offences. penetration of a woman's valva or vagina
(a) Natural sex· assaults or offences are ·by the penis of a man. Examples:
assaults which are performed in the or- 1. Sodomy or anal coitus*
der of nature, i.e., by penetration of the 2. Buccal or oral coitus*
female organ (vulva) by the male organ
3. . Lesbianism or tribadism**
(penis). Examples are:
4. Bestiality.
1. Rape - All het erosexual intercourses
(* 1 and 2 above now amount to the offence
which. fulfill the criteria of definition of
of RAPE in Indai, in heterosexual inter-
'rape' described u/s 375 IPC (see pages 2 course when any of the ingredients of'rape'
& 3 of this appendix). is present.
2. Adultery:. ** This homosexual pr<:J,ctice may or may not
3. Incest (not in all countries or societies it . amount to offence depending on legal pro- ·
is an offence). vision of a country.)
4. Cohabitation by a man deceitfully indue- (c) Sex linked or sex oriented offences.
,.
Examples: It is to be remembered that not in all

1. Assault or application of criminal force cases of sexual offence or assault a medical
to outrage the modesty of a woman. man has a duty. But in a number of cases or
2. Sexual harassment - unwelcome physi- circumstances of these cases he may have to
cal contact, advance, demand or request participate at some stage in the process of
for sexual favours, showing pornographic investigation.
matters. The amendments are incorporated in the
3. Assault or use of criminal force on a CrPC, IPC and Indian Evidence Act with im-
woman with intent to disrobe her (make mediate effect.
her fully or partly naked). N.B. More details of the bill used for amend-
4. Voyeurism- peeping at a woman's pri- ment of concerned Acts are available
vate act, her genitals, posterior or breast, as annexure in this book.
exposed or covered with underwear or her For sections 375, 376, 376A, 376B, 376C
using a lavatory or doing a sexual act, and 376D of the Penal Code, the following
not ordinarily done in public, dissemina- sections shall be substituted namely:
tion of an image of her to a third person
to whom not consented by her to be dis-
seminated. RAPE
5. Stalking or pursuing a woman, contacts Sec. 375 IPC defines rape as below:
or attempts to contact for personal inter- A man is said to commit "rape" ifhe-
action, repeatedly despite clear indication
(a) Penetrates his penis, to any extent, into
of disinterest by her.
the vagina, mouth, urethra or anus of a
6. Trafficking one or more minor or major woman or makes her to do so with him
person or persons, using threat, force, or any other person; or
fraud, abuse of power or by abduction for
illegal purposes, exploitation, on induc- (b) Inserts, to any extent, any object or a part
ing sexual exploitation. of the body, not being the penis, into the
vagina, the urethra or anus of a woman
The Bill also includes the offence of throw- or makes her to do so with him or any
ing of acids or corrosive agents on the face other person; ·or
and body (of a woman), their effect and con-
sequential punishments for commission of (c) Manipulates any part of the body of a
the offence. woman· so as to cause penetration into
the vagina, urethra, anus or any part of
The Bill provides guidelines for free treat- body of such woman or makes her to do
ment of the victims of any of the offences so with him or any other person; or
described, in any Government or private hos-
(d) applies his mouth to the vagina, anus,
pital.
urethra of a woman or makes her to do
The Bill also narrates the duties of a po- so with him or any other person,
lice officer/public servant, how they should
- under the circumstances falling under
act on receiving information of commission
any of the following seven descriptions:
or occurrence of any of the offences described
in the Bili and the consequences and punish- Firstly - Against her will.
ments for failure in the duty by the public Secondly - Without her consent.
servant/police. It also dictates guideline of
Thirdly - With her consent, when her
investigation.
consent has been obtained by putting her or
The present bill suitably amends the Act any person in whom she is interested, in fear
of protection of children from sexual offences. of death or of hurt.

APPENDIX 18 I 3
Fourthly - With her consent, when the (2) Whoever,

man .knows that he is not her husband and (a) being a police officer, commits rape-
that her consent is given because she believes
(i) within the limits of the police station
that he is another man to whom she is or
to which such police officer is ap-
believes herself to be lawfully mar ried.
pointed; or
Fifthly - With her consent when, at the (ii) in the premises of any station house;
time of giving such consent, by reason of or
unsoundness of mind or intoxication or the
(iii) on a woman in such police officer's
administration by him personally or through
custody or in the custody of a police
another, of any stupefying or unwholesome
officer subordinate to such police of-
substance, she is unable to understand the
ficer; or
nature and consequences of that to which she
gives consent. (b) being a public servant, commits rape on
a woman in such public servant's custody
Sixthly - With or without her consent, or in the custody of a public servant sub-
when she is under eighteen years of age. ordinate to such public servant; or
Seventhly- When she is unable to com- (c) being a member of the armed forces de-
municate consent. ployed in an area by the Central or a
Explanation 1. For the purposes of this State Government commits rape in such
section, "vagina" shall also include labia area; or
majora. (d) being oh the management or on the staff
Explanation 2. Consent means an un- of a jail, remand home or other place of
equivocal voluntary agreement when the custody established by or under any law
woman by words, gestures or any form of for the time being in force or of a wom-
verbal or non-verbal communication, commu- en's or children's institution, commits
nicates willingness to participate in the spe- rape on any inmate of such jail, remand
cific sexual act; home, place or institution; or
(e) being on the management or on the staff
provided th~t a woman who does not physi-
of a hospital, commits rape on a woman
cally resist to the act of penetration, shall
in that hospital; or
not by the reason only of that fact, be re-
garded as consenting to the sexual activity. (f) being a relative, guardian or teacher of,
or a person in a position of trust or au-
Exception 1. A medical procedure or in-
thority towards the woman, commits
tervention shall not constitute rape.
rape on such woman; or
Exception 2. Sexual intercourse or sexual (g) commits rape during communal or sec-
acts by a man with his own wife, the wife not tarian violence; or
being under fifteen years of age, is not rape.
(h) commits rape on a woman knowing her
376. (1) Whoever, except in the cases to be pregnant; or
provided for in sub-section (2), commits rape, (i) commits rape on a woman when she is
shall be punished with rigorous imprison- under eighteen years of age; or
ment of either description for a term which
(j) commits rape, on a woman incapable of
shall not be less than seven years, out which
giving consent; or
may extend to imprisonment for life, and shall
also be liable to fme. ' (k) being in a position of control or dominance

4 I PRINCIPlES OF FORENSIC MEDICINE
over a woman, commits rape on such 376A Whoever, commits an offence pun-
woman;· or ishable under sub-section (1) or sub-section .
(2) of section 376 and in the course of such
(l) commits rape on a woman suffering from
commission inflicts an injury which causes
mental or physical disability; or .
the death of the woman or causes the woman
(m)' while committing rape causes grievous to be in a persistent vegetative state, shall
bodily harm or :maims or disfigures or · be punished with rigorous imprisonment for
endangers the life of a woman; or a term which shall not be less than twenty
(n) commits rape repeatedly on the same years, but which may extend to imprison~
ment for life, which shall mean imprisonment
woman,
· for the remainder of that person's natural life,
shall be punished with rigorous impris- or with death.
onment for a term which shall not be less 376B. Whoever ,has sexual intercourse
than ten y~ars, but which may extend to im- with his own wife, who is living separately,
prisonment for life, which shall mean impris- whether under a decree of separation or oth-
onment for the remainder of that person's erwise, without her consent, shall be pun-
natural life, and shall also be liable to fine. ished with imprisonment of either descrip-
Explanation. For the purposes of this tion for a term which shall not be less than
two years but which may extend to seven
su~-section,-
years, and shall also be liable to fine.
(a) "armed forces" means the naval, military
Explanation. In this section, "sexual in-
and air forces and includes any member
tercourse" shall mean any of the acts men-
of the Armed Forces constituted under tioned in clauses (a}to (d) of section 375.
any law for the time being in force, in-
37{)C. Whoev:er, being-
cl~ding ·the paramilitary forces· and any.
auxiliary forces that are under. the con- (a) iri a position of authority or in a fiduciary
trol of the Central Government or the relationship; or ·
State Govemment; (b) a pu.blic servant; or
(b) "hospital" means the precincts of the hos- (c) superintendent or manager of a jail, re-
mand home or other place of custody es-
pital and includes the precincts of any in-
tablished by or under any law for the time
stitution for the reception and treatment
being in force, or a women's or children's
of persons during convalescence or of institution; or
persons requiring medical attention or
(d) on the management of a hospital or be-
rehabilitation;
ing on the staff of a hospital, abuses such
(c) "police officer" shall have the same mean- position or fiduciary relationship to in-
ing as assigned to the expression ffpolice" duce or seduce any woman either in his
under the Police Act, 1861; custody or under his charge or present
· (d) ''women's or children's ·institution" means in the premises to have sexual inter-.
course with him, such sexual intercourse
an institution, whether called an orphan-
n~t amounting to the offence of rape, shall
age or a home for neglected women or
be punished with rigorous imprisonment
children or a widow's home or an institu- of either description for a term which
tion called by any other name, which is shall not be less than five years, but
established and maintamed for the recep- which may extend to ten years, and shall ·
tion and care of women or children. ·also be liable to fine.

APPENDIX - 18 I 5
Explanation 1. In this section, "sexual the words "shall be punished with simple im-
intercourse" shall mean any ofthe acts men- prisonment for a term. which may extend to
tioned in clauses (a) to (d) of section 375. one year, or with fine, or with both", the
Explanation 2. For the purposes of this words "shall be punished with simple impris-
section, Explanation 1 to section 375 shall onment for a term which may extend to three
also be applicable. years, and also with fine" shall be substituted.
Explanation 3. "Superintendent", in re- General considerations

lation to a jail, remand home or other place
of custody or a women's or children's institu-· No age is excluded either for the victim of
tion, includes a person holding any other ofrape or for the accused, However, when the
fice in such jail, remand home, place or insti- · victim, not being the wife, is below 18 years
tution by virtue of which such person can of age, sexual intercourse in any case,
exercise any authority or control over its in- amounts to rape. Sexual intercourse with a
mates. woman below 18 years of age is thus
Explanation 4. The expression "hospital" STATUTARY RAPE. In case of the accused
and "women's or children's institution" shall male, law does not specifically exclude any
respectively have the same meaning as in age group, higher or lower, when a person
Explanation to sub-section (2) of section 376. cannot be charged for commission of rape.
However it is obvious that a child of 8 yis
376D. Where a woman is raped by one
age physiologically should not have desire or
or more persons constituting a group or act-
feeling and erection (capacity) for sexual in-
ing in furtherance of a common intention,
tercourse ordinarily, but 13: child of 11 years
each of those persons shall be deemed to have
may not have anY deficiency. The court takes
committed the offence of rape and shall be
decision as· to whether a young accused can
punished with rigorous imprisonment for a
be considered as sexually potent or. capable,
term which shall not be less than twenty
or not. However, for the purpose of commit-
years, but which may extend to life which
ting rape one need not be potent in all senses,
sha~l mean imprisonment for the remainder
because to commit the offence of rape slight
of that person's natural life, and with fine:
penetration of vulva etC. by the penis is ·suffi- ·
Provided that such fine shall be just and cient: Full erection and intermission, ejacu-
reasonable to meet the medical expenses and lation, orgasm, are not essential. Old age is
· rehabilitation of the victim: not a bar for a man to be capable to perform
Provided furthe! that any fine imposed sexual intercourse.
under this section shall be paid to the victim. The phrases "against her will" and ·
376K Whoever has been previously con- "without her consent" both have signifi-
victed of an offence punishable under section cance and the latter has been explained. Will
376 or section 376A or section 376D and is and consent does not mean the same thing,
subsequently convicted of an offence punish- though consent is generally dependant on
able under any of the said sections shall be will. A woman may have will for sexual in-
punished with imprisonment for life which tercourse, but she :rp.ay not give consent for
shall mean imprisonment for the remainder shyness, for fear of detection, social stigma
of the person's natural life, or with death. or becoming pregnant. On the other hand, a
In section 509 (uttering any word or woman may give consent suppressing her un-
making any gesture intcmded to insult the wi}iingness due to some other. factors e.g. for
modesty of a woman) of the Penal Code, for some benefit or fear.

It may be possible to prove her expressed band due to frigidity or some other reason,
unwillingness and absence pf consent from the the husband may instead pray for nullity of
marks of resistance offered by her, which may marriage or divorce.
leave some injury on her body e.g. on the back, As of now charges of rape, adultery (sec
inner aspects of thighs or on arms. But, if a
-497 IPC), cohabitation by deceitfully induc-
woman subjects herself to sexual intercourse
ing to a belief oflawful marriage (sec 493 IPC)
for fear of death, injury, blackmailing or some
and charges as described under sec. 376A,
such other reasons then, marks of resistance
376B, 376C, 376D and 376E cannot be brought .
may not be there to substantiate absence of
against a woman for commission of the of-
will and consent. If unwillingness is sup-
fence on a man in reverse but otherwise iden-
pressed, there will not be anything to prove it
except by otherwise close investigation of the tical circumstances.
case. Further, no signs of unwillingness or
Rape by a woman on a man
absence of consent should be expected, when,
at the time of rape, the girl was intoxicated or According to Indian Law a woman cannot
stupified. These are apart from invaLidity of commit rape on a man. In many countries a
consent in circumstances, like insanity, im- woman may be charged as a perpetrator to
personation, being younger than 18 yrs of age commit sexual act which is a criminal offence
etc. Even a professional prostitute cannot and is punishable if she compels a male or
be subjected to intercourse against her will makes a situation to compel a male to per-
and without her consent. Ordinarily, the form sexual intercource with the woman.
burden to prove unwillingness and absence
of consent lie with the prosecution. But in Examination of the Victim of an Alleged
rape cases as described under sec. 375 and
Case of Rape
all clauses of subsection 2 of sec. 376, if the
victim states in the court of trial that, she (Examination should be undertaken without
did not give consent, it then lies with the ac- unnecessary delay, so that, the findings do
cused to prove that, she consented for the not obliterate, e;g. spermatozoa, if present
intercourse. In clause 'i' and "j" of subsection in the vagina, should not disintegrate. A sec-
2 of section 376, question of giving a valid ond day for examination may be suitably cho-
consent does not arise. sen for further examination of the woman, if
If a husband performs sexual intercourse she is in her period during first examination
forcefully on his wife above the age of 15 yrs, or if there is possibility of gonorrhoea! infec-
against her will it will as such not amount to tion due to rape).
rape, as marriage is to be consumated by
sexual intercourse. However, that does not Procedure for examination
mean that, the husband, for the purpose of A. Prerequisites:
sexual intercourse should use force causing
1. A requisition for examination of the vic-
pain, injury or mental trauma to the wife
tim of alleged rape from an authorised
without considering temporary difficulties of
person, either a Magistrate or from the
the wife. In such a case, though the husband
may not be charged for commission of rape, officer in charge of a police station.
he may be charged for cruelty and assault on 2. An authorised person should be there to
wife. If the wife, continuously and unreason- identify the victim before the medical of-
ably refuses sexual intercourse with the hus- ficer.

APPENDIX - 18 I 7
3. The victim woman should give consent D. General Examination - Height,

for examination if she is 12 yrs of age or Weight, General built and configuration
above. If she is below 12 yrs of age or if should be recorded which will give idea
mentally unsound or intoxicated then, about her capacity to resist the offender.
consent for examination should be given Teeth erupted, with pattern of position-
by her legal guardian about whom there ing noted. Any developmental anomaly
should be mention in the requisition. or any disease should also be recorded.
Examination of teeth helps (a) to estimate
Consent for examination is a must.
the age, and (b) if, the accused has any
4. An adult mentally sound female attend- teeth bite mark on his body, then this
ant should be present during examina- can be compared with the pattern and po-
tion. - sitioning of teeth of the victim girl which
B. History of the case should be taken from will help to establish that she resisted the
the victim and recorded in brief. It should act.
be about the date, hour and place of al- E. Examination of Mental Status- If
leged occurrence of the rape; whether she mental unsoundness is doubted then, she
knows the accused, if she resisted and should be referred to a psychiatrist. If she
shouted for help, if she was given any food appears to be intoxicated, then her blood
or drink prior to the act which affected and urine should be preseryed.
her consciousness, desire and capacity to F. Examination of Developmental State
resist. If she was put under any threat. If of Secondary Sex Features- Growth
there was palpable penetration due to the and appearance of breasts, axillary and
act of coitus and ejaculation, or there was pubic hair should be noted. Removal of
premature ejaculation before penetra- dress should be done part by part by the
tion. Whether she experienced pain and victim herself or by the female attend-
bled during the act. It should also be as- ant and not by the male doctor himself.
certained from her if she was wearing the The breasts give information about the
same dress during the incident as during sexual habit of the woman. The breasts
the examination. Her mens~rual history of a woman not accustomed to sexual
should be taken including the LMP. Her practices will be hemispherical, firm,
marital status should be noted. If unmar- spongy with smaller nipples and areola . .
ried it should also be enquired from her, If habituated with sexual practices, the
if she had any previous experience of breasts are larger, lax, slightly pendulous
sexual intercourse, if she is habituated with larger raised nipples.
to frequent intercourse, or habitually G. To note marks of injuries, if present
practices masturbation manually or with on the body, other than on sex organs.
some aid. She may be asked if she noted Some of these injuries are due to resist-
any purulent discharge from, or ulcer on ance_offered by her and some are due to
the penis of the stated offender. Her oc- excessive passion and sexual act by the
cupation and educational status should offender. Injuries due to offer of resist-
also be recorded. ance may be present in the forms ofabra-
c. Minimum two identification marks, sions and bruises on the back of chest,
preferably from exposed or exposable buttock, forearms, face (nail scratches),
parts of the body should be noted. inner aspects oflips (due to friction with

teeth if the offender attempted to stop habituated with sexual intercourse labia
her from crying for help), at the inner minoras are slightly projected out,
aspects of thighs (in the form of nail pigmented and enlarged. In others, these
scratch abrasion or bruise, in an attempt are pinkish, smaller and covered by
to forcefully push, t:P.e thighs wide apart), majoras.
or abrasions over the vulva (caused while The parts deeper to labias may. show
removing the woman's hand covering her seminal and blood stain which should be
private part). Injuries due to excessive preserved in swabs. These parts may
passion of the offender may be present show congestion, bruise and often tear
in the form of bruise, nail scratch abra- or laceration over the posterior commis-
sions, teeth bite injury over face, breasts, sure, in case the girl was a virgin before
mons veneris. being raped.
H. Examination of the private parts- Clitoris is slightly enlarged in women
The woman should be laid in lithotomy habituated to intercourse and masturba-
position. Undressing of the priva.te parts tion.
should be done part by part as examined, Hymen: In case of rape of a virgin, there
only by the Victim herself or the female will be one or many fresh tears usually
attendant and not -by the doctor. The at- on the posterior aspect at 5, 7 or 6 O'clock
tendant should not apply any force to positione Jfveryfresh, then the margins
undress her. of the te s. 3 will be reddish, swollen, and
The pubic hair should be examined. Any may still show oozing ofblood which usu-
matting due to semen should be noted ally stops within a few hours. Swelling
and the matted hair should be cut by a and redness persist for 2-3 days . .
scissor and preserved. Any foreign pubic In a previously deflorated woman, recent
hair identified should be preserved. tears may not be there. Instead, there
The inner aspects of thighs may show may be old tears at places. In a woman
presence of dried seminal stain, blood habituated to sexual intercourse, carun- ·
stain and injuries. Dried stains should be culae hymenalis appearance will be there.
scrapped out by a blunt blade and pre-
Hymen may not rupture after rape, in the
served.
following circumstances
Vulva: Labia majora may show conges-
tion, bruise, scratches, seminal and blood 1. If the penetration is not full.
stain and foreign pubic hair. For blood 2. If the hymen is tough, fleshy and elastic.
and seminal stain, swab should be taken There may be only congestion or bruise.
and this along with foreign pubic hair, if 3. If hymenal opening is large due to prac-
present, preserved. In woman who had tice of masturbation.
no habitual experience of sexual inter- 4. In very young children, due to deeper
course, the labia majoras are roundish, placement of the hymen and less capac-
fleshy and both side lie in close apposi- ity of the vagina, penetration with rup-
tion. In women habituated to intercourse, ture of hymen may not occur. Instead,
these are lax and not in apposition. there may be congestion, bruise or even
Labia ·m inora may show stain, foreign tear laceration of the structures of pos-
pubic ]j."air' and injury. Here also same terior wall ofihtroitus and vagina which
pr?cedure should be followed. In women may extend upto perineum.

APPENDIX.,. 18 / 9
5. In deflorated woman no fresh rupture of Gait- Gait may be altered and painful.
hymen may occur. I. Examination of clothings - If the
Any vaginal discharge should be noted clothes were not changed then, they
and preserved. It may contain semen, may show recent tear (mark of resist-
blood, purulent discharge due to gono- ance), mud or soil stain (a corroborative
coccal infection contaminated from the sign; the mud or soil should be matched
offender (present after 2 days of the in- with the same of the alleged place of oc-
cident), or ordinary leucorrhoea of the currence), seminal stain (starchy in ap-
woman. pearance), blood stain and foreign pubic
Vaginal wall congested, may even show hair. The clothes are preserved for fur-
contusion and be tender. In sexually ha- ther examination at Forensic Science
bituated subject (intercourse or mastur- Luuoratory.
bation), it will easily permit 2 fingers. In
J. Other materials to be preserved-
virgins prior to rape, introduction of more
(1) Scrapping from the nail beds of the
than 1 finger is painful. Vaginal rugos-
ity is partially 1ost after repeated acts :;f woman, which may contain cuticle of the
intercourse. offender, if the victim girl scratched him.
(2) Swab from the teeth _b ite marks for
Vaginal swab and cervical smear should
detection of saliva and group factor of the
be taken to test for semen and sperma-
offender from the saliva.
tozoa, if present and if of recent occur-
rence. The group factor may also be de- K. Blood, vaginal fluid, stain from cloth or
tected if the offender is a "secretor". body should be preserved for compara-
Presence of blood of the victim and the tive study ofDNA of the accused.
offender may be detected from the swab. L. Further recommended investiga-
The cervical smear may show in Gram tions:
stain test gonococcal infection with dem-
1. X-ray of ossification centres for assess-
onstration of gram negative intracellu-
lar concavo-convex diplococci. ment of age, if the victim is around
18 yrs of age.
2. Urine test after 15 days for Human
chorionic gonadotrophin if the alleged
rape was committed during the 'dan-
ger' period.
M. Treatment and further action:
1. Treatment for injury, mental shock
should be provided.
2. If pregnancy occurs and abortion de-
sired, then it should be induced
(within 20 weeks).
3. Total.t:teatment of the victim girl
Fig. 1: (a) Human spermatozoa, (b) Enlarged view should be given free of cost, whether
showing different parts.
(1) Ant. 2/3rd of head (nucleus) , (2) Post it is in Cen~ral, State or Private hos-
1/3rd of head, (3,) Neck, (4) Tail . pital.

Su mmary of materials preserved from the Preparation of report

victim
While preparing the report, name, address,
1. Vaginal swab and Cervical smear- age of the victim, case reference, date, time
For Seminal fluid, Blood, Gonococcus. and place of examination, brief history of the
2. Foreign pubic hair- To compare with case, identification marks and other findings
the pubic hair of the accused. of examination should be properly incorpo-
3. Matted pubic hair - For presence of rated. The opinion should be regarding sexual
Semen and Blood. intercourse, forceful or otherwise and notre-
4. Her own pubic hair- To compare with garding rape, which is decided in Court.
the foreign pubic hair available on the In alleged rape cases the vital question
body of the accused. is- whether rape was committed or not. It is
5. Scrapping of suspected stain mark on the most difficult question for the medical man
the body surface - For test for Semen to answer. An affirmative answer can be
and Blood. given only in a very limited number of cases,
6. Scalp hair - For comparison with for- when the vaginal fluid of the alleged victim
eign scalp hair available from the body of ofless than 18 years of age (or 15 yrs in case
the accused or his dress. of wife) or of an insane shows presence of
7. Swab from teeth bite marks- For spermatozoa under microscope with tear of
group factors from saliva. hymen at the expected sites with or without
marks of resistance over other expected parts
8. Wearing dress with under garments.
of the body. From medical points of view,
9. Scrapping from nail beds for blood and
findings present in the private organs includ-
cuticle, if she scratched him.
ing spermatozoa in vaginal fluid and tear of
10. Blood and urine- For grouping, DNA hymen are only supportive of sexual inter·-
test and in suspected case of intoxication. course and not essentially of rape. Marks of
11. Urine as mentioned in column "L" above. resistance in addition, of course acts as strong
Fig. 2: Different sites of healed rupture of hymen in a Fig. 3: Old healed tears on hymen of a woman
girl with experience of sexual intercourse for accustomed to sexual intercourse' and sodomy
some time (also note the dilated anal sphincter)

APPENDIX - 18 I 11
hymen) than in the latter (vide page .......).

In both cases positive genital findings are
supportive of sexual intercourse and marks
of resistance including bodily injuries and
tears of clothes in presence of genital find-
ings are strong corroborative signs of rape.
Rape on very young children- There
may not be penetration and rupture of h y-
men (see page ..... ) but there may be other
local injuries. Seminal stain may be present
near the vulva.
Fig. 4: Sex assault and murder. Forceful sexual
intercourse with ecchymosis in the private· Rape on sleeping woman - Theoreti-
parts cally, slight penetration is possible without
the knowledge of the sleeping woman. But
corroborative evidence in support of rape. full intercourse is impossible.
"Medical evidence of sexual intercourse is not
necessarily the legal evidence of rape". Marks Intercourse, intoxication and con·
sent- generally speaking, consent given for
of resistance may not be there when the of-
sexual intercourse in a state of intoxication
fence is committed under threat, by imper-
is invalid and such intercourse amounts to
sonation or after stupefaction. The opinion
rape. ~ut if the woman wilfully took the in-
essentially rests on all available evidences.
toxicating agent to enjoy sex act, commission
Rape on virgin and deflorated of the same by the desired man will not
women- Genital findings are more conspicu- amount to rape.
ous in the former (with recent rupture of
Offering of resistance during rape-
A smart, working and educated woman can
offer reasonable resistance when she is free
from fear or is not intoxicated and it is not a
case of impersonation by the accused as her
husband or not committed by misrepresen-
tation of any fact. A timid, weak and shy or a
Fig. 6: Venereal warts in the private parts in a minor girl,

Fig. 5: Sexual intercourse on a minor a false virgin ·

2. Death may also occur due to suffoca-

tion due to closure of the mouth and nose
of the victim by the accused or due to
gagging to stop her cry. ·
3. Vaginal stricture or Recto-vaginal fis-
tula, due to gross injury of the vagina.
4. It may cause a social stigma for the vic-
tim and affect her future.
5. It may ·cause psychological trauma to
the victim (Rape Trauma Syndrome)
characterised by emotional imbalance,
depression, feeling of guilt during the
first phase (phase of disorganisation)
followed by gradual adjustment with oc-
casional phobia and fear state during the
second phase (phase of reorganisation).
6. Pregnancy due to rape causes additional
mental trauma.
Fig. 7: Murder after rape
EXAMINATION OF THE ACCUSED
The procedure of examination ofthe accused

very young girl or an intoxicated woman is is more or less same as in case of examina-
not expected to offer much resistance. tion of the victim. Here also the same pre-
Rape by impersonation as husband may requisites are necessary. The same formali-
be possible in dark, during night, with a mod- ties and the same line of examination should
erately intoxicated woman. be.followed, except that:
Example of rape by misrepresentation 1. Consent should be asked for. But if re-
of fact - when it is done in the pretext of fused then, the accused can be examined
therapy for some disease . with application of minimum force so as
not to injure or assault him (Sec. 53 CrPC).
Rape and venereal disease - When
the accused has some venereal disease and 2. Presence of an attendant is not a must.
the victim shows signs of same venereal dis- 3. History taking p~rt may be omitted or
ease after some days of alleged rape, the pe- recorded as his version.
riod matching with the incubation period of Marks of identification should be noted.
the disease, it becomes a strong. corrobora- General examinatipn should be performed as
tive evidence of rape, if the man denies sexual in case of the victim. Marks of injury on the
intercourse with the woman. body should be no-ted, .They may be the re-
sult of resistance offered by the girl. Devel-
Complications ofrape
opment of secondary sexual features should
1. Rape may be followed by mul,'der (for fear be noted. Lastly; ~:xamination of private parts
of disclssure ofthe offence by. the victim). should be undex:t,a.k~n.

APPENDIX- 18 I 13
Examination of Private Parts 6. Urethral swab should be taken after

prostatic massage to test for presence of
1. If there is any morphological defect or
gonococcus.
disease on or around the private parts
7. Blood should be collected for testing for
that should be noted. Pubic hair should
blood group and DNA study.
be searched for presence of any foreign
pubic hair, which if present, should be 8. Swab taken from any bite mark in-
preserved. His own pubic hair, whether flicted by the victim any where may help
matted or not should be preserved for to link the offender.
detection of semen and for detection of 9. When the accused is very young, his age
foreign blood with its group and to match is ascertained from physical findings,
with foreign pubic hair obtained during teeth and X-ray findings.
examination of the victim. 10. If required, his potency may be tested if
2. The penis, pa1ticularly the glans and the possible. If the findings in the accused
prepuce may appear :r:noist due to vagi- corroborates with those in the victim,
nal fluid and semi nal fluid. A swab then sexual intercourse is established. In
should be taken and preserved. Presence such a case, denial of sexual intercourse
of vaginal fluid can be known by testing between him and the said girl is strongly
for vaginal epithelium and monilia. suggestive of rape but not confirmatory
(a) The glans is soaked with a moist blotting
course for fear of conviction for rape.
paper which is then exposed to iodine
vapour. Brown discolouration of the Materials preserved duri ng examination
soaked part indicates presence of vagi- of the accused
nal epithelium, as they contain glycogen
1. His clothings
which turns brown in presence of iodine
2. Foreign pubic hair
vapour.
3. His own pubic hair
(b) A drop of wash of glans is placed under
4. Scalp hair
high power observation of microscope.
Vaginal epithelium and monilia can 5. Swab from glans
be detected. The former stains brown if 6. Urethral swab
a drop of lugol's iodine is added, as the 7. Swab from teeth bite mark if any
same contain glyco gen. 8. Blood
(c) Test for seminal fluid may be performed 9. Matted pubic hair.
as described in pages ...... .
3. Tear of the frenulum may be noticed. Establishment of relat ionship between the
-t prepuce is present and not re- accused, the offence and the victim
~-...ed,then presence of smegma goes 1. Matching of blood group factors ofblood,
against full penetration and intercourse seminal stain, saliva and tissue debris
within last 24 hours. This is because from the nails ofthevictim with the blood
penetration and intercourse removes group of the accused. If group factor de-
smegma which takes 24 hours for re- tected from the saliva fi:om the bite mark
on the body of the accused tallies with
'"nes m.a) be present on the blood group of the victim or that of the
pems, caused by the victim. blood stain available on the undergar-

APPENDIX- 18/13
Examination of Private Parts 6. Urethral swab should be taken after

prostatic massage to test for presence of
1. If there is any morphological defect or
gonococcus.
disease on or around the private parts
7. Blood should be collected for testing for
that should be noted. Pubic hair should
blood group and DNA study.
be searched for presence of any foreign
pubic hair, which if present, should be 8. Swab taken from any bite mark in-
preserved. His own pubic hair, whether flicted by the victim any where may help
matted or not should be preserved for to link the offender.
detection of semen and for detection of 9. When the accused is very young, his age
foreign blood with its group and to match is ascertained from physical findings,
with foreign pubic hair obtained during teeth and X-ray findings.
examination of the victim. 10. If required, his potency may be tested if
2. The penis, particularly the glans and the possible. If the findings in the accused
prepuce may appear moist due to vagi- corroborates with those in the victim,
nal fluid and seminal fluid. A swab then sexual intercourse is established. In
should be taken and preserved. Presence such a case, denial of sexual intercourse
of vaginal fluid can be known by testing between him and the said girl is strongly
for vaginal epithelium and monilia. suggestive of rape but not confirmatory
(a) The glans is soaked with a moist blotting
course for fear of conviction for rape.
paper which is then exposed to iodine
vapour. Brown discolouration of the Materials preserved during examination
soaked part indicates presence of vagi- of the accused
nal epithelium, as they contain glycogen
1. His clothings
which turns brown in presence of iodine
2. Foreign pubic hair
vapour.
3. His own pubic hair
(b) A drop of wash of glans is placed under
4. Scalp hair
high power observation of microscope.
Vaginal epithelium and monilia can 5. Swab from glans
be detected. The former stains brown if 6. Urethral swab
a drop oflugol's iodine is added, as the 7. Swab from teeth bite mark if any
same contain glycogen. 8. Blood
(c) Test for seminal fluid may be performed 9. Matted pubic hair.
as described in pages ...... .
3. Tear of the frenulum may be noticed. Establishment of relationship between the
4. If the prepuce is present and not re- accused, the offence and the victim
tracted, then presence of smegma goes 1. Matching of blood group factors of blood,
against full penetration and intercourse seminal stain, saliva and tissue debris
within last 24 hours. This is because from the nails of the victim with the blood
penetration and intercourse removes group of the accused. If group factor de-
smegma which takes 24 hours for re- tected from the saliva from the bite mark
deposition. on the body of the accused tallies with
5. Nail scratches may be present on the blood group of the victim or that of the
penis, caused by the victim. blood stain available on the undergar-

ments of the accused, suspected to be woman who is not lawfully married to him,
from the injury of the victim. to believe that she is lawfully ma'rried
3. DNA profile of semen if present in the to him and to cohabit or have sexual inter-
vaginal fluid of the victim, or dried semi- course with him in that belief, shall be pun-
nal or blood stain on the cloths or body of ished with imprisonment of either descrip-
the victim and sample of blood taken from tion for a term which may extend to ten
the accused if matches. years; and shall also be liable to fine (Sec.
4. Foreign pubic hair on the body of the vic- 493 IPC). (This section has some similarity
tim if matches with the.pubic hair of the with one clause of Sec. 375).
accused and vice versa.
5. Gonorrhoea in the accused, and the vic- INCEST
tim suffering from it after 2-3 days. It is not an infrequent sexual behaviour, in
6. Presence of seminal fluid in the vagina which the sexual partners are close blood
relations, often belonging to the category of
of the victim and presence ofvagin~ cells
and absence of smegma on the glans of prohibitory relationship e.g., between
the accused. father and daughter, mother and son, brother
7. Rupture (recent) ofhymen of the victim and sister, with nephew or neice, cousins etc.
and tear of frenulum in the accused. Incestual pmctice is legally prohibited in
many countries. In India, though it is not a
8. Marks of struggle, on the body ofthe vic-
generally accepted practice all over the coun-
tim as well as the accused.
try, in some parts, it is not only allowed but
9. Teeth bite mark on the body of one, · even promoted by compulsive marriage, if
matching with the same of the other. within some specific relationship. In some
10. Garments of both the accused and the cases, it is seen in subjects of otherwise timid
victim stained with soil and mud of the personality, having no appreciable exposure
complained place of occurrence. to outer world, in subjects with low mental
development, among persons having organic
OTHER NATURAL SEX OFFENCES- NOT psychiatric problems or in subjects with psy-
AMOUNTING TO RAPE chological aberrations.
Adultery- Whoever has sexual intercourse Covert incest means no intercourse but
with a person who is and whom he knows or getting sexual pleasure by discussing such
has reason to believe to be the wife of an- matters with relative of opposite sex. Brother
other man, without the consent or con- having desire for intercourse with sister is
nivance of that man, such sexual intercourse pharoan complex, son having such desire
not amounting to the offence of rape, but of towards mother is oedipus complex and
the offence of adultery, and shall be pun- when daughter has such desire towards fa-
ished with imprisonment of either descrip- ther it is electra complex.
tion for a term which may extend to five
years, or with fine or with both. In such AMENDMENT TO THE PROTECTION OF
case the wife shall not be punishable as an CHILDREN FROM SEXUAL OFFENCES ACT,
abettor (Sec. 497 IPC). 2012
Cohabitation caused by a man de- For section 42 of the Protection of Children
ceitfully inducing a belief oflawful mar- from Sexual Offences Act, 2012, the follow-
riage- Every man who by deceit causes any ing sections shall be substituted namely:

APPENDIX- 18 I 15
"42. Where an act or omission consti-

tutes an offence punishable under this Act
and also under sections 166A, 354A, 354D,
370, 370A, 375, 376, 376A, 376C, 376D, 376E
or section 509 of the Indian Penal Code, then,
notwithstanding anything contained in any
law for the time being in force, the offender
found guilty of such offence shall be liable to
punishment under this Act or under the In-
dian Penal Code as provides for punishment
which is.greater in degree.
42A. The provisions of this Act shall be Fig. 8: Amputation of penis as a punishment for sex
in addition to and not in derogation of the offence
provisions of any other law for the time be-
ing in force . inconsistency,
. and, in case of any mal shall be punished with imprisonment for
the provisions of this Act shall have overrid- life or with imprisonment of either descrip-
ing effect on the provisions of any such law tion for a term which may extend to ten years
to the extent of the inconsistency." and shall also be liable to fine. Some change
In relation to sex offence cases and in attitude in the legal and social status in
amendment of2012, the provisions have rel- different countries about the culpability is no-
evance. ticed presently. In India after recent
ammendment of provisions of IPC, sodomy
and buccal coitus, when heterosexual and not
UNNATURAL SEX OFFENCES
consensual, amont to rape. On the other hand
Definition for . homosexual sodomy and buccal coitus
courts appear to think for a soft stand.
These are sexual acts against the order of
natl,].re and provision of Law. Explanation- Penetration is sufficient to
constitute the carnal intercourse necessary
Types to the offence described in this section.
1. Sodomy or anal coitus- most common
unnatural sex offence. May be homo- SODOMY
sexual or heterosexual. Sodomy or anal coitus is the commonest
2. Tribadism or lesbianism - female hoof the unnatural sex practices, also termed
mosexuality. by general population as buggery (which also
3. Buccal coitus -with opposite sex or includes intercourse with animals i.e., besti-
same sex. ality). Sodomy may be homosexual or het-
4. Bestiality (zoophilia) - sex act per- erosexual, involving two males (homosexual)
formed with an animal. or one male and one female (heterosexual).
Male is the active agent (active sodomite)
Punishment for unnatural sex of-
and either another male or a female acts as
fences has been described under section
the passive agent.
377 IPC which states that, whoever vol-
untarily has carnal intercourse against the It mostly involves two males (gays).
order of nature with a man, woman or ani- Mythologically, it was practised in the town

16 I 'PRINCIPLES 0F FORENSIC MEDrC1Ni:
ofSodom. Thus it acquired the name sodomy. partly enjoys it, and also likes to feel it as an
This sexual practice prevails all around the exciting way of male arousal. It is also not
world without any age limitation, involving unlikely that, such behaviour is a reflection
adults, children and old subjects. Old and of rejection of their own sex.
children usually act as passive agents. Sod- A medical man may have to examine both
omy is popularly referred to as paederasty active and passive agents. Some of the sub-
with a child acting as passive ag~nt who is jects of both the groups turn out to be ha-
known as catamite. With old people serving bitual active or passive agents, while for oth-
as passive agent gerontophilia is the other ers it is just isolated incidentls.
term.
In many circumstances sodomy may not
In many cases, sodomy may have minor be taken as abnormal sexual practice. For
degree Psychological aberration. In vast ma- hostel inmates or inmates of a barrack, this
jority of cases, possibly it is a compulsive or is the sexual behaviour in the compulsive seg-
easy outlet of sexual desire, or may also due
regated life having no other preferred alter-
to non-availability of natural outlet.
native for gratification, available to them.
Among male homosexualities sodomy is Allmost all of these subjects usually change
comparatively popular and pr3:cticed. In In- to normal sexual practice, once out of the
dia, still now generally both passive and ac- compulsive environment.
tive agents, of sodomy are punishable with
exception to the passive agent when he or Examination and findings of a non-habitual
she is forced to act or participate as passive sodomite
agent. However, present social attitude indi-
Procedure of examination
cates amendment in the matter. Giving due
consideration to the mental make up and The steps of examination of both the active
harmless effect of sodomy in the society, it is and passive agents are same in all respects
conditionally not considered an offence in except that, when the passive agent is a fe-
many countries. In our country, there are male, a female attendant should be present
professional passive sodomities, the so called during her examination. The prerequisite
"male prostitutes" who allures vulnerable ac- and the procedure as recorded in case of ex-
tive agents. It is bread earning profession for amination ofthe victim of a case of rape, may
the castrated eunuchs and the so called be taken as the standard for medicolegal ex-
'Zenana' males. It is hard to say if these peo- amination of sodomites also, except that, in
ple have any female psychological trait. How- sodomy when both are adult males, both stand
ever, some physiological change is apparent on the accused platform and to examine them
in castrated eunuchs due to the changed hor- their consent is desirable and should be
monal influence after castration, and possi- sought for, but their consent is not essential
bilities of development of female psychologi- and it they refuse examination then, mini-
cal trait may not be ruled out in these people mum force can be applied to examine them.
which causes unusual passion for or a criptic When the passive agent is a catamite and is
hatred against their own sex, expressed a minor child his examination needs consent
through their sexual activity. In heterosexual from his legal guardian, ifhe is below 12 years
sodomy, sometimes the female accepts it and age.
APPENDIX - 18 f 17
The pre-requisites are The perineum also ext~rnally appears to

(a) A requisition for examination of the sub- some extent like that of a female.
ject, from an authorised person. A "non-habitual" passive agent may turn
(b) Identification ofthe person to the medi- out after examination to be a habitual one.
cal officer, by a person authorised to do so.
Examination of anorectal region:
(c) Consent of the person to be examined.
(performed in knee-elbow position)
(d) Presence of a female attendant while
examining a female passive agent. In a non-habitual passive agent, the anus
may appear to be swollen with temporary
In case of examination of a habitual sodo-
reduction of tonicity of the anal sphincter.
mite, history taking is irrelevant. But in those
cases where a child is forcefully subjected to . There may be congestion of the cutaneo-
act as a passive agent, a brief history may be mucous tissue with some contusion and some-
taken. times a posteriorly placed tear laceration. The
area may be stained with mixture of semen,
Examination proper faeces and sometimes blood. Foreign pubic
hair may be present. When the passive agent
Examination of an occasional or acci-
is a young child and when intromission is
dental (non-habitual) passive agent
forceful, the tear is more common with free
Examination should constitute bleeding and sometimes some degree pro-
(a) brief general examination lapse. If two fingers, can be inserted without
(b) examination of the anorectal region pain, then probably no forceful anal inter-
(c) examination of wearing clothes, parti- course occurred. If there is some pain, it is
cularly the undergarments. suggestive of anal intercourse. Internal ex-
amination is performed in full aseptic condi-
(d) preservation of some materials.
tions, with the help of a proctoscope of suit-
Genera1 examination should include able size. Mucosa of anal canal and rectum is
measurement ofheight, weight and to note congested, may show recent tear and evi-
general configuration of the subject. In case dence of seminal discharge may still persist.
of a child, teeth and development of the sec- In occasions contusions, may be noticed par-
ondary sexual characters should be noted.
ticularly in the anal canal. Evidence of use of
In other cases, the signs of eunachoidism
lubricants may be there in some.
or signs of any type of intersexuality or go-
nadal dysgenesis may be seen. During exami- After a few days evidence of gonococcal
nation, the doctor should try to assess the infection may be noticed, if the active agent
mental status of the subject and if he feels is having the disease.
required, may arrange for his subsequent ex-
Materials to be preserved
amination by a psychiatrist.
(a) Swab from around the anus.
Eunuchs after castration, develop
feminish features with s1ight eplargement (b) Swab from the anal canal.
of breasts, absence of male. -distribution of (c) Any foreign pubic hair.
hair; increase in the -deposition of subcuta- (d) Und,ergarments of the passive agent, if
neous fat with change of gait and behaviour. not changed after the act.

Examination of a non-habitual active

agent
A non-habitual active agent will have no per-
manent sign ofbeing a sodomite. Hence very
few or none of the expected fmdings may be
seen, if examined after gap of some period,
as the accused gets time to clean his organ.
The findings expected are:
(a) Moist appearance ofthe glans and shaft
of the penis which may be stained with
mixture of semen, faecal matter and Fig. 9: Venereal warts around the anus of a passive
sodomite
lubricant, when used.
(b) The penis, the glans in particular, will (a) Presence of seminal fluid mixed with fae-
emit smell of faeces or smell of secretion cal matter and lubricant, in the swab col-
of anal glands. lected from the anal area of the passive
(c) Tear of frenum in some cases. agent and detection of semen in the swab
(d) Absence of smegma in all cases examined from the anal canal of the passive agent
will indicate that, he acted or was made
within 24 hrs.
to act as passive sodomite. Congestion or
(e) Presence of anal hair of the passive agent injury in the area are additional substan-
on the glans or prepuce. tiating points.
The above are the local findings. General (b) Presence offaecal stain mixed with semen
examination will occasionally show marks of and lubricant, foreign anal hair if any, on
resistance by the passive sodomite on the the glans and body of penis of the alleged
body of the active agent (including on his pe- active agent will substantiate his role.
nis) in the form of nail scratches, teeth bite (c) Similar stains on the clothing (undergar-
marks etc. ment) and the handkerchief ofthe alleged
active agent will add to the conclusion.
Materials to be preserved (d) Matching of foreign pubic hair recovered
Swab from the glans and prepuce, urethral from the anal region of the passive agent
swab after prostatic massage, wearing with the pubic hair of the active agent
and foreign anal hair recovered from the
apparels, particularly the undergarments,
penis of the active agent with the anal
handkerchief, which might have been soiled
hair of the passive agent will establish
due to cleaning of the penis, are to be pre-
link between the alleged active and pas-
served.
sive agents.
Further evidence as will be available (e) Evidences of venereal diseases either in
from examination of materials preserved the form of a chancre on the penis of the
during examination of the victim and the ac- active agent or presence of gonococcus.
cused and inter-relationship of the evi- in his urethral smear and simila,.r diseases
dences (when both the active and passive developing around the anal region of the
agents were involved for the first time). passive agent subsequently, after lapse

APPENDIX- 18 I 19
of incubation periods for the diseases, will (f) By inserting a finger, elasticity and to-
further establish link between the active nicity of the sphincter can be tested.
and the passive agents, relating the act The anus will appear lax and patulous.
of sodomy. (g) Bimanual examination with sidewise
Note: It is necessary that, pubic hair of the active traction of marginal skin of the anus will
agent and anal hair of the passive agent cause complete relaxation of the sphinc-
are preserved. To impart any evidential ter and dilatation of the anus.
value to the diseases noted above, it is im-
(h) Proctoscopic examination may show
perative that the passive agent should be
examined twice more, once each after the old tear with tunnel formation.
incubation period of the two common vene-
real diseases as noted. Further evidence Examination of a habitual Active agent
may be obtained if either of the agents has
Local Findings in case of the habitual ac-
any bleeding injury which will stain the ef-
tive Sodomite:
fective part of the other agent, when match-
ing of group factors of the blood from the The penis appears partly twisted with
two sites may be corroborative to link both relative constriction at some part of its
ofthem in the same act of anal coitus. The length.
blood group factor of the active agent may
also tally with the blood group factor Presence of signs of recent anal coi-
available from semen collected from the tus may additionally be there, both in pas-
anal canal of the passive agent, if the ac- sive and active habitual agent, if they are ap-
tive agent is a secretor. prehended and examined after an act of anal
coitus.
Examination of a Habitual Passive Agent
The general examination will be same as in TRIBADISM OR LESBIANISM
case of a non-habitual passive agent. The lo-
cal examination will show some permanent" This is female homosexuality, in which two
changes due to regular anal coitus. women, by mutual acts of foreplay and arousal
achieve gratification. Lesbianism is the old
Local Findings term which came from the name of an island,
(a) The area around the anus will take the the Isle of Lesbos, mentioned in Greek my-
shape of a funnel with its apex at anus thology, where statedly the women used to
due to loss oflocal subcutaneous fat due practice homosexuality. The act includes
to frequent anal coitus. sexual arousal and drive like kissing, massag-
(b) The anal sphincter is lax with loss of ing the breasts and private parts, mutual rub-
tonicity and constricting strength, and bing of private parts and use of artificial phal-
will admit two fingers easily. There may lus or something similar, for gratification. One
be haemorrhoids in a few, particularly of the women acts as a more active partner.
in elderly habitual passive agents. Such a lesbian girl may have avulsion towards
(c) There may be healed or active anal fis- males and she develops some masculine fea-
sure. tures, particularly behavioural. A lesbian girl
(d) Venereal warts (syphilitic) may be searches out a female partner who herself may
present in the region around the anus. be of lesbian category or may be one with es-
(e) Anal hair is shaved. The skin is smooth sentially normal sexual inclination, and acts
and thick. rather as a passive partner.

A lesbian woman accustomed to such in both sexes, it is morG common in males.

homosexual practice may have enlarged Cattle, a she-goat, may be chosen by a male,
clitoris. and a pet dog by a woman. Cases involving
females do not come to light usually.
Practice of lesbianism is presently pun-
ishable under Section 377 IPC. These cases A male accused, on examination may
do not usually go to the court, because in most have his penis stained with a mixture of his
circumstances these are not reported. It is also semen and the animal dung. Animal hair may
not very easy to carry on full investigation suc- be seen adhered. In some cases, due to being-
cessfully, due to lack of evidence. Our society kicked by the animal, bruises may be sus-
tained by the accused on the lower limb.
and also the law-courts are inclined to take a
soft stand. On examination of the animal, human
semen may be seen present in the vagina or
Some endocrinal or psychological factor
anus of the animal. There may be tear of the
is thought to have some role for such sexual
organ. Human pubic hair may be present near
deviation in a woman.
the perianal zone. The act ofbestialityis pun-
ishable under sec. 377 IPC.
BUCCAL COITUS
(Oral coitus I Sin of Gomorrah)
INDECENT ASSAULT
This offence has mention in Bible, statedy
used to be practised in the town of Gomorrah. Indecent · assault generally means sex
Hence the name "Sin of Gomorrah" is attrib- linked misbehaviour towards a person
uted to this practice. Oral coitus may be of opposite sex or same sex. The desire
practiced by both sexes. When the male or- may be to get sexual pleasure but not aimed
gan is sucked by a female or another male, it to intercourse. Often the acts are aimed to
is termed fellatio. When female sex organs insult a person or just for 'fun' or to enjoy
including clitoris is sucked by a male or an- the embarrassment ofthe victim. Some ex-
other female, it is called cunnilingus. Thus, amples of indecent assault are, to squeeze
it may be a heterosexual or homosexual prac- the breast of a woman, to kiss a woman force-
tice. Either way it is presently punishable by fully, to touch or press the private parts of a
law under section 377 IPC. There may not be female or a male, to forcefully embrace a
any sign in the face or mouth of the passive woman, to try to undress a person (male or
agent due to washing but signs of resistance female). These criminal applications of force
in the form of minor injuries may be present on women are dealt under:
on the face and elsewhere. The penis of the 1. Sec. 354 IPC- Criminal force to woman
accused may show abrasions, caused by the with intent to outrage her modesty. Pun-
teeth and may have stain of saliva. In the prac- ishment - imprisonment of either de-
tice of fellatio, there is a little '"danger for the scription for 2-5 years with or without
victim to be choked in case.. of "deep fine.
throating". In non-consensual sex practice 2. Sexual harassments (described under a
by a man with women, it amounts to rape. new section 354A). Types-
(a) Physical contact and advances involving
BESTIALITY
unwelcome and explicit sexual overtures;
In bestiality, lower animal is chosen for (punishment- rigorous imprisonment up
sexual intercourse. Though it may be seen to 3 years and or fine).

APPENDIX:_ 18 I 21
(b) A demand or request for sexual favours; nated, such dissemination shall be considered
(punishment as above). an offence under this section.
(c) Showing pornography against the will of Stalking (Sec. 354D)- Any man who (i)
a woman; (punishment as above). follows a woman and contacts, or attempts
(d) Making sexually coloured remarks, (pun- to contact such woman to foster personal in-
ishment - imprisonment of either de- teraction repeatedly despite a clear indica-
scription up to 1 years and or fine. tion of disinterest by such woman; or (ii)
monitors the use by a woman of the internet,
Disrobing a women (Sec. 354B) email or any other form of electronic com-
munication, commits the offence of stalking.
Assault or use of criminal force by a man to
any woman or abetment to such act to dis- But it will not amount to stalking ifthe man
robe or compel her to be naked shall be pun- who pursued it proves that-(i) it was pur-
ished with imprisonment of either descrip- sued to prevent or detect crime and the man
tion for three years to seven years, and shall accused of stalking had been entrusted with
also be liable to fine. the responsibility of prevention and detection
of crime by the State; or (ii) it was pursued
Voyeurism (Sec. 354C)- Watching or under any law or to comply with any condi-
capturing the image by a man of a woman
tion or requirement imposed by any person
engaged in a private act in circumstances
under any law; or (iii) in the particular cir-
where she would usually have the expecta-
cumstances such conduct was reasonable and
tion of not being observed either by the per-
justified.
petrator or by any other person at the be-
hest of the perpetrator or dissemin ates such Whoever commits the offence of stalk-
image shall be punished on first conviction ing shall be punished on first conviction with
with imprisonment of either description for imprisonment of either description for up to
one year to three years, with or without fine, three years, with or without fine; and be pun-
and be punished on a second or subsequent ished on a second or subsequent conviction,
conviction, with imprisonment of either de- with imprisonment of either description for
scription for three years to seven years with up to five years with or without fine.
.or without fine. Trafficking-(Sec. 370 IPC)- Sec. 370
Explanation 1. For he purpose of this (1) IPC states that whoever, for the purpose
section, "private act" includes an act of watch- of exploitation, (a) recruits, (b) transports, (c)
ing carried out in a place which, in the cir- harbours, (d) transfers, or (e) receives, a per-
cumstances, would reasonably be expected to son or persons, by-using threats, or using
provide privacy and where the victim's geni- force, or any other form of coercion, or by
tals, posterior or breasts are exposed or cov- abduction, or fraud, or deception, or abuse of
. er-ed only in underwear; or the victim is us- power, or by inducement, including the giv-
ing a 1avatory; or the victim is doing a sexual ing or receiving of payments or benefits, in
act that is not of a kind ordinarily done in order to achieve the consent of .any person
public. h;;rving control over the person recruited,
Explanation 2, Where the victim con- transported, harboured, transferred or re-
sents to the capture of the images or any act, ceived-commits the offence of trafficking.
but not to their dissemination to third per- Explanafion 1. The expression "exploita-
sons and where such image or act is dissemi- tion" shall include any act of physical exploi-

tation or any form of sexual exploitation, slav- 370A. (1) Whoever, knowingly or having
ery or practices similar to slavery, servitude, reason to believe that a minor has been traf-
or the forced removal of organs. ficked, engages such minor for sexual exploi-
Explanation 2. The consent of the victim tation in any manner, shall be punished with
is immaterial in determination of the offence rigorous imprisonment for five years, which
may extend to seven years, and shall also be
of trafficking.
liable to fine.
Sec. 370 (2) says whoever commits the
370A. (2) Whoever, knowingly by or hav-
offence of trafficking shall be punished with
ing reason to believe that a person has been
rigorous imprisonment for ten years, with or
trafficked, engages such person for sexual
without fme.
exploitation in any manner, shall be punished
Sec. 370 (3) IPC says, where the offence with rigorous imprisonment for three years,
involves the trafficking of more than one per- to five years, and shall also be liable to fine.
son, it shall be punishable with rigorous im-
Sec. 166 IPC provides steps for public
prisonment for ten years but may extend to
servants disobeying law with intent to cause
imprisonment for life, and shall also be li-
injury to any person.
able to fine.
"166A. says whoever, being a public serv-
Sec. 370 (4) IPC says where the offence ant,-(a) knowingly disobeys any direction of
involves the trafficking of a minor, it shall be the law which prohibits him from requiring
punishable with rigorous imprisonment for the attendance at any place of any person for
a term ten years, to imprisonment for life, the purpose of investigation into an offence
and shall also be liable to fine. or any other matter, or (b) knowing disobeys,
Sec. 370 (5) IPC says, where the offence to the prejudice of any person, any other di-
involves the trafficking of more than one rection of the law regulating the manner in
minor, it shall be punishable with rigorous which he shall conduct such investigation, or
imprisonment for fourteen years, but may (c) fails to record any information given to
extend to imprisonment for life, and shall him under the concerned provision of CrPC
also be liable to fine. in relation to cognizable offence punishable
under section 326A, section 326B, section 354,
Sec. 370 (6) says that if a person is con-
section 354B, section 370, section 370A, sec-
victed of the offence of trafficking of minor
tion 376, section 376A, section 376B, section
on more than one occasion, then such per-
376C, section 376D, section 376E or section
son shall be punished with imprisonment for
509, shall be punished with R.I. not less than
life, which shall mean imprisonment for the six months but may extend to two years, and
remainder of that person's natural life, and may also be fined.
shall also be liable to fine.
166B, whoever being in charge of a hos-
Sec. 370 (7) says when a public servant pital, public or private, run by Central or State
or a police officer is involved in the traffick- Government, local bodies or any o~her per- .
ing of any person then, SJICh public servant son, should stick tot he provision of constitu-
or police officer shall be punished with im- tion for scheduled castes and tribes. Contra-
prisonment for life, which shalll)lean impris- vention of the provision of Sec. 357C ofCrPC
onment for the remainder of that person's of 1973 will lead to imprisonment for 1yr and/
natural life, and shall also be liable to fine. or fme.

APPENDIX - 18 I 23
In section 228A IPC "offence under sec- Code, the Code of Criminal Procedure, 1973
tion 376, section 376A, section 376B, section and the Indian Evidence Act, 1872, as
376C, section 376D or section 376E" has to amended by the said Ordinance, shall be
be substituted in sub-section (1) in place of deemed to have been done or taken under
"offence under Section 376, Section 376A, Sec- the corresponding provisions of those Acts,
tion 376B, Section 376C, Section 376D" (con- as amended by this Act.
cerns disclosure of identity of the victim).
New sec. 326A says that causing perma- SEX PERVERSIONS OR URANISM OR
nent or partial damage or deformity to, PARAPHILIA
burns , m aims, disfigures or disables, or
causes grievous hurt by throwing or admin- Sexual perversions are different from sexual
istering acid or by using any other means with offences. Some of the perversive acts may
the intention or knowledge that he is likely be punishable on some account. But perver-
to cause such injury or hurt, shall be pun- sions are of different entity.
ished with imprisonment of either descrip-
tion for a term which shall not be less than Sexual Perversion
ten years but may extend to imprisonment
for life, and with fme: Definition
Such fine shall be just and reasonable to It is defined as "sexual activity or fantasy di-
meet the medical expenses of the treatment rected towards orgasm, other than genital
of the victim and any fine imposed under this intercourse with a willing partner of oppo-
section shall be paid to the victim. site sex and of similar sexual maturity, or
326B. Throwing or attempts to throw otherwise, persistently recurrent, not merely
acid on any person or attempts to administer a substitute for preferred behaviour made dif-
acid or use any other means, to cause per- ficult by the immediate environment and con-
manent or partial damage or deformity, trary to the generally accepted norm of sexual
burns, maiming, disfigurement, disability or
behaviour in the community".
grievous hurt to that person, shall be pun-
ished with imprisonment of either descrip- This is the most satisfactory comprehen-
tion for a term which shall not be less than sive defmition of sexual perversions.
five years but may extend to seven years, and To simplify, sexual perversion can
shall also be liable to fine.
be defined as recurrent abnormal sexual
Expln. 1. "Acid" includes any substance activity of fantasy, directed towards
which has acidic or corrosive character or orgasm, when normal sexual activity, as
burning nature leading to scars or disfigure- approved by the society is possible.
ment or temporary or permanent disability.
On the 'basis of this. definition an act of
Expln 2. Permanent or partial damage
sodomy between two males or the act of mas-
or deformity shall not be required to be irre-
versible. turbation may amount to perversion in some
occasions but may not be so in other occa-
sions. Indulgence to sodomy once in a while,
THE CRIMINAL LAW (AMENDMENT)
may be viewed as to be not very unusual an
ORDINANCE, 20131S HEREBY REPEALED
occurrence. Example- in a barrack or a hos-
Notwithstanding such repeal, anything done tel, male inmates lead a iife of strict disci-
or any action taken under the Indian Penal pline and they may have no scope or approach

to any female and may not have a substitute (v) Unusually excessive sexual
for preferred sexual behaviour i.e., vaginal arousal and drive e.g., (iJ Sa-
intercourse. But when it is regularly prac- tyr,asis in males (ii) Nympho-
tised by a married man while living with his mania in females.
wife or when a man has approach to other 2. Perversions, not requiring a willing part-
women for natural sexual intercourse it ma' ner
be viewed as a perversion. Sim~ly, mas-
(a) 'froilism,
turbation is nothing unu.sual in young unma
(b) Voyeurism or Scopophilia or Scopto-
ried persons. But ~fa married man li'iing with
wife, indulges to masturbation l'egu4u'ly, in- philia, P~<er ing Tom
stead of natural sexual intercourse with his (c) Exhibitionism
cooperative wife, the act of masturbation (d) Frotteurism
then may be viewed as perversion. (e) Necrophilia
Some of the perversions amount to sex (f) Necrophagia
offences or some other offences linked with
3. Perversion, where no human partner is
sex. Natural sex offences may also be consid-
ered as perversions, if the alleged circum- necessary.
stances of the sex act is against the social (a) Fetichism or Fetishisr_n -when some
norms and if other avenues oflawful natural objec 1 \.1 the substitute for a partner
sexual practice are open to the person. For (b) Transvestism
example, if a healthy, young, recently mar- (c) Bestiality- where an animal is the
ried man vvho lives with his sexually warm, substitute for a human partner (an
cooperative and willing wife, indulges to
offence).
sexual assault of another woman, then that
may be considered as offence and also act of (d) Masturbation (if excessive and unex-
perversion committed by the young husband. pected).
Classification of Sexual Perversions Fetichism or Fetishism
1. Perversions, requiring a willing partner This condition is mostly seen in males. The
(may be both homosexual or hetero- pervert gets sexual gratification by seeing or
sexual) touching female body parts; dress, partint·
(a) Anal or oral intercourse, mutual larly the under garments or some article of
masturbation, i.e., orgasm obtained feminine use. Though to a small extent, this
without genital intercourse. tendency is not altogether unusual, yet to
achieve gratification exclusively from such
(b) Requiring unusual condition for
gratification: practices and to indulge with the same regu-
larly is considered as perversion. There may
(i) Sadis.m
have some co:r:o.pu~f;live factor related With this
(ii) Masochism condition as is noticed in some fetichist "rho
(iii) Lust Murder cannot suppress their desire to steal small
(iv) Requiring ~pecial type ofp~:r,t articles used by females. Gratification is ob-
ner as in case of incest, inter- tained sometime by just seeing or touching
cdurse with child, prostitute, the articles ot sometime with subsequent
inttixicated:partner etc~ '-- ' masturbation arid eJaculation.

APPENDIX - 18 I 25
Transvestism: (Eonism) as the voyeurist gets gratification by seeing

a woman micturating (a condition specially
Here sexual gratification is obtained by wear-
ing attire of opposite sex. It is also more com- termed as undinism) or by seeing defeca-
mon in males. This represents a psychologi- tion by an woman or any such thing is neces-
cal aberration with secret reverse passion for sary for his sexual gratification.
same sex (so as to get pleasure by making
Sadism (Algolagnia)
himself ready for his own sex) or in some
cases simple direct fascination for the oppo- In sadism, the person gets sexual gratifica-
site sex. Hizras or Zenanas who dress them- tion by torturing and humiliating the sex
selves in female attire may not be true partner by beating, biting, whipping etc. The
transverstites. In them, a psychology acts to ~ruel sexual behaviour is named sadism in
facilitate homosexual practices. They dress the name of Marquis de Sade, who in his
like females to attract male active sodomites. stories and novels presented practice ci cruel
sexual behaviour. Without these activities
Peeping Tom or Mixoscopia
sexual arousal is not achieved by some. A
This term has a mythological background of sadist is a mentally aberrated person.- The
'Lady Godiva' who once moved on roads na- sadistic act might be the reflection of a de-
ked on horse-back, the roads of the town sire for revenge, jealousy due to the influ-
under her husbands control, with some good ence of some adverse experience of childhood
purposes for the poor people. All in the town of being tortured or humiliated.
were cautioned to keep their doors and win-
dows shut during the period. But one person Lust murder
named Tom secretly viewed her by making a
hole in his door. He became blind later. It is the consequence of extreme sadistic prac-
tice, common in males. With torturing the
A peeping tom gets sexual gratification
partner, sexual arousal start and with death
by secretly observing the sex performance of
of the partner full gratification is obtained.
others. Orgasm is usually preceded by mas-
Often the body of the victim partner is muti-
turbation.
lated. In some cases after full arousal in this
Troilism way, the pervert performs sexual act with the
dead body of the victim.
In troilism, the pervert gets sexual gratifica-
tion by inducing his wife to sexual intercourse Necrophagia
with another person and observing the same.
It is another extreme form of sadism, where
Scopophilia or scoptophilia the pervert who is a male, mutilates the body
of the female and after the death of the vic-
It means getting pleasure by seeing a nude tim, even eats the.body parts (which are of-
woman in her privacy, in bathroom, while ten sex organs) to achieve sexual gratifica-
bathing, dressing or undressing. tion. It occurs in males.
In voyeurism, the scopophilic desire
takes more perversive shape, in which the Masochism (Passive Algolagnia)
feeling of pleasure is not limited to only look- It is the opposite of Sadism. Here the person
ing for the genital organ. It takes a bad shape gets sexual gratification or peak arousal by

the exposure is aimed to attract a particular

woman then, often there is an expectation of
similar exposure by the woman, or it may be
a reflection of a hidden desire to observe the
private parts of the woman. This act of of-
fence is punishable under section 290 and 291
IPC.
Frotteurism
It is a mischievous act usually practised by a

male sex-pervert in a crowded place to de-
Fig. 1o· Injury to clitoris by an iron rod before murder
rive sexual gratification, even orgasm by rub-
bing his private part against a female's body.
being bodily tortured or abused. The term is This is also an offence and is punishable un-
derived from Leopold Von Sacher Masoch. der section 290 and 291 IPC.
He was a novelist and as a stimulus to write,
he liked to be whipped by his wife. Male maso- Necrophilia
chists are more common than females. Maso-
It is a desire for sexual intercourse with a
chistic asphyxial death occurs when a per-
dead body. Males are the sufferer. The suf-
vert creates a state of hypoxia in him to get
ferer is psychosexually incompetent. He finds
orgasm, either by hanging or by strangula-
this as most suitable a process, as there is no
tion. After experiencing orgasm the constrict-
resistance or rejection and which will not be
ing force around the neck is released. In
course of such practice, once the release of known to anybody else. Often he secretly vis-
constricting force may fail to release and its a prostitute. This condition is a result of
causes death of the person. mental aberration accompanied by personal-
ity defect.
This also is an example of mental aber-
ration and possibly childhood experience of
Satyriasis
cruelty and adversity gets reflected in the
masochistic self-torturing. It is excessive sexual desire, arousal and drive
in case of a male. The subject is liable to com-
Exhibitionism
mit sex offences or perversive acts.
This condition is just the opposite of sco-
pophilia and is related mostly to males. He Nymphomania
gets sexual pleasure by exposing private parts
in public or in vision of a woman, sometime Excessive sexual desires in a woman. Some
with demonstration of masturbation. When of the women may turn lesbian.

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Princi pies of

f (J RI \~ SI( , ~\: lE~ ~D~ IC: Il\r }=

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

Ex-Professor and Head of the Department of Forensic and State Medicine,

New Central Book Agency (P) Ltd

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

212 Shahpur Jar House No. 3-I-315, 1st Floor

Principles of Forensic Medicine including Toxicology • Apurba Nandy

© Copyright reserved by the Author

PUBLISHER AND TYPESETTER

lSllN 978 81 7381 064 0

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

~~. , · . _' Pert - f ~ .,

1. FORENSIC MEDICINE-A BRIEF INTRODUCTION ............................................... ... 1-4

Preliminaries; Investigation of a c;riminal case, Investigation of case of death in a suspicious

~Ethics; Etiquette; Different Codes of Ethics, Declaration of G eneva,2 004 ;-Amendment2006;

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

4. IDENTIFICATION OF AN INDIVIDUAL ....................... :....................... ............ .... 89-188

5. IDENTIFICATION FROM TRACE SUBSTANCES AND

6. DEATH AND POSTMORTEM CHANGES .......................................................... 221-286

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

Examination of scene of crime, procedure of medicolegal autopsy, PM examination proper-

r set up of FSL, Chromatography-Column, Paper, Thin layer, Gas; Electrophoresis-Starch

9. INJURIES-LEGAL CONSIDERATION ............................................ ....... .. ...... ... 329-338

10. MECHANICAL INJURIES .................... ............................... ............................. 339-426

rClassifi~ation, Abrasion, Bruise, Laceration, lmcised :ou ndPefence wound, Self-inflicted

11. THERMAL INJURIES ............................................................ .......... ...... .. .. .. ..... 427-450

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

Road injuries-Primary impact injuries, Secondary injuries, Secondary impact injuries-to

15. M EDICOLEGALASPECTS O FI NJURIES ..................... ............ .......... ................ 511-516

[ Types, Features of, Fatal p~iod; Malnutrition, Featur:s, PM findin_§ls, MLI - =

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

22. IMPOTENCE, FRIGIDITY, STERILITY, ARTIFICIAL INSEMINATION,

23. VIRGINITY AND DEFLORATION ..................................................................... 637-642

24 . PREGNANCY, DELIVERY AND LEGITIMACY ETC. ............................................. 643-658

25. ABORTION ................................................................................................... 659-670

26. INFANTICIDE ................................ ............................................................... 671-686

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

27. SEXUAL OFFENCES AND SEX PERVERSIO ~ . .. ....................... 687-720

28. FORENSIC TOXICOLOGY ..................................................... . 721.744

29. CORROSIVE AGENTS ........................................... .. ....................................... 745-760

30. IRRITANTS: MECHANICAL& NON-METALLIC INORGANIC &

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

32 ORGANIC CHEMICAL iRRITANTS (INSECTICIDES AND ENVIRONMENTAL) ......... 799-808

33. VEGETABLE IRRITANTS ................................................................................... 809-822

34. ANIMAL IRRITANTS ......................................... .............................................. 823-838

36. SPINAL POISONS .......................................................................................... 881-884

37. PERIPHERAL NERVE POISONS ....................................................................... 885-886

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

General anaesthetics, Ether, Chloroform, Fluothane, Cyclopropane, Nitrous oxide, Spinal

43. NATIONAL HUMAN RIGHTS COMMISSION'S RECOMMENDATIONS

rmodel skeletal analysis protocol, Procedure to be followed during disinternment,

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24

INDEX ................................................................................... ........ ......... .... 959-l 013

APPENDIX-18 .................................................................................................... l-26

'Which of the favours Of your Lord will ye deny?'- Al Quran 55:38

Parvej Dr. Md. Ahsan Uddin (Nayan) CoMC-24