Forensic Medicine Notes 157 Pages-1.pdf

Forensic medicine notes mbbs third year cbme

1. FORENSIC MEDICINE








1. Legal Medicine
2. Medical Law and Ethics
3. Death and Medicolegal Importance
4. Autopsy
5. Post Mortem Changes
6. Mechanical Injury
7. Ballistics
8. Thermal Burns
9. Asphyxia
10. Drowning
11. Forensic Psychiatry
12. Impotence and Sterility
13. Infanticide
14. Sexual Jurisprudence
15. Agricultural Poisons
16. Corrosives
17. Deliriants
18. Somniferous Agents
19. Psychotropics and Hallucinogens
20. Spinal Poisons
21. Respiratory Poisons
22. Inebriants
23. Inorganic Non-Metallic Irritant
24. Heavy Metal Irritants
25. Organic Irritants

2. 1. LEGAL MEDICINE
DEFINITIONS:
Forensic Medicine
It deals with application of medical knowledge to law to aid the
administration of justice.
Medicine Law Justice

Medical Jurisprudence:
It is the study of legal rules and regulations that guides the medical profession
in their dealings with their patients, with each other and with the state.
Law Medical profession

Patients Other Doctors State
Medical Ethics:
It is the study of Moral principles that guides the medical profession in their
dealings with their patients, with each other and with the state.
Moral principles Medical profession

Patients Other Doctors State
Medical Etiquette:
It deals with conventional laws of courtesy observed between members of
Medical Profession.

Courtesy behavior
Doctor Doctor

INDIAN LEGAL SYSTEM
Indian penal code 1860: IPC
Defines various crimes and punishment admissible under court of law.
Criminal procedure code 1973: Crpc
Defines the procedure of investigations and trial of offences in whole
of India.
Indian evidence act 1872: IEA
Relates to evidences upon which courts come to conclusion in each
case.
INQUEST:
An enquiry into the cause of death in all cases of Sudden, Suspicious
&Unnatural deaths
Types of Inquest:
1. Police inquest
2. Magistrate inquest
3. Coroner’s inquest
4. Medical examiners system
POLICE INQUEST:
 Investigating police officer not below rank of sub inspector
 Receipt of information about suspicious death
 Informs Concerned Magistrate
 Proceeds To Crime Area And Prepares A Report
 With witness of two respectable person –“Panchas”

SUDDEN DEATH:
 If suspicious sent for postmortem

3.  If not suspicious hand over the body to relatives
PANCHANAMA
 Apparent cause of death
 Injuries
 Manner of death
 Signed by witness –“Panchas”

MAGISTRATE INQUEST:
 In certain cases police are not authorized to hold inquest and
magistrate himself will hold the inquest.
 Its superior to police inquest, as magistrate himself conducting, can
summon any person for enquiry and himself sends the body for
postmortem.
1. All dowry related death or death of a married women less than seven
years of marriage.
2. Deaths under police custody.
3. Deaths in police firing.
4. Death of a convict or under trial prisoner in jail.
5. Death in borstal school or reformatories.
6. Death in psychiatric hospital.
7. Exhumation.


Coroner’s Inquest:
 This inquest is held by the coroner, who was the specially appointed
state government.
 An officer entrusted with the duty of enquiring into all unnatural
death and suspicious cases.
 Coroner used to be a person with legal qualification of First Class
Magistrate
 This system was first implemented in England in 1275.
 This system was present at Kolkata and Mumbai previously. This
system has now been abolished from India but still present in England
and in certain European countries.

4. MEDICAL EXAMINER’S SYSTEM:
 In this type of inquest, Doctors having qualification in pathology, legal
medicine are appointed to the post of medical examiner.
 He will visit the crime scene, prepare inquest, conduct postmortem
examination and prepare the report. As both enquiry and PM are
done by medical professional, it is far superior but he lacks judicial
powers.
 This system is in practice in some states of U.S
Courts in India:
Civil courts:
 Family courts
 Labor courts
 Motors accident claims tribunal
 Consumer protection forum
 Administration tribunal

Criminal courts:
 Supreme Court.
 High court.
 Sessions court.
 Magistrate court.
SUPREME COURT:
• It is the highest judicial tribunal, present in New Delhi
• It has following powers

1. ORIGINAL JURISDICTION
2. APPELLATE JURISDICTION
3. ADVISORY JURISDICTION
4. CONCURRENT JURISDICTION

Original jurisdiction
- Disputes between govt. of India and state govt.
- Disputes between any two or more state govt.
- Arbitrator of election disputes relating to president and Vice-
president of India.

APPELLATE JURISDICTION
- Criminal appeals in cases given verdict by lower courts.
- Civil appeals if the value of the disputed subject matter
is more than 20 lakhs.

ADVISORY JURISDICTION
- The president can refer any question of law or opinion of fact to
Supreme Court.

CONCURRENT JURISDICTION
- This court has got concurrent jurisdiction with high court.
HIGH COURT:
 It is the highest court of judiciary in the state.
 It has the following powers
o APPELLATE JURISDICTION
o CONCURRENT JURISDICTION
 It is the highest appellate in both civil and criminal matters in
state.
 All death sentence given by any sessions court has to be
corroborated by high court.

5. SESSIONS COURT:
 It is established in every district.
 It is presided over by a session’s judge appointed by high court.
 It can pass any sentence of law except death sentence which has to be
confirmed by high court.
COURTS OF MAGISTRATE:
There are three of magistrates.
o CHIEF JUDICIAL MAGISTRATE
o FIRST CLASS MAGISTRATE
o SECOND CLASS MAGISTRATE
CHIEF JUDICIAL MAGISTRATE:
Chief of all other 1
st
& 2
nd
class magistrate of the district
- He can try any case except those of murder, rape, dacoit,
Criminal abortion.
Can pass
- Sentence of imprisonment not more than 7 years.
- Unlimited amount of fine.

FIRST CLASS MAGISTRATE:
- He can pass a sentence of imprisonment not more than 3 years
- He can impose fine not more than Rs. 10,000/-

SECOND CLASS MAGISTRATE:
- He can pass a sentence of imprisonment not more than 1 year
- He can impose fine not more than Rs. 5000/-
All judicial magistrates can impose both fine and imprisonment for any
number of times.



Punishments Authorized In India:
1. Capital punishment
Death sentence by hanging
2. Life imprisonment
Usually for 20 years, can be reduced to 14 years on good behavior.
3. Imprisonments
Simple – no hard labor
Rigorous – with hard labor
Solitary – in isolation not more than 3 months
4. Fine
Attachment of property
Detention in reformatories
Evidence:
It any oral statement or document of a witness recorded and accepted in
the court of law, under oath, relating to a particular fact under enquiry
Classification of Evidence:
Outside court
How the evidence was acquired by the witness
 Direct
 Indirect
Inside court
How the evidence was presented in court
 Oral
 Document
1. Direct evidence
The witness has directly seen the crime or felt it by any of his senses.

2. Indirect evidence
a. Circumstantial
Witness has not directly seen the crime but has seen several related
things which point strongly towards the commission of crime.

6. It is admissible in court until the connection is too weak to prove the
commission of crime.
b. Hearsay
Witness only heard about the crime from someone.
Generally not admissible exception – Dying declaration

1. Documentary evidence:
All documents that are produced in the court of law including
electronic records, in which matters are expressed by means of letters, marks
or figures.
Documentary Evidence in relation to medical Practice:
1.Medical certificates
2. Medico legal reports
3. Dying declaration
Medical certificates:
1. Sickness certificate
2. Physical fitness certificate
3. Birth and death certificate
4. Age certificate
5. Insanity certificate
6. Vaccination certificate
7. Disability certificate
Medico legal reports:
a. Wound/ injury report
b. Drunkenness certificate
c. Impotence/ sterility certificate
d. Post mortem report
e. Chemical examiner report
f. Ballistics report
Dying declaration:
 It is a statement, verbal or written made by a person who is dying
as a result of some unlawful act.
 It is relating to the cause of death or any other circumstances that
has resulted in his death
 Should be recorded by a magistrate in the presence of a doctor
and two witness.
 In the absence of magistrate if the patient condition is worse, then
doctor himself can record the evidence with two witnesses.
 Patient should be in sound state of mind
 No oath necessary

Dying deposition:
Statement made by a dying person under oath and recorded by a
magistrate in the presence of the accused and his lawyer.
 Oath is necessary
 Cross examination is allowed
 Bed side court
 Its practice is not allowed in India
Oral Evidence:
 All verbal statements under oath made before the court which it
records in relation to a fact under enquiry.
 It is more important than documentary evidence as cross
examination by opposite party is allowed.
 Moreover all documentary evidence has to be verified orally
before acceptance in the court of law. Except in following
conditions.
Exceptions to oral verification of documentary evidences:
1. Dying declaration
2. Expert opinion in treaties ( accepted textbooks)
3. Medical evidences recorded in lower court
4. Evidences given by a witness in previous judicial proceedings

7. 5. Reports of government scientific experts
Chemical Examiner, Inspector of Explosive, Finger Print Bureau.
6. Public records
Birth Certificate, Death Certificate, Marriage Certificate.
7. Hospital Records
Case Files, Investigation Records, Discharge Summary.
Witness:
 Is a person who gives evidence in the court of law under oath.
 All persons can give evidence unless they can’t understand the
question and give rational answer due to tender years of age or old
age or disease.
Types
o Common witness
o Expert or skilled witness
o Hostile witness
Common witness:
 Is a common man who gives evidence about a fact, what he has
seen or perceived.
 He will not give any inference from what he has observed.
Expert or Skilled witness:
 Is one who has acquired special knowledge, skill or experience in
any science, art or profession
 He not only gives evidence of fact what he has observed
 But also capable of giving certain inference from the observation
he has made.
 A medical profession can be a common witness and an expert
witness.
Perjury:
The act of wilfully giving false evidence in the court of law under oath
is called Perjury and he is punishable under section 193 IPC.
Hostile witness:
Hostile witness is a witness who in the court if conceals a part or
whole of truth and gives an evidence against the party that has called the
witness.

Summons or Subpoena:
 It is a written order issued by the court to a witness compelling his
attendance to give evidence under penalty in the court on a specific
date, time and place.
 Non-compliance without valid excuse is punishable.
In case of two summons on same date:
Civil court Vs Criminal Court - Importance to Criminal Court
Courts of same type - Importance to court of higher rank
Courts of same type & Rank - Importance to earlier received summon
Proceedings in court:
After oath taking
1. Examination in chief
2. Cross examination
3. Re examination
4. Questions by court

1. Examination in chief:
 Here the witness is examined by the lawyer of the party who has
summoned the witness
 Purpose is to bring out all the facts known to the witness and
relevant matters in the court of law
 No leading questions are allowed in examination in chief.

2. Cross examination:
 Here the witness is examined by lawyer of opposite party.
 Purpose is to test the reliability and truthfulness of the witness
and his evidence.

8.  The lawyer of opposite party will try to weaken the evidence given
in the examination in chief.
 Leading question are allowed in this stage


3. Re Examination:
 The witness is re-examined to clarify any doubt arisen during cross
examination
 The witness gets a second chance to correct himself here
 Leading questions are not allowed
 No new matter or fact can be brought in the re-examination.

4. Questions by Court:
 The judge can ask any questions at any point of time to clear any
doubt arisen.
 The court may recall the witness and re-examine him who has
been already examined if it is essential
 The witness has to read the recorded deposition made by him and
sign it before leaving the court.
Duty of doctor in court of law:
 Be well prepared
 Have all documents
 Do not memorise
 Well dressed and modest
 Speak audibly, clearly
 Simple language, no technical terms
 Do not exaggerate
 Do not fumble
 Do not discuss the case other than lawyer
 Address judge respectfully
 Avoid discrepancies with previous statements.
 If a question is not clear ask to be repeated.
 If you don’t know the answer admit it
 Do not lose your temper
 Do not Argue, Disagree firmly
 Be brief and precise
 Express opinions only on the basis of your knowledge and
experience
 Be honest
 Be absolutely impartial

9. 2. Medical Law and Ethics

Indian medical council:
Members
1. One member from each state
2. One member from each state medical council
3. One member from each medical university
4. Eight members from central government
 President, vice President and Register will be elected
 Tenure for office is Five years.

Functions of Indian Medical Council:
1. Medical Register
 Contains names of medical persons who registers
with MCI or with any state medical council, who
possess a recognized medical qualification.
 Names are usually erased at the death of the
member
 Names can be erased temporarily or permanentlyon
disciplinary actions when found to be guilty of
unethical practice.
2. Maintenance of standards of Medical Education
 Undergraduate&Post graduate Medical education
o Maintaining standards and uniformity
o Recommendation to central government for
starting new medical college/ new medical
course/ increase of seats
 Inspection of Medical colleges
o For every introduced medical qualification
(MD/MS/DM/Mch/Diploma)
o For routinely every 5 years to determine
standards, training, staffs and facilities.
3. Recognition of Foreign Medical qualifications
o First Schedule:
 Contains recognized medical qualification
granted by university of India.
o Second schedule:
 Contains recognized medical qualification
granted by university outside India.
o Third schedule part 1:
 Contains recognized additional medical
qualification granted by university of India.
o Third schedule part 2:
 Contains recognized additional medical
qualification granted by university outside
India.
4. Disciplinary Action
o Excercises disciplinary control over members of medical
profession.
o It acts as an advisory body of central government for
appeals by medical profession against actions by state
medical council.
o It issues warning notice periodically

10. o It’s a list of offences considered to be unethical
practice- infamous conduct/ professional
misconduct.
State medical council:
1. Maintenance of State Medical Register
• Registered medical practioners name and
qualification
• Date of registration
• Annual update to medical council of India
2. Disciplinary Action
• Investigation of various accusation of professional
misconduct.
Punishments:
1. Warning:
A warning is issued to the medical practioner to conduct
himself according to the ethical standards.
2. Temporary Erasure:
Name of medical practioner is erased from the register
temporarily and he is disqualified to practice medicine for a
specific period
3. Penal erasure:
Name of medical practioner is erased from the register
permanently and he is disqualified to practice medicine forever.
Also called as Professional Death Sentence.

Professional Misconduct:
Any act or behavior of a Doctor which is considered disgraceful
or dishonorable by his professional colleagues of good repute.
• Act or Behavior Medical Ethics
Disgraceful or Dishonorable
Professional Colleagues of Good Repute.
When such a behaviour complained to medical council, an
inquiry is done by an ethical committee comprising of team of
doctors from medical council and if found guilty any of the
following punishments can be awarded.
1. Warning
2. Temporary removal of name from the register
3. Permanent removal of name from the register - Penal
Erasure
1. Abortion:
Illegal termination of pregnancy – that is terminating
pregnancy against rules laid by The Medical Termination Of
Pregnancy Act 1971 is considered as professional misconduct.
2. Adultery:
A medical professional must maintain highest standard of
moral integrity. He should not misuse his position to commit
adultery with his patients, relatives or attendants.
3. Alcohol:
Attending the patients under influence of alcohol is
considered as professional misconduct.
4. Advertisement:
The following acts are considered as professional
misconduct.

11. • Giving interviews about disease in such way to advertise
his personal achievements in surgery or medical treatment.
• Having large sign board of advertisement
• Publicly displaying his fees except in consultation room
5. Addiction to narcotic drugs:
As a medical practitioner, he can get access to various
kinds of drugs. A doctor can be charged with professional
misconduct if he misuse his access to drugs and gets addicted
to it.
6. Association with unqualified persons:
The following acts are considered as professional
misconduct.
 Association with unqualified persons to promote one
practice
 Engaging unqualified persons in technical positions
 Dichotomy or fees splitting – giving or accepting
commissions from colleagues, agents, manufacturing
agents for personal gain.
 Accepting gifts, travel facilities from pharmaceutical
companies.
Medical Negligence:
• Negligence can be defined as doing something which a
prudent and reasonable man would not do or omission to
do something which a reasonable man would do.
• Medical negligence is defines as absence of reasonable
knowledge and skill or wilful failure in exercising due care
in the treatment of a patient which results in bodily injury
or death of the patient.
• When deviates from accepted practicesor
• When employs accepted practices but does it
unskilfully
Factors Necessary to prove medical negligence:
1. Duty of Care
2. Dereliction of Duty
3. Damage
4. Reasonable Foreseeability of Doctor
1. Duty of Care:
• The doctor must be under a duty of providing care to
the patient.
• Even if doctor is not charging any fees for consultation
also he is bound to duty of care.
• Even in an emergency condition like in causality, if
doctor sees a patient then he is under duty of care.
• But if a Doctor act as a ‘Good samaritan’ helping some
injured person at roadside then he is not bound to Duty
of Care
2. Dereliction of Duty:
• Failure of a doctor to honour his duty that is owed to
his patient is referred to as dereliction.
• Failure on the part of doctor to maintain skill and care
has to be proved.
• Not highest degree of skill or knowledge, But skill and
knowledge of ordinary competent doctor

12. • Error of Judgement either in diagnosis and treatment is
not considered to be negligence.
3. Damage:
• Damage refer to injury or disability suffered by the
patient.
• Failure to exercise a duty of care must lead to actual
damage to the patient.
• If no damage has happened, then, though there is
negligence the doctor can’t be sued.
• A causal relationship has to be proved that dereliction
of duty has caused damage to the patient.
4. Reasonable Foreseeability of Doctor:
• The inability of a doctor to predict an injury in future
which a reasonable doctor would have predicted is also
considered to be Medical negligence
Types of negligence:
1. Medical negligence
a. Civil negligence
b. Criminal negligence
2. Patient negligence
3. Contributory negligence
4. Composite negligence
5. Corporate negligence
1. Civil negligence
Is said to occur when the damage caused was generally
minor and patient demands for monetary compensation
for the damage that he has suffered due to doctor’s
negligence.
• Court: civil court or consumer forum.
• Punishment:only monetary loss have to bepaid. No
criminal liability so cannot be sent to jail.
• Burden of proof: it is the duty of patient to prove
negligence.
2. Criminal negligence
Is said to occur when the damage caused is generally
gross and the patient complains of doctor’s negligence to a
police and registers a case in criminal court.
• Court: criminal court.
• Punishment: criminal liability under various IPC
sections.
• Burden of proof: it is the duty of doctor to prove that
he is not negligent and proof of negligence should be
beyond doubt.
3. Patient negligence
The negligence is in patient’s part.
It is a good defence for doctor in cases of civil
negligence and not in criminal negligence
1. Not revealing previous history
2. Not following instructions given by doctor
3. Discontinuing the treatment
4. LAMA- leaving hospital against medical advice.
4. Contributory negligence:

13.  Both patient and doctor are negligent. It’s a
defence in civil negligence cases only.
 Quantum of injury caused will be assessed
according to the amount of negligence of patient
and doctor and compensation is awarded
accordingly.
Example: doctor prescribes a drug without informing about
side effects and patient not following instructions given by
doctor.
5. Composite negligence:
 When the patient has suffered injury due to
negligence of two or more than two doctors then it
is called composite negligence.
 The patient can claim compensation from each
doctor or from any single doctor he wishes as he
wishes
6. Corporate negligence:
It is the negligence of corporate – hospital and not of a
doctor who is working there.
 Defective or poorly maintained equipment
 Selecting incompetent employees
 Lack of electricity back up in operation theatre
 Not maintaining sterile OT.
Important Concepts of Medical Negligence:
1. Vicarious Liability
2. Borrowed Servant Doctrine
3. Res Ipsa Loquitur

1. Vicarious Liability:
Captain of ship doctrine:
 When the superior had the right, ability or duty to
control the employee working under him, then he is not
only responsible for his negligent acts but also of his
employee’s negligent act.
 Only If the negligent act happens in the course of
employment and within its scope.
Conditions to be satisfied:
Employer – employee relationship should be
established
Employee negligent conduct should be within the scope
of his employment
Senior doctor is also responsible for negligent acts by junior
doctor, intern or trainees.
2. Borrowed Servant Doctrine:
 If an employee is borrowed by a temporary employer
from a principle employer then the new employer is
vicariously liable for the negligent acts of the employee
 It is the duty of the new employer to check the
competency of the employee.
 New master is responsible for the employee only when
he works under his own supervision.
3. RES IPSA LOQUITUR:
 It means the thing speaks for itself.

14.  Usually in a case of medical negligence, the patient has
to prove it. But when the negligence is so gross, then
the rule of Res Ipsa Loquitur applies and the patient
need not to prove it..
 Conditions to be satisfied:
 Injury to the patient would not have happen in the
absence of negligence.
 The doctor had complete control over the injury
producing instrument or treatment.
 Patient is not guilty of contributory negligence.
Examples:
1. Prescribing overdose of a medicine
2. Failure to remove swaps from abdomen after a
surgery
3. Amputating wrong digit of a foot
Defences against negligence:
1. No duty owed by doctor – Good Samaritan
2. Patients negligence
3. Calculated risk doctrine
4. Novus actus intervenes
5. Medical misadventure
6. Products liability
7. Res limitica
8. Res judicata
1. No duty owed by doctor – Good Samaritan:
 If a Doctor act as a ‘Good samaritan’ helping some
injured person at roadside then he is not bound to
Duty of Care. And the doctor can’t be charged of
medical negligence in such cases.
2. Patients negligence:
 If the patient is negligent in his part then,it is a good
defence for doctor in cases of civil negligence and
not in criminal negligence.
3. Calculated risk doctrine:
 All medical treatment will have certain side effects
and as a doctor to save the life of patient he has to
take certain risk - Calculated risk doctrine.
 A doctor is not liable of medical negligence, if he has
taken a reasonable risk to save the life of a patient
and in the process if the patient suffers any injury.
Example:
1. Amniocentesis: has 0.1% of mortality to foetus
2. CPR: fracture of ribs
4. Novus actus intervenes:
 An unrelated action intervening.
 Refers to a situation where the doctor is negligent, but
a completely unexpected and unforeseen act happened
that has resulted in injury, death or worsening of the
patient condition.
 The new act has to be unexpected and unforeseen
breaking the chain of causation then the doctor can’t be
charged of medical negligence in such cases.

5. Medical misadventure:

15.  Is defined as a case where the patient suffered injury or died
due to unintentional act of the doctor/hospital
 It is due to undesirable outcome that is unrelated to the
quality of care provided.
 Therapeutic misadventure: when a serious allergic reaction
happens to common drug given in the absence of any
significant allergic history.
 Diagnostic Misadventure: when a diagnostic procedure
carried on and an unexpected injury could happen
irrespective of all precautionary measures.
 The doctor can’t be charged of medical negligence in such
cases.
6. Products liability:
 The injury or death of a patient may be due to
 Faulty, defective or negligently designed
instruments/ equipment
 Drugs that are adulterated, contaminated or of
inferior quality.
 In such cases, the manufacturer is responsible for the harm
caused except in following cases.
 Doctor/hospital misused the equipment
 Instrument was functioning well at the time of
supply and now malfunctioned due to improper
use, not serviced regularly, not maintained
properly
7. Res limitica:
 A suit for damages by negligence of a doctor should be
filed within two years of time from the date of alleged
negligence.
 A suit filed after two years will be dismissed as
being beyond the period of limitation.

8. Res judicata:
 The thing is already been decided.
 If a question of negligence is already been decided in a court
then the patient will not be allowed to file same negligence
case in another proceedings on same set of facts.
 Appeal against in a higher court is allowed.
Consent:
 It is a Voluntary agreement / Compliance / Permission for a
specified act…
 To be valid it should be intelligent and informed….
 Means it should be given after understanding for what it is
given and after acquiring the knowledge of risk involved
Types:
1. Implied consent
• It is indicated by manner and behaviour of the patient.
• It is adequate for general examination of a patient.
• For any special examination, diagnostic procedure, surgical
intervention, informed consent is must.
2. Informed consent
• It is consent given by a person after the receipt of
information for the specified act.
• Oral
• Written
Components of consent:
 Free
 Voluntary

16.  Under sound mind
 Informed
 Clear and direct
 Whenever possible it should be in written form
Information that should be provided:
 Nature and purpose of the proposed procedure or
treatment
 The expected outcome and the likelihood of success
 The risks involved and its likelihood to occur.
 The alternatives to the procedure and supporting
information
 The effect of no treatment or procedure and on prognosis
 Instructions regarding what should be done if the
procedure turns out to be harmful and unsuccessful.
Criteria for giving consent:
• Age should be more than 12 yearsto give consent for special
examination and diagnostic procedures
• Age should be more than 18 years to give consent for any
surgical procedures or treatment procedures.
• If the patient doesn’t met with the age requirements then
consent has to be taken from parents or legal guardians.
• Doctrine of loco parentis:
• In the case of absence of parents or legal guardian,
whoever in charge of the patient can act as legal
guardian or as local parents and give consent for the
specified act
Failure to get consent:
• Any doctor should examine or treat a patient after
informing the necessary things and getting a consent from
them, if not the treatment or examination done will be
deemed to be intentional interference with the patient’s
body without his sanction.
• This is in turn amounts to assault to the patient.
• For which the patient can charge you with medical
negligence.
EXCEPTIONS:
1. Therapeutic privilege:
In some cases the doctor may withhold some of the
information without revealing to the patient if he believes that
disclosure can cause psychological harm to the patient or it may
lead to discontinuing of treatment by the patient. This is called
as Therapeutic privilege.
In such a situation also the doctor has to document all
information and reason for withholding the information in the
case records.
2. Extension doctrine of consent:
 The patient has given consent for a specified procedure
and during the procedure if the doctor is confronted
with unanticipated condition requiring immediate
action to save the life of the patient then he is justified
to carry on with that procedure without getting
separate consent.
 This is referred to as the extension doctrine of consent.
3. Other exceptions:
 The patient is in coma and needs emergency treatment
 The patient is a child and needs emergency treatment
and parents are not immediately accessible.
 When a medico legal case is referred by court of law
for examination

17.  Consent of spouse is not necessary in procedures
involving no genital organs or affecting reproductive
function.
Consent in medico legal cases:
Consent for examining a person brought by police:
• The patient has to be informed about the nature of procedure,
the purpose of procedure and the consequences.
• He has the right to refuse the examination and the report may
go in his favour or against him.
Consent for examining a person arrested by police:
• If a person is arrested for charge of any crime then he loses his
right to refuse the examination. He can be examined without
his consent.
Professional secrecy:
• During the course of treatment a patient may reveal matters of
personal nature to doctor which he is obliged to maintain it as
secret until requested by law to divulge it or when the patient
consented for divulging it.
• In case of domestic servants, the details are not be shared to
his master, even though the master is paying the fees
• In case of prisoners, the details are not be shared toto the
Jailers
Exception:
• Minor
• Mentally insane
• Intoxicated person


Privileged communication:
• It is a statement made by a person to another person having a
corresponding interest, even though such communication may
under normal conditions amount to defamation.
• The doctor can divulge the information in certain conditions
this is called privileged communication.
Examples:
1. Of public interest:
The communicable disease of a labour working in a
restaurant can be shared to appropriate authority to
control the spread of disease.
2. Of relatives interest:
If either of spouse suffering from veneral disease,
then it can be shared with other spouse for necessary
precautions to avoid spread of it.
3. Under law:
The details of a patient have to be shared in court of
law if asked by the judiciary department.

Rights of a Doctor:
1. Right to practice anywhere in India
2. Right to add professional titles and qualification to name
3. Right to choose patients
4. Right to prescribe and dispense medicines
5. Right to issue birth, death, sickness, insanity certificates
6. Right to give evidence as an expert evidence
7. Right to possess, dispense and prescribe drugs listed in
dangerous drugs Act
8. Right to claim payment of fees for professional service
rendered.

18. 3.DEATH & ITS MEDICO-LEGAL
IMPORTANCE
Definition:
Registration of Births and Deaths Act, Sec.2(b) defines death
as ‘Permanent disappearance of all evidence of life at any
time after live birth has taken place’
TYPES OF DEATH:
1. SOMATIC DEATH: -
 It is complete and irreversible stoppage of circulation,
respiration and brain functions.
 The individual will never again communicate or
deliberately interact with the environment and is
irreversibly unconscious and unaware of both the
world and his own existence.
2.CELLULAR DEATH: -
 The cessation of utilization of oxygen and the normal
metabolic activity in the body tissues and cells is
known as cellular death.
 Different internal organs with different function and
with different metabolic rate have different rate of
cessation.
 Hence death is a process of cessation of different
internal organs which proceeds from somatic death/
systemic death to cellular death.
BRAIN DEATH: -
 Brain death is the irreversible end of all brain
activityincluding involuntary activities necessary to
sustain life.
TYPES OF BRAIN DEATH: -
1. Cortical death
 If the cerebral cortex of brain alone is damaged, the
patient passes into deep coma, but the brain stem
will maintain spontaneous respiration.
 This is called “persistent vegetative state” and death
may occur months or years later due to extension of
cerebral damage
2. Brain stem death
 If the brain stem is damaged due to various causes,
 Respiratory motor system fails &
 Damage to the ascending reticular activating
system - permanent loss of consciousness,
 Ultimately lead to whole brain death.
3. Whole brain death: - cortical + brain stem death

19. Various criteria for diagnosis of death:
Philadelphia Protocol (1969)
1. Lack of responsiveness to internal and external
environment.
2. Absence of spontaneous breathing movements for 3
minutes, in the absence of hypocarbia and while
breathing room air.
3. No muscular movements with generalized flaccidity
and no evidence of postural activity or shivering.
4. Reflexes and responses:
a. Pupils fixed, dilated, and nonreactive to strong
stimuli,
b. Absence of corneal reflexes.
c. Supraorbital or other pressure responses absent
d. Absence of snouting and sucking responses.
e. No reflex response to upper and lower airway
stimulation
f. No ocular response to ice-water stimulation of inner
ear.
g. No superficial and deep tendon reflexes.
h. No plantar responses.
5. Failing arterial pressure without support by drugs or
other means.
6. Isoelectric EEG (in the absence of hypothermia,
anesthetic deaths, and drug intoxication) recorded
spontaneously and during auditory and tactile
stimulation.
All these criteria should be present
- at least for 2 hrs&
- certified by two physicians other than involved in
organ donation.
MINNESOTA CRITERIA
1. Known but irreparable intracranial lesion.
2. No spontaneous movement.
3. Apnoea when tested for a period of 4 minutes.
4. Absence of brain stem reflexes:
i. Dilated and fixed pupils,
ii. Absent corneal reflexes,
iii. Absent doll’s head phenomenon,
iv. Absent cilio-spinal reflexes,
v. Absent gag reflex,
vi. Absent vestibular response to caloric
stimulation,
vii. Absent tonic neck reflex.
5. EEG not mandatory.
6. Spinal reflex not important.
All the findings above remain unchanged for atleast 12
hours.

20. HARVARD CRITERIA
1. Unreceptivity and unresponsivity:
2. Apnoea tested for 3 minutes.
3. Absence of elicitable reflexes:
a. -The pupils - fixed and dilated and don’t respond
to bright light.
b. -Ocular movement and blinking - absent.
c. -No evidence of postural activity.
d. -Corneal and pharyngeal reflexes - absent.
e. -Stretch tendon reflexes – absent.
4. Isoelectric EEG: - It is confirmatory.
All these tests should be repeated after 24 hours with no
change.

DIAGNOSIS OF BRAIN STEM DEATH:-as per THE
TRANSPLANTATION OF HUMAN ORGANS ACT,1994
Exclusions:
1. Under the effects of drugs, e.g. Therapeutic drugs or
overdoses.
2. Core temperature of the body is below 35°c.
3. Severe metabolic or endocrine disturbances which may
lead to severe but reversible coma, e.g. Diabetes.
Preconditions of diagnosis:
1. Patient must be deeply comatose.
2. Patient must be maintained on a ventilator.
3. Cause of the coma must be known.
Personnel who should perform the tests:
1. By two medical practitioners.
2. Doctors should be experts in this field and not
performed by transplant surgeons.
3. At least one should be of consultant status. Junior
doctors are not permitted to perform these tests.
4. Each doctor should perform the tests twice.
TESTS to be done:
1. Pupils are fixed in diameter and do not respond to
changes in the intensity of light.
2. There is no corneal reflex.
3. Vestibulo -ocular reflexes are absent, i.e. no eye
movement occurs after the instillation of cold water
into the outer ears.
4. No motor responses within the cranial nerve
distribution for painful stimuli.
5. There is no gag reflex to bronchial stimulation.
6. No respiratory movements occur when disconnected
from the ventilator for long enough to ensure that the
CO2 concentration in the blood rises above the
threshold for stimulating respiration, i.e. after giving
the patient 100% oxygen for 5 minutes.

Two doctors have to performed all these tests twice.

21. 4.AUTOPSY
Postmortem examination:
It is also called as Autopsy or necropsy. It is defined as
Investigative dissection of dead body. 1st autopsy done by
DrAmbroise Pare on King Henry II.
Objectives:
1. What are the injuries – Documentation of injuries
2. When injuries occurred – Time since injury occurred
3. Why were the injuries produced – Manner of death
4. Which injury caused death – Fatal injury
5. When death occurred – Time of death
6. Who is the victim - Identification
7. How the victim died – Cause of death
Secondary objectives:
1. Evidence collection
2. Reconstruction of event
3. Fetus :
a. Age and viability
b. Live birth or dead born
Types:
1. Medicolegal Autopsy
2. Clinical Autopsy
3. Psychological Autopsy
4. Endoscopic Autopsy
5. Virtual Autopsy

1. Medicolegal Autopsy:
 Done in suspicious cases, sudden death, unnatural deaths,
and criminal death.
 On request by an investigating officer.
 So requisition letter is a must.
 Consent of legal heirs is not necessary.
2. Clinical Autopsy:
 Done In death due to natural causes
 For academic purpose/research
 To ascertain the exact cause of death
 To confirm or refute the diagnosis
 Consent of legal heir/close relative is a must
 Requisition from investigating officer is not needed
3. Psychological Autopsy:
 It is retrospective study of events of deaths
 Done in cases of suicide to find out whether the person was at
high risk of committing suicide or not.
 Analyzing medical records, personal history,
 Analyzing crime scene, suicide notes.
 Interviewing all close associates to get vital information.
4. Endoscopic Autopsy:
 It is an alternative to traditional autopsy
 When fatal injury is confined to abdominal organs, Postmortem
endoscopic examination with trocar and telescopic device to
find out the exact cause of death.
5. Virtual Autopsy:
 Replacing traditional Autopsy.
 Using various modern cross sectional imaging techniques to
find out the cause of death
 CT, MRI, Postmortem X rays etc.

22.  3 Dimensional reconstruction of CT images to arrive at the
conclusion.
Procedure of Autopsy
1. External Examination
2. Internal Examination
External Examination:
a. Identification
• Age, Sex, Weight, Height, complexion
• Nutritional status, deformities, hair
• If Unknown - details of clothes, moles, scars
• Fingerprints, photographs of the body
• Bone/ teeth for DNA analysis
b. Coverings of body
 Wrappings of body
 Hospital dressings
 Clothing
o Loss Of Buttons
o Cuts And Tears
o Firearm Injuries – Burns Or Blackening
o Characteristic Odor
o Stains In Clothing
 Blood, Semen, Saliva
 Vomit, Poison, Vitriolage
 Feces, Mud, Grass
c. Examination of body:
 Head to toe examination
 Any deformity
 Signs of diseases, pallor, jaundice
 Status of natural orifices
 Traces of blood, semen, saliva
 Characteristics of odor
 Documentation of injuries
d. Estimation of time since death:
 Hospital records
 Status of eyes
 Postmortem lividity
 Rigor mortis
 Features of decomposition
 Rectal temperature
 Entomology activities
Internal examination:
Various incisions:
1. I incision:
– From chin to pubic symphysis with deviation to
umbilicus
- Skin reflected laterally
2. Y shaped incision:
-From behind each ear from mastoid to extend down to
sternal notch and downwards to pubic symphysis
3.Modified Y Shaped Incision:
- Starts below anterior axillary folds andthen extends
below breasts meets at xiphisternum and then extends
down to pubic symphysis.
4. T shaped incision:

23. - From acromion process to suprasternal notch and then
downwards to pubic symphysis.
5. Cosmetic autopsy incision:
- To avoid disfigurement.
Techniques of organ removal:
1. Virchow Method
 After opening up the cavities, the organs are removed
one by one.
Advantage:
 Quick and Easy
Disadvantage:
 Inter Relationship Lost,
 No Continuity between Organs
2. Rokitansky Method
 In situ dissection
 Done in highly contagious cases
 In pediatric cases
Advantage:
 In children,
 Infected bodies
Disadvantage:
 Difficult In Adults
3. Ghon method:
 Also called as en bloc removal
o Thoracic bloc
o Intestinal bloc
o Coeliac bloc
o Urogenital bloc
Advantage:
 Preservation of organsexcellent
Disadvantage:
 If disease extends beyond bloc then Inter
relationship Lost.
4. Letulle Method:
 Also called En masse removal.
 Cervical, thoracic, abdominal, and pelvic bloc are
removed in one mass
Advantage:
 Excellent preservation of organs and inter relationship
with their lymphatic drainage.
Disadvantage:
 Difficult in handling the organs as en mass
Negative autopsy:
At the end of a complete and thorough post mortem examination,
inclusive of all relevant investigation such as histopathological, toxicological
and biochemical examination, if the cause of death of the deceased could
not be ascertained, then such an autopsy is termed as “Negative or Obscure
Autopsy”.
Approximately 2 to 5% of all autopsies are negative in nature.
Causes:
1. Inadequate history
2. Natural diseases which is difficult to establish as a cause of autopsy
like cardiac arrhythmias, uraemia, adrenal insufficiency
3. Death due to vagal inhibition
4. Death due to anaphylaxis
5. Death due to certain kinds of poisons like anaesthetics, snake bites

24. 5.Post Mortem Changes
Signs of Death & Postmortem changes after
death:
1. Immediate Changes
2. Early Changes
3. Late Changes
Immediate Changes:
Permanent Cessation of Brain function.
Complete Cessation of Circulatory function.
Permanent cessation of Respiratory function.

Suspended Animation
It is a condition in which the metabolic needs and vital
functions of the body are reduced to such a low level that
they can’t be appreciated by clinical examination and the
person appears apparently death.
Such persons are actually not dead and can be revived
by resuscitation.
Features:
1. Pulse is not palpable,
2. Heart sounds not audible,
3. Respiratory movements are not visually perceptible
and
4. Reflexes are either absent or not possible to elicit
Examples:
1. Voluntary- by yogis
2. Involuntary – drowning, electrocution, heat stroke,
typhoid fever, new born hypothermia etc.
Early Changes:
1. Changes in the eye
2. Changes in the skin
3. Cooling of the body/Algor mortis
4. Post mortem lividity/Hypostasis
5. Rigor mortis/Cadaveric rigidity


1. Changes in the eye:
1. Opacity of cornea
 Cornea becomes opaque in 6 hrs - Dry, Cloudy and
opaque
 Cornea can be harvested within this six hour for
transplantation.
2. Sclera – Tache Noire
If the eyelids are left open, desiccation of sclera
occurs leading to triangle shaped brownish discoloration
of areas on either side of cornea known as Tache Noire
3. Flaccidity of eyeball:
 Intra Ocular tension falls, eye balls become flaccid and
sinks.
 Normal IOP is 15 – 20 mm hg; after 2 hrs – 12 mm hg, 3
hrs - 10 mm hg, 4 hrs – 8.5 mm hg, 8 hrs – 5 mm hg

25. 4. Pupils:
 Fully dilated in the early stage and constricted later due
rigor mortis of constrictor muscles.
5. Retinal:
 Blood flow in the retina becomes discontinuous and
segmented.
 This is known as rail roading phenomenon or
Kevorkian Sign
 The color of retina becomes pale after death and the
paleness increases with time.

2. Changes in the skin:
 Pale and Ashy white appearance
 Loss of Elasticity
 Lips become dry, brownish and hard due drying.
 Wounds will not gape if it is inflicted after death
 Wounds caused during life will retain their
characteristic features.
3. Cooling of the body/Algor mortis:
Cooling of the body after death due to
 Loss of thermo - regulatory mechanism of the
body which maintains the body temperature
 Imbalance between heat production and heat
loss.
 Loss of heat of body to surrounding till it
balances with environmental temperature by
means of
• conduction
• convection and
• radiation,
For the first two hours after death, there is some heat
production due to utilization of stored ATP molecules and
by anaerobic glycolysis.
Due to which
there is little or
no fall in body
temperature
during initial two
hours and then
rate of cooling is
fast during next
few hours and
later slows down.
Temperature is recorded by Chemical thermometer-
Thanotometer 25 cms inserted in anus.
Rectal temperature at the time of
death – Rectal temperature at the
time body found
Time since death = ---------------------------------------------
Rate of fall in temperature

26. Factors affecting rate of cooling:
1. Environmental temperature
Rate of fall of body temperature is faster in winter and
cold environment when compared with summer and
hot climate
2. Build / body surface area
Rate of fall of body temperature is faster in babies due
to larger body surface area per body weight compared
to adults
3. Physique / Fat Content
Rate of fall of body temperature is faster in persons
with lean body mass as body fat acts as a body heat
insulator.
4. Environment – Air, water
Rate of fall of body temperature is faster in body found
in free flowing water body compared to stagnant water
body as moving water reduces the body temperature
5. Position of body:
Rate of fall of body temperature is slower in body
which lies in curled up position as it reduces the loss of
heat to environment.
6. Coverings:
Rate of fall of body temperature is slower in body
covered with thick clothes.



Post Mortem Caloricity
Is a condition in which the temperature of body after
death instead of decreasing it increases.
Causes
 Body lying in open hot summers
 Infections – cholera, malaria, tetanus, typhoid
septicaemia
Temperature already increased at the time of
death
Metabolism of micro-organisms continuing
after death
Other causes:
 Strychnine poisoning
 Sun stroke

4. LIVOR MORTIS:
It is the reddish-purple discoloration of the most
superficial layer of the dermis due to accumulation of fluid
blood in the dependent area of body after death.
Other terms:
 Livor lividity, Post mortem Hypostasis, Post mortem
Staining
Suggillation, Lucidity, Vibices, Darkening of Death.
Mechanism of appearance:
 It occurs after death when circulation stops.
 When circulation stops, the blood gets stagnated.

27.  Gravity now acts on the stagnant blood and pulls it to
the lowest accessible areas.
Fixation of Livor mortis:
 Post mortem staining starts to appear as patches
within 1 – 2 hrs, the multiple patches merges with each
other by 4 – 6 hrs
 The gravitated blood coagulates and gets fixed to
surrounding tissues by 6 – 10 hrs.
 And thereby the post mortem staining is fixed by 6 hrs.
 Suppose
• If the body is changed to a new position within 6
hours of death, then the hypostasis patches
disappears and occurs in the new dependent
areas.
• If the body is changed to a new position after 6
hours of death, then the hypostasis stays in the
same original areas.

Distribution of lividity:
 Most commonly, when body lying on the back,
• It is present all over the back except over areas
of contact flattening, like occipital scalp,
shoulder blades, mid back, buttock, posterior
thighs, calves and heels wherein the tissue is
compressed by supporting bed preventing
accumulation to blood
 Prone position
• It is present in front of the body except,
forehead, nose, chin, cheek (if face is turned),
chest, lower abdomen, anterior thighs, knees and
toes points.
 Vertical position as in hanging
• It is seen most markedly in feet, legs and to
lesser extend in the distal parts of arms and
hands.
 If the body is seen in moving water like river
• The body is in constant change of position and
hence there will be no formation of hypostasis as
the body is not allowed to rest for gravitation of
blood to occur.
Color of hypostasis:
 It depends on the amount and state of hemoglobin of
the red cells.
a. Pink color:
• Death due to Hypothermia.
• Exposure to cold in agonal period.
• Refrigeration of body in mortuary
immediately after death.
The pink color of the hypostasis is due to oxygenated
hemoglobin.

28. b. Cherry Red color:
• Seen in cases of death by carbon monoxide
poisoning.
• Due to carboxy hemoglobin.
c. Brick red color:
• Seen in cases of death by cyanide
poisoning.
d. Brownish red color:
• Seen in cases of death by nitrate poisoning.
e. Dark brown or yellow color:
• Seen in cases of death by phosphorus
poisoning.
f. Pale bronze color:
• Seen in death by infection by clostridium
prefringens.
g. Greenish brown color:
• Seen in death by infection by clostridium
welchii.
h. Green color:
• Seen cases of death due to hydrogen
sulfide.
Medico-Legal Importance:
• It is a reliable sign of death
• Information about the position of the body at the time
of death
• Time since death can be estimated
• Color suggest the cause of death
• Distribution of lividity gives information about the
manner of death
Changes in the Muscles
1. Primary relaxation/ Flaccidity
2. Rigor mortis/Cadaveric rigidity
3. Secondary relaxation
1. Primary relaxation:
Starts immediately after death with generalized
relaxation of muscle tone:
• Drop of lower Jaw
• Eye balls lose their tension
• Pupils are dilated
• Joints are flabby
• Smooth muscle relaxation- incontinence of Urine and
Feces

2.Rigor Mortis/ Cadaveric rigidity
• It is generalized stiffening of the muscles of the body,
both voluntary and involuntary after death due to
formation of permanent actin myosin cross bridges.
• This phenomenon comes immediately after the
muscles have primarily relaxed.
Mechanism of development:
During alive, for contraction and relaxation of muscles,
• Calcium – required for formation of actin myosin
bridge -Contraction

29. • ATP - required for breaking the actin myosin bridge -
Relaxation
Immediately after death,
• Stored ATP is used – relaxed state of muscles in
Primary Relaxation
• Calcium stored in Sarcoplasmic reticulum- released
– actin myosin bridge formation – contraction of
muscles.
• Absence of ATP – no breaking of bridges –
formation of permanent actin myosin cross bridges.
• Generalized stiffening of all voluntary and
involuntary muscles.
Progression of rigor mortis:
• It starts in muscles around eyelids – facial and neck
muscles – muscles of trunk and upper limb – muscles
of lower limb – lastly in muscles of fingers and toes
• Rigor mortis disappears also in same order as it
appeared.
Time of Onset:
• Temperate climates – 3-6 hours
• Tropical climates – 1-2 hours
Duration it Lasts for:
• Temperate climate – lasts for 2-3 days.
• Tropical climate – 24 – 48 hours in winter
18 - 36 hours in summer
• In general In - 12 hours develops
For - 12 hours maintains
And - after 12 hours passes of
Circumstances modifying the Onset and
Duration of Rigor mortis:
1. Age-
 Rigor Mortis is very rare in premature
infants.
 Rigor mortis is slow in adolescence and
healthy adults
2. Muscular condition and activity before death-
• Onset is slow and duration is longer
• In muscular & healthy persons
• In dry and cold condition
• Onset is early and disappears soon.
• In wasting disease & great exhaustion- cholera,
plague, T.B, Cancer
• Warm and moist air condition
Conditions Simulating Rigor-Mortis:
1. Cadaveric Spasm:
Also called as instantaneous rigor, wherein only a
group of muscles which are active just before death go
into a state of sudden stiffens immediately after death
without the phase of primary relaxation.
Usually seen in cases of violent death as in
a. Drowning case – hand clutching grass and
weeds
b. Suicide by shooting – hand grasping the
gun tightly
Other conditions:
2. Heat Stiffening

30. 3. Cold Stiffening
4. Gas stiffening in putrefaction
Late Signs Of Death
1. Decomposition / Putrefaction.
2. Adiopocere formation / Saponification.
3. Mummification.
1. Decomposition / Putrefaction
Last stage in the resolution of the body, from the organic
to the inorganic state resulting in softening & liquefying of
the body tissue.
Mechanism of autolysis:
• Rise of autolytic enzyme levels in the tissue cells after
death.
• Action of bacterial enzymes on tissue components –
carbohydrates/fat/proteins.
Characteristic features:
a. Colour changes:
• Greenish to black discoloration- ‘Sulph-meth-haemoglobin’
formed by H2S due to microorganisms in the large intestine.
• Greenish discoloration of skin over caecum and flanks – first
sign of post mortem.
• Discoloration spreads - front of abdomen, external genitals,
chest, neck, face, arms and legs – spreads whole body in 24-36
hrs.
• Discoloration of vessel walls due to pigmentation from
decomposed blood over the shoulder and groin. Arborescent
pattern- ‘Marbling’

b. GASES OF PUTRIFACTION
• H2S, ammonia, phosphate, CO2 and methane
• Under the skin and hollow viscera - 18-36 hrs.
• in solid viscera - 24-48 hrs.
• Causes pseudo rigidity, exerts pressure.
• More gases accumulation, body floats in water.

Pressure effects of putrefactive gases:
• Displaces the diaphragm upwards.
• Shifting of the area of hypostasis.
• Bloating of the abdomen, face and genital.
• Changes in appearance of genitals.
• Liquefied tissue mixes with gases producing froth
• Extrusion of fluid from the mouth and nose.
Insect activity- Entomology:
• After 18-36 hrs - Flies lay eggs over the decomposed
body- nose, mouth, vagina and anus.
• After 24-36 hrs - eggs hatch into larvae or maggots,
enter the body and destroy the tissues.
• After 4-5 days – maggot develop into pupae.
• After 7-8 days – pupae develop into adult fly.
Other changes following
• Fall of teeth
• Separation of skull sutures
• Liquefied brain matter oozes out.

31. • ‘Colliquative putrefaction’ – this process takes place
between 7-14 days.
Internal post-mortem changes
Early putrefaction - 24-48hrs
Larynx, trachea, brain of infants, stomach, intestines,
spleen, omentum and mesentery, liver and adult brain.
Late putrefaction - 2-3 weeks
Heart, lungs, kidneys, bladder, oesophagus, pancreas, diaphragm,
blood vessels, prostate, testis and non-gravid uterus, ovaries.
ADIPOCERE
• Modification of the process of putrefaction in the dead body is
(checked and is replaced) adipocere formation.
• Due to Hydrolysis of body fat into fatty acids.
• Forms saturated fatty acids - palmitic, stearic, hydroxyl-stearic,
olic acids with the help of Bacterial fat splitting enzyme
Lecithinase and moisture.
• Adipocere tissue has appearance of Yellowish white, greasy wax
with rancid smell.
• It forms at any site where fatty tissue is present.
Requirements:
• Time required, in summer-3 wks, in tropics-5 to 15 days.
• Humid climate & warm temperature
• Still air
• Bacteria producing fat splitting enzymes.
Medico legal importance:
• Facial features maintained – Identification
• Ante-mortem Wounds preserved – helps in finding
weapon and cause of death

MUMMIFICATION
• Another modification of the process of putrefaction in the dead
body is (checked and is replaced) Mummification.
• It is a peculiar type of dehydration of dead body where its soft
parts shrivel up but retain the natural appearance & the features
of the body.
• Rusty brown colour, dry, leathery skin adherent to bones.
• Internal organs get transformed into a thick brown mass.
Requirements:
• Time required - 3 months to 1-2 yrs
• Dry and hot climate.
• Free flowing air currents.
• Bodies buried in shallow graves, in dry sandy soils.
Medico legal importance:
• Facial features maintained – Identification
• Ante-mortem Wounds preserved – helps in finding
weapon and cause of death.
Time since death/ post mortem interval
• Important clue for investigation of time.
• It helps to apprehend the person likely to be involved.
Post mortem changes helpful to ascertain time since death
are;
a. -cooling of the body
b. -post mortem lividity
c. -rigor mortis
d. -decomposition changes
e. Contents of stomach and bowels
f. Contents of urinary bladder
g. Biochemical changes
h. Circumstantial evidence

32. 6.MECHANICAL INJURY

Injury:
Legally under section 44 IPC, its defined as any harm
whatever illegally caused to any person in body, mind,
reputation or property.
Wound:
It includes any lesion, external or internal, caused by
violence, with or without breach of continuity of skin.
Legal Classification of Injuries:
1. SIMPLE INJURY - An injury which is not grievous is
simple
2. GRIEVOUS INJURY - According to Sec.320, IPC, any of
the following injuries
a. Emasculation
b. Permanent privation of sight of either eye
c. Permanent privation of hearing of either ear
d. Privation of any member or joint
e. Destruction or permanent impairing of the power of
any member or joint
f. Permanent disfigurement of the head or face
g. Fracture or dislocation of a bone or tooth
h. Any hurt which endangers life or which causes the
victim to be in severe bodily pain, or unable to follow
his ordinary pursuits for a period of 20 days
Classification of Mechanical Injuries:
1. Blunt Force Injuries/Trauma:
Abrasions,
Contusions,
Lacerations.
2. Sharp Force Injuries/Trauma:
Incised wounds,
Stab wounds,
Chop wounds.
3. Fractures.
4. Fire arm injuries.
Abrasion:
An abrasion is defined as loss of superficial layers of
skin or mucous membrane due to mechanical force.
Injuries involving superficial layers of the skin and are
caused by
-Impact of an object.
-Fall on rough surface.
-Pressure of finger nails, teeth, muzzle of a gun or
by rope.
Classification of abrasion:
According to direction of force

33.  Tangential abrasion – direction of force is
horizontal/tangential
1. Linear abrasion:
They are produced by horizontal or tangential friction
by the pointed end of an object sliding against the skin.
Thorn, needle, nail, tip of any weapon can cause such linear
abrasion.
2. Grazed abrasion/ Brush burns:
They are produced by horizontal or tangential friction
between boarder area of skin and object/ hard surface of
ground.
The epidermis will be heaped up at its end and the
pattern of heaping will indicate the direction of object
against the skin.
Usually seen in road traffic accidents where the
pedestrians will be dragged against ground for a distance.
 Compression abrasion – direction of force is vertical.
 Patterned Abrasion – pattern of weapon/ object
will be reproduced
 Non Patterned abrasion – pattern will not be
reproduced
1. Impact/imprint Abrasion:
The impacting force is vertical and it acts for
sufficiently long time to crush the epidermis resulting in
pressure type of abrasion and the imprint of impacting
object will be produced.
Usually seen in hanging where the pattern of ligature
material will be reproduced.
2. Contact Abrasion:
If a weapon with a pattern strikes at right angle to
body or if the body falls upon a patterned rough hard
surface, the abrasion will usually follow the pattern of the
object.
Classical example of this is seen in road traffic accident
when tyre of a car passes over body, it squeezes the skin
through the grooves of rubber thread leaving the pattern of
tyre marks.
Age of abrasion - helps to estimate time since injury
 Fresh – recent – bright red with no scab formation
 12 – 24 hrs – red in colour, moist scab
 2- 3 days – reddish brown dry scab
 4 – 7 days – dark brown scab
 8 – 14 days – scab fallen off – non pigmented
 14 – 28 days – partially pigmented – fully pigmented
Ante-mortem Abrasions:
 Reddish brown colour.
 Margins are blurred due to vital reactions.
Post-mortem Abrasions:
 Yellowish in colour.
 Translucent area.
 Margins are sharply defined.
 Absence of vital reactions.
Artifacts in Abrasion:

34. 1. Bites by ants and insects
 Postmortem bites
 Moist & exposed areas
2. Excoriation of skin by excreta
 Seen in infants
 After death napkin area becomes dry, depressed and
parchment-like
Medico-Legal importance of Abrasion:
 Site of impact and possibility of internal injury.
 Identification of weapon causing the injury.
 Direction of injury.
 Time of injury.
Contusion/Bruise:
Contusion is an infiltration of extravasated blood
into the subcutaneous tissue resulting from rupture of
vessels by the application of blunt force.
The internal organs underneath the area of impact may
also show extravasation of blood.
In all such cases the integrity of skin and underlying
organs is not lost except in few cases where the skin is
abraded and called by the term ‘abraded contusion’.
Factors modifying the appearance of contusion:
1. Site of injury:
Flexible areas such as abdomen, buttock will bruise less
with a given blunt force impact than areas with
underlying bony prominence like head, shin etc.
2. Vascularity of area:
Prominence of a bruise varies according to the amount
of blood extravasated, hence areas like face, genitalia,
scrotum with rich vascularity will bruise more than
other areas.
3. Depth of bruise:
Delayed bruise
Contusion present in deeper planes of tissue will
appear after a long time from the time of impact and
hence called as ‘Delayed bruise’ or ‘Come out Bruise’
Ectopic Bruise
At times extravasated blood from damage tissues may
track along the muscular planes with least appearance
and appear at places other than the original site of
impact and they are called as ‘Ectopic Bruise’
Patterned bruise:
A patterned bruise is one in which the size and shape
of bruise will resemble a part of whole of the object
causing it.
 A blow with solid object like hammer will
produce a round contusion.
 A blow with a rod or a stick will produce two
parallel lines of contusion with area spared in
between – Railway Line/ Tram Line Contusion.
Colour change in bruise:
 Fresh – few hours - red in colour – extravasation of
blood
 One day – blue – RBC lysis – haemoglobin
accumulation

35.  2-5 days – brownish – degradation of haemoglobin -
hemosiderin
 6-9 days – greenish – haemotoidin
 10 – 12 days – yellowish – bilirubin
 More than 2 weeks – normal skin colour
Self-inflicted contusion/ Artificial bruise:
 Artificial bruise is a deliberately induced injury by a
person on himself to substantiate false allegation of
assault against another person.
 It can be inflicted by applying irritant substances like
juices of Marking nut, calotropis.
 It is usually seen in exposed and accessible parts of the
body.
 The artificial bruises are irregular in shape, dark brown
in colour, covered with small vesicles and surrounding
area shows sign of inflammation.
 The vesicles might be present also on the tips of fingers
used for applying the irritant juice.
 The vesicles contain acrid serum and it induces itching
in the surrounding area.

Contusion vs post-mortem lividity

Contusion Pm lividity
Cause Rupture of vessels and
extravasation of blood
Engorgement of vessels
due to pooling of blood
Site Anywhere Dependent parts
Surface Elevated Not elevated
Colour Changes with time Normally reddish purple
Incision Extravasated blood in
tissues – not washed off
Blood oozes out of cut
vessels – can be washed
off
Histology Signs of inflammation No signs of inflammation
Medico-Legal importance:
1. Identification of the object/ weapon.
2. Degree of violence.
3. Time of injury.
Laceration wounds/Injuries:
These are the wounds caused by the blunt force
resulting in tearing of the skin and the underlying tissues,
with a minimal bleeding.
Features of the lacerated wounds:
 Edges are ragged, irregular and contused.
 Deep tissues are crushed; Hair bulbs are crushed.
 Less bleeding due to crushing of underneath vessels.
 Presence of foreign materials.
 Shape-Irregular.
 Size-May or may not correspond to the weapon.
 Healing-Process delayed due to gross damage and
infection and produces permanent scar.
Types of laceration:
1. Split laceration:

36.  Split laceration are caused by crushing of skin
and underlying tissues between two hard
objects.
 Seen in cases of blow to tissues overlying bones -
scalp laceration occurs due to tissue being
crushed between skull and impacting hard
object.
 It simulates the incised wound as the margins
grossly look like cleanly cut but on magnification
shows irregular edges. So it is also called as
‘Incised Like Looking Laceration’
2. Stretch laceration:
 Due to over stretching of skin and tissues which
gives away.
 Laceration seen overlying bony fractures, where
the fractured ends of bones stretches the skin
overlying it.
3. Avulsion laceration:
 An avulsion may be seen when force is applied at
an acute angle to surface of the body sufficient
enough to detach the skin from underlying
tissues by its shearing and grinding force.
 Commonly seen in run over by vehicles, where
the wheel passing over the limb may produce a
separation of skin from underlying tissues.
(avulsion)
4. Tear laceration:
 Due to impact with irregular or blunt pointed end
of a weapon or an object on the surface of the
body.
 Stabbing with blunt pointed weapon causes tear
laceration.
5. Cut laceration:
 This type of lacerated wound is produce by “not
so sharp” edge of heavy weapon.
 Seen in chop wounds.
 Abrasions or contusions are seen on the margins.
Medico-Legal importance:
 Homicidal-occurs in any part of the body. produced by
blows with hard and blunt weapon.
 Suicidal-Very rare.
 Accidental-Road traffic accidents, accidental fall from
height.
 Foreign bodies-Mud, gravel, oil etc. helps in finding the
location.

Incised wounds:
Its produced by sharp cutting instruments-knife, razor,
blade, swords, chopper, axe etc.
Features:
 Edges are regular, clean cut.
 Except in neck and scrotum-margins irregular-
laceration like looking incision

37.  Spindle shaped wound, maximum widening in the
central part.
 Length is greater than the breadth.
 Gaping is greater if underlying muscles are divided
across or cut obliquely.
 Hemorrhage is excessive due to the clean division of
blood vessels.
 By nature of the incised wound, weapon used can be
identified.
 Light sharp cutting weapons-razor blades, knife
produces incised wounds by striking, drawing or by
sawing.
Drawing cuts-
Deeper at start, gradually become shallow and at the
end only skin is cut “Tailing of the wound” – indicates the
direction of stroke.
Sawing cuts –
Multiple at the beginning and only one deep cut
wound called “Tentative or Hesitation cuts”- usually seen
in suicidal cases.
Bevelling cuts-
When weapon is used oblique or tangential way over
the body, it raises a flap from underlying tissues.
STAB WOUND\PUNCTURED WOUND:
 These are the deep wounds produced by the pointed
end of a weapon or an object, entering the body.
 These injuries generally caused by ‘weapons with
pointed ends -knives, dagger, bayonet, arrow, pick-axe,
broken glass pieces.
 The depth of the wound will be more than length and
breadth of the wound.
 Depth is the greatest dimension of a stab wound
produced by the length of the weapon introduced.
 The length and breadth of wound corresponds to the
breadth and thickness of the weapon respectively.
 A stab wound caused by a sharp pointed weapon will
have clean cut edges,
caused by a blunt pointed weapon will
have irregular edges.
 When the edges of the weapon are sharp, the wound
produced is an ‘Incised penetrating wound’.
 When the weapon edge is blunt, it produces a
‘Lacerated penetrating wound’.
 Shape of the wound in case of stab wound depends on
the shape of the weapon and its edges.
 In case of weapon with one edge sharp we will have
acute end corresponding to the sharp end and obtuse
end corresponding to blunt edge of weapon.
 In case of weapon with both edge sharp, we will have
both ends of wound to be acute

38. Weapon with single sharp edge producing one acute
angle end and one obtuse angle end.
 Weapon with double sharp edges producing
wounds with both ends acute angled.
 Hilt marks are common when the weapon is pushed till
the handle.
 When a stab wound enters into a body cavity -
thoracic, abdominal, joint cavities it is called as
‘penetrating wound’.
 When the wound pierces the body through and
through and comes out it is known as ‘perforating
wound’.
Chop wounds:
 Heavy sharp cutting weapons-like swords, axes, choppers
etc. chop wounds are greater and severe. Usually
homicidal in nature.
 Injuries caused by these weapons show signs of bruising
over the edges and extensive damage to deeper structures
and organs.
Medico-Legal importance
MANNER
 Homicidal-Any part of the body, commonly on the neck,
head and trunk, also be found on the inner side of
forearm or hand of victim while defending or
protecting. ‘Defense Wounds’.
 Suicidal-Found in the accessible parts by light weapons
on the throat (cut throat wounds). Tail end of the
wound indicates which hand has been used.
 Accidental-Any part of the body hands, fingers during
the handling of knife, razor blades etc.
Identifying weapon
 Incised wound indicates use of sharp cutting weapons.
 Beveled cuts and chop wounds suggest use of heavy or
moderately heavy sharp cutting weapons.
Manner of use of weapon
 Deep chop wounds and beveling suggests striking with
the weapon.
 Tailing cuts indicate drawing of the weapon.
 Multiple superimposed or overlapping injuries are
indicated by saw like movement of the weapon.
Direction of application of force
 From the tailing and beveling, the direction of
application of force can be known.
 The relative position of the victim and the assailant can
also be known, by the direction of application of force
Age of the wound or time since injury
 In case of dead bodies-histological examination of tissue
from the margin of the wound, gives the clue that the
survival of time after injury.
 When fresh- Bleeding is still present or fresh soft clot is
adhered, margins are red, swollen and tender.
 By 12 hrs- Blood clot and lymph dry up, margins are red
and swollen. Histologically there is infiltration of
leucocytes.
 By 24 hrs- Proliferation of connective tissue cells and
vascular endothelium for neo-vascularization.
 By 36 hrs- Fibroblastic infiltration and capillary network
formation starts.

39.  By 48 hrs- Capillary network is completed. Fibroblasts
run across the new vessels.
 By 3-5days- Vessels are obliterated and thickened,
wound heals and scar formation starts and advances.
 By 6
th
day- Scar formation is completed. Scab over the
wound falls off.
 After weeks to months, soft, tender, reddish scar
becomes tender less, whitish and firm.
FRACTURE
Fracture of a bone is defined as disintegration or breakage
of bone due to blunt/ sharp force acting either directly or
indirectly.
Direct Fractures
1. Focal fractures
 Small force applied to a small area. Injury to overlying
soft tissue is minimal.
Eg-forearm and leg, while defending blows during an
attack.

2. Crush fractures
 It results from application of a large force over a large area
and is typically fragmented.
 Injury to the surrounding soft tissue is usually extensive.
 If two bones lie adjacent to each other, both are involved.
Eg- fracture of tibia and fibula in RTA.
3. Penetrating fracture
 It results from applications of a large force over a small
area.
Eg- Bullet injury to a bone.
Indirect Fractures
1. Traction Fractures
2. It results when a bone is pulled apart by traction.
i. Eg- Transverse patellar fracture due to violent
contraction of quadriceps.
3. Angular fraction
It occurs due to bending of bone. The concave surface of
the bend is compressed, while the convex surface is put under
traction resulting in breakage.
4. Rotational fracture
Fracture in spiral, when the bone is twisted in opposite
direction.
5. Vertical compression fracture
In this type, when a proximal part of bone is compressed
against distal part, an oblique fracture with driving of
proximal part into distal part results.
Repair and healing of the fracture
Healing of the fracture depends on the age and nutritional status
of a person.
1. Haemorrhage phase.
2. Proliferation phase.
3. Callus phase.
4. Consolidation phase.
5. Remodelling phase.
 In the Hemorrhagic phase, bleeding will be at the site of
fracture.
 In the Proliferation phase, a collar is formed around the
fractured ends by proliferation of cells from periosteum
and endosteum.

40.  In the Callus phase, cellular elements give rise to
osteoblasts and chondroblasts which produce a matrix of
collagen and polysaccharide, impregnated with calcium.
 In the Consolidation phase the callus is transformed into
mature bone by 4-6weeks in children and in adults by 12-
14weeks.
 In the final, the Remodeling phase, matured bone will take
place.


Medico-Legal Importance:
1. Fracture of a bone constitutes grievous injury according
to law.
2. The type of fracture can give the clue of causative force,
whether direct, indirect, rotational or angular etc.
3. Age of fracture/ injury can be found out from healing
stage
4. The site of fracture may help to indicate the cause of
death.
Eg- fracture of hyoid bone suggestive of throttling.

41. 7.FORENSIC BALLISTICS

Forensic ballistics
 Forensic ballistics is the science dealing with the
investigation of firearms, ammunition and the problems
arising from their use.
Firearms
 A firearm is any instrument which discharges a missile
by the expansive force of the gases produced by burning
of an explosive substance.
Proximal ballistics:
 Study of firearms and projectile
Internal ballistics:
 Study of motion of a projectile after its ejected until it
hits the target
Terminal ballistics:
 Study of injuries produced by firearms
Fire arm
 A firearm consists of a metal barrel in the form of
hollow cylinder of varying length which is closed at the
back end (breech end) and an open front end (muzzle
end).
 A chamber at the breech end to accommodate the
cartridge.
 A taper that connects the chamber to barrel.
Types
According to barrel
1. Rifled
The barrel is grooved spirally so that it gives a spinning
movement to bullet.
2. Smooth bore
The barrel is not grooved and it is smooth.
Ammunition
 A round of ammunition. Generally, refers to a single,
live, unfired, cartridge comprising the missile, cartridge
case, propellant and some form of primer.

Primer
 Highly sensitive explosive chemical which, when struck
by the firing pin or hammer of a weapon, will explode
with great violence, causing a flame to ignite the
propellant
 Mercury fulminate/ lead azide
 Potassium chlorate
 Antimony sulphide

Propellant
Present in the body of cartridge
Three types
1. Black powder
2. Semi smokeless powder
3. Smokeless powder
Black powder
Chinese traditional gun powder
 75% potassium nitrate (salt peter)

42.  15%charcoal, and
 10%sulfur,
Large quantity of bluish-grey smoke and a characteristic
sulfurous residue
Smokeless powder
 Smokeless powders compounded from
 Nitrocellulose – single base
 Nitrocellulose + Nitro-glycerine – double base
 They generate some smoke but not to the extent of black
powder
 Power generated is much higher than tradition black gun
powder.
Semi Smokeless powders compounded
20% smokeless powder + 80% black powder
BULLET
 A bullet is a projectile propelled by a firearm, sling, or
air gun.
 A bullet does not contain explosives, but damages the
intended target by its impact or penetration

Shotgun cartridge:

THE PROJECTILES
Small round lead balls or lead-antimony alloy for added
hardness.
 Pellets used in shotgun cartridges
 Lead with a small amount of antimony to increase their
hardness
 Soft steel, usually with a copper coating;
 Bismuth, a heavy metal often alloyed with iron;
 Tungsten, a very heavy metal often alloyed with iron
THE BRASS HEAD
 Forms the base of the shot shell,
 Contains the primer, and is in direct continuity with the
cartridge case.
 The base has a rim to allow extraction of the spent shell
after discharge.

THE CARTRIDGE CASE
 Contains the gun powder, wadding, piston, and
projectiles.
PISTON
 To contain the projectiles.
 The function of the piston is:
 to contain the projectiles in a tight cluster until the
instant of muzzle exit
THE WADDING
 Discs of cardboard (commonly called cards) or felt
 To separate the propellant from the projectiles and
 To secure the projectiles at the apex of cylinder.

43. Classification of guns:
Hand guns:
 Single shot and double barrel pistols
 Revolvers
 Semiautomatic pistols
 Automatic and machine
pistols
 Air pistols
Long arms
Rifles
 Single shot
 Magazine repeaters
1) Lever action
2) Slide or pump action
3) Single shot bolt action
4) Semiautomatic
5) Automatic
Caliber of rifled firearm:
 It is the size of the barrel
of a rifled firearm.
 It is the distance between two vertically opposite lands
in the barrel of a rifled firearm.
e.g 9mm caliber means the distance between two
vertically opposite land inside barrel of this rifled
firearm is 9 millimeter
Gauge of a smoothbore Firearm (Shotgun):
 It is the size of the barrel of a smoothbore firearm
 It is the number of lead balls of equal diameter that
exactly fits into the barrel of shot gun that can be made
from one pound of lead.
e.g 16 gauge shot gun means 20 lead balls, all of equal
diameter of size that exactly fits into this shot gun made
from one pound of lead
Choking of shotgun:
• A choke is a tapered constriction of a shotgun barrels
bore at the muzzle end.
• Purpose is to shape the spread of the shot in order to
gain better range and accuracy










Types of Bullets:
1. Ricochet bullet:
 A type of bullet which gets bounced back or deflected
by striking an intermediary hard object before
striking the target.
2. Tandom bullet or piggy tail bullet:
 Sometime one bullet may get logged inside the barrel
without getting out, so on second firing, the second
bullet along with first bullet comes out
3. Dum Dum bullet:
 The tip of bullet is hollow with grooves made up of
lead, so that when it strikes a target it expands and
produce larger wound.
Smooth bore
firearms:
 Single barreled
 Double barreled
 Magazine repeaters
1) Lever action
2) Slide or pump
action
3) Bolt action
4) Self-loading or
semiautomatic shot
guns

44. 4. Frangible bullet:
 Entire bullet is made up of iron and easily frangible
metals, so that on hitting the target its breaks into
multiple fragments and produce greater damage
5. Incendiary bullets:
 Contains white phosphorous/ barium nitrate and
powdered aluminum and magnesium at the tip of it
 ignited upon firing
6. Tumbling bullets:
 When the bullet in motion rotates end to end after
firing in its projectile.
7. Souvenir bullet:
 when the bullet remains existing within the body
encapsulated with dense fibrous tissue.
8. Tracer bullets,
 Leaving a trail of blue smoke
 Rear portion is filled with barium nitrate/ powdered
strontium nitrate and magnesium
Components of a Shot responsible for damage
 Bullet – spinning moment - Abrasion collar
 Flame & heat – Singeing of hair, burning of skin
 Smoke - Blackening
 Unburnt gun powder - Tattooing
 Grease from the barrel - Grease collar
RIFLED FIRE ARM
ENTRY WOUND –
SINGLE HOLE:
Inverted margins.
SHAPE:
 Depending upon the angle of firearm with the body
 -Circular,
 Oval/ Elliptical,
 An elongated furrow.
SIZE :
 Proportionate to the diameter of the bullet
 Small - skin elasticity
 Large - explosive blast effect of gases so either
1. Contact shot
 Entry wound of variable shape with collar of abrasion
 Burning, blackening, tattooing present in the track or
interior of wound
 Pinkish discoloration due to CoHb.
 Muzzle imprint on close examination.
 Margins may be inverted or everted
2. Close shot (within range of flame)
 Barrel is held close to skin in the range of flame &
smoke -7.5 cm in revolvers / pistol - 15 cm in rifles
 Circular defect, Inverted margins.
 Burning, singing present. (Flame)
 Blackening present. (smoke)
 Tattooing present. (un burnt powder)
 Collar of abrasion, grease present
3. Near shot (within range of un burnt powder)
 Barrel is held in the range of out of flame but within
unburnt powder -60 cm in revovlers/pistol, 75- 90 cm
in rifles
 Circular defect, Inverted margins.
 Burning, scorching absent. (Flame)
 Blackening absent. (smoke)
 Tattooing present. (un burnt powder)
 Collar of abrasion, grease present
4. Distant Shot (out of range of un burnt powder)

45.  Barrel is held in the range of out of unburnt powder
>60 cm in revolvers/pistol, >90 cm in rifles
 Circular defect, Inverted margins.
 Burning, scorching absent. (Flame)
 Blackening absent. (smoke)
 Tattooing absent. (un burnt powder)
 Collar of abrasion, grease present


SMOOTH BORE FIRE ARM - SHOT GUN
1. Contact shot
 Entry wound usually large due to blast effect
 Burning, blackening, tattooing present in the track or
interior of wound
 Pinkish discoloration due to CoHb.
 Muzzle imprint on close examination.
2. Close shot (within range of flame)
 Barrel is held close to skin in the range of flame &
smoke –upto 30 cm
 Circular defect, Inverted margins.
 Burning, scorching present. (Flame)
 Blackening present. (smoke)
 Tattooing present. (un burnt powder)
 Pellets travel as single mass
 Surrounded by contusions by card disc,

3. Near shot (within range of un burnt powder)
 Barrel is held in the range of out of flame but within
range of unburnt powder 60 to 90 cm
 Up to 45 cm – single entry wound
 45 cm to 1 meter – single wound with scalloped
margins – rat hole entry wound.
 Burning, scorching absent. (Flame)
 Blackening absent. (smoke)
 Tattooing present. (un burnt powder)
4. Distant Shot (out of range of un burnt powder)
 Barrel is held in the range of out of unburnt powder
>1 meter
 Satellite entry wound: multiple small entry wound
surrounding the central entry wound will be there
from 1 meter to 2 meters
 Central entry wound size decreases proportionately >
2 meters
 >5 meters no central entry wound
 Burning, scorching absent. (Flame)
 Blackening absent. (smoke)
 Tattooing absent. (un burnt powder)
Medicolegal importance
 Bullets
 Size
 Weight

46.  Number
 Kind of metal
 Striations in it – identification of weapon.
Test firing and comparing
 If weapon and bullet recovered from scene of crime
 Test fire it and collect the bullet.
 Compare the test fired bullet with the bullet
recovered after postmortem from the decease.
 Study various marks and compare with comparison
microscope
Striations
 As the bullet travels through the barrel, the grooves
guide the bullet and cause it to spin.
 Striations, or fine lines, in the gun barrel make the
same striations on the bullet. These striations are
unique to the firearm.
Identifying Marks from the Firing Pin
 Metal-to-metal contact between the bullet case and
the firing pin leaves an impression on the case. This
impression is in the shape of the firing pin.
 A shotgun has a smooth barrel so the projectile is
not marked with any type of striation.
 However, the shotgun cartridge may have the same
markings as a bullet case.

Gunshot Residues GSR:
 When a firearm is discharged, unburned and partially
burned particles of gunpowder in addition to smoke
are propelled out of the barrel along with the bullet
towards the target.
 The GSR is most likely concentrated on the thumb
web and the back of the firing hand.
 The GSR stays on the hands for approximately 2
hours and is easily removed by washing or wiping the
hands.
 In a suicide, the hands will be bagged and tested for
GSR at the Medical Examiner’s office.
 The Dermal Nitrate Test, developed in 1933, was
used for many years. However, many false positives
with cigarette ash, urine and cosmetics.
 During the test, the suspects hands were covered in
wax. After the wax hardened it was removed and
chemically tested.
 Barium, copper, lead and Antimony are both
components in GSR. Several techniques are used to
test for these elements.
 First, the investigator will remove the GSR particles
with tape or swabs.
 Next, the particles may be examined with a Scanning
Electron Microscope, Neutron Activation Analysis or
Flameless Atomic Absorption Spectrophotometry

Manner of death

47. 8.THERMAL BURNS

• Thermal burns are injuries caused by exposure of living tissue
to high temperatures that will cause damage to the cells.
• The extent of the damage caused is a function of the length of
time of exposure as well as of the temperature to which the
tissues are exposed.
• The minimum temperature required to cause cell damage
• 44°C if exposed for several hours,
• Over 50°C or so, damage occurs more rapidly,
• At 60°C tissue damage occurs in 3 seconds.
The heat source may be dry or wet;
• where the heat is dry, the resultant injury is called a
‘burn’,
• whereas with moist heat from hot water, steam and
other hot liquids it is known as ‘scalds’.
Classification of thermal burns according to sources of heat
1. Flame burns
• In flame burns, there is actual contact of body and
flame, with scorching of the skin progressing to
charring.
• Flame burns may or may not produce vesication but
singeing of hairs and blackening of skin is always
present.
• Hair singed by flame burns become twisted and
curled, breaks off or is totally destroyed.
2. Flash burns
• Flash burns are a variant of flame burns.
• They are caused by the initial ignition flash fires that
result from the sudden ignition or explosion of gases,
petrochemicals or fine particulate material.
• Typically, the initial flash is of short duration, a few
seconds at most and because the thermal conductivity
of the skin is low, the burn is superficial.
• All exposed surfaces are burned uniformly.
• Flash burns usually result in partial-thickness burns
and singed hair.
• If the victim’s clothing is ignited, a combination of
flash and flame burns occurs.
• Flash burns from methane explosion. Hair singed.
3. Contact burns
• Contact burns involve physical contact between the
body and a hot object.
• A heated body when applied to the body for a short
period causes a blister or reddening corresponding to
the size and shape.
• For a longer duration causes, trans-epidermal
necrosis.
• The hair may be singed or distorted.
4. Radiant heat burns
• They are caused by heat waves a type of
electromagnetic wave.
• There is no contact between body and flame, or
contact with a hot surface.
• Initially, the skin appears erythematous and blistered,
with areas of skin slippage.
• With prolonged exposure to low heat, the skin will
become light brown and leathery

48. • Radiant heat burns with erythema, blistering of skin
and skin slippage
Classification of thermal burns according severity of burn
injuries:
1. Dupuytrynes
I degree – erythema with transient swelling
II degree –vesication with blister formation
III degree – partial destruction of dermis
IV degree – complete destruction of dermis
V degree – involvement of subcutaneous tissues and also
the muscles
VI degree involvement of bones
2. Hebras classification
1
st
degree - Involves only epidermis
2
nd
degree - Involves both epidermis and dermis
3
rd
degree - Involves subcutaneous tissues, muscles and
bones.
3. Wilsons Classification
Epidermal - Involves only epidermis
Dermo epidermal - Involves both epidermis and dermis
Deep - Extend beyond dermis.
4. Evans classification
Superficial burn - involves only epidermis
Partial thickness - involves both dermis and epidermis
Full thickness - involvement beyond dermis
5. Muir and Sutherlands classification
Superficial partial thickness burn
Deep partial thickness burn
Full thickness burn
6. Modern day classification
I. First degree (superficial)
o Redness without blister
o Involving only epidermis
o painful
II. Second degree
a. Superficial partial thickness
o Redness with blisters
o Extending into superficial papillary dermis
o Very painful
b. Deep partial thickness
o Yellow or white burns
o Extending into deep reticular dermis
o Pressure discomfort with no pain.
III. Third degree
o Full thickness – white/ brown
o Extending into entire thickness of skin.
o Painless
IV. Fourth degree
o Black, charred with Escher formation
o Extending into entire skin, subcutaneous fat, muscles
and bone.
o Painless
Classification of burn injuries according to involvement of
body surface area:
Wallace rule of nine divides body surface into following regions
o Head, neck and face - 9 %
o Front of thorax - 9 %
o Back of thorax - 9 %
o Right upper limb - 9 %
o Left upper limb - 9 %
o Front of abdomen - 9 %
o Back of abdomen - 9 %
o Front of right lower limb - 9 %
o Back of left lower limb - 9 %

49. o Genitals – 1%
Causes of death in victim of burn injuries:
1. Primary (neurogenic) shock due to pain
2. Secondary shock due to fluid loss (in 48 hrs)
3. Smoke inhalation – CO, Cyanide, free radicals.
4. Biochemical disturbances secondary to the fluid loss and
destruction of tissues.
5. Acute renal failure usually occurs on third or fourth day.
6. Sepsis occurring after four to five days.
7. Gastrointestinal disturbances, as peptic ulceration, dilation
of stomach, hemorrhage into intestines.
8. Edema of glottis and pulmonary edema due to inhalation
of smoke containing CO.
9. Pyaemia, gangrene, tetanus etc
10. Pulmonary embolism from thrombosis of veins of legs
11. Death due to malignant transformation of a burn scar
(Marjolin’s ulcer)
Postmortem appearance in a deceased died due to burn
injuries:
External
1. Clothes
 Cotton fabrics burns faster.
 Nylon, polyester and wool produce less severe burns.
 Close fitting garments are safer.
 Portions of body under tight fitting are comparatively
unaffected, like belts, shoes, brassier or buttoned collar.
 All clothes should be sent for examination of flammable
substances
2. Hair changes
 Hairs are singed, twisted, charred, broken off or completely
destroyed.
 In lesser degree of burns, bulbous enlarged of hair ends
present.
 The hairs present in armpits and skin folds are sometimes
spared from singeing.
 The color of light hair changes on exposure to heat.
o at 120
0
C gray to brassy blond
o 200
0
C for 10 – 15 minutes brown hair to slight reddish.
 The black hair will show no color changes on exposure to
heat.
 Any unburnt or partially singed hair should be sent for
examination for flammable substances.
External changes:
 The face may be swollen and distorted
 Tongue protrudes and burnt due to contraction of muscles
of neck and face.
 Froth may be present at mouth and nose due pulmonary
edema caused by irritation of air passages.
1. Heat ruptures
 In severe burning, skin and underling tissues contracts and
bursts to form heat ruptures.
 Usually seen in extensor aspects of limbs and joints.
 Several centimeters in length and resembles lacerations or
incised wounds,
 Differentiated by
o Absence of bleeding as heat coagulates the blood in the
vessels.
o Intact vessels and nerves at the floor
o Irregular margins
o Absence of vital reactions in the margins.
 Can happen before and after death of individual.
2. Pugilistic attitude

50.  The characteristic posture of a body which has been
exposed to high heat.
o Legs – flexed at hips and knees
o Arms – flexed at elbows and wrists, held out in front of
body
o Head – slightly extended
o Fingers – hooked like claws.
o Trunk – Opisthotonus due to contraction of para spinal
muscles.
 The attitude is similar to boxers defending position,
pugilism(sport of fighting with fist) and so the name.
 This stiffening is due to coagulation of proteins of the
muscles and dehydration.
 The flexor muscles being bulkier than extensors their
contraction causes this attitude.
 It occurs in both alive and dead at the time of burning.
Internal changes
1. Heat hematoma
 Whenever head is exposed to intense heat, there will be
collection of clotted blood in extradural space of1.5 mm to
15 mm thickness
 Soft, friable clot of brown/ pink color due to presence of
carboxy hemoglobin
 On cut section of clot, Honeycomb appearance is present
due to bubbles of stream produced by heat.
 Parieto-temporal region is the most common site.
 Mechanism of development is due to contraction of
meninges and expansion of blood in venous sinuses
expulses the blood in extradural space.
 Resembles extradural hemorrhage but with no signs of
external injuries.
 Charring of surrounding outer table of vault.
2. Thermal fractures of skull
 Two mechanism of causation
o Increase in intracranial pressure bursting the non-united
sutures and producing widely separated bony margins.
o Due to rapid drying of the bone causing contracture of the
outer table.
 Usually seen on either sides of template region.
 Usually stellate shaped
 May crosses the suture line.
 Fractures of long bones are also seen in cases of intense
heat
 Due to excessive shrinkage of muscles attached to bones.
 Completely burnt bones will be greyish white in colour.
3. Inhalational injuries

51.  Carbon monoxide levels will be more than 10% and can go
up to 70 to 80 %
 Children and old people die at 30 to 40 %
 Aspirated blackish coal particles are seen in nose, mouth,
larynx, trachea, bronchi, esophagus and stomach.
 When mouth is open, passive percolation of soot particles
may present up to pharynx but not beyond vocal cords.
 Inhalational injuries can occur due to other poisonous gases
like cyanides and oxides of nitrogen
 Presence of carbon particles and an elevated CO level are
absolute proof of patient being alive at the time of burns.
 If flame or super-heated air is inhaled, burns are seen
interior of mouth, nasal passages, larynx with vocal cord
epithelium destruction, edema of larynx and lungs are seen.
4. Brain and Meninges
 Usually shrunken.
 Firm in consistency.
 Yellow to light brown in color.
 Dura matter becomes leathery.
 Dura matter may split with brain matter oozing out forming
frothy paste.
5. Pleura and Lungs
 Pleura are congested and inflamed.
 Lungs are usually congested and edematous.
 Heavy, airless and consolidated.
 Blood vessels of lungs may contain a small amount of fat
due to physio chemical alteration of already fat present.
6. Heart and Pericardium
 Petechial hemorrhages present in pleura, pericardium and
endocardium.
 Heart is usually filled with clotted blood.
 Interstitial edema and fragmentation of myocardial fibers
are also seen.
7. Gastro intestinal tract
 Inflammation and ulceration of peyers patches and glands
of the intestines.
 Curlings ulcer
o Seen in less than 10% cases
o Usually seen after 10 days of survival
o Sharp punched out lesions in duodenum
o May be superficial or deep
 Gastric ulcers may occur within a day.
 May erode vessels leading to fatal hemorrhage
8. Spleen
 Enlarged and softened
9. Liver
 Enlarged and congested
 May develop jaundice
10. Kidneys
 Enlarged with capillary thrombosis and infarction
11. Adrenals
 Enlarged and congested
Time of death in burns cases
The features from which time since death were assessed are
altered in a case of complete burns.
 Rigor mortis cannot be assessed as most of muscles tissues
are destroyed.
 Heat rigors may be present in the muscles.
 Postmortem hypostasis cannot be assessed in completely
burnt bodies, as skin over the body are usually charred and
destroyed.
 Body temperature will also be altered in complete burns.

52. Thus its always difficult to assess the time since death in burns
cases.
Establishment of identity
 Weight and height are unreliable in complete burns
Due to drying of skin,
Skeletal fractures
Pulverisation of intervertebral discs
 Moles, scars and tattoo marks are usually destroyed
 Dental charts should be prepared and used.
 Postmortem x rays can be compared with previous x rays of
suspected individual.
 DNA typing and identification will be useful
 Sex can be identified by presence of uterus or prostate,
which resist burning to marked degree.
 Personal belongings like key chains, watch, buttons, belt
buckle and cuff links are also useful
Antemortem burns
Line of redness
 5 to 20 mm in width.
 Surrounds the burnt area.
 Involves whole thickness of skin
 Permanent and persist after death
 Absent when whole body is burnt.
Antemortem Blisters:
 Raised dome with gas or fluid
 Contains serous fluid with proteins
 Base and periphery shows red and inflamed areas.
 Surrounding areas show increase in enzymes like acid
mucopolysaccarides.
Postmortem Blisters:
 Dry, hard and yellow
 Contains air and thin Clear fluid
 Base is not inflamed.
 Peripheral zone doesn’t shows increase in enzymes.
Circumstances of burns
Accident:
 Women’s clothes may caught in fire while cooking.
 Injuries are concentrated in front of thighs, chest, abdomen
and face.
 Hands also shows injuries as they will try to douse the fire.
 Feet and ankles are spared.
 While lying on a flat surface, the skin resting is spared
Suicidal burns:
 Extensive burns present all over the body.
 Only the skin folds such as axillae, perineum and soles are
spared.
 Sometimes person use to keep clothes in mouth to
suppress the cries.
 Inflammable substances are usually present in high
amounts in head.
Homicidal burns:
When inflammable substances are thrown and lighted, then the
burns are found more on.
 Sides of neck.
 Sides of trunk.
 Between the thighs.
 Attempts may be made to burn the body after the homicide
to conceal the crime.
So in all cases of burns, during postmortem the presence of any
other fatal injuries should be identified.
Sometimes chemicals, irritating substance, hot boiling liquids are
thrown over the victims with the criminal intension.

53. Effects of high environmental temperature
 Heat cramps
 Heat exhaustion
 Heat stroke
1. Heat cramp – fireman’s cramp/ miner’s cramp
 Occurs in person working in hot atmosphere and sweating
Profusely.
 It is due to rapid dehydration with loss of water and salt
through sweat
 Characterised by severe painful cramps of voluntary
muscles.
 Muscles of arms, legs and abdomen are usually affected.
 Face will be flushed, pupils dilated
 Complaints of dizziness, tinnitus, headache and vomiting -
rare.
2. Heat Exhaustion- Heat Prostration/Heat Syncope
 It is a condition characterised by collapse without increase in
body temperature.

 Due to exposure to excessive heat and aggravated by muscular
work and unsuitable clothing.
 Leading to extreme exhaustion and peripheral vascular
collapse
 Patient may feel sudden weakness and giddiness.
 Face will be pale, skin cold, subnormal body temperature,
Pupils dilated, small and thready pulse with shallow respiration
 Death rarely occurs by cardiac failure due to cardiac overload.
3. Heat Stroke – Heat Hyperpyrexia/ Sun Stroke
 Hyperpyrexia is fever above 41.5
o
C
 Heat stroke is characterised by rectal temperature above
41.5
o
C and neurological disturbance like psychosis, delirium,
stupor, coma and convulsion on exposure to sun.
 Due failure of thermo-regulatory mechanism of thalamus.
 Onset is sudden with sudden collapse and loss of
consciousness, skin will be dry, hot and flushed with complete
absence of sweating
 Pupils contracted, rapid & irregular pulse(>130), rapid and
deep breathing(130)
 Convulsion occurs leading to delirious and comatose state.
 Death occurs in five minutes due circulatory collapse and
cardiac failure.
 Predisposing factors – high temperature, increased humidity,
minor infections, muscular activity, lack of acclimatisation, old
age, unsuitable clothing.

Electrical injuries
 Electrons, the outer particles of an atom, contain a negative
charge. If electrons collect on an object, that object is
negatively charged.
 If the electrons flow from an object to another, the flow is
called electric current.
 Voltage is the fundamental force or pressure that causes
electricity to flow through a conductor and is measured in
volts.
 Resistance is anything that impedes the flow of electricity
through a conductor, which is measured in ohms.
 Current is the flow of electrons from a source of voltage
through a conductor, which is measured in amperes
Factors Influencing Electrical Injuries
1. The type of current:

54.  Alternating current is 4 to 5 times more dangerous than the
direct current of same voltage.
2. The amount of current:
 Amount of current that flows through the body is given by the
formula Ampere(A) = voltage / resistance. So a current of
high voltage and body of low resistance will cause more
damage.
3. The path of current:
 Death is more common if the brain stem or heart are in the
path of current.
4. Duration of current:
 Severity is directly proportional to the duration of flow of
current.
Effects of Current on living tissues.
1mA- Tingling of the fingers
5mA- Tetanic muscle contractions and so grab the power
conductor (no-let-go threshold),
Leading to increase in the duration of contact with
current.
15mA- control over muscles is lost
50mA- loss of consciousness, severe muscles contractions,
leading to fractures in bones.
Paralysis of respiratory muscles and respiratory arrest.
eg. Bilateral scapular fractures, Bilateral humeral
fractures, Bilateral neck of femur fractures, T12- L1
fractures.)
70mA- Fatal
Local effects:
 Current passing through skin produces heat
causes burns in skin and underlying tissues, also
boiling and electrolysis of tissue fluids.
 Depends on Resistance (R)–
If increased-
o increased local injury due to more heat generation,
o but decrease the entry of ampere amount and decrease fatality.
If decreased-
o decreased local injury due to less heat generation
o but increase the entry of amperes and hence the fatality.
Well moistened skin reduces resistance and so no electrical
burn marks in comparison to dry skin which shows well
marked skin.
Electric Mark – Joule Burn
 It is thermal burns caused due to heat generated by passage of
electric current through body.
 Theses marks are round or oval in shape, 1 to 3 cm in diameter
with shallow crater with a ridge of skin raised around part or
whole of circumference.
 The skin surrounding the mark are some times blanched often
with hyperaemic border.
 As the duration of contact increases, the skin in the mark will
become brown and then charred.
 If the conductor contains copper, the electric mark will have a
green colour.
 Occasionally the electric mark resembles the shape of
conductor.
 It is specific and diagnostic of contact with electricity found at
the point of entry of current.
Histopathological findings of electrical burns:
 Coagulation of dermis
 Cells of epidermis is elongated and arranged in parallel
rows at right angles to dermis
Flash or Spark Burns or arc burns

55.  When the body comes in close range of a high tension
wire, electrons jump from wire to skin even though
there is no contact, which results in arc burns.
 These arc burns are multiple in number and usually
pinpoint in nature.
 They have a central nodule of fused keratin of brown or
yellow colour surrounded by areola of pale skin.
 Confluence of arc burns over a large area produce
crocodile skin/ crocodile flash burns.
Cause of death in electrocution
1. Ventricular fibrillation
2. Respiratory failure due to spasm of respiratory muscles
3. Cerebral anoxia
4. Delayed death due to complication of burns.
Autopsy Findings & Medico Legal Importance
 Entry wound and exit wound helps to find out the pathway of
current
 All the organs will be congested with petechial haemorrhage
 Usually accidental, however there are cases of suicide and
homicide
 Judicial electrocution is followed in some states of US
LIGHTNING
 Natural, high voltage direct current (DC) in the atmosphere is
called lightning or lightning flash.
 Usually seen with thunderstorms
 Sometimes when it is not raining.
 Lightning is attracted to
o Trees, Metal fences, Gates,
o Tall light poles, Power lines
o Open areas such as grounds, swimming pools (unless properly
grounded)
Lightning power
 Voltage- 10-100 million V
 Current 10,000-100,000A
 Temperature- 15,000-50,000 F
 But the duration is extremely small. (1/10,000sec),
Due to phenomenon called flashover, majority of energy
travels over the surface of the victim’s body therefore, no
burns at all or very small burns- pin head sized or scratches
like, minor singeing of hair Pinhead sized exits
Mechanism of Injury
1. Direct strike-
 Current strikes directly, affect metal objects worn,
2. Side flash or splash-
 Current jump ricochets from adjacent object to the victim and
transient fern-like (Lichtenberg/ arborescent burns) marking
may be seen. May remain or disappear with time, associated
with singing of adjacent hair. Haemolysis due to heat along the
BVs may be the cause
3. Ground strike-
 Current conducts from ground to the victim, can enter through
one leg and exit through the other.
4. Contact strike-
 when in contact with a electrical conductor
Post Mortem findings
1. Melting of metallic objects – eg coins, wrist watches,
ornaments- contact burns
2. Magnetization of objects- eg coins, wrist watches, ornaments
3. Metallization- small metal particles travel into the body with
current. (could be demonstrated by histopathology)
4. Blast wave effects- blast of shoes, tearing of clothes etc
tearing of internal organs such as lungs, bowels etc.

56. 5. Burns. Could be surface burns beneath metallic object.
6. Linear burns – along skin creases. Eg. on palm. Due to
dampness on creases.
7. Fern like/ arborescent burns-
 Superficial, thin, irregular torturous markings like a branch of
tree.
 Due to rupture of smaller blood vessels.
 Transient disappears in few hours
 Diagnostic of burn injury due to lightening.
Explosive effect can cause
 Rupture of eardrums.
 Multiple foci of SAH
 Throws the victim away, and fall
 May rip clothing and shoes. Clothes can get shredded, or burnt

57. 9.ASPHYXIA

Mechanical Asphyxia

Hypoxia/anoxia
 To survive, a person must be able to take in oxygen from
atmosphere, deliver it to the tissues, and the cells have to
eliminate unwanted byproducts through the circulation of
blood.
 Reduced amount of oxygen at cellular level can happen due
to variety of internal and external causes.
 According to reduced level of lack of oxygen,
If it is partial- hypoxia.
If it is complete- Anoxia.
Physiologically anoxia/hypoxia can be five types according to
the causes.
1. Hypoxic
Reduced oxygen in inspired air
2. Anemic
Reduced hemoglobin to bind to oxygen
3. Stagnant
Obstructed blood flow to tissues
4. Affinity
Loss of ability of hemoglobin to bind to oxygen or inability
to deliver the oxygen to tissues
5. Hisotoxic
Inability of cells to utilize the delivered oxygen.
 This reduced level of oxygen is often accompanied by
increase in level of carbon di oxide in blood and tissue
level.
Asphyxia
 Literal translation of the word asphyxia from the Greek
means ‘without pulse’
 A - not, sphyxia- throbbing/ pulsation.
 Asphyxia is defined as an interference with respiration due
to any cause leading to lack of oxygen and accumulation of
carbon di oxide
Causes and types
 The causes of asphyxia can be mechanical or chemical.
 Mechanical asphyxia - some physical force or abnormality
affecting breathing or circulation.
 Chemical asphyxia - a reaction between any chemical and
the body -resulting in interference with oxygen uptake,
transport and utilization.
Mechanical Asphyxia
1. Suffocation (cutting off the air supply)
A. Vitiated atmosphere
 Irrespirable gases
 High altitude/ closed space
 Insufficient oxygen
B. External airway
 Smothering
C. Internal airway
 Gagging
 Choking
2. Airway swelling or obstruction
 Anaphylaxis
 Infection
 Mass (neoplastic and nonneoplastic)
 Trauma
 Mucus or debris

58.  Functional (bronchospasm)
3. Air way compression:
I. Neck Compression
 Hanging
 Strangulation
 Manual (throttling)
 Ligature
 Bansdola
 Mugging
 Garrotting
II. Chest compression
a) Manual Compression
 Overlying
 Burking
b) Traumatic asphyxia
c) Postural (positional) Asphyxia
d) Miscellaneous
Chemical Asphyxia
1. Oxygen uptake, delivery and transport
 Carbon monoxide
 Carbon Dioxide
2. Oxygen utilization
 Cyanide
 Narcotics

Pathophysiology:
 The pathophysiology and symptoms of Asphyxia are
divided into four types according to the oxygen saturation
levels.

1. Indifferent stage
2. Compensatory stage
3. Disturbance stage
4. Critical stage
1. Indifferent stage
 Oxygen saturation level: 98% to 87%
 Minor physiological symptoms hence the name.
 Deterioration in night vision.
 Electrocardiographic changes mainly tachycardia.
2. Compensatory changes
 Oxygen saturation level: 87% to 80%
 Symptoms are
 Confused mental state
 Headache
 Irregular heart beat
 Tachypnea
 Changes in visual acuity
 Loss of hearing
 Tingling sensation in extremities
 Decreased muscle coordination
3. Disturbance stage
 Oxygen saturation level: 70% to 80%
 Tissues can no longer depend on physiological
compensatory mechanism.
 Symptoms of following systems worsens
 Respiratory system
 Mental process.
 Senses of touch.
 Muscular coordination.
 Personality and psychomotor functions
4. Critical stage
 Oxygen saturation level: less than 69%

59.  Within 3 to 5 mins of hypoxygenation of this level,
judgment and coordination deteriorate to inappropriate
function.
 Quick progression of mental confusion to loss of
consciousness and death.
Asphyxia signs
The ‘classical’ features of asphyxia are found, where there has
been a struggle to breathe.
They all are non specific to any type of asphyxia
 Congestion of the face.
 Cyanosis of the skin of the face
 Tardieu spots - Petechial haemorrhage in the skin of the
face and the eyes.
 Increase in Fluidity of blood.
 Right sided heart engorged
 Edema of the face.
Congestion
 Congestion is the red appearance of the skin of the face and
head.
 It is due to the filling of the venous system when
compression of the neck or some other obstruction prevents
venous return to the heart.
 The jugular veins are constricted when a force of 2 kg
applied by means of ligature.
 Cyanosis is the blue color imparted to the skin by the
presence of deoxygenated blood in the circulation.
 A minimum of 5g/dl of deoxygenated hemoglobin is
required to impart cyanosis.
Tardieu Spots
 Petechiae are pinpoint hemorrhages produced by rupture of
small vessels,
 Due to sudden over distention and rupture of the vessels
following abrupt increases in intravascular pressure
 Classically seen in the conjunctivae and sclera.
 Common in the visceral pleura and epicardium.
Fluidity of blood
 Not characteristic of asphyxia or any cause of death.
 Result of a high rate of fibrinolysis that occurs in rapid
deaths.
 Due to high agonal levels of catecholamines.
Edema
 Edema is the swelling of the tissues due to transudation of
fluid from the veins caused by the increased venous
pressure as a result of obstruction of venous return to the
heart.
1. Vitiated Atmosphere
 It is one in which adequate oxygen is lacking, may occur by
displacement or depletion of oxygen.
 Can be displaced by other nontoxic gases such as methane,
nitrogen or argon.
 Oxygen may also be consumed and reach insufficient
atmospheric concentrations
 So called closed spaces, such as wells, closed containers or
in large space with less air movement
 Common to encounter multiple victims in these types of
cases
 No physical signs to recognize a victim of a vitiated
atmosphere.
 Postmortem measurement of the oxygen and carbon dioxide
content of blood does not yield meaningful results
 Postmortem air sampling is often compromised by the
efforts of rescue

60. 2. Smothering
 It is the obstruction to the passage of air by occlusion of the
mouth and/or nose.
 Things as the hand, a pillow, a plastic bag or dirt can act as
obstruction.
 Occlusion of the upper throat by the tongue, can occur
when a gag is forcibly placed in the mouth of an infant.
 Smothering may be homicidal, accidental or suicidal.
 Smothering is a common form of asphyxical homicide
among children.
 Investigation plays an important role in determining the
manner of death.
 Various injuries may present over central part of face.
 Abrasions/contusions of the nose, cheeks, chin, inner
surface of the mouth and inner surface of the cheeks.
 There may also be injuries incurred by the victim struggling
to prevent being smothered.
 Pinpoint hemorrhages may occasionally be found on the
face, eyelids, eyes and gingiva.
3. Choking
 Choking involves blockage of the internal airway —
posterior pharynx, larynx, trachea, bronchi — by a foreign
material.
 He might be able to exhale but cannot inhale since the
object functions as a ball valve.
 For this reason, forcibly expelling air from the lungs or
stomach may dislodge the object and prevent death (e.g.,
Heimlich maneuver).
“CAFÉ CORONARY ,”
 It is choking in an adult whose cough reflex is impaired by
conditions such as intoxication, neurologic disease, senility,
mental illness or dentures.
 In such an individual chocking is usually caused by a large
piece of inadequately chewed meat lodging in the throat.
 This lodged meat act as a foreign body obstructing the
airway leading to asphyxia causing sudden collapse and
death of the individual at the dining place itself.
 The victim can be saved by applying Heimlich maneuver (a
sudden upward and backward thrust at the xiphisternum
with fist of both hands) by standing posterior to the victim
to dislodge the chocked food particle.
 In contrast, children who lethally choke are typically not
impaired.
 Children are most at risk because of small-diameter airways
and propensity to put small objects in mouth.
 Most deaths due to choking are accidental. However,
occasionally choking may be homicidal.
 Examples of homicidal choking include force-feeding and
occlusion of the airway by a gag (gagging)
 Some gags, such as washcloths, may permit the passage of
air when they are dry but become less permeable and
occlusive as they become saturated with saliva.

4. Airway Swelling and Obstruction
 Swelling of the narrowest parts of the airway is usually
involved in these cases.
 Acute allergic reaction with drugs, bee string etc.
 Bacterial infection (acute epiglottitis)
 Viral infections to small airways in children.

61.  Irritating substances such as pepper or other chemical
agents introduced into the airway
 A mass, such as a tumor, may grow within the airway.
 A mass extrinsic to the airway exerts pressure on it and
compresses it like hematoma.
 Direct trauma to neck can also cause the larynx to swell.
 Obstruction may be further complicated by mucus,
inflammatory debris and spasm.
5. Neck compression
 Hanging and strangulation cause asphyxia by compressing
vital structures within the neck.
 Compression of the major blood vessels appears to be most
responsible for the onset of unconsciousness and death.

Hanging
 Hanging is defined as a constriction of neck by a force
applied as a result of suspension of weight of the body or at
least a part of the body.
 Hanging is classified into complete and partial depending
upon the position of hanging.
Complete hanging:
 Whole of body weight act as constricting force
 Body is suspended from a height with no part of the body
touching the ground.
Partial hanging:
 Part of body weight act as constricting force
 The body is partially suspended with any of the part
touching the ground.
The following weight is required to constrict various
structures of neck.
 Jugular vein – 2 kg
 Carotid artery – 2.5 to 10 kg
 Trachea – 15 kg
 Vertebral artery – 30 kg
 Fracture thyroid lamina – 14 - 15 kg
 Fracture Cricoid cartilage – 18 - 20 kg
External examination
 Dependent livor mortis are produced in lower arms and
legs.
 While upper part of the body will be pale.
Face
 Cyanosis if veins are compressed and arteries are partially
pressed
 Pale if total arterial blockage is present
 Congestion and edema of conjunctiva
 Dried blood stained mucous in mouth, nostrils and ears
 Tongue can protrude
Petechiae
 Typically seen over
 Eyes- conjunctiva / sclera
 Eyelids
 Skin of face
 Skin of neck above ligature mark.
 They are an indication of patient being alive when
suspension occurred.
Evolution of petechiae depends upon
 Tightness
 Duration of suspension

Le Facie Sympathique
 If the ligature knot presses on cervical sympathetic, the eye
on same side may remain open with pupil dilated.

62.  Dribbling of saliva from the angle of mouth
 It indicates ante mortem hanging.
Engorgement of penis due to hypostasis. It might be semi erect
with semen at the tip.
Urine and feces may escape due to relaxation of sphincters
Ligature mark
It depends upon
 Composition of ligature. - thick rope- abrasions
 Width of ligature
 Multiplicity of ligature
 Weight of the body suspended
 Tightness of ligature
 Length of time of suspension
 Position of knot
 Slipping of knot
Ligature mark feature
 At neck, a furrow is formed.
 It is yellow or brown in color.
 Thick parchment like appearance is seen.
 Typically at or above the thyroid prominence.
 Typically angled towards the point of suspension, which is
usually at either side of neck.
 Inverted v shaped furrow at the point of suspension is usual.
 At times pattern of rope is reproduced.
 Usually oblique
 Usually encircles the neck incompletely.
Absence of ligature marks
 If any cloth is introduced between neck and ligature
 If the person is cut down immediately
 If a soft material or broad ligature is used
 If death happens immediately by vagal stimulation
Knot
 It can be simple slip knot
 It produces running noose to the point of suspension
 It can be fixed reef knot
 At times it can be just a loop
 Usually seen on either side of neck or in occipital region,
rarely under chin.
 Removal of noose is done by cutting the rope away from
the knot.
Internal findings
Sites of soft tissue hemorrhages
 Strenocleidomastoid muscle
 Strap muscles
 Thyrohyoid membrane
 Soft tissues adjacent to thyroid cartilage
 Soft tissues adjacent to hyoid cartilage
 Soft tissues adjacent to fracture sites
Petechiae are seen
 Buccal mucosa
 Base of tongue
 Epiglottis
 Rarely at epicardium
 Rarely at visceral pleurae
Though fractures are rare, they are seen at
 Greater horn of hyoid
 Superior horn of thyroid
The incidence of fracture increases with age due to ossification

63. HYOID BONE FRACTURE
ACCORDING TO DISPLACEMENT OF FRACTURED
ENDS
1. Inward Compression Fracture/ Lateral
 Force of compression acts from lateral aspect.
 The fractured ends displaced inwardly
 Periosteum surrounding the fractured ends is torn from outside.
 Seen in case of throttling.
2. Outward Compression Fracture/ Anteroposterior
 Force of compression acts from antero - posterior direction.
 The fractured ends displaced outwardly
 Periosteum surrounding the fractured ends is torn from inside.
 Seen in case of Hanging.
ACCORDING TO MECHANISM OF FORCE
1. Direct pressure fracture:
 Pressure is directly on the hyoid
 Commonly seen in hanging & strangulation
2. Avulsion fracture:
 No direct pressure on hyoid bone
 Due to muscular over activity
 Hyoid is held upright by muscles attached to upper end
 If downward pull is exerted on thyroid - traction between
thyroid and hyoid - stretching of thyrohyoid membrane -
avulsion fracture of hyoid.
Other findings
 Injuries to tongue in the form of bite marks.
 Tears to upper respiratory tract leading to secondary
emphysema.
 Transverse intimal tears in carotid arteries
 Ruptures, intimal tears and sub intimal tears in vertebral arteries.
Features of brain.
 Can be pale in complete occlusion of carotid arteries.
 In partial occlusion it is congested due to venous system
compression.
 Features of hypoxic ischemic encephalopathy are seen at times if
the death is not immediate.
Cause of death
Immediate
1. Asphyxia
2. Venous congestion
3. Combined asphyxia and venous congestion
4. Cerebral anemia
5. Reflex vagal inhibition
6. Fracture of cervical vertebra
Delayed
1. Aspiration pneumonia
2. Infection
3. Edema of lungs
4. Edema of larynx
5. Hypoxic encephalopathy
6. Cerebral infections
Judicial hanging
 Death is caused by fracture-dislocation of the upper cervical
vertebrae with transaction of the cord.
 Knot is placed under the left ear or, less commonly under the
chin.
 A trapdoor is sprung and the prisoner falls a specific distance
determined by his weight causing his head to jerk suddenly
fracturing his spine.
 Fracture through the pedicles of C2 with the posterior arch
remaining fixed to C3.
 They are variable fracturing body of C1 to C3
 Bilateral vertebral artery lacerations with associated basilar
subarachnoid hemorrhage are also seen.
 Fractures of the hyoid and thyroid cartilage and hemorrhage into
the cervical muscle are also seen.

64.  In judicial hangings, consciousness is lost immediately, though
the heart may continue to beat for 8–20 min.
 There may be muscular contractions of the facial muscles,
twitching and convulsions of the limbs and trunk, and violent
respiratory movements of the chest.
Auto erotic asphyxia
 Also known as Sexual asphyxia, asphyxiophilia, kotzwarrism
 It is accidental death caused by self-induced decrease in
oxygenation of blood most commonly by partial hanging.
 Decrease in oxygenation of brain is thought to lead to
enhancement of sexual orgasm.
 Partial asphyxia brings about sympathetic arousal which in turns
heightens orgasmic pleasure.
FEATURES
 Victim often dresses in opposite sex attire.
 Neck is protected by a soft cloth, so as to avoid injury due to
ligature.
 Usually the legs or wrist are tied to enhance sexual pleasure.
 Pornographic literature may be seen in the surrounding of the
victim
 Death is accidental as the constriction required to produce sexual
pleasure and for to be fatal is very narrow.
1. Lynching
 Several persons acting jointly & illegally and hang a
person in public
2. Garrotting
 Victim attacked from behind without warning and
strangulated by a ligature thrown around neck and
tightening it.
3. Spanish windlass
 It is a type of garrotting and official mode of execution
in Spain. Neck is strangulated with an iron collar tighten
by a screw.
4. Bansdola
 Neck is compressed between two sticks or hard objects
5. Burking (Burk and Hare)
 Combination of Smothering and traumatic asphyxia.
 Two serial killers by name Burk and Hare followed this
method to kill people.
 Burk used sit on chest of victim with one hand he will close
nostrils and mouth and with other hand he will push the jaw
upwards closing the mouth.
 Hare will drag victim by holding the foot around the room.

65. 10.DROWNING

 Drowning is a form of asphyxial death due to aspiration
of fluid into the air passages by complete or partial
submersion of the body in a fluid medium.
 Complete submersion not necessary, submersion of nose
and mouth is enough.
CLASSIFICATION OF DROWNING
1. WET DROWNING
a. FRESH WATER
b. SALT WATER
2. DRY DROWNING
3. NEAR DROWNING
4. IMMERSION SYNDROME
Dry drowning
 Reflex spasm of larynx on entry of water into mouth and
nostrils leading to complete blockage of respiratory
passage and leads to asphyxia.

Near drowning
 Victims of drowning survives for 24 hours and then dies
due to complications like secondary infection,
pulmonary edema, cerebral anoxia etc
 Also called as secondary drowning
Immersion syndrome:
 Sudden exposure of the body to cold water results in
reflex vagal stimulation leading to cardiac arrest and
death of the victim.
Fresh water drowning:
 Water cross the alveolar membrane into the circulation.
 Produces marked hypervolemia
 Circulation will suffer 50% dilution within 2-3 min
 Dilution of blood leads to hyponatremia
 Hypervolemia leads to Red cells swelling
 Swollen RBC bursts
 Hemolysis
 Liberation of potassium.
 The heart is submitted to the insult of anoxia,
hypervolemia, potassium excess and sodium deficit.
 Ventricular fibrillation due to anoxia and potassium
excess leading to death within 4-5 min.
Salt water drowning
 Marked hypertonicity (excess of Nacl) of the inhaled
water in alveoli
 Increase osmolarity inside alveoli.
 This causes sucking of fluid from circulation into the
lungs
 Massive pulmonary edema
 Also progressive hypovolemia and Hemo concentration
 Hemo-concentration leads to Hypernatremia.
 Circulatory shock and cardiac arrest due hemo
concentration and pulmonary edema
 Death occurs in 6 to 12 mins.
External findings
 The cloth is wet, skin is wet cold and pale due to
contraction of peripheral blood vessels.
 Face is cyanotic, conjunctiva congested with petechial
hemorrhage
 Pupils dilated
1. Froth

66.  Fine, white, copious, lathery and rarely blood stained
froth and increases in amount with compression of the
chest.
 This is due to churning effect of water mixing with
surfactant during violent respiratory movement.
 This characteristic froth doesn’t develop if the body is
immersed after death (Postmortem drowning)
2. Washer Women hands and feets
 The skin of the finger, palms and later the soles of the
feet may be wrinkled, bleached and sodden.
 Due to osmotic action of water, it gets absorbed from the
outer layers of skin leading to wrinkled and thickened
skin.
 This immersion changes known as Hands and Feet of a
Washer-Woman.
 This change in skin of palms and soles can develop even
if the body is immersed in water after death(Postmortem
drowning)
3. Cadaveric spasm:
 The drowning person while struggling to survive
clinches on weeds and plants found in water body and
the group of small muscles of hand that are violently
acting before death goes to immediate stiffening after
death.
 Cadaveric spasm is a common feature in victims died
due to drowning
 Hands commonly clinched with weeds, plants etc. are
seen
4. Cutis anserine (Goose skin)
 When the body is immersed in cold water body, Skin
appears granular and puckered with hair standing on
the end.
 Due to spasm of the erector pilae muscles and due
to exposure to cold water at the time of death.
 Extremities are mainly affected.
Internal findings
1. Lungs & respiratory tract:-
 Airways filled with froth, sand, weeds etc found in the
water.
 Lungs are voluminous, edematous, doughy to feel with rib
markings.
Paltauf’ hemorrhages seen.
 Subpleural hemorrhage due to rupture of interalveolar wall.
 Due to violent respiratory movements, rupture of alveolar
walls results in this hemorrhage.
Cross section
Emphysema Aquosum
 Oozing out of blood stained frothy fluid and ballooning of
the lungs is known as “Emphysema Aquosum”.
 It is produced by violent respiratory movments during the
drowning
OedemaAquosum
 Ballooning of lungs along frothy fluid with no blood is a
feature of passive immersion of body in water -
(Postmortem drowning)
 Watery fluid transudates into pleural cavities during
putrefaction.
 Hemorrhages in the middle ear & mastoid air cells.
 Water in the stomach & intestine.

67. Getlers test
 This test helps to differentiate fresh water drowning from salt
water drowning by measuring the chloride levels in blood of
heart chambers.
 Chloride content in chambers of the heart normally
600mg/100ml.
 Chloride decreases by 50% in fresh water & increases of
40% in salt water.
 Test is of doubtful value in
 -Septal defects
 -Putrefaction
 -Death due to vagal inhibition
 -Chloride in water
DIATOMS
 Microscopic unicellular algae present in water.
 Silicaceous cell wall which resists acid digestion, heat
and putrefaction.
 Size 10-80 microns.
 During drowning, the victim swallows water which
contains the diatom. After entering the stomach, the
diatom enters circulation and reaches all organs of body.
 Only a live body with a circulation can transport diatoms
from lungs to the brain or bone marrow.
Isolation-
 Acid digestion of tissue commonly bone marrow, lung,
blood and kidney-centrifugation and washing.
 Residue is examined under phase contrast microscopy.
 The diatom isolated from the dead body will be compared
with that of the diatom species obtained from the water
sample of drowning site
Causes of death in case of drowning victims:
1. Asphyxia
2. Ventricular fibrillation
3. Laryngeal spasm.
4. Vagal inhibition.
5. Exhaustion.
6. Injuries.

68. 11.FORENSIC PSYCHIATRY

Psychiatry:
 It deals with the study, diagnosis and treatment of mental
illness
Mental illness/ insanity/ unsoundness of mind:
 It is defined as a disease or the personality, in which
there is derangement of the mental or emotional
processes and impairment of behaviour control.
Forensic Psychiatry:
 It deals with application of psychiatry in the
administration of justice.

Delirium
 Disturbance of consciousness
 Orientation is impaired
 Thought content is irrelevant
 Ability to think what is right/good/true (critical faculty)
is blunted or lost
 Usually occurs in physical diseases with high
temperature, overwork, mental stress or drug
intoxication.
 Early stages – restless, uneasy and sleepless
 Later stages – loses self-control, excited and talks
furiously
 Delusions and hallucinations can also be present
 Such persons become violent at times, may commit
suicide
 Such persons are Not responsible for his/her criminal
acts.
Delusion
 It is a false belief in something which is not a fact.
 It persists even after its falsity has been clearly
demonstrated.
 Normal person can have delusion but he can correct it by
his reasoning power, by past experiences or by being
convinced by others.
 It is often a symptom of underlying mental illness.
 Found in epileptic, affective psychoses, schizophrenic
psychoses.
Medico legal importance:
 Never an isolated disorder, usually seen with underlying
mental illness
 Cannot be fully responsible for criminal acts
 Suicide is a major risk
 Can commit homicide also.
Types of delusion
1. Grandeur or exaltation:
 A person imagines himself to be very rich while in
reality he is pauper.
Seen in delirium tremens
2. Persecution/ paranoid:
 A person imagines that attempts are being made to
poison him by his close relatives like wife, son or
parents.
 Seen in paranoid schizophrenia, dementia and
depressions.
 Delusion of grandeur and paranoid can happen in same
person.
3. Reference:

69.  A person believes that people, things, events etc are
referring to him in a special way. Even strangers are
looking at him and are talking about him or items in
radio or newspaper referring to him.
4. Influence:
 A person complains that his thoughts, feelings and
actions are being influenced and controlled by some
outside agency. Like radio, telepathy, hypnotism.
5. Infidelity:
 A man imagines his wife to be unfaithful while in fact
she is chaste.
6. Self Reproach:
 The person blames himself for his past failures and
misdeeds, which are of no importance
7. Nihilistic:
 The person declares that he does not exist or that there is
no world etc.
8. Hypochondriacal:
 The person believes that there is something wrong with
his body though in real he is healthy.
9. Ertomania:
 The person believes that someone is deeply in love with
him/ her
 Develops an obsession for a particular person and starts
believing that the other person is reciprocating.
 Usally of a higher status, famous, superior at work or
can be a complete stranger
 Tries to get close to them through telephone calls, letters,
gifts, visits etc.
Hallucination
 It is false sense perception without any external stimulus
or object to produce it.
 Purely imaginary and may affect all or any senses
Types:
1. Visual:
 A person imagines to be attacked by lion when no
lion is existing.
2. Auditory:
 A person hears and imagines a voice speaking about
him when no one is present.
3. Olfactory:
 A person smells pleasant or unpleasant odour when
nothing is present
4. Gustatory:
 A person feels sweet, sour, bitter, good or bad taste
though no food is present.
5. Tactile:
 A man imagines rats and mice crawling into is bed
when there are none. Usually seen in alcohol with
drawl syndromes
6. Psychomotor:
 A man will have feeling of moving some parts of the
body in the absence of such movement.
7. Command:
 The patient feels like he is ordered by imaginary
voices to do things which may be frightening or
dangerous.
 They may be pleasant or often unpleasant.
 Persons suffering from unpleasant hallucinations may
be incited to commit suicide or homicide.
8. Microptic/ macroptic:

70.  A normal sized object appears usually smaller or
bigger.
9. Sexual:
 A person feels sexually satisfied from unfounded
self-imaginative objects
Illusion
 It is false interpretation by the senses of an external
object or stimulus which has a real existence.
 E.g 1. when a person sees a rope and imagines it to
be a snake.
2. when a person hears notes of birds and
imagines it to be human voices.
 Normal person can have illusion but he can correct
false impressions
 Whereas insane person continues to believe it even
after the real facts are pointed out.
 Illusions are features of psychoses particularly of
organic type.
 impulse
 This is sudden and irresistible force compelling a
person to the conscious performance of some action
without motive or forethought.
 A sane person is capable of controlling impulse
 An insane person with no reasoning power, no
judgement and no capacity to understand the facts
may do things on impulse.
 Usually seen in imbecility, dementia, acute mania
and epilepsy.
Types:
 Kleptomania: Irresistible desire to steal articles of little
value
 Pyromania: Irresistible desire to set fire to things
 Mutilo mania: Irresistible desire to mutilate animals
 Dipsomania: Irresistible desire for alcoholic drinks at
periodic intervals
 Sexual impulses: Compulsive urge to perform sexual
intercourse often in a perverted way.
 Suicidal and homicidal impulses
Obsession
 It is disorder of content of thought
 In this a single idea, thought, or emotion is constantly
entertained by a person which he recognises as
irrational, but persistent in spite of all efforts to drive it
from his mind.
 Any attempt to resist makes them appear more insistent
and yielding is the almost inevitable outcome.
 It is borderline between sanity and insanity
 Usually seen in person with neurotic disorders, Usually
associated with some fear.

MENTAL DISORDER AND RESPONSIBILITY:
 Responsibility, in the legal sense, means the liability of a
person for his acts or omissions, and if these are against
the law, the liability to be punished for them.
 The law presumes that every person is mentally sound,
until the opposite is proved.
CIVIL RESPONSIBILITY:
The question of civil responsibility arises in following
conditions:
1. Management of property and affairs
2. Insanity and contracts
3. Insanity and marriage contract

71. 4. Competence of insane to be a witness
5. Consent and insanity
6. Insanity and testamentary capacity
1. MANAGEMENT OF P ROPERTY AND AFFAIRS
 If a person who owns property becomes insane and is
incapable of managing his affairs with sound judgment, a
relative or friend can approach the court for judicial
inquisition. The medical evidence is given in the form of
a certificate which should state “that insanity is of such a
degree as to make him incapable of managing his
property.”
 On enquiry if it’s found that the person is incapable of
managing his property the court can appoint a guardian or
manager depending on the circumstances.
 The court may order the sale or disposal of the person’s
property, for the payment of his debts and expenses.
 The court may order a second inquisition, if it’s reported
that unsoundness of mind had ceased.
2. BUSINESS CONTRACT
 If it is proved that at the time of signing a contract one of
the two parties were insane, then the contract becomes
legally invalid.
 Insanity developing subsequently to a legal agreement
will not necessarily invalidate the contract.
 If at the time of signing, the fact that one of the
signatories to the contract was insane was not known to
the other party, the contract may not be declared valid.
 For the purpose of a contract, a person is said to be of
sound mind if at the time of making the contract, he is
capable of understanding it and forming a rational
judgment.

3. MARRIAGE
 A marriage is considered invalid if at the time of
marriage, either party is
 Incapable of giving valid consent due to insanity.
 Though capable of giving valid consent, has been
suffering from such kind or degree of mental disorder as
to be unfit for marriage or procreation.
 Has been suffering from recurrent attacks of insanity.

4. THE COMPETENCE OF INSANE TO BE A WITNESS
 An insane person is not competent to give evidence, if
he cannot understand the necessity of telling the truth
due to insanity.
 A person of unsound mind who suffers from delusions,
but is capable of telling what he has seen and who
understands the importance of an oath, is competent to
give evidence
 An insane person is competent to give evidence during
the lucid interval.
5. CONSENT AND INSANITY
 Consent to certain acts like, sexual intercourse or hurt is
not valid, if such consent is given by a person who due to
unsoundness of mind is unable to understand the nature
and consequences of the act, then it is considered as
invalid consent.
6. TESTAMENTARY CAPACITY
 Testamentary capacity refers to the capacity of a person
to make a valid will. The law defines it as possession of a
sound disposing mind (corpus mentis) which must be
certified by a doctor.

72.  A will is a document detailing the disposition of property
owned by a person, which is prepared by him during his
lifetime but takes effect only after his demise.
 The person who makes the will is referred to as the
testator.
 Will written by the testator in his own handwriting is
called “Holograph will”.
 It can be revoked or changed any number of times
ELIGIBILITY FOR MAKING A WILL
As per Indian succession act 59, the following persons are
eligible to make a valid will
 Every person of sound mind who is over age of 18 years
 An insane person cannot write a valid will unless he is in
a lucid interval.
 An intoxicated person cannot make a will, unless it is
certified by a doctor that he was under his senses
 A deaf dumb or blind person can make a will if he can
communicate effectively
 Convicts are not debarred from making a will.
CRIMINAL RESPONSIBILITY OF THE INSANE
MCNAUGHTON'S RULE:
 In 1843, one person named McNaughton, under delusion of
persecution shot dead Mr. Drummond, the private secretary of Sir
Robert Peel, Prime Minister of England. In fact, he wanted to kill
Sir Robert Peel but since he could not identify him properly, he shot
dead Mr. Drummond by mistake. He was later arrested and sent to
prison. Since he was insane and there was no English law at that
time to fix criminal responsibility of an insane, a committee of 14
judges were constituted to frame law which resulted in
“McNaughton's Rule” or “Legal Test” according to English law
which states as follows:
CRIMINAL RESPONSIBILITY OF THE INSANE
 That to establish a defense on the ground of insanity, it
must be clearly proved that “at the time of committing the
act, the accused was laboring under such a defect of
reason, from disease of the mind, as not to know the
nature and quality of the act he was doing, or, if he did not
know he was doing what was wrong.”
Section 84 of the I.P.C:
 In India, Section 84 of the I.P.C. defines the legal test or
criminal responsibility of the insane, as:
“Nothing is an offence which is done by a person who, at the
time of doing it, by reason of unsoundness of mind, is incapable
of knowing the nature of the act, or that he is doing what is either
wrong or contrary to law.”
Section 85 of the I.P.C:
 Defines legal responsibility of a person under
intoxication. If it is proved that a person was given
intoxication without his knowledge or against his will,
and due to intoxication he lost mental reasoning and then
committed the crime, he will not be held responsible for
it.
 Drunkenness caused by voluntary use of alcohol or drugs
offers no excuse for committing the crime.
Loss of Self-control or Sudden and Grave:
Provocation
 Sometimes, a person may lose self-control, or there is sudden and
grave provocation, and as a result, he may commit crime. Common
situation is that, if a person sees his wife teased by goons, he may
lose self-control and may kill any goon. In such cases doctrine of
partial responsibility is used and the murder may be charged the
under Section 304 of the I.P.C. rather than Section 302 of the I.P.C.
Section 304 the of I.P.C. prescribes less sentence as compared to
Section 302 of the I.P.C.

73. Other GUIDELINES
 One of the major defects in the McNaughton's Rule, is
that, from deciding that a person is insane, only cognitive
(intellectual) faculties are taken into consideration,
whereas emotional factors, hallucination and the ability of
the individual to control the impulse (resistible impulse)
are not considered.
 Durham Rule (1954)
 Curren’s Rule (1961)
 American Law Institute Test. (1970)
DURHAM RULE (1954): The Durham rule states that an
accused is not criminally responsible if his unlawful act was
the product of mental disease or mental defect.
 The Durham rule was eventually rejected by the federal
courts, because it cast too broad a net. Alcoholics,
compulsive gamblers, and drug addicts had successfully used
the defense to defeat a wide variety of crimes.
 The federal insanity defense, established by the
Comprehensive Crime Control Act, now requires the
defendant to prove, by "clear and convincing evidence," that
"at the time of the commission of the acts constituting the
offense, the defendant, as a result of a severe mental disease
or defect, was unable to appreciate the nature and quality or
the wrongfulness of his acts".
CURREN’S RULE (1961)
 An accused person will not be held criminally
responsible, if at the time of committing act, he did not
have the capacity to regulate his conduct to the
requirement of law, as a result of mental disease or defect.
 As per Curren’s rule, it was contested that, at the time of
committing the criminal act, a person may have the
knowledge that what he was doing was wrong but he
neither had the capacity nor the will to control (adjust) his
act. Therefore such person should not be held responsible.
AMERICAN LAW INSTITUTE TEST. (1970)
 A person is not responsible for his criminal conduct if at
the time of such conduct as a result of mental disease or
defect, he lacks substantial capacity either to appreciate
the wrongfulness of his conduct or to adjust his conduct
to the requirement of law.

74. 12.IMPOTENCE AND STERILITY

Impotence:
It is defined as inability to perform sexual intercourse.
Sterility:
It is defined as inability to beget children/ conceive children
Frigidity:
Impotence in females- inability to initiate / maintain sexual
arousal pattern in females
Causes of impotency/sterility in males:
1. Age:
• Ability for erection and coitus present even before puberty
but sperms are usually not found before puberty
• Ability for erection and sperm count diminishes with age
2. Developmental defects and other acquired
abnormalities:
• Absence or non - development of sexual organs
• Malformation of external genitalia - intersexuality,
epispadiasis, hypospadiasis
• Loss of both testes
3. Local disease:
• Large hernias, large hydrocele, phimosis- mechanical
obstruction to intercourse
• Diseases of testicles, epididymis or penis- cancer, sarcoma,
syphilis- impotence/ sterility / both
4. General diseases:
• Acute illness,
• Pulmonary tuberculosis,
• Chronic nephritis,
• Endocrine diseases causing impotence,
• Disease of CNS causing hemiplegia, paraplegia,
• Syringomyelia,
• Erectile dysfunction caused due to smoking, alcohol etc.
5. Psychological causes:
• Emotional stress, fear, disgust of sexual act, dislike of
partner
• Quoad hoc/ quoadhanc
Inability to perform sexual intercourse/ initiate sexual
arousal against one particular individual and normal with all
other individual.
Causes of impotence/ sterility in females
1. Age:
• Age has no effect on potency of a female.
• Females are Fertile from puberty to menopause
2. Developmental defects and other acquired
abnormalities:
• Malformed genitals in turner’s Syndrome, intersexuality
• Absence of uterus, ovaries or fallopian tubes
3. Local disease
• Hyperesthesia of vagina, vulval or vaginal tumours-
impotence
• Disease of genital organs- gonorrhoea, syphilis, diseases of
ovaries, obstruction of fallopian tubes etc cause sterility
4. General diseases-
• Exposure to lead, x-rays/ drug dependence- sterility
5. Psychological causes-
• Vaginismus- spasmodic contraction of vagina
• Spasm of all perineal muscles, levatorani muscles &
adductor muscles of thighs with severe constriction
of vaginal outlet

75. Legal issues:
Civil: Criminal:
1. Nullity of Marriage, 1. Adultery,
2. Divorce, 2. Rape,
3. Disputed Paternity, 3. Unnatural Sexual Offences
4. Claim for damages where sexual function
is lost due to assault/ accident
STERILIZATION
Procedure to make a male / female sterile without
interfering with potency
Types:
• Compulsory – made mandatory by the government
even without the
consent of the individual
• Voluntary –
• Therapeutic – as a treatment for any disease
involving reproductive organs
• Eugenic – to prevent birth of child with
congenital deformities from an individual with
hereditary disease
• Contraceptive – as a family planning method
Methods:
• Permanent - Vasectomy in males
- Tubectomy in females
• Temporary - condoms, oral hormonal pills, spermicidal
jellies
Artificial insemination:
Process of artificially introducing semen into vagina, cervix
or uterus to produce pregnancy
Indications:
1. Husband is impotent
2. Husband is unable to deposit semen in vagina due to
epispadiasis/ hypospadiasis
3. Husband is sterile
4. Husband suffering from hereditary disease
Types:
1. Artificial insemination homologous:
When the husband is impotent but not sterile then the sperm
of the husband is collected and used.
2. Artificial insemination donor
When the husband is sterile then the sperm of a donor is used
3. Artificial insemination homologous donor - pooled semen
When the husband is sterile but has minimum sperms the
sperm of a donor mixed with sperm of husband and used.
Guidelines:
1. Consent of donor and his wife is mandatory
2. Identity of donor remains secret
3. Donor should not know to whom semen is donated &result
of insemination
4. Mentally and physically healthy donor with no familial /
hereditary diseases
5. Donor should not be relative of either of spouse
6. Donor should have healthy children of his own
7. Donor should be of same blood group as that of the husband
8. Doctor’s best judgement in selecting donor
9. Written consent of recipient woman and her husband
10. Pooled semen is preferred
11. Doctor doing artificial insemination should not deliver the
baby
Legal issues
1. Adultery (497 I.P.C)
A women begetting child through artificial insemination
cannot be held with crime of adultery. But if the women do

76. it without the consent of her husband then he can claim for
divorce.
2. Legitimacy
Any child born out of artificial insemination is illegitimate
until it is legally adopted as a legitimate child.
3. Nullity of marriage and divorce
If the reason for a woman to go for artificial insemination is
impotency of her husband, then she can claim nullity of
marriage. But if the reason is sterility of her husband, then
she can’t claim for nullity of marriage as nullity is not a
ground for divorce
4. Natural birth after A.I:
Any child born naturally after the birth of a child by
Artificial insemination is a legitimate child.
5. Incest
As the identity of the donor is not revealed the parents,
there is a chance of a child born out of artificial
insemination latter getting married to child born to the
donor.
SURROGACY:
• A surrogate mother is a woman who by contract agrees to
bear child for someone else. (womb leasing)
• Legal issues same as artificial insemination

VIRGINITY, PREGNANCY AND DELIVERY
• VIRGIN - A person who has not experienced sexual
intercourse
• DEFLORATION -Loss of virginity
Types of hymen-
1. Semilunar
2. Annular
3. Infantile
4. Cribriform
5. Vertical
6. Septate
7. Microperforate
8. Carunculaehymenales/ myrtiformes
 Hymen present as notches - symmetrical, anterior,
does not extend to vaginal wall and is covered by
mucous membrane - mistaken for tear
Causes of rupture
1. Accident
2. Masturbation- objects/ foreign bodies
3. Surgical operations
4. Foreign body- sola pith
5. Ulcerations
6. Sanitary tampons
Medico legal significance
1. Divorce/ nullity of marriage
2. Rape
3. Defamation cases - Presence of un-ruptured hymen is a
presumption and not absolute proof of virginity


PREGNANCY
Condition of having a developing embryo or foetus in a
female after an ovum is fertilized by a spermatozoon.
• Signs of pregnancy
 PRESUMPTIVE SIGNS
1. Amenorrhea
2. Changes in the breasts- montgomery’s tubercle
3. Morning sickness- 1-3 months
4. Quickening- 16
th
-20
th
week

77. 5. Pigmentation of skin-vulva/ axilla
6. Changes in vagina- Jackquemier’s/Chadwick’s sign
7. Urinary disturbance
8. Fatigue
 PROBABLE SIGNS
1. Enlargement of abdomen
2. Changes in uterus- haegar’s sign
3. Changes in cervix- goodell’s sign
4. Intermittent uterine contraction- braxton-hick’s sign
5. Ballottement
6. Uterine souffle
7. Immunological tests- presence of HCG - 12-15 days
after implantation
 POSITIVE SIGNS
1. Foetal movement and parts- 36wks
2. Foetal heart sounds- 18-20wks
3. Placental souffle
4. Umbilical souffle
5. Ultrasonography
Normal human gestation period- 10 months/ 40 weeks/ 280 days.
Viability of foetus- 210 days/ 7 months
The ability to foetus to live on its own after separation from
mother owing to maturity of the foetus.
Pseudocyesis(spurious/ phantom pregnancy)
 Patient presents with subjective signs of pregnancy when she
is not actually pregnant
 Patient usually has an intense desire for begetting child
 Psychic or hormonal disorder
 Clinical examination with radiological confirmation
Superfecundation:
Fertilization of 2 ova which has been discharged from ovary
at the same period by 2 different acts of coitus committed in
short interval. Development parallel but not equal
Superfoetation:
• Fertilization of second ovum in a woman who is
already pregnant
• Ovulation may occur in 1
st
trimester of pregnancy.
• Two foetuses may be born at the same time showing
different stages of development or two fully
developed foetuses are born at different period
varying from 1-3months
Foetus compressus or foetus papyraceus:
One of the foetus can be compromised for the
development of other foetus leading to death of one foetus
and it gets compressed and mummified.
LEGITIMACY
 Legal state of a child born in lawful marriage
Legitimate child:
 Born during continuance of a legal marriage or within
280 days of dissolution of marriage or death of the
husband
Medico legal significance
1. Inheritance of property
 A legitimate child only can inherit the property of his
father
2. Affiliation cases
 A women may allege a particular man to be a father of
her illegitimate child.
 May file a case in court for fixing paternity

78.  If paternity is fixed, he becomes responsible to support
the child.
3. Supposititious child
 It means fictitious(fabricated) child
 A women may pretend pregnancy and delivery, later
produce a living child as her own child.
 She may substitute a male child for a female child born
for her or for an abortion.
 This is done to obtain money or for the purpose of
claiming property.
4. Posthumous child
 Child born after death of the father, the mother having
 conceived the child by the said father.
 This child is considered as legitimate child.
Methods of determining paternity
1. Parental likeness:
 A child may resemble the father in feature, in
gesture and also in other personal peculiarities.
 They are considered only as corroborative evidence.
 Atavism-
 A child resembles not its parents but resembles
its grandparents.
 Its due to chance of recombination of genes.
 Any mental or physical characteristic feature
or disease of ancestor may
be inherited. eg: achondroplasia, haemophilia
2. Developmental defects:
 Disease or deformity of parents may be inherited to
children
3. Blood grouping test:
 Blood group of a child are inherited from parents.
4. DNA fingerprinting
DELIVERY
 Expulsion or extraction of child at birth
Signs of recent delivery:
1. General indisposition-
 For first two or three days, the women looks pale &
exhausted
 Increase in pulse and slight fever
2. Breast changes:
 Enlarged nodular breasts.
 Colostrum or milk may be expressed
 Dark areola
 Enlarged nipples with superficial prominent veins &
Montgomery’s tubercles
3. Abdomen:
 Pendulous, wrinkled with Linea Albicantes over
flanks
4. Perineum:
 Lacerated, age of tear may be useful
5. Labia:
 Tender, swollen, bruised or lacerated
6. Vagina:
 Relaxed, capacious , tear heal by 7 days, rugae
reappear by 3
rd
week
7. Uterus:
 Immediately after delivery contracts and retracts lies
3cm above umbilicus.
 Involution at the rate of 1 and half cm per day
8). Cervix:
 Soft, dilated and edges torn transversely

79. 9). Lochia:
 Discharge from uterus which lasts 2-3 weeks after
delivery
 First 4-5 days- bright red colour- lochia rubra
 Next 4 days- serous and paler- lochia serosa
 9
th
day- yellowish grey or turbid- lochia alba
Signs of remote delivery:
1. Abdomen: lax, lineaalbicantes
2. Breasts: lax, pendulous, wrinkled, enlarged nipples, dark
areola, montgomery tubercles present
3. Vulva: labia does not completely close, vagina partially
open, scars of old tear in perineum, vaginal rugae absent
and walls relaxed.
4. Uterus: enlarged, twice length of cervix, wall concave from
inside forming rounded cavity, cervix irregular with scars
on the edges.
ABORTION
DEFINITION
 Expulsion of foetus before 20 weeks of gestation
(medical)
 Premature expulsion of foetus from the mother’s womb
at any time of pregnancy before full term is completed
(legal)
CLASSIFICATION
1). Natural
Spontaneous
Accidental
2). Artificial
Therapeutic
Criminal
Natural abortion- 10-15% of pregnancy common in 2
nd
/ 3
rd

month
Causes:
 Chromosomal defects
 Developmental anomalies in foetus
 Low implantation
 Disease of placenta
 Rh incompatibility
 Hormonal deficiency
Therapeutic abortion:
 Done in good faith to save life of mother
 Considered under Medical Termination of Pregnancy
Act 1971
 To prevent the fatalities due to criminal abortions
Criteria to be met legally before conducting an abortion:
1. Reasons under which termination of pregnancy can be
done
a) THERAPEUTIC:
If the continuation of pregnancy endangers the mother’s life
or cause serious injury to her physical or mental health
b) EUGENIC:
If there is risk of child being born with physical or mental
abnormalities
c) HUMANITARIAN:
If the pregnancy caused by rape
d) SOCIAL:
If the pregnancy due to failure of contraceptive methods
2. Doctor who can perform Medical termination of
pregnancy
Qualified registered medical practitioner with prescribed
experience as below

80. a) Upto 12 weeks gestation
 Registered medical practitioner who has assisted in 25
MTPs, 5 of which are conducted independently in an
hospital established/ maintained/ training institute
approved for this purpose by government.
b) 12-20wks of gestation
 Registered medical practitioner with experience in
practice of obstetrics and gynaecology for not less than 3
years
 Registered medical practitioner who has completed 6
months’ house surgency in obstetrics and gynaecology /
has experience in recognised hospital for not less than 1
year in practice of obstetrics and gynaecology
 Registered medical practitioner with post graduate
degree or diploma in obstetrics and gynaecology
3. The place where Medical termination of pregnancy can
be performed
 Government hospitals or hospitals and institutes
recognised by government for this purpose
 Licence to conduct MTP has to be obtained from chief
medical officer of the district and has to be displayed
prominently
 Licence has to be renewed every 5 years
4. Gestational age up to which Medical termination of
pregnancy can be performed
 Period of pregnancy less than 12 wks- can be terminated
on opinion of a single doctor
 Period of pregnancy between 12-20 weeks- 2 doctors
must agree there is an indication and termination can be
done by any 1 doctor.

CONSENT
 Consent of woman to be taken before procedure
 Consent of the guardian if woman is a minor or mentally
ill
 Consent of husband not necessary
 Cannot be performed at the request of the husband if the
woman is not willing
OTHER PROVISIONS
 Woman need not produce proof of her age
 Police complaint in case of alleged rape case not
required
 Admission register for MTP is maintained as
confidential document
 In an emergency pregnancy can be terminated by a
single doctor even without required training even after
20 weeks without consulting a second doctor in a private
hospital which is not recognised but done in good faith
and exercised proper care and skill.
METHODS USED IN MTP
1
st
trimester
Medical method:
 Mifepristone used for induction and after 36-48 hours’
misoprostol is given which causes contraction of uterine
muscles and softening of cervix
Surgical method:
 Vacuum aspiration: cannula with 0.4-0.6kg/sq.cm
 Dilatation and curettage
2
nd
trimester
Medical method:

81.  Amniotic fluid replacement therapy: amniotic fluid is
removed and replaced with equal volume of 20% saline
or 50% glucose- abortion after 24-48 hrs of injection
 Intra amniotic injection of prostaglandin F2
Surgical method:
 Dilatation and evacuation
 Hysterectomy: done when sterilization has to be done
along with MTP/ failure of induction.
CRIMINAL ABORTION
 Any abortion done outside the purview of MTP act
METHODS
Upto end of 1
st
month:
 Violent exercises cycling, jumping from height, lifting
heavy weights, running up and down the stairs.
 Very hot and cold hip baths alternately
 Severe pressure on abdomen by kneading, blows, kicks
 Use of purgatives
 usually successful in people who have natural irritability
of uterus and are prone for abortion
Upto end of 2
nd
month:
Abortifacient drugs:
I. ECBOLICS
Action: Increase uterine contraction but do not dilate the
cervix
a. Ergot: commonly used
Toxic side effect: arterial spasm and gangrene of
extremities
b. Hydrastiscanadensis( golden seal plant): action similar
to ergot but less intense.
c. Quinine: direct action upon uterus and uterine nerves
d. Lead: pills made from lead oleate. Causes tonic
contraction of uterus and also toxic effect on cells of
developing ovum. Symptoms of lead poisoning may be
seen
e. Pituitary extracts: oxytocic effect on uterine muscles
f. Decoctions of cotton root bark, nitrobenzol, picrotoxin
and strychnine
II. EMMENAGOGUES
 Action: Produce or increase menstrual flow
 Act as abortifacient when given in large, repeated doses
 Savin, borax, apiol, rue, laburnum, oestrogen,
sanguinarin, senecio, caulophyllin, hellebore, etc.
I. IRRITANTS OF GENITO-URINARY TRACTS
 Action: reflex uterine contraction
 Eg: oil of pennyroyal, oil of tansy, oil of turpentine,
canthrides, potassium permanganate etc.
II. IRRITANTS OF GASTROINTESTINAL TRACT
 Action: substance causing irritation of colon ->
hyperaemia and contraction of uterus
 Eg: cathartics such magnesium sulphate or purgatives
such as aloes, calomel, phenolphthalein, rhubarb etc
III. DRUGS WITH POISONOUS EFFECT ON BODY
 Inorganic irritants: lead, copper, mercury, antimony
 Organic irritants: canthrides, unripe fruit of papaya,
unripe fruit of pineapple, carrot seeds, juice of
calotropisetc
After 3
rd
month:
 Mechanical interference either by woman or some other
person

82. 1). Syringing: irritant fluid syringed at high pressure into
uterine cavity. Air embolism, chemical peritonitis, general
toxemia through absorption, vagal inhibition
2). Cupping: negative pressure of over turned mug cause
separation of membranes and abortion
3). Rupturing the membranes: uterine sound, catheter, stick,
pencil, umbrella rib, glass rod. Infection, perforation of vaginal
or uterine wall
Syringe aspiration: syringe attached to catheter to produce
suction within uterus sufficient to rupture chorionic sac and
precipitate abortion
4). Dilation of cervix: foreign bodies left in cervical canal like
laminaria tent or slippery elm bark swell due to moisture and
dilate the cervix, irritate uterine mucosa and cause uterine
contraction and expulsion of foetus
5). Abortion stick: 12-18cm long wood or bamboo stick used.
One end covered with cloth soaked irritant juice of calotropis/
SemecarpusAnacardium and introduced to uterine cavity.
EVIDENCE OF CRIMINAL ABORTION
IN LIVING
 Signs of injury to abdomen
 Signs of recent abortion similar to signs of recent
delivery but may vary depending on length of pregnancy
1
st
2-3 months:
 Haemorrhage, slight softening of cervical os and vaginal
wall, slight enlargement of uterus
 Breast changes more prominent in primipara
4
th
-5
th
month:
 Haemorrhage more marked, internal os admits 1 finger,
genital organs softened, vaginal canal shows erosions
and lacerations, cervix show marks of valsellum forceps
indicating use of an instrument
 In case of suspected sepsis following criminal abortion
fluid from vagina, uterine cavity and blood collected for
chemical and bacteriological examination
IN DEAD:
Suspected when:
 Deceased is pregnant and deeply cyanosed
 Instruments to procure abortion or abortifacient drugs
are found at scene of death
 Underclothing appear to be disturbed after death
 Fluid, soapy or blood stained fluid coming out of vagina
Evidence of criminal abortion:
 Deceased’s medical history and her whereabouts prior to
death
 Clinical or autopsy examination
 Examination of the aborted material if available
AT THE SCENE
 Condition of bed linen and the under clothing
 Scenes of recent interference of pregnancy
 Discarded linen, dressing, cotton wool, swabs
 Presence of known abortifacient drugs
AT AUTOPSY
 To get a bloodless field, all organs are removed prior to
removal of pelvic organs
 Uterus is opened along long axis and any fluid obtained
is collected
 If chorionic sac is still present then its integrity and
attachment to decidua is noted
 Look for products of conception and state of placental
bed noted
 Cervical canal, vaginal canal examined for injuries,
inflammation or foreign materials

83. Abortion by drugs:
 GI tract for signs of irritant poisoning
 Whole tract with contents along with other organs sent
for chemical analysis
 Urinary tract examined for signs of inflammation
 Vagina and cervix examined for erosions and
inflammation due to application of local irritants
 Necrotic pseudo membrane formed in vagina due to
irritants send for analysis
Instrumental abortion:
 Signs of injury to abdomen
 Abdomen is opened and peritoneum, pelvic floor and
pelvic organs are examined for punctures, ruptures,
haemorrhage and inflammation
 Presence of air in large veins - in case of embolism
 Uterus crepitant and bubbles seen under serosal surface
or parietal peritoneum
 Gas bubbles seen in the wall of placental bed
 If evacuation done by curetting, endometrium will have
evidence of scooping
 In Dilation of cervical canal, Groove like parallel
notches on cervical canal around external orifice-
holding with valsellum forceps
 Perforation of vagina and uterus may be of varying form
and size
 Multiple perforations may be present
 Small/ large intestine may also be perforated segments
of intestine, omentum or mesentry may enter uterine
cavity
 Foreign body found in genital tract to be preserved
Abortion by syringing:
 Fluid in vagina
 Cervical mucous plug displaced/ disintegrated
 Corrosion/ tissue damage due to use of antiseptics
 Cervical canal dilated and injured
 Foamy dark red fluid found between uterine wall and
foetal membranes with partial detachment of placenta
 Bubbles of gas in the venous system from uterus to right
heart
 Right side of heart, SVC and IVC contain foamy blood
and are ballooned out with elastic feel
 Fatal venous air embolism- beaded appearance of IVC,
uterine and pelvic veins due to air bubbles
In case of sepsis following abortion:
 In uterine infection- uterus is spongy, swollen and
discoloured
 Serosal surface brownish, endometrium ragged , foul
smelling or purulent
 General signs of septicemia - enlarged soft spleen,
prominent lymph nodes
 Kidney- bilateral cortical necrosis
 Skin - bronzed with mottled/ rain drop appearance-
clostridial infection
Examination of expelled material:
 Material alleged to be expelled from uterus examined for
products of conception
 Wash with water to dissolve the blood
 Histopathological examination- blood clot/ foetus/
polyp/fibroid
 If blood clot- grouping and precipitin test
 If foetus- determine the age

84. Causes of Death:
1. Immediate:
Vagal inhibition, air embolism, haemorrhage, fat
embolism, amniotic fluid embolism
2. Delayed:Within 48-72 hrs- septicemia, pyaemia,
peritonitis, tetanus
3. Remote:Hepato-renal failure, bacterial endocarditis,
pulmonary embolism

85. 13.INFANT DEATH

Definition:
1. FOETICIDE:
Killing of foetus at any time prior to birth
2. FILICIDE:
Killing of child by its parents.
3. INFANTICIDE
Unlawful killing of a child under 1 year
Derived from Infanticide act of England
Motive: usually committed by young unmarried or widowed
women

Investigations to be done:
 In mother: signs of recent delivery
 In child: still born / dead born / live born
 Attained viability or not
 If born alive- cause of death

Still born:
 Born after 28wks of pregnancy and did not breathe or
show any signs of life at any time after being completely
born
 Signs of prolonged labour or any genetic abnormalities
causing death

Causes:
 prematurity,
 Intracranial haemorrhage due to severe moulding,
 Placental abnormalities,
 Erythroblastosis foetalis
Dead born:
 Died in utero and after birth shows either rigor mortis or
maceration or mummification

Maceration:
 It is a process of aseptic autolysis and is a usual change.
 This occurs when the dead child remains for about 3-4
days in uterus surrounded by amniotic fluid with no air.
 Signs of maceration will not be present if child is born
within 24 hrs of its death.
 If air enters the liquor amnii after death of the foetus,
then putrefaction occurs instead of maceration.

Features
 Reddening of skin with skin peeling- 12 hrs
 Body is soft, flaccid and flattens when placed on table
 Sweetish unpleasant odour
 Large blebs containing serosanguinous fluid- 24 hrs
 Epidermis detach- moist greasy area underlying
 Tissue reddish due to hemolysis
 Abdomen distended
 Cavities contain reddish fluid- 48hrs
 All viscera soft, edematous and lose their morphology
 Joints abnormally mobile
 Skull bones separated
 Brain greyish red and pulpy
 Vertebral column collapse

86. Spalding’s sign
 Radiological finding seen in dead born
 Loss of alignment and overriding of cranial vault due to
shrinkage of cerebrum

Mummification:
 Foetus dies of deficient supply of blood, liquor amnii is
scanty, no air entry in uterus

Live born:
 Child which shown signs of life even when it is partly
out of mother
 Causing death of live born- homicide

Signs of live birth
 In civil cases: any sign of life after complete birth of
child
 In criminal cases: signs of live birth to be demonstrated
by post mortem examination











Autopsy findings


Raygat’s hydrostatic test
• Breathing increases lung volume and decreases specific
gravity of lung from 1040-1050 to 940 after respiration
• Ligate the lungs at hilum put in water, if it floats,
• Cut the lung into 12 – 20 pieces and put in water if it floats
again,
• Squeeze them to see for bubbles and again see for floating,
if it is floating then it floats because of residual air - – air in
lung – foetus respired – live born foetus.
• Compare with pieces of liver as control : if liver pieces also
floats – False positive.

87. False positive: floating of unexpanded lungs:
1. Putrefactive gases
2. Artificial inflation of lungs
False negative: Sinking of expanded lungs:
1. Atelectasis
2. Lung diseas like pulmonary edema, pneumonia, congenital
syphilis
Test is unnecessary
1. Gestational age< 180 days
2. Foetus is macerated, mummified
3. Stomach contains milk
4. Scar formed due to umbilical cord separation
Microscopic changes in lung
 Lung parenchyma- gland like structure with cuboidal or
columnar lining- 4
th
month
 Adult type of alveolar lining seen at full term
Vagitus Uterinus
 A child may start crying while still in uterus
 Occurs when membranes ruptures and air enters the
uterus
 It means the child started breathing in uterus – live born
foetus
Vagitus vaginalis
 A child may start crying while head still in vagina during
delivery.
 It means the child started breathing while head still in
vagina – live born foetus
Other changes in child after birth
 Nucleated RBC disappear in 24hrs.
 Hb F (foetal haemoglobin) reduces to 7-8% by 3
rd

month.
 Meconium completely excreted from large intestine by
24-48hrs
 Caput succedaneum- area of swelling over the
presenting part. Resolves by 2-4days
 Cephal-hematoma- localised accumulation of blood
deep in scalp between periosteum and the bone. It does
not cross suture lines. Increases after 1 or 2 days and
then disappears by 15days.
 Skin is bright red on 1
st
day, becomes darker by 2
nd
or 3
rd

day, normal by 1 week
 Neonatal/ physiological jaundice- seen by 3
rd
day
 Vernix caseosa- cheesy white substance made of
sebaceous secretions and epithelial cell- 1-2 days.
Protects foetal skin from maceration while being in
liquor amnii.
Changes in umbilical cord
 Blood clot at cut end- 2hrs
 Umbilical vessels close- 24 hrs
 Cord dries and shrinks- 12-24hrs
 Inflammatory ring- 36-48hrs
 Mummification- 2-3
rd
day
 Cord falls off- 5
th
-6
th
day
 Ulcer heals and forms a scar- 10-12 days
Changes in circulation:
 Contraction of umbilical arteries- starts by 10hrs
completes by 3
rd
day
 Umbilical vein and ductus venosus- close by 4
th
day
 Ductus arteriosus- close by 10
th
day
 Foramen ovale closure- 2
nd
-3
rd
month

88. MEDICO-LEGAL ASPECTS OF INFANTICIDE
CAUSE OF DEATH
 Natural
 Unnatural- accidental/ homicidal
Natural-
 Immaturity,
 Congenital diseases,
 Anomalies of placenta,
 Infections,
 Anoxia,
 Erythroblastosis
Accidental
 Prolonged labour especially through contracted pelvis,
 Cord prolapse,
 Cord around the neck,
 Death of mother
Precipitate labour
 Labour terminating in a very short time than that of
average
 3 stages of labour merged into one.
 Usually in multipara with roomy pelvis
 Death of child due to- suffocation, head injury,
haemorrhage from torn end of the cord
Medicolegal importance:
 Mother accused of killing an infant/ death of infant
falsely attributed to precipitate labour
Homicide
Act of commission
 Acts done positively to cause death of the infant
 Suffocation, strangulation, drowning, blunt trauma to
head, poisoning
Act of omission
 Failure to take ordinary precautions to save the child after
birth
 Failure to ligate cord after its cut, failure to protect from
exposure, failure to provide food

BATTERED BABY SYNDROME
Synonym:
 Non accidental injury of childhood, Caffey’s syndrome,
Cinderella syndrome
Definition:
 Child receives repetitive physical injuries as a result of
non-accidental violence produced by parent or guardian
FEATURES
 Discrepancy between nature of injuries and explanation
provided
 Delay in seeking medical attention
 Several injuries in varying stages of healing and severity
 Age: may occur at any age usually less than 3yrs
 Position in family: either the eldest /youngest, unwanted
child
 Socio economic factors: young parents, low socio
economic and low education
 Precipitating factors: violence precipitated by crying,
refusal to be quiet, persistent soiling of nappy
Injuries:
 Head, Face &Neck
-multiple abrasions, contusions and lacerations of
different age
 Laceration of inside of the lip with tear of frenulum
 Six penny contusions on the either side of the chest

89.  Subdural haemorrhage, intra ocular bleed, retinal
detachment- infantile whiplash syndrome
 Patterned bruise caused by hitting with objects
 Butterfly shaped bruise- pinching
 Bursting injury of liver or spleen
 Burns- cigarette or hot liquid
 Bucket handle fracture- epiphyseal separation and
periosteal shearing- pulling and twisting of the limbs
 Nobbing fractures- string of bead appearance in
paravertebral gutter

MUNCHAUSEN ’S SYNDROME BY PROXY
 Person inflicts harm on the dependent to gain sympathy
and attention for their suffering
 Parent has personality disorder
 Frequently admitted in the hospital for medical
evaluation of non-existing diseases
Diagnostic criteria
 Illness alleged by the parent alone
 Request for multiple medical procedures in absence of
any symptoms
 Parental denial of knowledge about the cause of the
symptoms
 Regression of symptoms on separation from the parent
Methods used
 Adds blood to urine sample of child and taken to doctor
 Suffocate the child
 Inject insulin and produce hypo glycemia
 Induce vomiting by giving emetics
 Induce diarrhoea by giving laxatives
SUDDEN INFANT DEATH SYNDROME
Synonym:
SIDS, cot death, crib death
Definition:
 Sudden and unexpected death of a seemingly healthy
infant whose death remain unexplained even after
thorough investigation, review of clinical history and a
complete autopsy
FEATURES
 Age: 2wks-2yrs
 Development: premature and low birth weight
 Apparently healthy may have minor URTI
Autopsy Findings:
 Multiple petechial haemorrhage on heart, lungs and
thymus
 Froth in air passage and facial pallor
 Nonspecific findings
 Diagnosis of exclusion
 Prolonged sleep Apnea- hypoxia
MEDICO LEGAL IMPORTANC E
Sec 317 IPC
 Abandoning a child under 12 years- 7years
imprisonment
 Abandoning a girl child under 12 years- rigorous
imprisonment of 10years with fine 1 lakh rupees
Sec 318 IPC
 Concealment of birth- imprisonment for 2 years
 Concealment of birth of a girl child- rigorous
imprisonment of five years with fine of fifty thousand
rupees

90. 14.SEXUAL JURISPRUDENCE

SEXUAL OFFENCES

CLASSIFICATION
Natural:
 Rape,
 Adultery,
 Incest
Unnatural:
 Sodomy,
 Tribadism,
 Bestiality,
 Buccal coitus
Sexxual Perversions:
 Sadism,
 Masochism,
 Exhibitionism etc
 Sex linked offences- stalking, trafficking, sexual
harassment
Definition of Rape:
375 IPC
A man is said to commit rape if he-
a). Penetrates his penis to any extent into the vagina, mouth,
urethra or anus of a woman or makes her to do so with him or
any other person
b). Inserts to any extent any object or part of body not being
the penis into the vagina, urethra, or anus of a woman or makes
her to do so with him or any other person
c). Manipulates any part of body of a woman so as to cause
penetration into vagina, urethra, anus or any part of body of
such woman or make her to do so with him or any other person
d). Applies his mouth to the vagina, anus, urethra of a
woman or makes her to do so with him or any other person
Under the circumstances falling under any of the following
7 descriptions:
1). Against her will
2). Without her consent
3). With her consent when her consent is obtained by
putting her or any person in whom she is interested
in fear of death or of hurt
4). With her consent when the man knows that he is not her
husband and that her consent is given because she
believes that he is another man to whom she is or
believes herself to be lawfully married
5). With her consent when at the time of giving such
consent by reasons of
unsoundness of mind or intoxication or the
administration by him personally or
through another of any stupefying or unwholesome
substance, she is unable to
understand the nature and consequence of that to which
she gives consent

6). With or without her consent when she is under 18 years
of age
7). When she is unable to communicate consent

91. EXCEPTIONS
1). A medical procedure or intervention shall not constitute
rape
2). Sexual intercourse by a man with his own wife, the wife
not being under age of 15 years
Statutory rape:
 Sexual intercourse with a girl less than 18 years even
with consent
Gang rape:
 Rape by more than 1 person constituting a group. Each
person shall be considered to have committed the
offence of rape
Date rape:
 Sexual intercourse with a woman after giving her a drink
containing sedative (GHB/ rohypnol/ ketamine)
Marital rape:
 Forceful sexual intercourse with wife without her
consent

PUNISHMENT FOR RAPE
Sec 376 IPC amended
Rape - shall be punished with rigorous imprisonment not
less than seven years, to imprisonment for life
with/without fine
Sec 376(2)
Whoever –
 Being a police officer, commits rape - within the limits
of the police station
 On a woman in such police officer's custody
 Being a public servant, commits rape on a woman in
such public servant's custody
 Being a member of the armed forces
 Being the staff of a jail, remand home or other place of
custody
 Being the staff of a hospital,
 Being a relative, guardian or teacher of, or
 A person in a position of trust or authority towards the
woman,
 Commits rape during communal or sectarian violence; or
 Commits rape on a woman knowing her to be pregnant;
or
 Commits rape on a woman when she is under sixteen
years of age (12 years); or
 commits rape, on a woman incapable of giving consent;
or
 commits rape on a woman suffering from mental or
physical disability; or
 commits rape repeatedly on the same woman
 shall be punished with rigorous imprisonment not
less than ten years, to imprisonment for life
with/without fine
376A
 Punishment for causing death or resulting in
persistent vegetative state of victim.
 rigorous imprisonment for not less than twenty years,
to imprisonment for life, or with death sentence.
376B
 Sexual intercourse by husband with his wife during
separation
 Imprisonment for not less than two years to seven years,
with/without fine
376C
 Sexual intercourse by person in authority

92.  abuses such position to induce or seduce any woman
to have sexual intercourse with him, such sexual
intercourse not amounting to the offence of rape,
shall be punished with rigorous imprisonment for not less
than five years, to ten years, with/without fine
376D
 Punishment for gang rape
 Where a woman is raped by two or more persons
constituting a group, each of those persons have
committed the offence of rape
shall be punished with rigorous imprisonment for not less
than twenty years, to life imprisonment with/without fine.
376E
 Punishment for repeat offenders
Shall be punished with imprisonment for life or with death
sections

EXAMINATION OF A VICTIM OF RAPE
Objectives
 Search for injuries to corroborate the history given by
the victim
 To collect and preserve trace evidence for laboratory
investigations
 To treat the victim for any injuries, prevent venereal
diseases and pregnancy
 Prevention/ lessening of permanent psychological
damage
 Scene of alleged offence may be examined if required
 The main crime scene- body of the victim
 Examination to be done as soon as possible- loss of
evidence with time
Examination to be done in presence of a female nurse -
record the name
 History - general and specific
 Examination- general and specific
 Stand on a clean sheet of paper- victim to remove her
clothes herself- button, mud, grass- which falls on paper
to be collected
 Clothes to be examined, dried, preserved in paper bag
and sent to laboratory
 Sanitary pads if used at the time or after offence to be
preserved
 Presence of mud, grass, leaves on body- corroborate
with history
 Examine body under UV light - seminal stains
 Photograph the injuries
 Scratches, bruises, lacerations and areas of tenderness-
extent , situation probable age
 Petechiae on the face and conjunctiva- partial asphyxia
 Bruising and tearing of inner aspect of lips/ throat
 Bruising around wrist/arms
 Injuries on back-shoulder and buttocks
 Bruises over breasts and inner aspect of thighs
Bite marks- true bite/ love bites- suction lesions
 Oval or circular areas of bruising with intra dermal
petechial haemorrhages caused by sucking skin into the
mouth resulting in rupture of small vessels from
negative air pressure. Lips produce semi lunar marks at
the periphery and teeth produce indentations or
abrasions
Collect samples before doing local examination
 Hair,

93.  Swabs,
 Slides,
 Vaginal Wash,
 Dried Seminal & Blood Stains
Local examination
 Lithotomy position for examination
 Gross external injury- mild anaesthesia
Injuries absent-
 mere touching of genitalia
 used to sexual intercourse
 lack of resistance
 use of lubricants
Rape on a virgin
 Labia majora and minora to be inspected first
 Red, inflammed and slight edema of vaginal introitus
 Compression of labia anteriorly and laterally- bruising
 Thin tears between labia majora and minora
 Small tears in fourchette and fossa navicularis due to
excessive stretching
 Fourchette fragile and tear in first intercourse
 Fossa navicularis disappears
 Posterior commissure ruptures in first intercourse
 Hymen torn posteriorly usually between 5’o clock
and 7’o clock position
 Tear extends to margin
 In pre pubertal children- tear extends to fourchette
 Soon after act- margins are sharp , red and bleeds on
touch
 In 3-4 days- edges congested and swollen,
 Heals by 1 week.
 Over period of months V shaped tear becomes rounded
and form U shaped defects
 Hymenoscope or Glaister Keene rods
Bruising of vagina-
 dark red area against overall redness of vaginal mucosa.
Penile penetration:
 Anterior vaginal wall in lower third and posterior
vaginal wall in upper third
Digital penetration:
 Abrasion of vaginal mucosa
 Abrasion of cervical os- (colposcopic examination)
Rape on deflorate woman
 Hymen is completely destroyed, vaginal orifice dilated,
mucus membrane wrinkled and thickened
 Complete penetration with no evidence except presence
of semen- main evidence violence in other part of body
 Vagina may have deep injuries and swelling and
inflammation of vulva
 Injuries unless severe disappear in 3-4 days
 In old women- senile atrophy and friability of genitalia-
bruising, extensive vaginal laceration and perineal
trauma
Rape on children
 In young children - Less resistance- less sign of general
violence
 Small vagina- deeply situated hymen- penetration by
adult organ impossible.
 Hymen usually intact, redness and tenderness of vulva
 In pre-pubescent child- grasping injuries and bruises
from blows
 Hymen torn posteriorly

94.  Further penetration- hymenal tear extend to perineal
body and may involve anorectal canal
 Speculum examination not to be done in a pre pubescent
child
Specimen to be collected
 Scalp hair-5-10 different location
 Pubic hair combing
 Pubic hair cutting
 Foreign material including loose hair found anywhere on
body
 Fingernail cutting and scraping
 Blood- 5ml for grouping, 5ml for DNA, 5ml for drug test
and venereal diseases
 Urine- drug and alcohol screening, UPT
 Swab from body surface
 Genital swabs- low vaginal, high vaginal, introitus
 Clothes , sanitary pads used at time of offence

EXAMINATION OF ACCUSED
General examination:
 vital signs, development of secondary sexual characters,
mental state, under the influence of any intoxicants,
condition of clothes, trace evidences on clothes or body,
injuries on the body, existence of venereal diseases
Specific examination:
 Development of genital with special reference to
potency
 Injury on the genitals, abrasion or bruise of fraenulum or
glans penis
 Dried blood stains on shaft of penis, scrotum or
adjoining skin
 Lugol’s iodine test
 Presence of smegma
 DNA of victim from penile swab within 24hrs if person
has not bathed.
Specimens to be collected
 Swabs from coronal sulcus, prepuce, penile shaft, urethral
orifice
 Blood for grouping
 Pubic hair combing
 Pubic hair cutting
 Scalp hair cutting and combing
 Loose hair and other trace evidences found anywhere on
body
 Nail cuttings and scrapings - left and right

INDECENT ASSAULT
 Any offence committed on a female with intention or
knowledge to outrage her modesty
 Forceful kissing, fondling breasts, touching genitals or
thighs
 Can be between two males (friction of penis on gluteal
fold or between inner thighs and external genitalia,
handling genitalia) or two females (putting finger in
genitalia)
 Stripping a female patient naked for medical
examination without consent
 Punishable under 354 IPC: 1-5yrs imprisonment and fine
Incest
 Sexual intercourse by a man with a woman who is
closely related to him by blood and forms prohibited

95. degree of relationships (daughter, grand daughter, sister,
step sister, aunt or mother)
 Incest between father and daughter, brother and sister-
common
 Not an offence in India

ADULTERY
 Whoever has sexual intercourse with a person who is
and whom he knows or has reason to believe to be the
wife of another man, without the consent or connivance
of that man, such sexual intercourse not amounting to
the offence of rape, is guilty of the offence of adultery
(497 IPC)
 Imprisonment of either description for a term which may
extend to five years/ with fine/ both
 The wife shall not be punishable as an abettor
UNNATURAL SEXUAL OFFENCES
 Voluntary sexual intercourse against the order of nature
with any man, woman or animal (377 IPC)
 Punishment: imprisonment for life / imprisonment of
either description for a term which may extend to ten
years, and shall also be liable to fine.
Homosexuality:
 Persistent emotional and physical attraction to members
of the same sex
Sodomy:
 Syn: Buggery, Greek love, gerontophilia, paederasty
 Anal intercourse between two males or a male and a
female
 Gerontophilia- passive agent is an elderly person
 Paederasty- passive agent is a child (catamite)
 Paedophile- adult who engages in sexual activity with
children
 Any degree of penetration or any attempt at penetration
just into anal margin- punishable
 Most common- sailors, prisoners, military barracks
 Male prostitutes (eunuchs in India)- passive agents

BUCCAL COITUS
Synonym:
Coitus per os, sin of gomorrah, oral sex, blow job, fellatio,
sexual oralism
 Male organ is introduced into mouth of another male or
female/ obtaining sexual gratification by application of
mouth to sexual organs
Fellatio: stimulation of penis by the partner’s mouth
Anilingus (rimming): kissing, licking and sucking of anus by
sexual partner
Cunnilingus (mouth job): kissing, licking and sucking of
female genitals by her partner
 Death due to impaction of penis in hypopharynx or
aspiration of semen
 Autopsy: semen in respiratory tract/ stomach
 Spermatozoa in mouth upto 9 hrs- swab and oral rinse
 Medico-legal importance- punishable under 377 IPC

TRIBADISM
Synonym:
 lesbianism
 Female homosexuality
 Sexual gratification of woman is obtained by another
woman’s kissing, generalised body contact, manual

96. manipulation of breast and genitalia, sucking of breasts
or external genitalia, etc
 Artificial penis/ phallus (dildo) may be used
 Morbid jealousy- homicide, suicide or both

BESTIALITY
 Sexual intercourse by a human being with a lower
animal
 Animals used are usually those kept on farms or as pets
 Mostly seen in male
 Commonly used animals are calves, goats or sheep
 Intercourse may be vaginal or anal
 Both the accused and alleged animal is to be examined
 accused
 Animal faeces, vaginal secretion or hair on the penis
 Marks of injuries on body due to kicks, teeth or claws of
the animal
 Presence of hair from the external genitalia of the animal
on the person or clothes
 Stains of dung or animal blood on person or clothes
 animal
 Better that the animal is examined by veterinary surgeon
 Presence of human spermatozoa in vagina or anal canal
of the animal- positive sign
 Abrasions and lacerations with effusion of blood on
external genitals
 Presence of gonorrheal discharges in the animal
Medico-legal importance- 377 IPC
SEXUAL PERVERSIONS
Synonym:
 sexual deviations, paraphilias
Definition:
 Persistently indulged sexual acts or fantasies where
sexual gratification is sought and obtained without
sexual intercourse
 Acts are socially prohibited / unacceptable/ biologically
undesirable
 Mental state of accused to be determined by psychiatrist
in such cases

ALGOLAGNIA
 Combined term used to denote both sadism and
masochism
 SMBD
Sadism ( Active algolagnia)
 Sexual gratification obtained from acts of physical
cruelty or infliction of pain on one’s partner
 Usually seen in males with sociopathic/ personality
disorders
 Bite, whip, punch, produce cuts or cigarette burns, insert
foreign objects into vagina
Masochism (Passive algolagnia)
 Sexual gratification is obtained by suffering pain or
humiliation at the hands of the partner
 Usually seen in women- submissive partner in the sado-
masochisitic relationship
 Get pleasure from being beaten, tortured, humiliated or
dominated by sexual partner.
 Rarely men take submissive role- dominatrix
 Combined - bondage

97. LUST MURDER
 Extreme case of sadism
 Murder serves as stimulus for sexual act and become
equivalent to coitus, the act being accompanied by
erection, orgasm and ejaculation
Characteristic features:
 Period of normalcy while person tries to control his
impulse followed by a violent outbreak
 Cutting/stabbing of breasts, genitalia or lower abdomen
with sucking/licking the wounds- desire to drink blood
or eat flesh (necrophagia)
 Erection and ejaculation following sexual intercourse
with injured or dying victim (necrophilia)

NECROPHAGIA
 Extreme degree of sadism
 Derives sexual gratification by sucking/licking the
wounds, biting the skin, drinking blood and eating flesh
of his victim

NECROPHILIA
 Sexual gratification obtained by sexual intercourse with
dead bodies
 Severe personality disorder
 Committed on newly buried corpse or body awaiting
burial
 Medico-legal importance- Punishable under 297 IPC

FETICHISM
 Sexual gratification obtained by living/ non living
objects
 May be part of body or some article belonging to person
which has no sexual correlation in any sense
 Underwears, shoes, socks, hair etc
 Sexual pleasure derived from touching/smelling the
object
 May masturbate into the object
 Medicolegal importance- trigger for rape / indecent
assault

EONISM OR TRANSVESTISM
 Person whose personality is dominated by the desire to
be identified and thought as a member of opposite sex
 Males who obtain sexual gratification by wearing dress
of a female
 Starts as fetishistic interest in clothing of opposite sex
 Transexualists: obsession to become member of the
opposite sex and seek surgery for anatomical alteration

URANISM
sexual gratification obtained by fingering, fondling, licking,
and sucking of genitalia of opposite sex

ONANISM
 Also called masturbation.
 Sexual gratification obtained by deliberate self
stimulation
 Common in both men and women and is an offence only
when practised in public ( sec 294 IPC)

98. EXHIBITIONISM
 Sexual gratification obtained by exposing one’s genital
to unsuspecting strangers. Recurrent behaviour over a
period of 6 months
 Punishable under sec 294 IPC- 3 months
imprisonment/fine

VOYEURISM (SCOPTOPHILIA)
 Sexual gratification obtained by watching unsuspecting
strangers undressing, taking bath or engaging in sexual
intercourse
 Masturbate at the scene
 Sociopathic personality disorder- major sex crime

FROTTEURISM
 Sexual gratification obtained by rubbing private parts
against another person
Punishable under section 290 IPC- fine of 200 rs

TROILISM (ORGY)
 Extreme degree of voyeurism
 Sexual practice involving 3 person, 2 of one sex and one
of oposite sex
Oedipus complex: sexual desire of son towards mother
Electra complex: sexual desire of daughter towards her father
Pharoan complex: sexual desire of brother towards sister
Bobbit syndrome: sexual perversion where female partner
amputates the penis of her male partner with a sharp cutting
weapon



UNDINISM
 sexual gratification obtained by witnessing the act of
urination by person of same or opposite sex
Caprolalia ( talking dirty): sexual excitement obtained by
obscene language
Caprolagnia: sexual excitement associated with smell or sight
of faeces or defaecation
Urolagnia: sexual excitement associated with smell or sight of
urine or urination
Pygmalionism: person falls in love with an object made by
him

99. 15.AGRICULTURAL POISONS

Pesticides –
Organophosphates
 Non-carbamates,
 Carbamates,
 Organochlorines,
 Pyrethrum and pyrethroids.
Herbicide – which kill or prevent undesirable growth of
herbs/weeds.
 Paraquat,
 Tricholoroacetic acid,
 cholorophenoxy compounds.
Organophosphates - Non-carbamates
Appearance:
 Dust, granules, liquids.
Odour – kerosene smell.
Mode of action:
 Inhibition of acetylcholine esterase enzyme
 Leading to accumulation of acetyl choline
 Parasympathetic over activity
Classification of Organophosphates
Chemically as:
1. Alkyl Phosphates – Tetra ethyl pyro phosphate, Hexa
ethyl, Octo methyl, Malathion
2. Aryl Phosphates – Parathion, Methyl parathion,
Diazinon.
Based on Toxicity:
1. Mildly Toxic – Chlorothion, Malathion.
2. Moderately Toxic – Diazinon.
3. Highly Toxic – Parathion, Methyl Parathion.
Routes of entry
 Ingestion – GI tract.
 Inhalation.
 Aerosols through skin.
Mechanism of Action
Parasympathetic system over activity.
 Muscarinic action
 Nicotinic action
 At neuromuscular junction
At ganglion – sympathetic action
Onset of Action
 Rapid – inhalation.
 Slow – Percutaneous.
Muscarinic (Parasympathetic)
SLUDGE
 S = Salivation
 L = Lacrimation
 U = Urination
 D = Defecation
 G = GI symptoms
 E = Emesis
DUMBELS
 D = Diarrhea
 U = Urination
 M = Miosis
 B = Bronchorrhea, bronchospasm, and bradycardia
 E = Emesis
 L = Lacrimation
 S = Salivation
Nicotinic Effects

100.  Fasciculation
 Weakness
 Paralysis
 Hypertension
 Tachycardia
CNS
 Drowsiness
 Depression
 Headache
 Tremor
 Delirium
 Slurred speech
 Ataxia
 convulsions
Cause of Death
 Respiratory Failure.
INTERMEDIATE SYNDROME
 Onset: 1 – 4 days after exposure
 Action: long standing cholinesterase inhibition due to
Inadequate Treatment.
 Features: muscle weakness, motor cranial nerve
paralysis, acute respiratory paresis.
 Treatment: Supportive measures.
Delayed syndrome
 Onset: Occurs 1 – 5 weeks after exposure
Features:
 Characterized by organo-phosphate induced delayed
neurotoxicity (Demyelination)
 Paraesthesia
 Flaccid weakness
 Atrophy of distal limb muscles
 Spasticity
 Ataxia
Chronic poisoning
 Occupational hazard.
Mode of entry: Inhalation or unbroken skin.
Features:
 Polyneuropathy: muscle cramps, weakness, gait
disorders
 CNS effects: drowsiness, irritability, anxiety
 Sheep Farmers disease: psychiatric manifestations
Diagnosis
 RBC Cholinesterase level. <50% of normal
 In RBC, normal is 77 – 142 units
 In Plasma, normal is 40 – 140 units
 Mild poisoning if Cholinesterase level is 20 – 50 %
reduced
 Moderate poisoning if Cholinesterase level is 70 – 80 %
reduced
 Severe poisoning if Cholinesterase level is 90 % reduced
Atropine test
 Give two mg of atropine
 Normal person develops signs of atropinisation
 In op poisoning – symptoms relieved
Treatment
 Decontamination
 Antidotes
 Supportive measures
 Prevent further exposure
First aid
 MAINTAIN AIRWAY, BREATHING, CIRCULATION
 Decontamination:- Wash the body.

101. Antidotes
Atropine -- Blocks muscarinic manifestations – physiological
antidote
 Affects only post synaptic muscarinic receptors.
 No effects on muscle weakness and paralysis
 Dose: 2 - 4 mg test dose
 Double dose every 10 to 15 mins
 Until all tracheobronchial secretion dries up.
Pralidoxime
 Specific antidote
 Regenerates acetylcholine esterase at muscarinic,
nicotinic & CNS sites
 Dose: 1-2 g iv either as a solution in 5 mins
 Or in 150ml of NS, for 30 min.
 Repeated in 6 to 12 hrs
 Maximum dose should not exceed 12 g/24 hours
Convulsion
 Diazepam 10 to 20 mg
 Phenobarbitone 10 – 20 mg/kg
 Phenytoin 18 mg/kg
 General anesthesia

ORGANO - CARBAMATES
Classification of carbamates based on Toxicity
Extremely toxic
 Carboryl
 Carbofuran
 Propoxur
Moderately toxic
 Aldicarb
Mode of action
 Blocks Acetyl cholinesterase.
 By carbamylate action.
 Reversible binding- reverses within 24 to 48 hrs
Clinical Features
 Similar to OPC but limited to 24 to 48 hrs.
Treatment
 Atropine
 Oximes not as much effective
 Help prevent some morbidity

ORGANOCHLORINES
Chlorinated Hydrocarbons.
 DDT analogues – DDT.
 Benzene Hexachloride group – BHC.
 Cyclodiene compounds – Endosulfan ,Aldrin,
 Toxaphene compounds – Toxaphene.
Classification on based on Toxicity
Extremely toxic
 Dieldrin
Highly toxic
 DDT
 Endosulfan
 Lindane
Available as
 Powders
 Emulsions
 Granules
 Solutions
 Topical ointment, cream, lotion.
Used as
 Insecticide.

102.  Scabicide – Gamma BHC
 Pediculocide -- Gamma BHC
Fatal dose
 DDT – 15 to 30 mg.
Mode of action
 Interfere with nerve impulse transmission
In CNS
 First stimulates – convulsion
 Then depresses
Clinical Features
Acute
 Similar to op but has more CNS symptoms.
Chronic
 Weight loss, tremor, mental changes, Oligospermia,
leukemia, aplastic anemia, liver cancer.
Treatment
 Decontamination
 Seizures – anti epileptic drugs
 Cholestyramine
 Hyperthermia
Pyrethrin & Pyrethroids
Pyrethrum
 Origin from Chrysanthemum plant – active extracts.
 Neurotoxin, biodegradable
Pyrethroids
 Synthetic compounds similar to pyrethrins.
Commercially available Allerthrin, Cypermethrin, Permethrin.
Used as
 Insecticides, mosquito repellants as coils / mats.
 Pesticide.
Fatal dose
 Pyrethrum – 1g/kg.
Mode of Action
Type I:
 No Cyano group – Permethrin.
 Opens the sodium channels in neuronal membranes,
resulting in over excitation paralysis.
Type II:
 Cyano group – Cypermethrin.
 Inhibits GABA-mediated chloride channels – removal of
inhibition – over excitation.
Clinical Features
 Skin – blisters.
 Eye – irritation
 Inhalation – rhinorrhoea, wheezing.
 Ingestion – par aesthesia, fasciculations, seizures,
pulmonary edema, coma.
Diagnosis
 Blood cholinesterase – Normal.
 ECG – ST-T changes, tachycardia, ventricular
premature beats.
Treatment
 Skin – decontamination
 Eye – irrigation with normal saline or water.
Systemic poisoning
 Allergic – adrenaline, antihistamines.
 Ingestion – stomach wash.
 Activated charcoal.
 Avoid oils and fats.
 Supportive – oxygen, ventilation.
 Bronchodilators.
 Seizures – antiepileptic drugs

103. 16.CORROSIVES/CAUSTICS

 Substances that destroys the body tissues with which
they come into contact.
 Induces a chemical reaction on contact leading to
corrosion and destruction of tissues.
Classification
ACIDS
 Inorganic acids
 Organic acids
ALKALIS
ACIDS
Inorganic / Mineral Acids
 Sulphuric acid
 Nitric acid
 Hydrochloride acid
Organic Acids
 Carbolic acid
 Oxalic acid
 Acetic acid
 Salicylic acid
ALKALIS
Hydrates and carbonates of
 Ammonia
 Potassium
 Sodium

FACTORS DETERMINING THE CORROSIVE
POTENTIAL
 PH
 Highly corrosive if PH is < 2 or > 11
 Concentration
 Amount/quantity
 Period of contact
Mechanism of Action
ACIDS:
• Releases H+ ions
• Precipitates proteins
• Coagulation necrosis
• Formation of coagulum
• Prevents further damage
ALKALIS:
• Saponification of fats
• Dissolving of proteins
• Liquefactive necrosis
• Further penetration
• Rapid injury
Clinical Presentation
1. Acute inflammatory phase
 First 3 – 4 days
 Peaks within 48 hrs
 Local
 Edema, erythema, vascular congestion
 Thrombosis and necrosis
 Systemic
 Refractory shock
2. Latent Granulation Phase
 From 4 – 14 days
 Mucosal sloughing with Granulation tissue filling
 Fibroplasia starts forming with collagen fiber deposition
 Damaged tissue is weakest at this period

104.  Chances of perforation high
 Mediastinaitis
 Perforation peritonitis
3. Chronic Cicatrization Phase
 From 3rd week to years
 Scar tissue replaces the defects
 Stricture formation
 Esophageal obstruction
 Dysphagia, weight loss, anorexia
 Vocal cord paralysis
 Squamous cell carcinoma

Sulphuric Acid
 Oil of vitriol, oleum
 Heavy, oily, colourless, odourless, nonfuming liquid
 Hyroscopic
Uses
 Industrial chemical -95%
 Storage batteries – 30 – 35%
 Drain cleaners – 10%
Fatal dose: 5 to 10 ml
Fatal period: 12 to 24 hrs
Toxicokinetics: systemic absorption negligible
Mechanism of action:
 Coagulation necrosis
 Conversion of haemoglobin to acid hematin
 Chars and blackens skin.
Clinical features
 Burning sensation of mouth to stomach
 Intense thirst, vomiting
 Tongue-swollen, turns black/brown
 Teeth-chalky white, loss of enamel
 Drooling of saliva, Dribbling marks on face
 Stomach-perforation-peritonitis
 Strictures form pyloric obstruction, antral stenosis
 Eyes conjunctivitis, periorbital edema, corneal edema,
necrotizing keratitis
Diagnosis
 Litmus test: PH of saliva, blue-pink
 Clothing stains + few drops of sodium bicarbonate,
produces effervescence
 Suspected solution + barium chloride /nitrate gives white
precipitate of barium sulphate.
Management
Do’s
 Secure airway by endotracheal intubation,
ciricothyrotomy with 100% oxygen.
 Immediate dilution with plain water or milk 120 – 240
ml in adult, 60 – 120 ml in children.
 Irrigate exposed skin with copious water or saline
 Irrigate exposed eye with normal saline or ringer’s
lactate solution for 15 to 30 mins
Don'ts
 Gastric lavage – risk of perforation while attempting for
insertion of gastric lavage tube, ryle’s tube
 Emesis – risk of repeated damage and aspiration
 Neutralization - Leads to heat production more injury.
 Activated charcoal – obscures endoscopic view
Supportive measures
 Intra-lesional steroids within 48 hrs of ingestion.
 Prophylactic antibiotics.

105.  Flexible fibrotic endoscopy within 24 to 48 hrs to assess
the extent of damage.
 Emergency laparotomy in case of perforation and
peritonitis.
Postmortem appearance
 Corroded skin appears brownish or black.
 Teeth appear chalky white.
 Stomach mucosa consistency – wet bloating paper.
 Inflammation, necrosis, perforation of GIT.
Medico legal importance
Accidental:
 Resembles glycerin, castor oil
 Common among children

Suicide:
 Rare choice
Homicide:
 Extremely rare, but vitriolage is common
Vitriolage
 Throwing of corrosive agents on to face or other parts of
body in order to disfigure or blind the victim
 Usually out of jealousy or revenge.
 Started during industrial unrest of Glasgow (1820)
 Sulphuric acid ( oil of vitriol) commonly used.
Management
 Wash affected area with plenty of water.
 Soap, sodium or potassium carbonate.
 Apply thick paste of magnesium oxide or carbonate.
 Eyes are washed with dilute sodium bicarbonate
 Olive oil or castor oil into eye

Nitric Acid
 Aqua fortis, Red spirit of nitre
 Clear, colourless, fuming, heavy liquid
 Chocking odour
Uses:
 Metal refinery, electroplating
 Cleansing nickel ornaments
Yellow colouration of tissue:
 Xanthoproteic reaction, production of picric acid
Signs and symptoms
 Similar with sulphuric acid
 Inhalation of fumes  lacrimation, photophobia,
irritation of respiratory track
 More eructation, More abdominal distension
 Yellow coloration of tissues, tooth, clothes
 Oesophagus and stomach mucosa will be brown to black
due to acid hematin.
Fatal dose 10 to 15 ml
Fatal period 12 to 24 hours
Treatment
 Same as sulphuric acid
PM Appearance
 Same with sulphuric acid
 Yellow discoloration of tissues
 Perforation of stomach rare
 Acute inflammation and oedema of respiratory passage
and lungs common
Diagnosis
 Add strong ferrous sulphate solution and sulphuric acid
– brown ring will be formed at the junction of two fluids
Circumstances of poisoning

106.  Accidental or suicidal
 Rarely as an abortifacient or homicidal agent

Hydrocholoric acid
 Muriatic acid
 Spirit of Salts
 Colourless, fuming liquid, pungent irritating odour
Uses:
 Bleaching agent
 Manufacturing chlorine
 Removing fur from leather
Signs and symptoms
 Less corrosive
 Brownish fluid in stomach
 Does not corrode or seriously damage skin
 Grey or grey white colouration of tissue
 Fumes irritation of throat and lungs
Chronic exposure
 Coryza,
 conjunctivitis,
 corneal ulcer,
 pharyngitis,
 bronchitis,
 loosening of teeth
Fatal dose 15 to 20 ml
Fatal period 12 to 24 hrs
Treatment:
 Same as sulphuric acid
PM appearance
 Same as sulphuric acid
 Less corrosion
 Brownish fluid in stomach
 Perforation of stomach rare
 Acute inflamation and edema of respiratory passage and
lungs are common
Diagnosis
 Hydrochloric acid with solution of silver nitrate
produces heavy curdy white precipitate of silver
chloride.

Oxalic acid
 Acid of sugar, salt of sorrel
 Colourless, transparent, prismatic crystal
 Natural constituent of many plants in the form of oxalate
eg: spinach, cabbage etc
 20 ml is excreted in urine daily
Uses:
 Removes stain, ink, iron rust
 Calico printing, book binding, leather works
Mechanism of action
Local
 Crystals and concentrated solution > 10% are corrosive
in nature
 Rarely damages skin
 Corrode mucous membrane
 <10% cause serious systemic effects
 Urinary excretion persist up to 24 hours
Systemic
 Shock.
 Hypocalcemia – combines with calcium ion, death
occur within 12 hours.

107.  Renal damages – oxalates produce tubular necrosis death
by uremia in 2 to 14 days.
Fatal dose – 15 to 20 gms
Fatal period – 1 to 2 hours
Signs and symptom
Fulminating poisoning:
 Large concentrated dose of 15 g or more produces
symptoms and death within minutes
 Burning sore bitter taste
 Severe Burning pain
 Nausea vomiting
 Coffee ground vomitus
Acute poisoning:
 Large dose when patients survive for a few hours
 More symptoms of hypocalcemia
 Less symptoms of GIT.
 Muscle irritability, tenderness, tetany, convulsion
 Numbness and tingling of finger tips
 Cardiovascular collapse, stupor, coma
Delayed poisoning:
 Symptoms of uremia.
 Low urine output, traces of blood, albumin, calcium
oxalate crystals in urine.
 Metabolic acidosis, ventricular fibrillation
Treatment
 Stomach wash using calcium lactate or gluconate
 Antidote – lime water, calcium lactate, calcium
gluconate, calcium chloride, milk.
 10% calcium gluconate iv
 Dialysis in renal failure
 Parathyroid extract 100 units im in severe cases
 Demulcent drinks
PM appearance
 Whitening of mucous membrane
 Longitudinal erosion of oesophagus
 Red stomach mucosa
 Perforation is very rare
 Brownish stomach content acid haematin
 Swollen congested kidneys oxalate crystals in tubule
 Renal tubular necrosis
 Organ congestion
Diagnosis
 A solution of barium nitrate will give barium oxalate
white precipitate soluble in HCL, HNO3

Carbolic acid
 Short, Colourless, prismatic, needle like crystals
 Burning sweetish taste
 Characteristic carbolic or phenolic smell
 Turn pink and liquefy when expose to air
 Slightly soluble in water, Freely soluble in glycerine,
ether, alcohol and benzene
 Commercial – dark brown liquid containing several
impurities
Uses:
 Antiseptic, disinfectant
 Lysol 50% solution of cresol in saponified vegetable oil.
 Dettol – chlorinated phenol with turpineol.
Absorption
 From the alimentary tract, rectum, vagina, serous
cavities, wounds and through the skin

108. Excretion:
 Phenol is converted into hydroquinone and pyrocatechol
in the body - excreted in urine
 Trace is excreted by lungs, salivary glands, skin,
stomach
 Complete excretion 36 hrs
 Partially detoxicated by liver.
Fatal dose 10 to 15 g
Fatal period 3 to 4 hours
Signs and symptoms - Carbolism
Local
 Precipitate and coagulates protein
 Bleach tissues whitish discoloration
 White opaque eschar, painless fall off in few days, and
leaves a brown stain
 Necrosis and gangrene of tissues
 Lysol – brownish purple discoloration
 Skin burning and numbness due to damage to nerve
endings
Digestive tract:
 Burning pain followed by tingling and later anaesthesia
 Deglutination and speech become painful and difficult
 Lips, mouth and tongue are corroded – white and
hardened
Respiratory tract:
 Irritation - Pulmonary and laryngeal edema
 Progressive respiratory failure
 Vomiting - Aspiration bronchopneumonia
Systemic effect
 CNS depressant – respiratory centre.
 Head ache, giddiness, unconsciousness, coma
 Subnormal temperature, pupils contracted
 Rapid feeble pulse
 Respiratory alkalosis, metabolic acidosis
 Haemolysis, methemoglobinemia
 Odour of phenol in breath
 Convulsion and lock jaw
Urine: Carbaluria:
 It is scanty and contains albumin, free hemoglobin
 Colorless or slightly green
 Green or black when expose to air
 In body phenol  hydroquinone and pyrocatechol
excreted in urine further oxidation in air green
color urine
Chronic poisoning
Phenol marasmus
 Anorexia
 Weight loss
 Head ache
 Vertigo
 Dark urine
 Pigmentation of skin and sclera
 Ochranosis
Black pigmentation of cartilage, bones, sclera,
conjunctiva.
Cause of death
 Syncope
 Asphyxia due to failure of respiration, Edema of glottis,
bronchopneumonia
Treatment:
 Emetic often fails – anaesthetic effect.

109.  Stomach wash with plenty of lukewarm water containing
activated charcoal, olive oil, castor oil, magnesium or
sodium sulphate, soap solution, 10 % glycerine.
 After lavage 30g of magnesium sulphate or a quantity of
liquid paraffin should be left in stomach.
 Haemodialysis if renal failure
 Methylene blue iv if there is severe
methhemoglobinemia
 Skin esposure should be washed with solvents like olive
oil, methylated spirit, 10 % ethyl alcohol.
 PM appearance
External:
 corrosion of skin greyish or brown colour
 White and swollen tongue,
 Smell of phenol
 Sodden, whitened mucous membrane
Internal:
 The mucosa of oesophagus is tough white
 Stomach covered by opaque grey or brown coagulated
mucous membrane with intervening red furrows.
 Stomach content reddish fluid shreds of mucos and
epithelium
 Liver, spleen – whitened hard patches
 Kidney - Haemorrhagic nephritis
 Brain congested, oedematous
 Laryngeal, pulmonary oedema
Test:
 Add a few drop of 10% ferric chloride solution to 1 ml
of urine  blue colour will develop.
Circumstances of Poisoning:
 Suicidal
 Accidental
 Abortificant
 In discriminant medicinal use – chronic poisoning.
Caustic alkalis
 Ammonia
 Pottassium hydroxide
 Sodium hydroxide
 Calcium hydroxide
 Ammonium carbonate
 Potassium carbonate
 Sodium carbonate
Action:
 Commonest cause of chemical burn
 Hydroxyl ion  saponification of fat
 Soluble alkaline proteinases
 Cellular dehydration
 Exothermic reaction
 Liquefaction necrosis
Signs and symptoms
 Burning sensation
 Vomiting containing dark altered blood and alkaline
 Feces with mucus and blood
 Skin  greyish, soapy, necrotic area
 Blisters, brownish discoloration of of lips and mouth
 Digestive tract mucosa swollen soft and grey
 Household bleaches: sodium hypochlorite
 Detergents: sodium tripolyphosphate
 Drain cleaners: sodium hydroxide

110. Ammonium hydroxide, Ammoniacal vapour
 Miniature button batteries: potassium hydroxide
Fatal dose
 Potassium or sodium hydroxide 5 g
 Potassium carbonate 18 g
 Sodium carbonate 30 g
 Ammonia 5 to 10 ml
Fatal period usually 24 hours
Treatment
 Demulcents
 In mild cases stomach can be washed
 Ammonia vapour poisoning – oxygen inhalation
 Keep the airway patent – tracheostomy
 Give adequate parenteral analgesics
 Steroids
 Antibiotics
PM appearance
 Marks in mouth, dark brown, parchment
 Corrosion, Inflammatory oedema and erosion of
oesophagus - squamous epithelium severely affected
 Oedema of glottis, mucosa is brown alkali haematin.
 Pseudo membrane formation, Peri bronchial pneumonia
 Perforation rare can occur in ammonia poisoning
 Stricture oesophagus is common
Test
 The caustic alkalis produce a brown precipitate with
silver nitrate

111. 17.DELIRIANTS

Deliriant Poisons
Delirium:
Altered consciousness with confusion, frequently associated
with delusions & hallucinations
 Datura,
 cannabis,
 cocaine.

Datura
Various species:
 Atropa belladonna- devil berries
Plains –
 D. Fastuosa – D. alba (white), D. niger (black or
purple).
Himalayas
 D. Stramonium (extremely deadly)
Parts of Plant
Fruit:
 Spherical with sharp spines (Thorn apple).
Seed:
 Biconcave flattened, brownish in colour resembles chilly
seeds
Active principles
 Hyoscyamine,
 Hyoscine or scopolamine,
 Atropine.
Mechanism of Action
Central actions.
 Initially– (CNS) – excitement,
 Later – depression.
First all higher centers and motor center are stimulated and
then all centers are depressed especially vital centers of
medulla – RS & cardiac
Peripheral actions.
 Blockage of cholinergic fibres  Parasympathetic
paralysis.
 It blocks neurotransmitter acetyl choline action at muscarinic
receptors
 Blocks parasympathetic action
 Excess sympathetic actions
Symptoms & Signs
Blind as a bat
 Pupils dilated, sluggish light reflex, power of
accommodation interfered
Dry as a bone
 Dryness of mouth and throat
 Difficulty in talking , dysphagia, thirst.
Red as a beet
 Face – Flushed due to dilatation of cutaneous blood
vessels.
Hot as a hare
 Body temperature raised, skin dry and hot (inhibition of
sweat secretion).
 Pulse – rapid, full, bounding.
 Respirations – increased.
Mad as a wet hen
 Mental – confused, giddy, staggers, delirious
 Noisy , violent, visual and auditory hallucinations. Picks
at bedding, pulls imaginary threads from tips of fingers
(carphologia).

112.  Dilatation of pupil
 Dryness of mouth and throat, Dysphagia
 Dry and hot skin – due suppression of sweating
 Distension of bladder
 Drowsiness
 Drunken gait and incoordination of muscles
 Delirium
 Death
Stage of Coma
 Drowsy passes into coma.
 Death – Respiratory paralysis
Fatal dose
 50 to 100 seeds.
Fatal period – 24 hours.
Treatment
 Stomach wash with tannic acid.
Physiological antidote –
 Physostigmine 0.5mg, 1- 2 hrly IM/IV
 Pilocarpine 5 -15 mg dose SC
Delirium – short acting barbiturates – chlorpromazine,
diazepam.
Light diet, free purgation for 3 to 4 days – to remove seeds.
Postmortem appearances
 Stomach and intestines – fragments of seeds.
 Congestion of viscera.
 Seeds resist putrefaction.

Poisons which resist putrefaction:
1. Phosphorus,
2. Arsenic,
3. Antimony,
4. Hyoscine,
5. Strychnine,
6. Nicotine,
7. Yellow oleander,
8. Endrin.
Materials to be preserved
 Urine (as active principle excreted unchanged
immediately after administration and for 10 to 20
hours).
Medico-legal aspects
 Suicide – due to easy availability in rural areas
 Homicide – one of popular agents in rural areas
 Accidental – as seeds resembles the capsicum seeds
Stupefaction – literally means making a person stupid.
 Legally means making a person un/ semi conscious and
make him incapable of resistance
 Child kidnapping, theft, rape
 So also called railroad poison.

Cannabis sativa / indica.
Active principle
 Tetrahydrocannabinol.
Preparations
 Ganja – dried flowering tops crushed & smoked in a
pipe, later called Marijuana (pleasurable feeling)
 Bhang – dried leaves and stem made into decoction,
mixed with juice or milk
 Hashish (charas) – dried resin of flowering tops of
female plant, can be chewed or smoked
 Majun – sweet prepared with bhang. It increases appetite
and sexual desire

113. Odour
 Smell – as a burnt rope
Clinical features – acute
 Intial stage of excitation and release of inhibition –
 Excitement, impulsive ideas, talkative
 Uncontrolled laughter
 Appetite stimulant – carving for sweets
 Loss of perception to time, place and person
Later: stage of Narcosis
 Dream like state
 Delusions, hallucinations – frightful
 Giddy, ataxia, deep sleep, coma death due to respiratory
failure
Clinical feature – Chronic
 Amotivational.
 Tolerance
 Psychological dependence
 Reduced serum testosterone
 Reduced sperm count, gynaecomastia
Hashish insanity - Paranoid psychosis - (Run amok).
 An episode of violent behavior. Person claims amnesia.
An intense desire to commit murders. A number of
individuals are killed and the first one against whom he
has real/ imaginary enmity and all others are the those
on the way.
Treatment
Acute
 Decontamination.
 Psychosis – haloperidol.
 Psychotherapy.

Chronic
 Gradual withdrawal.
 Anxiety – diazepam
 Psychotherapy.
Forensic importance
 Drug of abuse.
 Withdrawal reaction.

Cocaine
Erythroxylon coca.
 From leaf - Cocaine (Synthesised)
Synthesised in lab – crack.
 Shiny, white crystals with bitter taste.
Uses
 Topical anaesthetic – cornea, ENT.
Routes of abuse
 Snorting / sniffing.
 Smoking.
 Ingestion.
 Injection IV.
 Sniffing
Clinical features – Acute
1. Stage of early stimulation –
Euphoria,
Hypertension,
Vertigo,
Nausea.
2. Stage of advanced stimulation –
Vomiting,
Muscle Twitching,
Convulsions,

114. Hyperthermia,
Hallucinations,
Circulatory, Respiratory failure.
3. Stage of Depression –
Muscle paralysis,
Reflexes lost,
Coma, death.
Clinical features – Chronic
 Emaciation.
 Hyperactivity, flight of ideas.
 Insomnia.
 Mydriasis.
 Hypertension.
 Blackening of teeth and tongue
 Perforation of nasal septum – due to local vasoconstriction effect
 Magnan’s syndrome – crawling of insects or sand particles under
skin
 Persecuting delusions & perversions mainly homosexuality
Chronic poisoning
 Develops Tolerance.
 Compulsive use – physical dependence.
 To enhance self-image, improve professional performance.
 Snorting / sniffing, smoking.
 Euphoria  depression compulsive intake.
 Complications
 Snorting / sniffing – rhinitis, nasal erosions, perforations.
 Smoking – chronic cough, bronchitis.
 IV – hepatitis, AIDS, venereal disease, endocarditis, osteomyelitis.
Treatment
Acute
 Decontamination.
 Convulsions – Bnz / Barbiturates.
 Hypertension – Propranolol.
 Psychosis – Haloperidol.
 Hyperthermia – ice bath.
 Supportive measures
Chronic poisoning
 Gradual withdrawal.
 Psychotherapy.
Post mortem evidences
 Nasal erosions, ulcerations, perforations.
 Nasal swabs – chemical analysis.
 Visceral congestion.
Body packer syndrome
 Stuffers / mules.
 Smuggling of narcotic drugs by stuffing them inside their
body
 Narcotic drugs are packed in small plastic bags / in condoms
swallowed or stuffed.
 Removed by cathartics, enema, metoclopramide.
 Risk of accidental rupture of plastic bags and toxic overdose
to individuals.
 Diagnosed by x ray.
Forensic importance
 Abuse.
 Accidental overdose.

115. 18.SOMNIFEROUS AGENTS

Somniferous agents:
 Drugs that are Sleep inducing /Narcotic
Opium
 Plant capsules  unripe  Incised  Milky fluid 
Dried  Opium.
Crude Opium – dark brown or grey mass.
Active Principles
1. Phenanthrene – mainly narcotic effect
– Morphine, Codeine, Thebaine.
2. Benzyl isoquinoline – mainly analgesic effect
– Papaverine, Noscapine
Mode of Action
1. Mu receptor
2. Kappa receptor
3. Delta receptor
Various forms
1. Opiate
 All natural and derived products of opium are called
opiates
2. Opioid
 All agonists and antagonists which have morphine like
activity are opioids
Natural
 Morphine - Analgesic
 Codeine - Antitussive
Semisynthetic
 Heroin
 Hydro morphone
 Oxy morphone
Synthetic
 Meperidine - Analgesic
 Methadone - antidote
 Fentanyl - Analgesic
 Paregoric
Routes:
 Oral
 S.C,
 I.V,
 I.M.
Duration of Action –
 Few mins to 8 hrs.
 Ultra short acting – Fentanyl.
Action
 Depresses all centers except
 Oculomotor, vomiting, sweating
1. Stage of excitement
 Very short- well being, talkactive, hallucination,
2. Stage of stupor
 Headache, nausea, vomiting, giddiness, deep sleep
3. Stage of coma
 Deep coma, muscles paralysed, respiratory depression
Pinpoint pupil, hypothermia, hypoglycemia,
hypotension,
4. DEATH
Medico Legal Importance
 Therapeutic,
 Accidental,
 Deliberate overdose.
Acute Poisoning - Treatment
Supportive

116. o ABC,
o Stomach wash though not taken orally
o Wake the patient
o Naloxone – antidote.
o Physostigmine salicylate (0.04 mg/kg IV) reverses
respiratory depression.
o Convulsions – Benzodiazepines.
Chronic Poisoning
o Mood swings. Loss of memory
o Anorexia, Weight loss, Pallor.
o Pinpoint Pupils. Dry skin
o Chronic Constipation
o Decreasing sexual drive
o Dermal scars.
o Amnesia, Confusion, Hallucinations.
o Withdrawal from activities. Unexplained absence.
Locked room.
o Conflicts with law. Pills syringes at scene.
Withdrawal manifestations - Cold Turkey
o Opposite of acute symptoms
o Lacrimation, rhinorrhea, diarrhoea, sweating
o Muscle twitching, goose bumps
o Rise of temperature, BP, Respiratory rate
o Drug carving
o Peaks by 36 to 72 hrs
o Disappears by 5 to 8 days

Chronic Poisoning - Treatment
o Gradual withdrawal.
o Substitution Therapy with methadone 30-40 mg/day
o Beta blocker relieves Anxiety and craving
o Antspasmodics for Abdominal cramps
o Tranquilisers for sedation
o Psychiatric Counselling.
Diagnosis
o Needle marks, Dermal scars.
o Detection in urine, blood.
o Administration of Naloxone precipitates reaction.
Marquis Test
o Suspected solution + H2so4 + formalin – purple to violet
to blue
Postmortem Appearance
External appearance –
o Injection marks, dermal abcesses, scarring.
o Tattooing for concealing injection marks.
o Emaciation, disordered appearance.
Internal Changes –
o Pulmonary oedema with froth from mouth, nostrils.
o Cerebral Oedema.
o Liver congestion with hepatic lymphadenopathy.
Lab Tests –
o Chemical analysis Positive in Hepatic lymph nodes.
o Blood, bile, urine samples.
o Presence of Serum Hepatitis, AIDS.
Medico legal aspects
o Abused by medical and paramedical
o Codeine – over the counter – abused by youth.
o Accidental deaths – i.V abusers (heroin)
o Suicides.
o Homicides

117. Heroin
o Widely abused.
o High solubility – Blood brain barrier crossed.
o Intense Euphoria  Sedation  Wear off.
Forms of Heroin
o Speedball – with cocaine
o Street Heroin -- + additives and adulterants.
o Cutting – Deliberate Adulteration.
o Hot shot – Heroin + Strychnine.


Pethidine
o Mu agonist
o Less effective than Morphine.
o CNS effects in toxicity. Excitation with Tremor, muscle
twitching, convulsions.
o Acute treated with Naloxone, diazepam IV barbiturates,
Carbamazepine.
o Abused by medical and paramedical personnel.




Codeine
o Oral – 60%
o Specific Antitussive action.
o Home Bake – Demethylation of Codeine  Morphine,
Heroin
o Sets – Glutethemide + Codeine


Fentanyl
o Synthetic.
o Mu agonist.
o 80 times more potent as Morphine.
o Anaesthetic
o Abuse – Sniffed, smoked, injected, on buccal mucosa,
gargled.
o Designer drugs – Recreational drugs – Alpha methy
fentanyl, 3-methyl fentanyl, fluorofentanyl.

118. 19.PSYCHOTROPICS AND
HALLUCINOGENS

Psychotropic Agents
Any drug that affects the
 Mental activity
 Behaviour
 Perception
Is called as Psychotropic Agents
Three types
1. Anti-depressants
2. Anti-psychotics
3. Hallucinogens
1. Anti-depressants
 Amphetamines
 Tri cyclic anti-depressants
 Monoamine oxidase
2. Anti-psychotics
 Phenothiazine
 Butyrophenones
 Indoles
3. Hallucinogens
 LSD
 Phencyclidine
 Psilocybin

Amphetamine
 Alpha‑methyl phen ethylamine
 is a potent CNS & CVS stimulant
 Used in the treatment of Attention Deficit Hyperactivity
Disorder (ADHD), Narcolepsy
 First synthesised in 1887.
Derivatives
 Methamphetamine, dextro amphetamine, levo
amphetamine
Synthetic analogues:
 MDA – methylene dioxy Amphetamine – Love Drug
 MDMA - methylene dioxy methamphetamine- Ecstacy
 MDEA - methylene dioxy ethamphetamine- Eve
Mechanism of action:
 Increases dopamine and nor epinedrine at synaptic centres
 By increasing the release from storage vesicles or by
inhibiting re uptake
 Potent stimulant of CNS & CVS
Uses:
 Attention Deficit Hyperactivity Disorder (ADHD),
 Narcolepsy
 Hypotension - mephentramine
Acute poisoning
CVS
 Tachycardia
 Dysrhythmia
 Hypertension
 Aortic dissection
 Myocardial ischemia
CNS
 Agitation, restlessness, confusion
 Headache, hyperactivity, hyperthermia
 Intracerebral haemorrhage
 seizures

119. GIT
 Nausea vomiting
 Ischemic colitis
Others
 Tachyapnea, tremor, muscle rigidity
Chronic poisoning
 Amphetamine psychosis
 Delusion of persecution
 Visual and tactile hallucination
 Paranoid personality
 Aortic and mitral regurgitation
 Cardiomyopathy
 Dermatitis
 Meth mouth
 Darkly stained, crumbling teeth, extreme cavities,
xerostomia, lock jaw
Management
Acute
 Decontamination
 Acidic diuresis
 Benzodiazepines
 sodium nitroprusside
 Ice bath

Chronic
 Chlorpromazine
 haloperidol

Lysergic Acid Diethylamide LSD
 Colourless
 Odourless
 Bitter taste
 Semisynthetic compound
 Lysergic Acid – part is natural obtained from fungus –
ergot fungus – Claviceps purpura
Mechanism of Action
 Potent Serotonin Receptor Agonist.
 Serotonin receptor are of seven types – 5 HT 1 to 5 HT
7.
 Except 5 HT 3 and 5 HT 4, it stimulates all mainly 5 HT
2A
 Rapidly absorbed from GIT and distributed with high
concentration in lungs, liver, bile, kidneys and brain.
 Half-life is 175 mins
 Effect starts from 25 µg
 Average recreational dose is 100 to 500 µg
Most common mode of taking is by placing on absorbent paper
 Tiny tablets – micro dots
 Coated over stamps - licked
 Coated over nails – licked
Signs and symptoms
 Taking a trip – rapid onset and relatively mild
 Good trip, bad trip, return trip
 Starts after 2 hrs, peaks in 2- 6 hrs and fades of after 12
hrs
1. Somatic symptoms
2. mood and perceptual changes
3. psychological changes
1. Somatic changes:
 Dilated pupils, photophobia
 Ataxia, muscle rigidity
 Increases HR, BP, RR

120.  Nausea, GI cramps, sweating
2. Psychological changes
 Illusions
 Hallucinations
 Depersonalization – feel separated from one’s own
personal physicality
 Derealisation – world seems unreal and strange
 Violent and panic
 Synaesthesia – stimulation of one sense leads to
experiences in another senses – colours are heard,
sounds are felt.
 Feeling like able to fly – may jump out of window
 Return trip
Adverse effects
 Depression
 Mood changes
 Panic attacks
 Paranoid states
 Psychosis
 Schizophrenic episodes
Tolerance
 Develops in 2 – 3 days
 Loss in 4 – 6 days
 Cross tolerance to other hallucinogens – phencyclidine,
psilocybin, mescaline.
 No with drawl syndromes
Flash back phenomenon
 Spontaneous reoccurrence of symptoms weeks or
months after last usage…. Free trip, return trip…
Fatal dose and cause of death
 200 µg/kg or around 14000 µg or 14 mg for a 70-kg
human
Cause of death
 May be due to psychic activity
 And Respiratory Failure
Management
For bad trips:
 Anxiolytic – diazepam
 Removal of sensory stimuli
 Prolonged talking – known as talking the person down –
for 12- 18 hrs

Phencyclidine
 Angel dust
 Recreational hallucinogen
 Formerly used as anaesthetic agent
 First synthesised in 1926
Mechanism of action
 Blocks NMDA receptor
Clinical features: RED Danes had Bad Cold
 R- rage
 E- erythema
 D – dilated pupils
 D - delusions
 A - amnesia
 N – nystagmus
 E - excitation
 S – skin dryness
 B – bizarre behaviour, increase in bp
 A – acute psychosis, agitation, ataxia

121.  D - dysarthria
 C - catatonia
 O - coma
 L - lethargy
 D – violent tendencies
Management
 Fatal dose is ingestion 100 mg, blood levels – 0.1 mg %
 Gastric lavage
 Acid diuresis
 Specific antigen biding fragment FAB therapy promising
in animals.
Medico Legal Importance
 Chief dangers are due to psychological effects
 Impairment in judgements – dangerous accidents
 Depression
 Suicides

122. 20.SPINAL POISONS

Strychnos Nux vomica.
 Strychnine powerful alkaloid
 Mainly act on the Spinal Cord
Ripe fruits –
 Round hard glossy orange, contain seeds which are
poisonous.
 Seeds – 2 cms diameter, half cm thickness, concave on
one side and convex on the other, ash-grey with fine
hair, with a bitter taste.
Active Principles
Alkaloids.
 Strychnine.
 Brucine – bark, wood, leaves.
 Glycoside
 Loganin
Fatal dose
 One crushed seed
 50 to 100mg
Fatal Period – 1 to 2 hrs
Action
 Ventral horn cells  inhibits glycine
o Increased reflex excitability.
o Normal inhibition of motor cell stimulation is lost so
that any slight stimulus such as noise, light, air,
breeze violent reflex generalized muscle spasms.
Symptoms & signs
Only crushed seeds are poisonous
Prodromal symptoms
o Bitter taste in mouth
o Sense of suffocation and fear
o Difficulty in swallowing
o Increased rigidity of muscles
o Muscular twitching
Convulsion
• Opsithotonus – backward bending of spine
• Empristhotonus- forward bending of spine
• Pleurosthotonus – lateral bending of spine
• Risus Sardonicus – facial muscles contracture
Cause of death
o Respiratory paralysis
o Medullary paralysis
Treatment:
o Dark room, free from noise, disturbance
o Convulsion – Diazepam 0.1 to 0.5 mg/kg i.v
Phenobarbital
o Stomach wash with charcoal, tannic acid
Post mortem appearance
o Rigor mortis appears early
o Extravasation of blood in muscles
o Mucosa of GIT congested
o All viscera congested
Forensic Importance
o Cattle poison- sui - needle shaped dried strychnine
extract
o Homicide – though bitter mixed with other food
o Suicide – rare as it causes painful death
o Accidental – adulterant in home medicines by quakes

123. 21. RESPIRATORY POISONS

RESPIRATORY POISONS - ASPHYXIANTS
DEFENITION
 Any gas or vapor that can cause unconsciousness or
death by inducing suffocation due to lack of oxygen
Classification
1. Respiratory irritants
2. Chemical asphyxiants
3. Simple asphyxiants
4. Volatile drugs
5. Systemic asphyxiants
1. Respiratory irritants
 Local irritant to air passage, lungs or both
eg: ammonia, formaldehyde, tear gases
2. Chemical asphyxiants
 Combine with haemoglobin or act on some tissue and
prevent oxygen from being used by the tissue
eg: carbon monoxide, hydrogen sulphide, arsine
3. Simple asphyxiants
 Inert gases in high concentration (20-30%) acts
mechanically by excluding oxygen
eg: carbon dioxide, methane, nitrous oxide, helium
4. Volatile drugs
 Little or no irritant effect on air passage , act after
absorption in blood as anaesthetic or toxic to liver,
kidney, or CNS
eg: aliphatic/aromatic hydrocarbons
5. Systemic asphyxiants
eg: insecticides, arsine, stibine

CARBON DIOXIDE
 Atmosphere contains 0.4%
 Colorless, odorless, heavy gas
 Solid state – dry ice - Used for industrial purpose
Sources
 Mine explosion
 Deep wells
 Manholes
 Decomposition of organic matter
Uses
 As fire extinguisher
 As respiratory Stimulant
 Soft drinks Aeration
 Gas welding
Action
Mild dose
 Stimulates breathing
Excess dose
 Paralyses the respiratory center
Clinical feature
According to arterial oxygen – four stages
 Stage of indifference
 Stage of compensation
 Stage of disturbance
 Terminal stage
1. Stage of Indifference
 90% saturation of oxygen
 Decrease in night vision
2. Stage of Compensation:
 82 – 90% of oxygen saturation.
Increase in

124.  Pulse rate,
 Respiratory rate
Reduction in
 Performance ability,
 Alertness
 Night vision
3. Stage of Disturbance
 oxygen saturation of 64 – 82%
Clinical features
 Fatigue
 Tunnel Vision
 Dizziness
 Hyperventilation
 Memory Loss
 Confusion
 Poor judgement
4. Terminal / critical stage
 Oxygen saturation is less than 60%
 Fall in Judgment
 Decrease in Coordination Abilities
 Unconsciousness
 Death
Management
 Removal from environment
 Airway care
 Artificial respiration with positive pressure oxygen
Autopsy Findings
 Cyanosis
 Prominent Postmortem hypostasis
 Dilated pupil
 Petechial hemorrhage
 Pinkish red color and fluidic blood
 Organs congested
Medico legal significance
Accidental
 Mines
 Deep well
 Manholes


CYANIDE
Physical Properties
 Gas – hydrogen Cyanide.
 Liquid – Hydro cyanic acid or Prussic acid.
 Salts are crystalline white
 Smell of Bitter almonds.
20 to 40 % of male do not posses the capacity to smell it – sex
linked trait.
Sources
Plant origin
 Cyanogenic glygoside with digestive enzymes releases
cyanide
 Seeds of peach, plum, apricot, apple. Pear
Drugs containing CN – sodium Nitro–prusside.
Combustion
 Burning of plastic furniture
 Burning of silk, wool
 Cigratte smoking
MODE OF ACTION
 Histotoxic anemia.
 Blocks cytochrome oxidase

125.  cytochrome oxidase in electron transport chain -
conversion of glucose to ATP.
 Death of cell due to lack of ATP.
 Also anaerobic glycolysis starts leading to accumulation
of lactic acid
 Metabolic acidosis
Acute Poisoning
Inhalation – immediate coma.
Ingestion – slower onset of coma
 CNS – headache, anxiety, agitation, convulsion, coma
and dilated Pupils.
 CVS - Tachycardia, Hypertension, Arrhythmias.
 RS – Pulmonary edema.
 GIT – Nausea, vomiting, abdominal pain
 Skin – Brick red color (decreased utilization of O2 by
tissues.
Chronic symptoms
Optic atrophy.
 Leber’s disease – congenital absence of rodanese
 Tobacco amblyopia
Neuropathy
 Tropical ataxic – ingestion of tapioca
Diagnosis
 Bitter Almond smell
 Serum Cyanide level
LEE – JONES bed side test:
Gastric Aspirate +NaOH + FeSo4 ---- Greenish blue colour
Treatment
 Assisted Ventilation with 100% oxygen
 Antidotal therapy
 Amyl nitrate + Sodium Nitrate + Sodium Thiosulphate
 4- Dimethyl aminophenol
 Cobalt EDTA
 Hydroxycobalamine
Forensic importance
 Suicidal – Cyanide bottles by LTTE
 Accidental – can happen
 Homicidal.
 Judicial hanging


CARBONMONOXIDE
Physical features:
 Colourless, odourless, non irritating, lighter than air
Sources:
 Incomplete combustion of any fuel
 Automobile exhaust
 Tobacco smoke (endogenous)
Fatal dose: 50-60% of COHb
Mode of action:
 Affinity to Hb 200-300 times more than O2
 Reduced arterial oxygen content with normal PO2
 CO causes leftward shift of oxygen dissociation curve->
affecting offloading of oxygen from haemoglobin to
tissues
 Decreased ability of haemoglobin to carry oxygen and
release to the tissue

126. Clinical features:
ACUTE

Characteristic features of CO poisoning
 Cherry red colour of skin and tissues (2-3%)
 Development of cutaneous bullae
Features of chronic poisoning
 Headache, dizziness, confusion
 Weakness, nausea, vomiting, abdominal pain
 Paraesthesia
 Visual disturbances
 Hypertension, hyperthermia
 Cherry red skin
 Palpitations, aggravation in angina
Diagnosis:
 Estimation of CO Hb level (normal range- 1-5%)
 Pulse oximetry- look for oxygen saturation
 Arterial blood gas analysis- PaO2 normal but O2
saturation is less.
 Metabolic acidosis present
 ECG- features suggestive of myocardial ischemia
- ST segment elevation or depression, flattening or
inversion of T waves and arrhythmias
 Chest X ray- ground glass appearance, peri hilar haze,
intra alveolar edema
Bed side tests:
Hoppe- Seyler’s test:
1ml of blood + 10ml of water + 1ml 5% NaOH
 Normal blood - brownish green
 COHb - remains pink

Kunkel’s test / tannic acid test:
Tannic acid added to blood
 Oxyhaemoglobin - deep brown
 COHb - remains pink
Treatment:
 Immediate removal from the contaminated environment
 No treatment required if person is conscious and
breathing
 Treatment required if cohb level is >25%
 Hyperbaric oxygen therapy through tight fitting mask /
endotracheal tube
 Monitor cardiac and respiratory status
 Convulsions- I.V diazepam/ phenytoin
 Complete rest for 48hrs
 Prophylactic antibiotic for lung infections
 Cerebral oedema - fluid restriction, mannitol
Hyperbaric oxygen therapy:
 Inhalation of oxygen at a pressure greater than 1
atmosphere absolute

127. Advantages:
incidence of neuropsychiatric symptoms is less in
patients who are treated with HBO
Disadvantages:
cerebral gas embolism, rupture of tympanic membrane,
visual deficit, oxygen toxicity, convulsions
Autopsy Findings
 Cherry red / pink post-mortem lividity (30-40% COHb)
 Cutaneous bullae seen in calves, buttocks, wrist and
knees
 Cherry red colour of blood and tissues (30-40%COHb) -
15-20% of cases
Similar discolouration seen in cyanide and
hypothermia
 Congestion of lungs with pink fluid blood
 Pulmonary and cerebral oedema
Delayed death:
 Necrosis and cavitation of basal ganglia esp putamen
and globus pallidus
 Tiny focal necrosis of myocardium
 Punctiform and ring shaped haemorrhages seen in white
matter of brain
Chemical analysis:
Routine viscera
 10ml of blood from heart- sodium fluoride as
preservative in tightly sealed air tight container
 If enough blood not available- spleen / muscle
 Ligate lungs at the bronchus- put in nylon bag-
refrigerate and sent
 Badly burnt body- CO from bone marrow
 CO not absorbed after death or produced as by product
of putrefaction and not altered by putrefaction,
embalming or burial
Medico legal importance
 Accidental - defective exhaust for generators /
automobiles
 Suicidal - rare in India.
 Common in western countries
 Start a car in closed garage
 Putting head inside gas oven
 Homicide- very rare
 Sabotage ventilation of gas heaters
 Adults incapacitated by drink

WAR GASES
 The term war gases include any chemical ( gas, liquid or
solid ) which is used to kill or injure or incapacitate the
enemies in war times.
 These agents are dispersed as tiny droplets through
chemical shells, spray tanks, bombs and missiles.
 Harmful effects produced by inhalation, ingestion or by
contact with skin and mucous membrane.
1. Vesicant or blistering gases
 Sulphur
 Mustard
 Phosgene
 Oximes
 Lewisite (arsenic)
All are volatile liquids
Discharged with artillery shells
• Irritation of eyes, nose, throat & respiratory passages

128. Clinical Features:
• Skin erythema, blister formation, intense itching, ulcer
formation in moist areas
• Nausea, vomiting, abdominal pain
Treatment:
• Wash affected parts with water.
• Eyes with sodium bicarbonate
• B.A.L
2. Asphyxiants or lung irritants
 Chlorine - gas
 Phosgene – gas
 Nitrous oxide - gas
 Sulphur dioxide -gas
 Ammonia- gas
 Chloropicrin – liquid
 Diphosgene - liquid

Mode of action:
• Action mainly on pulmonary alveoli producing pulmonary
edema
• Headache, vomiting, cyanosis, strenuous breathing, collapse
& death
• Death occurs in 24 – 48 hrs by acute pulmonary edema
Treatment:
• Wash eyes with boric acid
• Oxygen and adrenaline
• Anti tussives & Antibiotics
Nasal irritants
 Diphenyl chlorarsine
 Diphenylamine chlorarsine
 Diphenyl cyanarsine
 Solid organic compounds of arsenic
Sixty time heavy as air
 Specific action at vomiting centre in brain
Clinical features:
 Intense pain and irritation of nose, sinuses, sneezing,
headache, salivation, nausea, vomiting, tightness of
chest.
Nerve gases
 Tabun - GA
 Sarin- GB
 Soman- GD
 Esters of phosphoric acid
 Heavier than air
 So, tend to sink into valleys, basement, trenches

Mode of action:
 Similar to organophosphorous
 Inhibit acetyly choline esterase
 Exposure to large amount cause loss of consciousness in
seconds followed by convulsions.

Tear Gases
General properties
 Non-lethal lachrymatory agents.
 Sensory irritation to disabling physical effect.
 Disperse crowd.
 Clear a building.
Includes
 Pepper spray (2 hours)
 Tear gas. (15 mins)

129. Pepper spray
 MACE spray. (Active agent is capsaicin from capsicum).
 Pava spray. (synthetic analogue – Pelargonic acid).
Tear gas
 Any chemical used to cause temporary incapacitation,
irritation of eyes/ RS.
 Hand-held or in canisters.
 Produce clouds due to aerosols.
 ORTHO-CHLORO-BENZYLIDENE-MALO-NITRILE
(CS)
 CHLOR-ACETO-PHENONE (CN),
 DIBENZOX-AZEPINE (CR).
Treatment
 Skin – soap and water, 5 to 10% of soda soln.
 Skin – calamine. Vesicles to be drained. Denuded areas
– irrigated and topical antibiotics.
 Eye – flushed with water, topical antibiotics.
 Pulmonary – oxygen, assisted ventilation,
bronchodilators, antibiotics.
 Intensive air exchange.
 Powders in streets to be washed with water.

130. 22.INEBRIANTS
Definition:
 Any substance that intoxicates.
 Induces mental confusion, light headedness, disorientation,
drowsiness
Eg: Alcohol, Chloral hydrate, Formaldehyde, Paraldehyde
ETHANOL
Synonym: ethyl alcohol, grain alcohol
Classification: Inebriant, Centrally Acting, Neurotoxic,
Systemic Poison
General features:
 Clear,
 Colourless,
 Volatile liquid with a faint fruity odour and sweetish
burning taste
Sources:
 Produced by fermentation of a sugar (cereal, vegetable
or fruit) with yeast.
Cereal - malted - convert starch to maltose - fermented by
yeast
Fermentation stops- alcohol concentration 15% by volume-
death of yeast
 Alcohol separated by distillation
Beverages:
 Alcohol mixed with water and small amount of
congeners
Congeners:
 By- products of fermentation used as additives in
alcoholic drinks which gives characteristic flavour,
odour and colour
Eg: propyl alcohol, butanol, aldehydes, ketones, glycerine,
heavy metals like lead, cobalt etc
Ethanol content in alcoholic beverages- volume percentage /
proof
Proof: Twice the percentage of alcohol content of the drink
Proof spirit:
 Standard mixture of alcohol and water of relative density
12/13 at 51⁰F (57.10% by volume)
 Underproof: weaker spirit
 Overproof: stronger spirit
Absolute alcohol - 99.95% alcohol
Rectified spirit - 90% alcohol
Denatured alcohol/ methylated spirit- 95% alcohol and 5%
wood naphtha
Common drinks and its alcoholic content
1. Light beer ( lager, pilsener, breezer)- 4-6%
2. Heavy beer ( ale, stout)- 6-8%
3. Natural wine ( claret, cider, champagne) - 10-15%
4. Fortified wine (port, sherry) - 15-20%
5. Whisky, gin and brandy- 40-45%
6. Rum - 50-60%
7. Vodka - 60-65%
USES:
Beverage
Apart from the popular ones, indigenous preparations available
1. Arrack (33%)
2. Toddy (4-8%),
3. Feni (43-45%)- India
4. Tequila ( 40%)– Mexico
5. Sake (20%) – Japan
6. Eau de vie / fruit brandy (40-43%) – France

131. OTHER USES
 Solvent: after shaves, colognes, perfumes
Medical:
 Antiseptic – surgical spirit ( ethanol 95% and methanol
5%)
 Injections – relieving pain in trigeminal neuralgia
 Antihistaminic and cough syrups (2-2.5%)
 Preservative: rectified spirit (90-95%)
 Antidote for methanol and ethylene glycol poisoning
 Ethanol sponging- hyperthermia
Usual fatal dose:
 1 pint (550ml) / quart ( 2pints / 1100ml) of strong
distilled spirit like whiskey taken in short span of time
 Based on body mass - 6gm of alcohol /kg – adult
-3gm of alcohol / kg – child
 Based on blood alcohol level – 400-500gm/100ml
 Mixing of drinks - greater intoxication than the amount
consumed
 Form substances which increase the rate of stomach
emptying- rapid absorption of alcohol
Mechanism of action:
Two theories
1. Acts on GABAA receptors and chloride ion channels
2. Acts on N-methyl D-aspartate (NMDA) ligand gated
glutamate receptors and inhibit its functions
Metabolism:
 Require no digestion- smaller molecular size- pass
through membranes by simple diffusion
 Absorption starts from mouth and oesophagus
 80% absorbed from small intestine and 20% from
stomach
 Maximum concentration in blood- 45-90 min after
ingestion
 Effected by presence of food, carbonated drinks,
temperature of the drink, dilution, strength, gastrectomy
 90% -liver 10% - excreted unchanged by kidney,
lungs and sweat
Average rate of metabolism –
100-125 mg/kg/hr - occasional drinker
175mg/kg/hr - habituated drinker
Blood alcohol level fall- 15-20mg/ 100ml / hr
30mg/100ml/hr- habituated drinker
Metabolism- 3 pathways in liver
 Alcohol dehydrogenase pathway (in cell cytosol)
 Microsomal ethanol oxidizing system ( ER)
 Peroxidase - catalase system (hepatic peroxisomes)
Alcohol Dehydrogenase Pathway
Alcohol
Alcohol dehydrogenase
Acetaldehyde
Aldehyde dehydrogense
Acetic acid

Acetyl Co enzyme A
Krebs cycle
Co2 + water

EFFECTS
CNS:
 Depressant but produces apparent stimulating effect by
depressing the inhibitory control mechanism of the brain
 Depresses reticular activating system

132.  Frontal lobes- mood changes
 Occipital lobe- visual disturbances
 Cerebellum- loss of coordination
 Cerebral cortex- centres affecting conduct and
judgement resulting in unrestrained behaviour
 Increasing concentration- progressively depress brain
functions
 Depresses vital centers in mid brain and medulla -
death from cardiac or respiratory depression
CVS:
 Tachycardia and vasodilatation of cutaneous vessel->
warm and flushed skin
creates a sensation of warmth but actually causes heat
loss
GIT:
 Stimulate salivary and gastric secretion. Depresses in
large quantities. Mucosa congested and inflamed ->
erosive gastritis
Genito – urinary:
 Inhibits ADH and produces diuresis.
Not an aphrodisiac:
 Loss of inhibition and restraint rather than sexual
stimulation
 Large dose- effects the performance ( failure of erection/
premature ejaculation)
Clinical features- acute



Chronic alcohol poisoning (alcoholism/ ethanolism)
 Condition in which an individual consumes large
amount of alcohol over long period of time.
Characteristic features:
 Pathological desire for alcohol intake (CAGE criteria)
 Black outs during intoxication
 Withdrawal symptoms on ceasing alcohol intake

133. Medical complications of alcoholism
GIT:
 Gastritis, increased rate of oropharyngeal and
oesophageal cancer
Liver:
 Fatty liver with portal hypertension, hepatitis, cirrhosis,
hepatic carcinoma
Pancreas:
 Acute/chronic pancreatitis
CVS:
 Cardiomyopathy (munich beer heart syndrome),
dysrhythmias, hypertension
CNS:
 Polyneuropathy, cerebellar degeneration, demyelination
of corpus callosum (marchiafava- bignami syndrome),
amblyopia, stroke
RS:
 Aspiration pneumonia
Endocrine:
 Hypogonadism and feminisation in males, amenorrhea,
menorrhagia in females, infertility
Blood:
 Anaemia and thrombocytopenia








Alcohol Withdrawal Syndrome



Withdrawal
reactions
Period of onset Features
Common
abstinence
syndrome
6-8hrs Tremors affecting hands, legs and
trunk (shakes), agitation, sweating,
nausea, headache, insomnia
Alcoholic
hallucinosis
24-36hrs Objects appear distorted in shape,
shadows seems to move
Seizures
(rum fits)
7-48hrs Clonic-tonic movements, with or
without loss of consciousness
Alcoholic
ketoacidosis
24-72hrs Drowsiness, confusion,
tachycardia, tachypnea developing
into kussmaul breathing pattern
and coma
Delirium
tremens
3-5 days Disorientation, loss of recent
memory, vivid visual and auditory
hallucination, severe agitation,
tremors, sweating, fever,
tachycardia and dilated pupils.
Dehydration and electrolyte
imbalance characterisitc
Wernicke-
korsakoff
syndrome
gradual Rare withdrawal phenomenon due
to thiamine deficiency. Acute
form- wernicke encephalopathy.
Drowsiness, disorientation,
amnesia, peripheral neuropathy,
and nystagmus. Gradually develops
into chronic amnesic syndrome -
korsakoff’s psychosis. Impairment
of memory and confabulation

134. Differential diagnosis

Treatment
Acute poisoning
 Airway protection, ventilator support
 Stomach wash
 Thiamine 100mg I.V
 50% dextrose (50-100ml I.V)
 I.V fluids
 Effectiveness of caffine, naloxone and physostigmine
not proven
Chronic poisoning
Alcoholic hallucinosis:
 Phenothiazine (chlorpromazine 100mg 8
th
hourly)
Alcoholic ketoacidosis:
 Correction of volume depletion by I.V fluids
 Correct electrolyte imbalance with potassium
supplements
 Thiamine to prevent the development of wernicke-
korsakoff syndrome
Delirium tremens:
 Well lit reassuring environment
 Diazepam 5-10mg i.v for agitation
 Thiamine (50-100mg)
 Correction of fluid and electrolyte imbalance
Wernicke- korsakoff syndrome
 Thiamine 50-100mg I.V daily as infusion for 5-7
days
 Fluid replacement
Aversion therapy- Disulfiram therapy:
 Interferes with the metabolism of alcohol at the
acetaldehyde stage as a result acetaldehyde accumulates
and produce unpleasant symptoms
 Ensure patient is off alcohol for minimum period of 12
hrs
 Dose: 250mg/day for indefinite period of time
Disulfiram-ethanol reaction
Warn the patient explicitly of the reaction which can occur
even with small quantity of alcohol may even be fatal
 GIT: abdominal pain, nausea, vomiting
 CNS: blurred vision, confusion, vertigo, headache and
weakness
 CVS: syncope, hypotension, tachycardia, arrhythmia, chest
pain
 Skin: sweating, flushing, pruritis
 RS: Tachypnoea
Post mortem appearance
 Congested conjunctiva
 Characteristic fruity odour
 Congestion of g.i.t
 Pulmonary and cerebral edema
 Stigmata of chronic alcoholism (fatty / cirrhotic liver,
cardiomyopathy)

135.  Routine viscera + one half of brain + csf and vitreous
humor.
 Blood to be collected from peripheral veins
Medico legal importance
 Assaults, brawls, homicides, suicides – associated with
alcohol
 Ethanol and crime – sec 86 IPC and 85 IPC
 DUI – punishable offence throughout the world.
Punishable in India (IMV Act Sec 185).
 Surgeon performing surgery under influence of alcohol-
sec 304(A) IPC
 Professional misconduct
Accidental death
 Adulteration with chloral hydrate- mickey finn /
knock out drops
 Illicit brewing of alcohol- adulteration with
methanol- hooch tragedy
DRUNKENNESS
 A person is said to be drunk if he is so much under the
influence of alcohol that he has lost control of his
faculties to the extent that he is unable to execute safely
the occupation which he was engaged in material time.
BREATHALYSER
Henry’s law
 Volatile compound dissolved in liquid and is brought to
equilibrium with air there is a fixed ratio between the
conc of compound in the air and liquid when the
temperature is constant.
 Ratio between breath and blood alcohol level- 2100:1
 Blow into plastic container containing crystalline
dichromate – sulphuric acid mixture
 Sophisticated versions – fuel cell sensing, electro
chemical oxidation, infra red photometry,
microprocessors.
Limitation
 20mg% - Poland, Sweden
 30mg% - India
 50mg%- Finland, Norway, Netherlannds
 80mg% - Denmark, Germany, U.K , France And
Switzerland
 100mg% -Ireland
In practice conviction based on drunkenness certificate
WIDMARK’S FORMULA
 To calculate the amount of alcohol in the body from
concentration of alcohol in blood or urine.
a= pcr
a - Weight of alcohol present in body in gms
p - Weight of person in kg
c – Conc of alcohol in blood in mg/kg
r- Constant (0.68 for males and 0.55 for females)
a= ¾pqr
a - Weight of alcohol present in body in gms
p- Weight of person in kg
q- Conc of alcohol in urine in mg/kg
r- Constant (0.68 for males and 0.55 for females)

METHANOL
Synonym:
 Methyl alcohol, wood spirit, colonial spirit, wood
naphtha
 Clear, colourless, volatile liquid with characteristic
odour and bitter taste

136. Uses:
1. Antifreeze (10-50%)
2. Denatured spirit (5-10%)
3. Embalming fluid (20%)
4. Leather dyes (30%)
5. Varnish (5%)
6. Windshield washing fluid (35-95%)
Fatal dose: 70-100ml
Metabolized in liver
Alcohol dehydrogenase
Formaldehyde
Aldehyde dehydrogenase
Formic acid
(Retinal toxicity and metabolic acidosis)
Clinical features
 Symptoms after 12-24hrs
Early manifestations:
 Vertigo, Headache with Meningismus, Nausea,
Vomiting, Abdominal Pain
Later:
 Ocular Toxicity - Blurred or Dimmed Vision,
Photophobia.
Examination:
 Dilated pupil with sluggish light reaction
Fundoscopy:
 Hyperemia of optic disc and retinal edema
Irreversible sequlae:
 Optic atropy and visual field impairment

 Severe metabolic acidosis (high anion gap)
 Tachycardia, hypotension, hypothermia
 Convulsion followed by coma
 Cause of death: respiratory failure
Diagnosis:
 High anion gap acidosis
 Elevated osmolal gap
 Blood methanol level- more than 50mg/100ml
Treatment
 Stomach wash with sodium bicarbonate (500ml retained
in stomach after lavage)
 Specific antidote: ethanol
 Competes for alcohol dehydrogenase- prevents
metabolism of methanol- excreted unchanged in urine
 10% ethanol at dose of 10ml/kg for 30min bolus
followed by 1.5ml/kg/hr maintenance dose (I.V)
 1ml/kg of 95% ethanol in 180ml of fruit juice over 30
min. maintenance dose- 0.17-0.28ml/kg/hr of 50%
ethanol in fruit juice (oral)
Alternative:
 4-methyl pyrazole / fomepizole
Advantage: does not cause CNS depression
 Sodium bicarbonate- 500-800ml of 7.5%solution slow
I.V
 Folinic acid- 1-2mg/kg 6
th
hourly I.V - hastens
elimination of formic acid
 Haemodialysis- removing methanol, formaldehyde and
formic acid
Postmortem appearance
 Cyanosis especially in upper parts of body
 Toxic damage in liver and kidney
 Lungs- edema, emphysematous changes,
desquammation of alveolar epithelium

137.  Retinal edema
 In addition to routine viscera preserve one cerebral
hemisphere.
Medico-legal Importance
 Accidental- liquor tragedies / hooch tragedies –
adulteration of arrack

Ethylene glycol
 Colourless, odourless, syrupy, non volatile liquid with a
bitter sweet taste
Uses:
 Anti freeze
 Coolant
 Hydraulic brake fluid
Fatal dose : 70-100ml
Mechanism of action
 Rapidly absorbed through GI tract
 Metabolised to glycoaldehyde, glycolic acid and oxalic
acid - inhibits several metabolic pathways
Clinical features


Treatment
 Stomach wash and activated charcoal
 Antidote: ethanol I.V (dose same as methanol poisoning)
 Fomepizole better alternative
 Sodium bicarbonte I.V
 Pyridoxine 50mg and thiamine 100mg I.M, 6
th
hourly for
2days
 Monitor serum calcium and replace as required with
calcium gluconate 10% I.V
Postmortem appearance
 Cerebral edema
 Toxic damage to liver and kidney
 Oxalate crystals in brain, spinal cord and kidney
Medico-legal significance
 Suicidal poisoning

VOLATILE SUBSTANCE ABUSE
Synonym: Solvent abuse , glue sniffing
Deliberate inhaling of volatile substances
Substances commonly abused:
 Toulene, petrol, xylene, benzene, methylene, ethylene
chloride, carbon tetra chloride, butane, propane,
kerosine, acetone.
 Paint remover, correction fluids, fabric cleaner, glue
solvent
 Inhaling vapours from a cloth saturated with volatile
substance- huffing
 Inhaling and exhaling into a bag containing volatile
substance- bagging
 Inhaling directly from the neck of the container- sniffing
Clinical manifestation:

138.  Depends on the substance abused
 Effect vary from condition resembling alcohol
intoxication to actual hallucinations
 Behaves irrationally, commit antisocial acts, may
commit suicide
 Complete amnesia of period of intoxication
 No physical withdrawal reactions
Postmortem appearance
 Reddening and excoriation of skin around the nose and
mouth due to irritant action of the solvent
 Severe damage of the liver, kidney, bone marrow, and
nervous system
 Chemical examination- clothing, blood, fat, brain, and
lungs
 Blood in plastic screw cap bottle filled to top
 Organ samples send in nylon bags
 Nasal swabs to be preserved
Cause Of Death
 Sudden cardiac arrest following arrhythmia
 Hypoxia and hypercapnoea from persistent rebreathing
 Plastic bag asphyxia
 Reflex cardiac arrest due to inhalation of gaseous
substance
Drug dependence:
 Maladaptive pattern of substance use leading to a cluster
of behavioural, physiological and cognitive phenomenon
that develop after repeated intake
Drug abuse:
 Persistent or sporadic excessive drug use inconsistent
with or unrelated to acceptable medical practice
Drug intoxication:
 Unwanted physiological or psychological effects that
cause maladaptive behaviour
Drug addiction:
 Chronic disorder characterised by compulsive use of
drugs resulting in physical, psychological and social
harm and continued use despite evidence of that harm

139. 23.INOGANIC NON METALLIC
IRRITANT

Inorganic Non-Metals
 Phosphorus
 Aluminium phosphide
 Chlorine
 Iodine Halogens
 Bromine
 Fluorine


Phosphorus
Forms of Phosphorus
 Yellow / white
 Red
Yellow Phosphorus
 Waxy, crystalline solid with a Garlicky Odour.
 Highly Toxic.
 Highly Volatile – constantly stored under water
(insoluble).
 Oxidises on exposure to air to Phosphorus Pentoxide.
 Ignites into flame at 34 c.
 Glows in dark – PHOSPHORESCENCE .
Uses – Yellow Phosphorus
 Military –
o Tracer bullets,
o Incendiary bombs,
o Smoke screens,
o Air sea rescue flares.
 Insecticide and Rodenticide :
o Zinc Phosphide mixed with Molasses or Butter.


Red Phosphorus
 Non-Toxic. Non-fuming, Non-luminous.
 AMORPHOUS, ODOURLESS.
 Insoluble,
 Harmless not absorbed from GIT.
 Derivatives include
o Phosphoric acid
o Phosphine,
o Aluminium Phosphide,
o Zinc Phosphide.

Uses – Red Phosphorus
Matches:
 Lucifer matches.
 Safety matches – Potassium Chlorate, Antimony Sulphide.
 Match box side has Powdered Glass and Red Phosphorus.
 Fireworks.

Fatal Dose
 1 mg / kg body weight. = 60 mg.
Mode of Action
 Phosphorus (protoplasmic poison)  HEPATOTOXIN.
 Fatty infiltration of viscera.
Absorption
 Absorption increased in – empty stomach, presence of
fat or bile.

140.  Distributed to all organs.
 Excreted through urine, faeces, expired air.
Effects
Locally :
 Skin necrosis & Mucosal irritation.
Systemic Effects
Large doses :
 CARDIOTOXIC – CVS collapse, Shock
Clinical Features – Fulminant
Massive dose – 1 – 2 g.
 PERIPHERAL VASCULAR COLLAPSE .
 Death – 12 – 24 hours.
Clinical Features – Acute Poisoning
First stage (3 days) –
 Local effects on GIT (Burning pain, vomiting, diarrhoea,
pain abdomen)
Second stage (upto several days after first stage subsides)
 Symptom-free and discharge from hospital is planned.
Third stage – Due to systemic effects of phosphorus.
 Return of Digestive symptoms.
 Signs of liver toxicity
o Tender Hepatomegaly,
o Jaundice
o Purities,
o Bleeding From Multiple Sites,
o Hepatic Encephalopathy,
o Stupor,
o Coma
o Mousy odour in breath (foetor hepaticus)
o Renal damage – Oliguria, Haematuria, Albuminuria,
ARF.
Diagnosis
o Garlicky odour – Breath, Vomitus.
o Fumes from Vomitus and Stools (Smoky Stool
Syndrome).
o Vomitus and stools luminous in dark.
o Evidence of Renal and Hepatic failure.
Treatment – Acute Poisoning
Gastric lavage with
 Potassium Permanganate (1:5000), - oxidises to less toxic
phosphoric acid Or
 Copper sulphate solution (0.2%) - converts to non toxic
copper phosphide.
 No milk or oily / fatty foods – as these enhance
absorption.
 Intravenous fluids.
 Steroids and inotropes – Shock.
 Coagulation defects –
 Whole blood,
 Fresh frozen plasma.
 Vitamin K (IV drip) – 65 mg slowly to combat
Hypoprothrombinaemia.
 Dermal burns – Warm water or 1 % copper sulphate
solution
 Non-fatty purgatives – For excretion.
 Diet – Carbohydrate & Protein rich diet.
Clinical Features – Chronic Poisoning
Phossy Jaw:
 Occupational exposure to fumes of Phosphorus
Pentoxide.
 Carious tooth  phosphorous deposits  leading
to bone Necrosis, Sequestration,

141.  Osteomyelitis of lower jaw with multiple
discharging sinuses.
Treatment – Chronic Poisoning
 Removal of patient from exposure.
 Dental treatment with follow-up.
Post Mortem Appearances
 Mouth – Garlicky odour.
 Gastric mucosa – Haemorrhagic, Desquamated.
 Gastric contents – Garlicky odour, luminous.
 Jaundice
 Skin, Mucous membranes, viscerae – Purpura,
Congestion
 Liver – Enlarged, Fatty  Acute yellow atrophy.
 Kidney – Tubular degeneration.
 Viscera – Preserved for chemical analysis in
Saturated Saline as luminosity can be lost with
rectified spirit.
Medico Legal Importance
 Accidental – Matches, fireworks, cockroach
and rat poisons in children. Pregnant women
while using it for abortion.
 Suicidal – Lucifer match heads mixed in water /
brandy and sugar and consumed.
 Homicidal – Phosphorus mixed with jam, rum.
 Arson – wrapped in a wet rag / covered with dung
placed on thatched roof. Catches fire on drying.
 Can be detected in Putrefied bodies.

Aluminum phosphide
Marketed As….
 Alphos
 Celphos
 Chemfume
 Fumigran
 Phostoxin
 quickphos
 Greyish green tablets of 3 g each mixed with urea and
ammonium carbonate.
 Each tablet liberates 1 g of phosphine and Co2.
Uses
 Grain preservative – Repels pests.
 Tablets placed among grain.
 On exposure to moisture phosphine is released.
 Phosphine evaporates rapidly leaving no residue.
Fatal Dose
 1 – 3 tablets.
Mode of Action
Al. Phosphide + air + moisture Phosphine Multi-
organ damage.
Clinical Features
Symptoms: -
 Metallic taste, intense thirst, garlicky or fishy
odour of breath, burning epigastric pain, vomiting,
diarrhoea.
Severe cases :
CVS manifestations:
 Hypotension, Cyanosis and cold clammy skin,
tachy/bradycardia, ST-T wave changes,
bradycardia with heart block.
Mortality
 Death – 90 – 100 % mortality with >3 tablets.
Diagnosis

142.  Breath – Garlicky
 LFT – Abnormal.
 ECG – Tachy/bradycardia, ST-T wave changes,
bradycardia with heart block.
 Silver nitrate test:
o Filter paper impregnated with 0.1 N silver nitrate
solution as mask, through which patient is asked
to breathe for 5 – 10 mins.
o Blackening of paper – Presence of Phosphine.
(Due to reduction of silver nitrate)
Treatment
 Circulatory shock – IV fluids (4-6 lit over 6
hours). Dopamine – IV (4-6 mcg/kg/min).
 Respiratory distress – 100 % humidified oxygen,
intubation, assisted ventilation.
 Metabolic acidosis – Sodium bicarbonate (50
mEq/15 min) until arterial bicarbonate rises above
15 mmol/lit.
 Magnesium Sulphate therapy : 3 g bolus IV
followed by 6 g infusion over 24 hours for 5-7
days - Manages cardiac arrhythmias.
Post Mortem Appearances
 Viscerae – Congestion, Petechiae, Hypoxic organ
damage.
 Stomach – Contents Haemorrhagic with mucosal
shedding with Garlicky odour.
 Heart – Toxic Myocarditis with Fibrillar
Necrosis.
 Lungs – Evidence of ARDS.
 Microscopy – Necrotic changes in liver and
kidneys.
Medico Legal Importance
 Commonly Suicidal.
 Accidental (few).

Halogens
1. Chlorine
2. Fluorine
3. Bromine
Mode of Action
 Halogens + water (MM)  Acids / bases.
General Symptoms
 Intense pain, cough, capillary engorgement,
congestive edema,pulmonary edema.
Chlorine
 Chlorine – Greenish yellow gas with a Pungent
odour.
Uses
 Bleaching agent for cotton and paper.
 Water purification.
 Sewage treatment.
 Pharmaceutical.
Fatal Dose
 50 – 100 ppm inhaled is fatal.
Mode of Action
 Active Oxidizing agent  Rapid destruction of
Organic tissue.
Clinical Features
 Inhaled – Irritant, Rhinorrhoea, Lacrimation,
Coughing, Chest Pain, Shortness Of Breath.
 Continued exposure – Laryngeal Edema, Stridor,
Pneumonitis, Pulmonary Edema.

143.  Systemic toxicity – Vomiting, Vertigo, Headache,
Ventricular Ectopic Beats,
Chronic exposure –
 Corrosion of teeth.
Treatment
 Mild – Bedrest, oxygen.
 Cough – Codeine and bronchodilators.
 Respiratory symptoms – Nebulised Sodium
Bicarbonate (3.75%).
 Pulmonary oedema -- Steroids.
 Severe cases – IPPV.
 Eye contamination – Copious Water or Saline.
Post Mortem Appearances
 Massive Pulmonary Oedema.
 Inflammation & Denudation of Respiratory
Epithelium.
Medico Legal Importance
 Accidental –
 Domestic or Industrial Exposure,
 Disinfectant chlorine in Swimming Pools.

144. 24.HEAVY METAL IRRITANTS

Heavy Metals - Irritants
Arsenic
Lead
Mercury
Iron
Copper


Arsenic
Properties
 Metalloid.
Fatal dose
 200 to 300 mg – Arsenic Trioxide.
 Arsine gas – Most Toxic.
Absorption
 Oral.
 Inhalation.
 Cutaneous.
Mode of Action
 Binds to (sulphydryl groups) Proteins.
 Inhibits enzymes with sulphydryl group
Clinical Features - Acute
GIT –
 Abdominal Pain,
 Metallic Taste,
 Garlicky Breath,
 Dysphasia,
 Vomiting,
 Diarrhoea (Rice Water Stools).
Liver –
 Fatty Degeneration.
Kidney –
 Oliguria, Uraemia.
Neurological –
 Hyperpyrexia, Convulsions, Coma.
CVS:
 Cardiac Arrhythmias.
Clinical Features – Chronic
Dermal --
 Aldrich Mees Lines (Nails) -- Transverse white lines
that run across the nail, following the shape of the nail.
 Facial Oedema
 Pigmentation (Rain Drop Pattern).
 Melanosis.
 Hyperkeratosis and Pigmentation of Palms and Soles
 Desquamation of finger tips .
 Erythematous flush.
GIT –
 Anorexia, Nausea, Vomiting, Diarrhoea, Weight Loss.
Liver –
 Hepatomegaly, Jaundice, Cirrhosis.
Kidney –

145.  Nephritic Changes.
Neurological –
 Encephalopathy,
 Polyneuritis (Glove & Stocking)
 Tremor,
 Gangrene.
Haematological –
 Anaemia
 Leucopenia
 Thrombocytopenia
Diagnosis
Urine Level –
 24 Hour Excretion >100 Mg Indicates Toxicity.
Atomic Absorption Spectroscopy –
 Best Analytical Method.
Treatment – Acute Poisoning
 Supportive
 Gastric Lavage.
 IV Fluids.
 Cardiac Monitoring.
 Chelation -- Acute
 BAL.
 Pencillamine.
 DMSA.
 DMPS.

1. BAL – 3-5 mg/kg im every 4 hrs 7-10 days.
(until urinary excretion falls below 50 mg / 24 hrs)
2. Penicillamine 100 mg / kg / day (6 hrly)
oral * 5 days.
Treatment – Chronic
 Chelation Therapy Ineffective.
Post mortem Appearances
 Haemorrhagic Gastritis.
 Heart – Sub-Endocardial haemorrhages.
 Fatty degeneration of Liver
For Chemical Analysis
Preserve Routine viscera.
 Piece of long bone (femur).
 Pulled scalp hair.
 Wedge of muscle.
 Portion of skin (back of trunk).
Medico Legal Importance
Arsenic trioxide – Ideal homicide
 Tasteless, colourless and insoluble.
 Solubility is enhanced in hot fluids, but can separate out
as a deposit on cooling.
 Symptoms resembling due to natural disease.
 (Neural, alcoholism, tuberculosis, hepatic or renal
insufficiency)
 Acute poisoning confused with cholera.
Accidental poisoning –
 Occupational exposure. Consumption of contaminated
well water or food.

146. Lead
Properties
 Heavy, soft, steel grey metal.
Uses:
 Lead acetate – Therapeutics.
 Lead carbonate (white lead) – paints
 Lead oxide (litharge) – glazing pottery and enamel.
 Tetraethyl lead mixed with petrol – anti knock (prevents
detonation in combustion engines).
 Lead tetroxide – vermilion.
 Lead sulphide – eyeliner
Source of Poisoning
 Automobile Exhaust.
 Auto Repair.
 Battery Manufactures
 House Paints
 Glass And Plastics
 Steel Wielding
 Ayurvedic Medicines
 Toys and Pencils.
Fatal dose
 10 g / 70 kg for other lead salts
 100 mg /kg for tetraethyl lead.
 Permissible blood lead level – 35 mcg/100ml.
Fatal period – 2 to 3 days.
Absorption:
 Inhalation
 Ingestion.
 Intact skin - Tetraethyl lead Only.
o Deposits in (growing areas) bones as phosphate and
carbonate.
 Hypermineralisation
 Densities
 Lead lines on x-ray.
Excretion:
o Urine (65%)
o Bile (35%)
Mode of action
Lead + sulfhydryl enzymes  blocks action.
Lead + aminolaevulinic acid dehydrase, synthetase,
coproporphyrinogen oxidase, ferrochelatase  Anaemia.
CNS – Cytotoxic effect
o Oedema,
o Decreased nerve conduction,
o Increased psychomotor activity,
o Lower IQ,
o Behavioural and learning disorders.
CVS –
o Hypertension, Myocarditis
Kidney – Nephritis.
Reproductive organs – Infertility.
Clinical Features – Chronic
Plumbism or saturnism
Mild (40-60 mcg / 100 ml)
o Myalgia
o Paraesthesia

147. o Irritability
o Abdominal discomfort
Moderate (60-100 mcg / 100 ml)
o Arthralgia - nocturnal
o Fatigue
o Tremor
o Headache, abdominal pain, anorexia, metallic taste,
vomiting.
o Constipation, weight loss.
Severe (more than 100 mcg / 100 ml)
o Lead palsy – Wrist or foot drop
o Burton’s line – Bluish black line on gums due to deposition
of lead sulphide.
o Lead colic – Intermittent severe abdominal cramps, with
tenderness around the umbilicus.
o Lead encephalopathy – common in children.
o Facial pallor – Circum-oral (due to vasospasm).
Diagnosis
Blood
o Low haematocrit & haemoglobin with normal TC & DC.
o Peripheral smear –
o Hypochromic, Microcytic. Basophilic stippling.
o Free erythrocyte protoporphyrin levels elevated –
Impaired heme biosynthetic pathway with
elevated blood level of lead.
o Blood lead level - increased
Urine
o Urine lead level – Above 150 mg / litre is significant.
Radiology
o Bones – Growing ends show arrest of growth line.
o Dense transverse bands or lead line across the
metaphyses and margins of flat bones.
o Abdomen – Radiopaque densities if material has been
ingested in 24 – 36 hrs.
Treatment –
Acute with encephalopathy
o BAL 4 mg / kg
o Seizures – Diazepam /Phenobarbitone.
o Na EDTA 75 mg / kg/day Iv (for absorbed poison)
o Repeat BAL at 4 the hourly intervals until blood level
falls below 40 mcg / 100 ml.
o Reduce Na EDTA to 50 mg / kg day
o Stop chelation when levels fall below 20 mcg / 100 ml.
Treatment - Acute without encephalopathy
o BAL 12 mg / kg / day.
o EDTA 50 mg/ kg/ day.
o Discontinue BAL when blood level falls below 40 mcg
/ 100 ml
o Change to oral chelation with penicillamine until the
blood level falls to 20 mcg / 100 ml.
o Thiamine 10-50 mg/kg improves neurological status.
o Stomach wash if lead is found in stomach.
o Lead colic – IV calcium gluconate.
Post Mortem Appearances
o Pale skin, mucosa.
o Emaciation,

148. o Burtonian line.
o Lead line on x-ray.
Medico Legal Importance.
o Lead acetate used to sweeten WINE in roman times.
o Lead treated wines / cosmetics- 18 to 19 century.
o Pica in children – tendency to lick lead based paints and
toys.
o Occupational exposure among workers of miners,
plumbers, battery, plastic, garages.
o Accidental – common.
o Suicide / homicide – very rare.

Mercury
 Metallic (Quick silver) or Boxer
 Mercurous
 Mercuric
 Commonest poisoning – Mercuric Chloride.
Properties
 Quicksilver.
 Heavy, silvery liquid.
 Not poisonous if taken by mouth.
 Vaporizes at room temperature to give off a toxic
vapour – Mercuric Mercury.
Salt derivatives
 Mercuric chloride – Burning metallic taste
 Mercuric sulphide (sindoor)
 Mercurous chloride (calomel) – tasteless.
 Organic mercurials are more toxic.
 Most toxic compound is Methyl Mercury.
Uses:
 Thermometers.
 Ceramics.
 Dry cell batteries.
 Electrical switches.
 Explosives, fireworks.
 Fluorescent & mercury vapour lamps.
Medical uses
 Antiseptic, disinfectant.
 Dental amalgam.
 Diuretic.
 Purgative.
Industrial uses
 Electroplating.
 Embalming.
 Fabric softener.
 Fingerprint powder.
 Fungicide.
 Gold & silver extraction.
 Grain preservative.
 Paints
 Pesticides.
Fatal dose
 Mercuric chloride – 0.5 – 1 g.
 Mercurous chloride – 1.5 – 2 g.
Mode of action
 Inhaled  Enters alveolar membrane  blood stream
 Mercuric ions (Hg++)ions  renal tubular damage.
 CNS – Cerebellum, Temporal Lobe, Basal Ganglia,
Corpus Callosum.

149. Routes - Elemental &Inorganic Poisoning
 Inhalation
 Ingestion
 Injection
Clinical Features -
Upto 4 hrs –
 Dyspnoea,
 Cough,
 Fever,
 Headache,
 Chills,
 GI Disturbance,
 Metallic Taste,
 Blurring Of Vision.
Severe –
 Non-cardiogenic Pulmonary Edema,
 Dyspnoea,
 Convulsions.
 Conjunctival Congestion,
 Fever,
 Reddened Palms & Soles
 Deep Red Oral Mucosa With Strawberry Tongue
 Skin Rash
 Cervical Lymphadenopathy (Children).
Injection
 SC / IM – Abcess with ulceration,
 extruding tiny droplets of mercury.
 IV – Thrombophlebitis, granuloma formation,
 Pulmonary embolism.
Clinical Features - Chronic Poisoning (Hydrargyrism)
1. Tremor most consistent symptom
 Danbury tremors –
 Begins in the hands and is of a coarse intentional
type, interspersed with jerky movements.
 Later it progresses to lips, tongue, arms and legs
 Advances to Hatter’s shakes: tremor interferes
with daily activites.
 Concussio Mercurialis - Most Severe Form – No
Activity Is Possible.
2. Metallic taste,
3. anorexia, nausea,
4. increased salivation.
5. Gingivitis,
6. halitosis, blue line on gums.
7. Erethism –
 Cluster of psychiatric symptoms
 Abnormal shyness,
 loss of self confidence,
 depression, irritability,
 amnesia,
 progressing to delirium with hallucinations
8. Mercuria lentis –
 Brown reflex of anterior lens capsule of eye, with
fine punctate opacities.

150. 9. Membranous GN with hyaline casts, fatty casts in urine.
Ingestion
1. Colitis
2. Melanosis Coli
3. Dementia
4. Tremor
5. Renal Failure.
6. Acrodynia (Pink Disease) – Children.
 Insidious Onset.
 Anorexia, Insomnia,
 Profuse Sweating,
 Skin Rash,
 Photophobia.
 Hands and Feet – Puffy, Pinkish, Painful,
Paraesthetic, Perspiring, Peeling.
 Teeth – Shed With Ulceration Of Gums.
Poisoning with Organic mercurials
 Minamata disease – Mercury methylated under water 
Poisoning after eating contaminated fish.
Diagnosis
 X-ray
 Blood mercury level – normal level is less than 3 mcg /
100 ml.
 Urine mercury level – normal level is less than 10 to 15
mcg / 100 ml.
Treatment
Chelative therapy
 BAL -- 100 mg IM every 4 hrs for 48 hrs followed
by 100 mg every 8 hrs for 7 days.
 Pencillamine – 250 mg qid for adults.
Ingestion
 Stomach wash – Add egg white or 5% albumin or plain
milk to lavage to bind mercury. (insoluble albuminate
of mercury)
 Activated Charcoal - Well absorbed.
 Chelation.
Injection
 Incisions -- For abcess.
 Chelation.
Chronic inhalation
 Chelation
Post Mortem Appearances
 Mucosa of mouth, throat, esophagus and stomach –
Greyish with softening and superficial corrosion.
 Caecum, Large Intestine reveals ulceration
 Kidneys – Pale, swollen due to edema of renal cortex.
Medico Legal Importance
 Domestic poisoning –
 Broken Thermometer,
 Gold - ore Processing.
 Contaminated Fish consumption.
 Dry cell batteries – Small metal capsules contain 2 g of
mercuric oxide with zinc amalgam inside a stainless
steel covering.

151. 25. ORGANIC IRRITANTS

Classification - Irritants
Inorganic –
1. Metals – Salts Of Mercury, Arsenic, Lead, Copper, Iron,
Zinc, Thallium, Potassium,
2. Non-metals – Phosphorus, Halogens,
Organic
1. Vegetable – Castor, Croton, Abrus, Semecarpus,
Capsicum, Calotropis.
2. Animal – Venoms of Snakes, Scorpion, Bees, Wasp,
Cantharides, Caterpillars.
3. Mechanical – Glass Powder, Diamond Powder, Stone
Chips, Chopped Hair.
Plant Irritants
 Ricinus Communis (Castor)
 Croton Tiglium (Croton)
 Abrus Precatorius (Rati, Jequirity Bean)
 Semecarpus Anacardium (Marking Nut)
 Calotropis Gigantea (Akand)
 Capsicum Annum
Ricinus Communis
Castor.
 Fruits in clusters with 2 to 3 mottled grey- brown seeds.
 Ricinus – Fruits & Seeds
Active Principles
 Ricinoleic acid
 Ricin
 Seeds – Contains Ricinoleic acid (pale yellow oil with a
faint odour & acrid taste).
-- Ricin – more poisonous than cobra venom.
Uses
 Purgative.
 Lubricant – industries.
Fatal dose
 Ricin – 1 mg/kg body wt.
 5 to 10 seeds.
Clinical features
 Fever with chills.
 GIT - Vomiting, diarrhea, abdominal Pain.
 Vascular - Hypotension, dehydration.
 Kidneys - Haemolysis, renal failure.
Treatment
 Decontamination (gastric lavage, activated charcoal)
 Fluid and electrolyte Imbalance.
 Supportive measures.
Post Mortem Appearances
 GIT - Erosions.
 Viscera – Congestion.
Forensic Importance
1. Accidental - children.
2. Homicidal.
3. Iatrogenic – overdose of castor oil.

Croton Tiglium
 Oval, dark brown seeds.
 Seeds (Oil) – Extremely Toxic.
Active principles
 Crotin (toxalbumen).
 Crotonoside (glycoside).
Fatal Dose.
 1-2 ml of oil.

152.  5 to 6 seeds.
Clinical Features
 Similar to castor
 Contact – Inflammation.
Treatment:
 Decontamination.
 Fluid and electrolyte imbalance.
 Supportive measures.
Forensic Importance
 Accidental
 Ingestion.
 Homicidal
 Abortifacient – oil.

Calotropis
Active Principles
Juice from plant leaves and stem.
 Calotropin.
 Calotoxin.
 Calactin.
 Uscharin.
Clinical Features
 Contact - Inflammation & Vesication
 Eye – Mydriasis, Conjunctivitis.
 GIT - Vomiting, Diarrhoea, Abdominal Pain.
 Nervous - Convulsions, Delirium.
Treatment
 Gastric lavage.
 Demulcents.
 IV fluids.
 Diazepam – convulsions.
 Skin lesions – soap and water.
 Eye – saline irrigation.
Forensic Importance
 Abortifacient – Juice.
 Malingering – Artificial bruise/conjunctivitis produced
with juice.
 Accidental – Folk remedies.
 Cattle poison.

Abrus Precatorius
Toxic Parts
 Abrus - Seeds
 Seeds – Bright scarlet with a black spot on one side. 1
cm in size.
Active Principles
Seeds –
 Abrine (toxalbumen)
 Abralin. (glucoside)
 Abric acid.
Uses
 Seeds – ornamental.
 For weighing gold.
Clinical Features
 Haemorrhagic gastritis - Ingested Seeds or extract.
 Cardiac arrhythmias, convulsions, cerebral oedema -
Ingested Extract
(CVS manifestations similar to viperine bite)
 Death
Fatal Dose
 Abrin - 90 – 120 mg.

153.  1 to 2 seeds.
Treatment
 Decontamination.
 Supportive measures.
Post Mortem Appearances
 GI tract – Congestion.
 Injected – Local signs of inflammation.
Forensic Importance
 Accidental – Children.
 Homicidal.
 Cattle poison – Sui are needles made out of dried paste.

Semecarpus Anacardium
Marking Nut
Toxic Parts
 Semecarpus - Seeds
 Seeds – Acrid juice used by washerman for marking
clothes.
Active Principles
Juice
 Semecarpol.
 Bhilawanol.
Uses
 Laundry marker.
 Quack remedy.
Clinical Features
 Skin – Inflammation and Vesication. (juice)
 Ingestion – GI distress, Hypotension, Delirium.
Fatal Dose
 10 g.
Treatment
 Supportive measures.
Forensic Importance
 Abortifacient - Juice.
 Malingering – Artificial Bruise /Conjunctivitis.
 Accidental – Quackery.

Capsicum Annum Chilly)
Toxic Parts
 Fruit – Contains small flat, yellowish seeds.
 Chilly - Seeds
Active Principles
 Capsaicin (alkaloid).
Uses
 Fruit and seeds – used in Indian cuisine as condiment.
 Appetite stimulant.
 Counter irritant.

Clinical Features
 Skin – Irritation, Reddening.
 Eye – Intense Burning, Lacrimation, Reddening.
 Ingestion – Burning Mouth, Salivation, Abd Pain,
Vomiting, Diarrhea, Sweating.
Treatment
 Topical (Skin) – Bathed in vinegar/ice cold water.
 Ingestion – Ice cubes, sips of ice cold water.
 Supportive measures.
Forensic Importance
 Homicide
 Eyes – Throwing powdered chili for robbery, rape.
 Rectum / vagina – Torture.

154.  Accidental –
 Datura mistaken for chilly seeds.

Animal Irritants
Venomous snakes in india
 Common Cobra (Indian)
 Common Krait
 Russell’s viper
 Saw-scaled viper


Common cobra
Common cobra
 Head – Large scales.
 Hood – has spectacle / Monocle mark.
 Teeth – III supra-labial shield touches eye and nose
shield.
 Fangs – small, grooved.

Common Krait
 Back – Bands / half rings.
 Scales – Back – central row – hexagonal,
enlarged.
 Scales – under surface of tail – undivided.
 Infra-labials – IV Infra-labial largest.
 Fangs – small.
 Scales – Back central row

Russels Viper
 Head – Triangular.
 Scales – Head – small.
 Head – V mark on head (apex pointing downwards)
 Patches – 3 rows diamond-shaped.
Spect
acle
Supra-
labial
Shield

155.  Fangs – Long, channelized.
 V -- shaped mark on head

Saw-Scaled Viper
 Head – Triangular, small scales.
 Head – White arrow.
 Body – wavy line on flanks.
 Scales – Body – Serrated.
 Fangs – Long, channelized.

Venom:
 Saliva secreted by modified parotid gland.
 Clear, amber-coloured.
 Contains Toxins, Enzymes, Miscellaneous.
 Toxins – LMW Peptides, Proteins.
 Enzymes – Proteinases, Hydrolases, Hyaluronidase,
cholinesterase, phospholipase, ATPase, ribonucliase,
deoxyribonucliase.
 Miscellaneous – Neurotoxin, cardiotoxin, Haemolysin,
haemorrhagins.
Classification of Venom
1. Neurotoxic – Cobra, Krait.
2. Haemotoxic – Vipers.
3. Myotoxic – Sea Snakes.
Neurotoxic
Symptoms – Cobra, krait
Local features.
 Fang marks – Indistinct.
 Pain – Burning.
 Swelling & discoloration.
 Discharge - Blood Stained.
Systemic features
Pre-paralytic stage
 Vomiting,
 Headache,
 Unconsciousness.
Paralytic stage
 Ptosis,
 Ophthalmoplegia,
 Drowsiness,
 Dysarthria,
 Dysphasia,
 Convulsions,
 Bulbar paralysis,
 Respiratory failure.
Haemotoxic

156. Symptoms – Vipers
Local features.
 Rapid swelling,
 Discoloration,
 Blister formation.
 Frank bleeding from bite site.
 Severe pain.
Systemic features.
Generalized bleeding –
 Epistaxis, haemoptysis,
 Bleeding gums,
 Haematuria,
 Melaena,
 Purpuric spots in skin.
 Renal failure.
Myotoxic
Symptoms – Sea Snakes
Local features.
 Minimal swelling & Pain.
 Bite site - Frank bleeding.
 Pain - Severe.
Systemic features.
 Myalgia,
 Muscle stiffness.
 Myoglobinuria,
 Renal tubular necrosis.
 Renal failure.
Diagnosis – Venomous
 Fang marks – 2 separate puncture wounds, separated
from each other by 8 mm to 4 cm (based on species).
 Side-swipe – single puncture wound.
 Identification of snake.
Diagnosis – By Lab tests -- Venomous
 Hematological – Anemia, leucocytosis,
Thrombocytopenia, high haematocrit initially  later
falls.
 Haemolysis – fragmented RBC.
 Prolonged clotting time & prothrombin time.
 Prolonged partial thromboplastin time.
 Depressed fibrinogen levels. Elevated FDP.
 ECG –
o Bradycardia, with ST elevation / depression, T
wave inversion, QT prolongation,
Hyperkalaemia.
 Metabolic –
o Hyperkalaemia, hypoxemia (respiratory acidosis,
Metabolic acidosis or lactic acidosis).
 Urine –
o Haematuria, Proteinuria, Haemoglobinuria,
myoglobinuria.
 Immunodiagnosis –
 ELISA detection of venom antigens (Highly sensitive).
Treatment
Venomous -- Immediate
 Reassurance.
 Warm
 Complete rest.
 Immobilize bitten area.
 Non-sedating, non-salicylate analgesic.
 Tourniquet – applied lightly, proximal to bite site.
Sutherland wrap.
Hospital

157.  Observation.
 Monitor – Pulse, Respiration, BP, WBC.
 Blood urea, creatinine.
 Urine output.
 Vomiting, diarrhoea, bleeding.
 Local swelling, necrosis.
 ECG, ABG analysis.
Antivenom therapy – only when
 Incoagulable blood
 Spontaneous systemic bleeding.
 Hypotension.
 Neurotoxic / Myotoxic features.
 Depressed consciousness.
 Local swelling.
 Tender regional lymph nodes.
 Polyvalent antivenom – (common cobra, common krait,
Russell’s viper, saw-scaled viper).
Mode of administration –
 Skin test – (I.D) 0.02 to 0.03 ml of 1:10 dilution of
antivenom.
 +ve test – urticarial wheal with erythema in 15 mins.
 Desensitization – (S.C) 0.1, 0.2, 0.5 ml of antivenom at
15 min intervals.
 Then 1:10 dilution given followed by undiluted
antivenom.
 No reaction – IV injection.
 Antivenom dissolved in NS mixed in 500 ml of, NS
infused at 15 to 20 drops / min.
 8 to 10 vials given. Each vial to run for 1-2 hrs.
 No improvement – 6 to 8 vials given.
 Maximum dose – 25 to 30 vials.
 Dose same in children.
 Can be given during pregnancy.
 Adverse reactions – Anaphylaxis. (Adrenaline)
 Serum sickness.
Other measures –
 Bite site cleaned
 Local necrosis – excise slough & saline dressings.
 Tetanus Toxoid.
 Antibiotic.
 Pain.
 Rehydration with nutrition.
 Blood transfusion / fresh frozen plasma.
 Neurotoxicity – Neostigmine 0.25 to 0.5 mg IV half
hourly.
 Oxygen, Ventilators – respiratory failure.
 Renal failure.
Post Mortem Appearances
 Skin around bite site incised and sent for lab testing –
levels of enzymes.
 Fang marks, local swelling, bleeding into tissues,
pulmonary edema, froth in airways, cerebral edema
evidences noted.
Medico-legal Importance
 Accidental. -- entails compensation to kin.
 Homicides – Occasional. Throwing an agitated snake on
a victim.
 Suicide – rare.