Forensic Medicine Revision E6.5

M v o 1 01 1
FORENSIC MEDICINE REVISION 1 ----- Active space -----
Legal procedures 00:00:30
Types of offenses :
Cognizable offence Non cognizable offence
Police can arrest without warrant Police can arrest with warrant only
2 (c) CrPC 2 (l) CrPC
E.g. Murder, robbery, rape. E.g. Simple hurt.
Summons case Warrants case

Punishment < 2 yrs of imprisonment > 2yrs of imprisonment
Inquest/Enquiry :
Police inquest Magistrate in- Coroners inquest Medical exam-
quest iner system
• 174 CrPC • 176 CrPC Not followed in • Overall best.
• M/C followed • Superior to India. • Not followed
in India. police inquest. in India.
Police inquest :
Minimum rank to become investigation officer (IO) : Head constable.
Enquiry report : Panchanama (prepared by IO).
Power of IO to summon witness : 175 CrPC.
Magistrate inquest : Two types.
Judicial magistrate Executive magistrate

(Superior to executive magistrate)
Appointed by High court Appointed by state government
Conduct inquest in custodial Conduct inquest in dowry death
death/rape/dowry death (suspected) & exhumation
(suspected)/exhumation
Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

2 01 Forensic Medicine
----- Active space -----

Court room procedures 00:05:05
Hierarchy of criminal courts :

Apex courts Maximum punishment
Supreme court
(National level) Any punishment including death sentence.
High court
(State level)
Sessions court • Any punishment.
(District level) • Lowest court to give death sentence.
• Death sentence must be confirmed by the high
court.
Lower courts Maximum punishment
Assistant sessions court 10 yrs
Chief judicial magistrate 7 yrs
1st class magistrate 3 yrs
2nd class magistrate 1 yr
Power of commutation ( punishment) : Any higher court.
Lowest court to commute a death sentence : High court.
Mercy petition for death sentence given by supreme court is sent to :
• President of India.
• State governor.
Evidence :
Oral or written statement produced in the court of law.
Evidence
Direct evidence : Proves fact. Indirect evidence :

E.g. Eyewitness/CCTV Indirectly proves fact.
Circumstantial evidence Hearsay evidence

M v o 1 01 3
Evidence ----- Active space -----
Oral evidence Documentary evidence

(Superior evidence because
Cross examination can be done).
Witness :
Common witness Expert witness
(Fact witness)
Can be any person : Any person with :
Who has perceived the fact. Knowledge, experience or training in a
particular field.
E.g. Direct & indirect witnesses. E.g. Fingerprint expert.
Gives only facts, no opinions. Gives both facts & opinions.
First hand knowledge rule applicable. Not applicable.
Summons/Subpoena/Under penalty :
Legal document issued by presiding officer of the court.
Punishable (If not attended).
Given for both civil & criminal cases.
Summons
Ad testificandum : Oral evidence. Duces tecum : Documentary evidence.
Conduct money :
a. Travel expense paid to the witness in civil cases.
b. Amount is paid by the party & fixed by the court.
Recording of evidence :
1. Oath • Compulsory.
• Refusal : Punishable under 178 IPC.
• Child < 12 yrs exempted from taking oath.
2. Examination in Chief/Direct Same side lawyer.
examination
3. Cross examination • Opposite side lawyer.
• Leading questions are permitted.
4. Re-direct examination Same side lawyer.


Note : Judge can ask questions at any stage of the trial.
Prosecution witness Defence witness
Chief examination Public prosecutor Defence lawyer
Cross examination Defence lawyer Public prosecutor
Re-direct examination Public prosecutor Defence lawyer
Leading questions are permitted only during the cross-examination by the
lawyer from the opposite side.
Exception for leading questions : Hostile witness (same side lawyer).
Dying declaration : Oral or written statement given by the person at the time
of dying (32 IEA).
• Recorded by : Anyone (Magistrate/doctor/police/public).
• Oath : Not necessary.
• Presence of accused or their lawyer : Not necessary.
• Valid only if patient dies.
Medical ethics 00:23:06
Ethics : Compulsory moral principles given by NMC.

Infamous conduct (Unethical acts) : Punishable.
List of unethical acts/warning notice : Given by state medical council.

A : Adultery, Addiction, Alcohol, Association with unqualified person,
Abortion (Criminal), Advertisement (Repeated/inappropriate).
B : Bribery.
C : Covering (Employing/assisting unqualified persons).
D : Dichotomy (Fee splitting).
E : Euthanasia (Active).
F : False certificates issuing.
A : Accepting gifts.
Note : Only passive euthanasia is allowed in India.
Disciplinary action :
By state medical council (Rarely by NMC).
Punishment :
• Warning.
• Penal erasure :
M v o 1 01 5
a. Temporary : Suspension. ----- Active space -----

b. Permanent : Professional death sentence (Serious professional
misconduct).
Appeal against state medical council Ethics and medical registration board
Not satisfied NMC channel.
Medical negligence/Malpraxis 00:28:46
Essential components of medical negligence :

1. Duty of care.
2. Dereliction of duty : Absence of reasonable skill & care /wilful negligence.
3. Direct causation.
4. Damage :
a. Monetary loss.
b. Painful suffering.
c. Disability.
d. Death.
Bolam’s test : Absence of reasonable skill & care by the doctor during the
treatment of the patient is punishable.
Types of negligence :
Civil negligence Criminal negligence Contributory
negligence
Doctor negligence +
Gross negligence/
Simple lack of care patient contribution
Definition wilful negligence/
& skill. (Applicable only in
utter carelessness
civil cases).
Surgery on wrong Improper follow up by
Examples Wrong prescription.
side. the patient.
Civil/consumer
Court of trial Criminal court. Civil court.
court.
Prosecution (State)
Parties Patient v/s doctor. Patient v/s doctor.
v/s doctor.
Burden of Plaintiff
Prosecutor. Doctor.
proof (Patient).
Monetary
Punishment Imprisonment/fine. To liability & fine.
compensation.


IPC Sections of criminal negligence :
• 304 (A) IPC : Negligence leading to death.
• 336 IPC : Negligence endangering life of the patient.
• 337 IPC : Negligence leading to hurt.
• 338 IPC : Negligence leading to grievous hurt.
• 352 IPC : Treatment without proper consent (Equates to assault).
Doctrines : 00:35:56
1. Res Ipsa Loquitor :
The fact speaks for itself.
Applicable in gross negligent act.
Burden of proof : On doctor.
E.g. Wrong blood transfusion, operating on wrong limb.
2. Respondent superior doctrine (Vicarious liability) :

The superior (Employer) is liable for the negligent act of the third party
(Employee).
Applicable only for civil cases.
Defenses in medical negligence :

1. Denial defence :
a. Denial of duty.
b. Denial of dereliction : Rx given by the doctor as per standard practice.
2. Misadventure : Doctor is not liable for therapeutic, diagnostic, experimental
misadventure.
3. Contributory negligence : Only a partial defence.
4. Novus actus interveniens : Damage due to new/unrelated intervening act.
5. Res indicata (Limitation period) : Time period for filling a case.
a. Civil cases : 2 years.
b. Criminal cases : No limitation period.
3. Calculated risk doctrine : Unavoidable risk with every treatment.
4. Product liability (Defective products) : Liability falls on manufacturer.
Consent 00:42:03
Types of consent :
1. Implied consent : Based on gesture or body language.

M v o 1 01 7
2. Expressed consent : ----- Active space -----

a. Oral/written consent.
b. Written informed consent (best).
3. Blanket/open consent :
a. One consent at the time of admission for all treatments.
b. Invalid in India.
4. Substituted consent : Parents/guardians give consent in case of minors or
unconscious or mentally ill patients.
Doctrines of consent :
1. Doctrine of full disclosure.
2. Doctrine of partial disclosure/therapeutic privilege : E.g. In psychiatric
patients.
3. Emergency doctrine (92 IPC) :
Consent not required for life saving procedures.
Only if patient is unconscious and relatives are not around.
4. Doctrine of loco parentis :
Teachers in charge of consent for children in residential schools.
5. Doctrine of extended consent :
Invalid in India.
Specific consent required for each procedure In India.
Applicable only for unanticipated life saving procedures.
6. Doctrine of informed refusal : Patient’s right to refuse Rx.
Rules of consent :
Minimum age for giving consent for General Physical Examination (GPE) :
12 years.
GPE in a pt < 12 yrs : Consent by guardian (89 IPC).
Minimum age for consent for major procedures : 18 years.
Invalid consent (90 IPC) :

1. Child <12 years.
2. Insane person.
3. Intoxicated person.
4. Under the influence of threat.

8 02 FM
----- Active space ----- FORENSIC MEDICINE REVISION 2
Traumatology 00 00 15
Injury :
Defined by Section 44 IPC.
Harm done to body, mind, reputation & property.
Injuries can be blunt force or sharp force injuries.
• Blunt force injuries : Abrasion, contusion, laceration & fracture.
• Sharp force injuries : Incised injury (Light cutting weapon), chop injury
(Heavy cutting weapon), & stab injury (Any weapon with pointed end).
Abrasion :
Medicolegally most significant wound.
Loss of partial epidermis with no bleeding or scar.
All abrasions are simple hurt except corneal abrasion.
Abrasions due to tangential force :
Types :
1. Scratch (Linear) abrasion : Pin, nail, thorn etc.
2. Grazes (Grinding/sliding) : Aka gravel rash/brush burns (M/C seen in road
traffic accidents).
Epithelial tag :
• Epithelium is scraped off and heaped.
• Indicates tail end of the abrasion.
• It tells about the direction of force.
Abrasions due to perpendicular force :

1. Pressure abrasion :
• Crushing of epithelium d/t constant pressure.
• E.g. → Ligature mark from hanging and strangulation, shoe bites.
2. Imprint abrasion (Contact/imprint) :
Tyre marks in road traffic accidents, recoil abrasion from gunshot (More
force, less duration).
3. Imprint/Pressure + Pattern :
Patterned abrasion.

M v o 2 02 9
Graze abrasion
Pressure abrasion
Scratch abrasion
Abrasion tells about the time since injury depending on healing of injury (Color
of the scab).
Abrasion heals within 1 week.
Mnemonic : RRRBB
• Raw without scab : < 12 hours.
• Reddish : > 12 hours.
• Reddish brown : 2-3 days.
• Brown : 4-5 days.
• Black : 6-7 days.
Antemortem abrasion Postmortem abrasion

Site Anywhere Bony prominences
Colour Red Pale/Yellow
Vital reaction + -
Contusion/Bruise :
Blunt force
Rupture of dermal vessels

(Vein/Venules/Capillaries)
Extravasation of blood (ill defined margins)
Contusion

10 02 FM

Types of bruise :
1. Intradermal bruise (Subcutaneous).
2. Deep bruise (Delayed/Come out bruise).
3. Ectopic bruise (Migratory bruise) : Away from the impact of force.
a. Raccoon eye sign/black eye/spectacle hematoma/panda eye sign :
Periocular bleeding due to fracture over anterior cranial fossa.
b. Battle sign : Ecchymosis in the mastoid region due to fracture of middle
cranial fossa.
Raccoon eye sign Battle sign

4. Patterned bruise :
a. Six penny bruise :
Coin shaped bruise due to pressure of tip of fingers on the skin.
Seen in throttling, child abuse (Battered baby syndrome).
b. Butterfly bruise : Seen in child abuse due to pinching.
c. Tramline/Railway line bruise : Blow with a rod/lathi/cane.
Ageing of contusion :
Contusion takes 2 weeks to heal.
Over bony prominences, scrotum : Lesser force, bigger contusion
Over palms & soles : Larger force, lesser contusion.
Age is estimated by :
• Color (M/C). • Spectrophotometry.
• Histology. • Pearls stain reaction.
Ageing of bruise by color :
Type of hemoglobin Color Age of bruise
Oxyhemoglobin Red Fresh
Deoxyhemoglobin Blue Few days to 3 hours
Hemosiderin Brown 4 days
Biliverdin Green 5-6 days
Bilirubin Yellow 7-12 days
M v o 2 02 11
Multiple bruises of different color in a child : Battered baby syndrome. ----- Active space -----
Bruise with no color changes : Subconjunctival hemorrhage.
Livor mortis vs contusion :

Livor mortis Contusion
Site Dependent areas Anywhere
Blanching Present Absent
Extravasation Absent Present
Color changes Absent Present
On incision, pour water Washed away Remains
Laceration & Incision :
Lacerated wound vs incised wound :
Laceration (Tear) Incision (Cut)
Edges Irregular Well defined
Margins Bruising Nil
Floor (Hair bulb, vessels) Crushed Cut
Tissue bridges Present Absent
Bleeding Less Profuse
Image
Types :
1. Split laceration/Incised looking laceration :
Skin is crushed between 2 hard objects
i.e. over bony prominences.
Split laceration
2. Avulsion laceration :
• Shearing force (Tangential) : Separation of layers
of skin “flaying”.
• E.g. : Degloving injury, scalp (Scalping).
Degloving injury

12 02 FM

3. Tear lacerations :
Caused by semi sharp objects.
4. Stretch lacerations :
• Due to over stretching of skin.
• Pressure with pull force.
Swallow tailing in a Tailing in an incision.

lacerated injury
Lacerated looking incision :

Seen in areas with skin folds (Looks like serrated edges) : Scrotum, axilla.
Stab wound :
Produced by any weapon with a pointed end.
• Entering into the cavity : Penetrating wound.
• Entering and exiting the cavity : Perforating wound.
Stab injury with single edged weapon : Wedge/tear drop shaped.
Stab injury with double edged weapon : Oval/spindle shaped.
Type of weapon Shape of injury

Single edged blade Tear drop/wedge shaped/
fishtail

M v o 2 02 13
Type of weapon Shape of injury ----- Active space -----
Screw driver
Dinner fork
Ice pick
Hilt marks :
Patterned bruises/abrasions produced in
complete penetration injuries that help in
determining the direction of injury.
Double edged stab wound with
hilt mark
Lines of Langer :
Correspond to the collagen fibers in the body and
determine the gaping of the wound.
• When the stab injury is perpendicular to the lines,
there is more gaping.
• When the stab injury is parallel to the lines, there is
less gaping.
Lines of Langer
Chop wounds :
Deep gaping wound caused by heavy cutting weapon (Axe).
Margins : Regular with areas of adjacent bruising.
Floor : Crushing of the tissue + Fracture of the bone.
They are usually homicidal.
Chop wound
Wounds suggestive of homicides :
1. Bevelling (Blade enters obliquely into the skin → Undermined edges).
2. Defence cuts :
a. Active (Holding the weapon, palmar surface cut).
b. Passive (Medial margin of forearm cut when trying to protect face).
Note :
It is not mandatory to have defensive wounds in all cases of murders.
14 02 FM

Wounds suggestive of suicide :
1. Hesitation cuts :
Also known as :
a. Tentative cuts.
b. Intentional cuts.
c. Trial cuts.
d. Feelers strokes.
Sites : Accessible parts of body.
Hesitation cuts
2. Hara-kiri :
Also known as seppuku.
Suicidal stab wound of the abdomen.
Cause of death : Evisceration and hypotension.
Hara-kiri
Head Injury 00 33 35
Types of skull fractures :
Fracture Image
1. Fissure fracture (Linear crack) :

M/C type of skull fracture.
2. Depressed fracture :
• Caused due to weapon with
smaller striking surface
(Hammer).
• Also known as signature
fracture (Weapon can be
found out).

M v o 2 02 15
Fracture Image ----- Active space -----
3. Pond fracture :
• Variant of depressed fracture.
• Also known as indented fracture/ping pong
fracture.
• Seen in infants (Elastic bones) born out of
obstetric delivery.
4. Gutter fracture :
Associated with oblique bullet.
5. Comminuted fracture :
Multiple fractured segments due to multiple
blows to the skull.
6. Diastatic fracture :
• Aka sutural fractures as the fracture line is
along the sutures of the skull.
• Commonly seen along the sagittal suture &
in young adults.
7. Ring fracture :
• Seen at the skull base.
• Caused due to fall from height or heavy
weight falling on the head.
• Fracture line (Posterior cranial fossa)
around the foramen magnum like a ring,
hence called ring fracture.

16 02 FM
----- Active space ----- Fracture Image

8. Hinge fracture :
• Seen at the skull base.
• The fracture line starts from one side and
reaches the other side.
• Three types : Type 1, type II and type III.
i. Type 1 : Motorcyclist’s fracture
(Entire skull base is bisected).
ii. Type II : Fracture line runs obliquely.
iii. Type III : Fracture line is located in
anterior cranial fossa.
Puppe’s rule :
• Tells about sequence of trauma when multiple
fracture lines are present.
• The second (New) fracture line will stop at the
previous (Old) fracture.
Coup & contrecoup injuries :

Coup injury : At the site of impact.
Contrecoup injury : Opposite to the site of impact.
• Occipital fall can cause frontal lobe contusion (M/C).
• Frontal fall does not affect the occipital lobe.
• Temporal fall on side affects the contralateral temporal lobe as well the
opposite surface of the ipsilateral temporal lobe d/t presence of falx cerebri.
Intracranial Hemorrhage 00 2 35
Type of intracranial hemorrhage Source of bleed

Extradural hemorrhage Middle meningeal artery
Subdural hemorrhage Bridging veins/dural venous sinuses
Subarachnoid hemorrhage Arteries (Circle of Willis)

M v o 2 02 17
Extradural hemorrhage : ----- Active space -----
Trauma to the temporo parietal region
Fracture of temporal bone (fissure)
Rupture of middle meningeal artery at pterion
Bleed in the extradural space
Brainstem compression
Death due to respiratory failure

It is usually a coup injury.
C/F :
1. Lucid interval : The period of consciousness between two unconsciousness.
• During lucid interval, the patient can write a valid will, evidence & criminally
liable.
• If the doctor fails to diagnose lucid interval & patient dies → Considered as
medical negligence → Punishable under section 304 A IPC.
• Seen in EDH (40%) > SDH.
2. Dilated & fixed pupil.
3. C/L hemiparesis.
Kernohan’s notch :
False localizing sign; the patient presents with ipsilateral weakness due to the
compression of cerebral peduncles.
Imaging :
CT shows a biconvex/lemon/lens/idly shaped opacity.
Does not cross sutures.
CT EDH : Biconvex opacity Autopsy finding : EDH

Management :
Removal of clot by craniotomy or burr hole procedure.
18 02 FM

Subdural hemorrhage :
A : Aged persons with minor trauma.
B : Rupture of bridging veins.
C : Child abuse “Shaken baby syndrome”.
After trauma,
• Symptoms <3 days : Acute SDH (Rupture of large vessel).
• Symptoms 3 days-3 weeks : Subacute SDH.
• Symptoms >3 weeks : Chronic SDH
(Rupture of small vessel).
CT scan shows concavo-convex/crescentic opacity which crosses sutures.
CT SDH : Crescentic opacity Autopsy finding : SDH

Subarachnoid hemorrhage :
Causes : “BATS”
• Rupture of Berry aneurysm.
• Arteriovenous malformation rupture.
• Trauma.
• Stroke.
Patient can present with thunderclap headache.
CSF finding on lumbar puncture : Xanthochromia (Blood stained CSF).
Transportation Injuries 00 51 10
Types of injuries in pedestrian accidents :

• Primary impact injuries : First impact with the vehicle.
• Secondary impact injuries : Second impact with the vehicle.
• Tertiary impact/Secondary injuries : Ground impact.
Primary impact injuries :

Impact with the bumper.
Bumper injuries : Abrasions, contusions, lacerations, internal hemorrhages,
fractures.
The fracture is triangle shaped and the tip indicates the direction of the vehicle.
M v o 2 02 19

Injuries to a person sitting inside a car hitting a wall/divider :
S.No Impact Injuries
1 Windshield Sparrow foot injuries.
• Sudden hyperextension and hyperflexion of the

neck or vice versa.
2 Whiplash injury
• Hyperextension is more dangerous.
• Spinal cord contusions may be present.
• Patterned bruise.
• Fracture of the wrist/arm/sternum.
3 Steering wheel
• Aortic injury : Ladder rung tears.
• Most common organ affected in seat belt

injury : Mesentery > small intestine.
• Chance fracture : Sudden hyperflexion over
4 Seat belt
the seat belt → Transverse fracture of the
posterior component of the vertebra.
• Patellar fractures.
5 Dashboard
• Posterior dislocation of hip/dashboard fracture.
Sparrow foot injuries Chance fracture

20 02 FM
----- Active space ----- Driver Front seat victim

Windshield injury + +
Neck injury + +
Steering wheel injury + -
Seat belt injury + +
-
Dashboard injury +
(Injury to ankle is m/c)
Thermal Injuries 00:58:15
Cold injury Heat injury

General
Hypothermia Heat related syndromes
effects
1. Dry cold :
• Frost bite.
• Areas affected are the body
peripheries (Tips of fingers,
nose, earlobes).
• Dry heat : Exposure to
• Freezing +
Local fire → “Burns”.
2. Moist cold :
effects • Moist heat : Exposure to
D/t prolonged immersion under
hot liquids → “Scalds”.
water → Trench foot/immersion
foot.
• Freezing absent.
Rx Rewarming -
Hypothermia :
Core body temperature <35°C.
Elderly, newborns, alcoholics & hypothyroid patients are
commonly affected.
Hypothermia can be :
• Mild : 35°C-32°C. Trench foot
• Moderate : 32°C-28°C (Shivering stops, reflexes are low, J wave in ECG).
• Severe : <28°C (Paradoxical undressing, hide and die syndrome).
FM Revision 2 02 21
Paradoxical undressing : Mimics sexual assault, undressing in extreme cold ----- Active space -----
climate → Death.
Hide and die syndrome : Mimics homicide, patient hides himself → Terminal
burrowing behaviour.
Autopsy findings in hypothermia:

• White deaths.
• Pink hypostasis.
• Wischnewsky’s bleeding spots in the stomach.
Heat related syndromes :

Thermo Core body
Pathology & C/F
regulation temperature
Heat Sweating causes loss of sodium →
cramps Muscle cramps.
Intact Normal
Loss of sodium and water →
Heat
Cerebral hypoperfusion →
syncope
Hypotension & syncope.
Triad of :
1. Core body temperature >40.5°C.
2. CNS dysfunction.
3. H/o heat exposure.
Heat ↑↑↑
HR↑ Impaired
stroke (>40.5oC)
BP↓
Pinpoint pupils +ve
Sweating is absent.
Autopsy : Post mortem caloricity.
Note :
Exertional heat stroke → Diaphoresis is seen.
Burns 01:07:03
Estimation of burns surface area :

• Wallace Rule of Nines.
• Lund & Browder chart (Best for children).
• Rule of palm (For patchy burns) : Size of burn area = size of palm =
approximately 1 %.
22 02 FM
Wallace Rule of Nines
Autopsy (PM) findings :

Non specific findings :
Heat stiffening Heat rupture Heat hematoma Heat fracture
Muscle → Protein Cracking and Intracranial Fracture of
coagulation → Body splitting of skin. rupture of vessels long bones/skull
is stiffened. It is large & → Clot in the bones.
Also known as : irregular. extradural space.
• Boxer’s Floor has It is chocolate
attitude. intact vessels, brown in color.
• Pugilistic hence it is pale. Honey comb
attitude. appearance d/t
• Fencer’s presence of gas
attitude. bubbles inside.
Heat stiffening Heat rupture

FM Revision 2 02 23
Heat hematoma
Specific findings of antemortem burns :

External findings “FIRE” Internal findings 3 C’s
• Fluid in blisters. • Carbon deposition (Soot) in airway.
• Inflammatory signs + • ↑sed cyanide levels in blood.
• Redness/redline/repair. • ↑sed carboxyhemoglobin in blood (>10 g%).
• Enzymes ↑sed.
Antemortem burns Soot in trachea
Burns vs Scalds : 01:17:03
Burns Scalds
Cause Dry heat Moist heat
Charring and singeing + -
Soddening - +
Lines of blisters - +
Splashing - +
Clothing Burned out Intact
At/above the level of At/below the level of impact/
Level of contact
impact/contact. contact
----- Active space ----- FORENSIC MEDICINE REVISION 3
Electrocution 00:00:12
AC (Alternating current) more dangerous than DC (Direct current).

Most important factor for death in electrocution : Amperage → Causes tetanoid
spasm.
Cause of death : Cardiac arrhythmia (M/C/C ) > Respiratory failure (D/t
brainstem or diaphragm involvement).
Most resistant to electricity → Dry skin.
Low voltage current & high voltage current :

Burns of high voltage
Burns of low voltage current.
current.
• Firm contact. • Loose contact.
• Joule burn/endogenous burn • Flash burn : Diffuse
: Burn at the point of contact burn.
of electric current → Central • Crocodile burn : Multiple
depressed area with peripheral punctate burns.
raised margin. Joule burn
• Metallization : Deposition of metallic ions in the
entry wound.
• Current pearl : Metallic ions in the
subcutaneous tissue.
Lightening injuries 00:03:57
High voltage DC.

Filigree burns (Lichtenberg markings/arborescent.
burns/ferning/keraunographic burn).
Filigree burn
Filigree burn vs marbling :
Filigree burn. Marbling.
Pinkish/reddish. Green/brown.
Doesn't follow blood vessels. Follows blood vessels.
FM Revision 3 03 25
Torture methods 00:05:31 ----- Active space -----
Declaration of Tokyo : Guidelines for doctors to handle the cases of torture

victims.
Torture methods :
Dry submarine : Plastic Wet submarine : Dunking : Immersion
bag asphyxiation. Immersion of head under of the whole body
sewage water. underwater.
Saw horse : Forced Telefono : Repeated Falanga/Falaka/

straddling. beating over ears. Bastinado : Beating
over the soles.
Hog tying : Tying wrist & El planton : Prolonged Cattle prod : Electric
ankle together in a prone standing. shock to genitalia.
position.
Bomb blast injuries 00:07:51
Types of blast :
1. Air blast.
2. Immersion blast : Underwater.
3. Solid blast : Contact with a solid or metallic vibrating surface during an
explosion (Ship). Skeletal fractures can occur.


Air blast :
Types of blast injuries :
Type Cause Injuries
Ear : Tympanic membrane (M/C).
Primary Blast wave. Lung : Blast lung (ARDS) : Most fatal blast injury.
GIT.
M/C blast injury overall.
Flying missiles/
Directional injuries.
Secondary projectiles/
Marshal’s triad : Abrasion + Contusion +
shrapnels
Laceration (same side of the body).
Wind/victim Fractures seen.
Tertiary
displacement
Quaternary Miscellaneous D/t other factors such as building collapse/fire.
Immersion blast :
Head below water level : Ear injury.
Head above water level : GIT injury.
Ballistics 00:12:24
Study of firearms.
Types of ballistics :
1. Proximal (Internal) ballistics.
2. Intermediate (External) ballistics.
3. Terminal wound ballistics.
Proximal ballistics :
Parts of firearm :
Muzzle
Stock/handle Breach Barrel

FM Revision 3 03 27
Classification of firearms based on the inner surface of barrel : ----- Active space -----
Helixometer : Instrument to study the inner surface of the barrel.
Rifled gun Smooth bored gun/shotgun Paradox gun
Inner Spiral grooves/ Smooth. Smooth bored
surface of riflings. with terminal
the barrel rifling.
Projectile Bullets. Lead shots/pellets.

Mechanics. Rifling helps spin • Shots undergo dispersion → Travel
the bullets → ↑ short distance.
Stability of bul- • Choking : Terminal constriction of the
lets. barrel to ↓ the dispersion → Travel
longer distance.
Grades of choking :
1. Unchoked : Maximum dispersion.
2. Quarter choked.
3. Half choked.
4. Fully choked : Least dispersion.
Cross section of barrel :

Rifle (Muzzle end). Smooth bored gun.
Lands Elevation. No lands, grooves.
Grooves Depression. Internal diameter measured as gauge/
Calibre Distance b/w two lands. bore.
Gauge : Measured using indirect method.
Number of lead balls that fit in the barrel
from one pound of lead.
↑ Number → ↓ Diameter of barrel.


Structure of shotgun cartridge & rifle :
Shotgun cartridge Rifle
Lead shots
Wad
Gun powder
Primer
Parts : Parts :
• Lead shots. • Bullet with a bullet/cartridge
• Wad : Made of plastic/cork. case.
Functions : • No wad needed as the single
a. Separation b/w gunpowder & lead bullet does not mix with
shots to prevent mixing b/w them. gunpowder.
b. Travels only 2-5 metres (Produces • Gunpowder.
only minor bruises).
• Gunpowder.
• Primer cup/detonator cup/percussion cup : Contains primer → Highly
inflammable.
Pull the trigger of the gun → Firing pin hits the primer cup & primer ignites
→ Flame enters gun powder → Gun powder blasts & the energy pushes the
lead shots/bullets out.
Gunpowder :
Types Black Smokeless Semi
smokeless
Composition • Potassium nitrate (75%). • Nitrocellulose (NC). Black 80% +
• Charcoal (15%). • Nitroglycerine (NGC). smokeless
• Sulfur (10%). • Nitroguanidine (NGU). 20%.
• FG (F : fineness), FFG, • Single base : NC.
FFFG, FFFFG. • Double : NC + NGC.
Finer powder → Better • Triple: NC + NGC +
effect. NGU.
Smoke More. Less. -
Energy Less. More. -

FM Revision 3 03 29
Primer : ----- Active space -----

Components (BLAST the gunpowder) :
• Barium nitrate. • Styphanate (Lead).
• Lead peroxide. • Tetrazine.
• Antimony sulphide.
Intermediate & terminal ballistics : 00:28:29

Discharges from a gun :
Discharges from a gun Effects
Burning/charring of skin.
Flame
Singeing of hair.
SMoke Blackening of skin.
Unburnt gunpowder Tattooing/peppering.
1. Puncture wound.
2. Grease collar/dirt collar/bullet wipe : Grease
Bullet deposition at the margin of the wound.
3. Abrasion collar : D/t spinning motion (Gyroscopic
action) of bullet.
Tattooing.
Blackening.
Burning.
Abrasion collar.
Bullet wound.
Grease collar.
Discharges from a gun Circular & oval abrasion collar
Wound ballistics in a rifle : Contact Close Intermediate

Rifle ranges : Near Distant
1. Contact shot. Flame
2. Close range. Smoke
3. Near range. Gun
powder
4. Intermediate range.
5. Distant range. Bullet


Contact shot :
Tight Loose contact. Contact shot over
contact. a bony prominence.
Stellate/cruciate
Bullet wound. + + entry wound d/t
blast effect.
Grease collar &
+ +
abrasion collar.
Recoil abrasion. + -
Flame & smoke escape
outside d/t gap → Stellate wound
Burning, blackening
Burning, Seen inside deposit around the
blackening & the track of wound → Corona.
tattooing. the wound.
Corona.
Wound characteristics in other rifle shots :

Distant
Characteristics Close shot Near shot Intermediate shot
shot
Burning + - - -
Blackening + + - -
Tattooing + + + -
Bullet wound, grease
+ + + +
collar & abrasion collar
Tattooing
Bullet wound
Intermediate shot. Distant shot.

FM Revision 3 03 31
Wound ballistics in a shotgun : ----- Active space -----

Flame → Travels upto 15 cm.
Smoke → Upto 45 cm.
Gunpowder → 60-90 cm (Maximum 1 m).
Dispersion of lead shots → Starts at 2m & completed at 4 m.
Shotgun ranges & its effects :

Shotgun Distance Effects
range
Contact shot Bony prominence : Stellate wound.
All the effects inside the wound.
Close shot < 1 m Burning, blackening & tattooing around the central
hole of lead shots.
Near shot 1-2 m Central single hole with irregular margins (Rat hole
appearance).
No other effects.
Intermediate 2-4 m Dispersion has started.
shot Independent pellet holes (Satellite holes) seen around
the central wound.
Distant shot >4 m Every pellet seen as an independent hole d/t
complete dispersion.
Intermediate shot Distant shot. Contact. Close. Near. Intermediate

Distant.


Entry wound & exit wound :
Entry wound. Exit wound.
Margin Inverted. Everted.
Grease collar, abrasion
collar, flame, smoke, + -
gunpowder effect
Smaller except in contact Larger.
Size of wound
shot with bony prominence.
Bleeding Less. More.
Bullet markings : 00:46:06
Types of bullet markings :

Primary marking Secondary marking
Macroscopic. Microscopic.
Produced by rifling grooves of the Produced by irregularities in the
barrel. barrel. Varies from gun to gun →
Fingerprint of a gun.
Indicates the model of the gun. Can identify the exact gun.
Handle the bullet with either

rubber-tipped forceps or gloves to
avoid making additional markings. Rubber tipped forceps
Identifying the shooter :

Take a swab from these areas (Green areas shown in the image) of the
accused’s hand & send it for analysis.
Gunshot residue test (GSR) is done to identify the shooter.
GSR tests (Mnemonic : HANDS) :
• Harrison & Gilroy’s test.
• Atomic absorption spectrometry.
• Neutron activation analysis.
• Dermal nitrate.
• SEM-EDXA : Scanning electron microscopy with energy dispersive X-ray
absorptive spectrometry (Specific test).

FM Revision 3 03 33
Atypical bullets : 00:51:04 ----- Active space -----
Type of
Features Image
bullet
Tandem 2 bullets coming out back to back.
Semi- Tip of lead core is exposed to

jacketed/ outside → Mushrooms on entering
dum-dum skin & cause greater damage.
Yawning Irregular bullet path.
Bullet rotates end to end.

Tumbling
Frangible Fragments on impact.

Retained bullet inside the body.
Souvenir
Chronic complication : Plumbism.
Hits intermediate surface at an
angle (Critical ricocheting angle :
10°-30°).
Bullet stops spinning on hitting
Richochet
intermediate surface → No
abrasion collar.
No effects of flame, smoke, or
gunpowder on the entry wound.
Luminous metal at the base → Glows → Can trace the path of
Tracer
the bullet.
Kennedy phenomenon : Iatrogenic alteration of gunshot wound → Difficulty in

range determination.
Gunshot wound on the skull :

Bevelling of skull table : Seen on an unsupported table.
Entry wound → Inner table.
Exit wound → Outer table.
Entry wound Exit wound


Atypical patterns in a shotgun :
1. Welding of shot/balling of shot :
• D/t incomplete dispersion of lead shots (Some lead shots stick with
each other d/t lubricants).
• Even at a distant range, it looks like a near/intermediate range.
2. Billiard ball ricochet effect : D/t erratic dispersion of shots on hitting
intermediate surface.

FM Revision 4 04 35
Autopsy/Postmortem(PM) examination/Necropsy 00:00:32
Medico legal autopsy (m/c type) Clinical/pathological autopsy

In unnatural deaths In natural deaths
Authorization from Investigating Officer (IO) Consent from relatives
Complete autopsy Partial autopsy
(all 3 primary cavities must be opened) (only suspected pathological
cavities are opened)
Body handed over to IO Body handed over to relatives
Other types of autopsy :

1. Virtual autopsy/virtopsy :
• Whole body imaging (CT/MRI) is done.
• Disadvantage : Only structural lesions are identified.
2. Psychological autopsy :
• To assess psychological state of the deceased before death.
• To confirm suicidal death.
• By interviewing relatives & friends.
3. Negative autopsy :
• No findings on internal & external examination (negative findings).
• No opinion can be given about the cause of death.
Rules of dissection :
Cause of death First cavity of dissection
Poisoning Cranial cavity (to detect the smell of poison)
Head injury Cranial cavity
New born Abdomen dissection : Check the level of diaphragm.
• Live born : Diaphragm at a lower level.
• Dead born : Diaphragm at a higher level.
Asphyxia Cranial cavity (1st cavity) → thorax/abdomen → neck
dissection (last cavity) (bloodless dissection of neck).
Pneumothorax/Air embolism Thorax
First cavity to be dissected : Choice of the doctor.

M/c cavity dissected first : Thoracic cavity.


Incisions 00:06:47
• I shaped incision (m/c) :
a. Starts at : Chin.
b. Ends at : Pubic symphysis.
• Y shaped incision :
a. Starts at b/l acromion process meets at xiphoid
process & ends at pubic symphysis.
b. Extends below the breasts.
c. Done in females, for cosmetic purposes.
• Modified Y incision :
a. Starts at b/l mastoid process meets at xiphoid &
ends at pubic symphysis.
• Inverted Y incision :
a. Done in newborns.
b. Starts from the chin upto umbilicus bifurcates
to b/l mid inguinal point.
• X incision :
a. In custodial deaths.
b. Incision applied on the back of the body.
c. Assess deeper injuries.
Techniques of organ removal 00:08:56
Technique Virchow Letulle’s Ghons Rokitansky

Method Organ by En masse Block In situ
organ (Ex : Cervicotho-
racic/abdominal/
urogenital block).
Other M/c •Rapid removal. - In infectious
points •Anatomical diseases
relationship (HIV, Hep B)
maintained.

FM Revision 4 04 37
Individual organ dissection : ----- Active space -----
Cranial cavity dissection :

Scalp reflection : Bi-mastoid incision.
Brain dissection : Dissection method → Cranial cutting
method.
Heart dissection :
• Inflow outflow method : Along the direction of blood flow.
• RA followed by RV then LA followed by LV.
Stomach :
• Dissection by : Double ligature method to prevent leakage of gastric content.
• Lesser curvature maximally damaged in acid consumption (maganstrasse).
• Incision for dissection : Along greater curvature.
Exhumation :
• Digging body out of earth.
• 176 (3) CrPC.
• Authorization by : Magistrate.
• No time limit (in India).
• Preserve soil samples to rule out soil contamination (postmortem imbibition).
• M/c metal in postmortem imbibition : Arsenic.
Thanatology (study of death) 00:16:08
Types of PM changes :
Immediate changes Early changes Late changes
(Somatic death) (Decomposition)
• Loss of voluntary Eye changes. • Autolysis (self
movement. Algor mortis : enzymes).
• Irreversible Onset : 15 min after death. • Putrefaction
stoppage of Livor mortis : (bacterial
circulation & Onset : 30 min after death. enzymes).
respiration. Rigor mortis :
Onset : 60 min after death.

----- Active space ----- Eye changes :

Retina :
• Kevorkian sign/cattle trucking sign/railway tracking sign
: Fragmentation of retinal blood vessels.
• Time Since Death (TSD) : Within few minutes. Kernovian sign
Sclera :
• Tache noire sign : Two triangular shaped opacities on
either sides of cornea.
• Seen when eyes are open.
• TSD : 3-6 hrs.
Tache noire sign
Algor mortis/PM chilling/PM cooling :
• Decrease in body core temperature (BCT).
• Site to measure BCT :
a. Commonest site : Rectum (except : Sodomy cases).
b. Ideal site : Sub-hepatic space.
• Shape of algor mortis curve : Sigmoid/inverted S.
• Rate of fall : 0.4 °C to 0.7 °C/hr.
PM caloricity :
• Body remains warm for the first 2 hrs after death.
• Ex : Heat stroke, pontine hemorrhage, nux vomica poisoning, tetanus,
septicemia (not seen with burns).
Livor mortis/PM staining/PM lividity :

AKA Cadaveric lividity, suggilation, PM hypostasis.
• Seen in dependent sites.
Sites of PM staining : Livor mortis in supine position
Position of the body Sites of PM staining

Supine Posterior surface of the body
Prone Anterior surface of the body
Vertically suspended Glove & stocking distribution
(not confirmatory of hanging)
Rolling
(Fast flowing river)
Absent livor mortis
Severe bleeding
Severe anemia
Drowning in a lake Face, upper chest, forearm, legs
FM Revision 4 04 39
• Normal Colour of PM hypostasis : Blue. ----- Active space -----

• Colour changes with different poisoning cases.
Rigor mortis/cadaveric rigidity 00:26:56
• Onset of rigor mortis : 60 mins after death.

• After death :
Primary relaxation Stiffening/Rigor Secondary Relaxation
• Relaxation of mortis
sphincters, passage • ATP depletion.
of urine or stools.
• ATP concentration :
100%.
• Generalized rigidity : 1st is involuntary > voluntary muscles.
• First site of rigor mortis : Myocardium.
• First external site : Eyelids.
• Last external site : Fingers & toes.
• Nysten’s rule : Sequence of rigor mortis (descending order).
Eyelid Neck Jaw Face Thorax
Upper limb Abdomen Lower limb Fingers & toes
• Rule of 12 in rigor mortis :
a. Onset : 1 hr.
b. Maximum by : 12 hrs.
c. Remains in muscle : For 12 hrs.
d. Gradually disappears : Over 12 hrs.
• Disappearance of rigor mortis also occurs in descending order.
Conditions similar to rigor mortis :

• Heat stiffening :
Seen in burns cases.
Boxer’s attitude (due to protein coagulation).
• Cold stiffening : Seen in bodies kept in freezer.
• Gas stiffening : In decomposition.
• Cadaveric spasm (instantaneous rigor).

----- Active space ----- Cadaveric spasm Rigor mortis

Onset : Immediately after death Onset : 60 min
(no primary relaxation)
Spasm of voluntary group of mus- Generalized rigidity
cle, last used at the time of death (involuntary & voluntary muscle)
Always antemortem in nature Postmortem in nature
Cannot be produced artificially -
Seen in drowning In all deaths
Putrefaction : 00:33:42
• Late change.
• Due to bacterial enzymes.
• Chief destructive agent : Clostridium welchii (lecithinase).
Changes in putrefaction :
Colour change Gas production Liquefaction
• 1st site of colour change: Aorta • Most important : H2s. aka
(reddish brown discolouration). • Gas stiffening/gas Colliquative
• 1st external site/1st external sign rigidity present (bloating). liquefaction
of putrefaction : Right illiac fossa • PM decomposition blisters : onset : 5-10
(greenish discolouration). Content : Gas. days after
• Significance : Calculate TSD. Base : Pale. death.
Summer : 12-18 hrs. • Burns blisters :
Winter : 1-2 days. Content : Inflammatory
•Marbling : Due to greenish fluid.
sulf-hemoglobin pigment staining Base : Reddish.
vessel wall (36-72 hrs TSD).
Casper’s dictum : Marbling

• Rate of putrefaction in different medium.
• Fastest in air, slowest in soil.
• Air : Water : Earth = 1 : 2 : 8 (AWEsome).
FM Revision 4 04 41
Adipocere & mummification 00:37:50 ----- Active space -----

Modified forms of putrefaction :
Adipocere (grave wax) Mummification
Hydrolysis & hydrogenation of fat Drying & dehydration of the body
(fat converted to fatty acids then
to waxy substance)
Acidic pH prevents bacterial growth -
Body features & injuries preserved Shrinkage & weight loss (70%) of body
Environment & cofactors : Environment :
• Water. • Dry & hot climate.
• Warm climate. • Free flow of air.
• Clostridium welichii.
• Lipase enzyme.
TSD : 3 days to 3 months TSD : 3 to 12 months
Adipocere Mummification
Asphyxial deaths 00:41:11
Hanging :
Types of hanging :
1. Based on position of knot :
Typical hanging Atypical hanging
Knot : Occipital region Knot : Anywhere else
2. Based on suspension of body :

Complete hanging Partial hanging
Whole body suspended Body part touches the ground
Constriction force : whole body weight Constriction force : Partial body weight
Faster death Slower death
Autopsy findings in hanging :
• Face :
Pale/congested.

Dribbling of saliva (surest sign of antemortem hanging) due to pressure on
salivary gland.
La facie sympathique (sign of antemortem hanging) : Although rare.
a. Pressure on cervical sympathetic chain.
b. I/L eyelid open, pupil dilated.
• Neck :
Typical ligature mark in hanging : Oblique,
incomplete & above thyroid.
Transverse ligature mark in hanging :
a. Partial hanging.
b. Slip knot with running noose.
Suspension peak : Discontinuity in ligature mark.
Suggestive of hanging.
Internal findings :
• Hyoid bone # : >40 yrs.
Types : Suspension peak
a. Abduction # (AP compression #).
b. Side to side compression #.
• Amussat sign : Intimal tear of carotid artery. Hanging with long drop
• Hangman # : C2 vertebral axis #. (Ex : Judicial hanging).
Hangman’s knot (in judicial hanging) is seen on the side of the neck.
Manner of death :
Suicidal (M/c) Homicidal Accidental
M/c method of Lynching (extrajudicial • Autoerotic/sexual
suicide : Hanging hanging) : By a mob. asphyxia/Hypoxiphilia/
(painless) > poison- Kotzwarism.
ing. • Form of :
a. Masochism.
b. Transvestism.
Strangulation 00:51:20
• Ligature strangulation :
Ligature mark : Complete, transverse & below thyroid.
Contusions & ecchymosis seen surrounding the ligature mark.

FM Revision 4 04 43
• Throttling (manual strangulation) : ----- Active space -----

Almost always homicidal.
External findings :
a. Nail marks present.
b. Six penny bruises (finger tip bruises).
Internal findings :
a. Extensive soft tissue contusion.
b. Adduction # of hyoid bone.
c. Thyroid/cricoid #.
Strangulation ligature Six penny Tissue contusion

mark bruises in throttling
Mugging Garroting Spanish windlass Bansdola
Suffocation 00:54:37
Smothering :
Closure of mouth & nostrils together.
Cannot be suicidal.
In homicidal smothering, if hands used :
• Perioral injuries.
• Lip contusion.
• Laceration of frenulum.
Perioral injuries
Gagging :
Asphyxia from thrusting of cloth/pad into mouth.
Always homicidal.


Choking :
Asphyxia from entry of foreign body/food bolus into airway.
Cafe coronary syndrome : Death d/t vagal inhibition of heart.
Traumatic & positional asphyxia :

Traumatic asphyxia : Positional asphyxia :
• Due to heavy weight on Restriction of • Due to abnormal
person. chest movements position.
• Eg : Person sitting on • Types :
chest, building falling on a. Jack knife position.
person. b. Overlaying.
• Masque ecchymotique : Asphyxia c. Burking (smothering
Pale chest with cyanosed + traumatic
face(due to low venous asphyxia).
return).
Masque ecchymosis Jack knife position Overlaying Burking
Drowning 00:58:24
Dry drowning Wet drowning

Rapid water entry Water entry into alveolus
into pharynx
Death due to as- Fresh/hypotonic water : Salt/hypertonic water :
phyxia from reflex Hemodilution → Hemoconcentration →
vocal cord spasm. Hypervolemia → RBC Increased Na+, Cl-, Mg2+ →
swollen → Hemolysis → RBC crenated → Death due
Hyperkalemia → Death due to pulmonary edema.
to ventricular fibrillation.
Hydrocution/immersion syndrome :
• Drowning in cold water (5 °C less than body temp).
• Death due to bradycardia/cardiac arrest (vagal inhibition of heart).

FM Revision 4 04 45
PM findings in drowning : ----- Active space -----

External signs of antemortem drowning :
Specific signs of antemortem drowning :
Cadaveric spasm : Surest sign of antemortem drowning.
Froth in nostrils :
• Fine, tenacious, persistent.
• Air+ water+ mucus + surfactant with respiratory struggle.
• No froth seen in :
a. Unconscious person.
b. Dry drowning.
c. Hydrocution.
Non-specific signs of antemortem drowning :

1. Cutis anserina (goose flesh).
2. Washer woman’s hand & foot :
• Wrinkling, peeling of cuticle.
• Bleaching, soddening of skin +.
• Significance : Time since immersion.
Cadaveric spasm Frothing in Cutis anserina Washerwoman’s

nostrils feet
Internal findings in antemortem drowning :
1. Lung findings :
Emphysema aquosum Oedema aquosum
In conscious person drowning In unconscious person drowning
Paltauff hemorrhages (rupture of More edema.
alveoli) + bullae + froth. No/minimal froth.
2. Water in :
• Stomach/intestines.
• Sinuses.
• Middle ear.
3. Middle ear hemorrhage.
Paltauff hemorrhages


Investigations in drowning :
1. Diatoms test :
Microscopy :
• Outer wall : Silica.
• Resistant to acid & alkalis.
Diatom in bone marrow, visceral organs : Sign of antemortem drowning.
2. Gettler’s test :
To differentiate between salt water & fresh water drowning.
Comparision of Cl- concentration.
Right heart chambers Left heart chambers
Normal Equal on both the sides
Fresh water Remains same Less Cl- concentration
drowning (due to hemodilution)
Salt water Remains same More Cl- concentration
drowning (due to hemoconcentration)
Both tests are not useful in :
• Dry drowning.
• Hydrocution.

M v o 5 05 47
Human identification 00:00:10
Identification Parameters
Presumptive/ Incomplete
Definitive/ Complete
Parameter Best bone
Race Skull Fingerprinting/Dactylography (Most reliable method)
Age - DNA fingerprinting.
Sex Pelvis Tattoo marks.
Stature Femur Superimposition.
(Height) Lip, Palate printing.
Assessment of stature : Long bones.
Bone % of contribution to stature
Femur (Best) 27%
Tibia 22%
Humerus 20%
Determination of Race 00:02:00
Assessed from bones (Skull best bone).

Indices for race determination : (Mnemonic : BCCI).
B : Brachial Index (upper limb).
C : Cephalic Index (Head).
C : Crural Index (Lower limb).
I : Intermembral Index (Humerofemoral index).
Cephalic Index = Max. breadth of skull (b/w parietal eminence)

Max. length of skull (b/w glabella & occipital protuberance)
Cephalic index Type of skull Race

70-75 Dolichocephalic Aryans/ Africans
75-80 Mesaticephalic Indians, Chinese, Europeans
80-85 Brachycephalic Japanese

Dolichocephalic Mesaticephalic Brachycephalic

Cephalic index
Determination of Sex from Skeletal Remains 00:04:48
1. Skull and mandible :

Male Female
General shape : Orbit/chin Square Round
Forehead Steeper/sloping Vertical
Marking & prominences :
Glabella/supraorbital ridges/mastoid More prominent Less prominent
process/occipital protuberance
Angle of Mandible < 120° > 120°
Note : Frontal & Parietal eminences are more marked in females.
2. Pelvis :
Male Female
Pelvic Inlet Heart. Circular.
Pelvic cavity Funnel. Bowl.
Preauricular sulcus Narrow, shallow. Broad, deep (Parous woman).
Sub pubic angle Acute. Obtuse (>90°).
Greater Sciatic notch (Best) Narrow, deep. Wide, shallow.
Obturator foramen Oval. Triangular.
Sacrum Uniform Upper half straight, lower
curvature, half curved forward,
More prominent Less prominent promontory.
promontory.

M v o 5 05 49
3. Sternum : Ashley’s rule of 149. ----- Active space -----

Length of sternum : Body + manubrium .
• Male : > 149 mm.
• Female : < 149 mm.
Krogman’s accuracy : Accuracy of bone in sex determination.

• Pelvis : 95%.
• Skull : 90%.
• Long bones (Femur) : 80%.
• Pelvis + Skull = 98%.
• Pelvis + Long bone = 98%.
• Complete skeleton : 100%.
Single best bone : Pelvis (Best bone even in children).
Indices for sex determination of bones :

• Sciatic index (best).
• Sternal index. Value is more in females.
• Sacral index.
• Ischiopubic index.
• Corporobasal index → Value is more in males.
Breadth of S x 100
Corporobasal index =
1
Breadth of sacrum
Determination of Age 00:13:50
Fetus Before puberty After puberty

1. Teeth 1. Secondary teeth
(Eruption & Mineralisation) changes
1. Rule of Hasse 2. Skull sutures closure
2. Ossification of long
3. Pubic symphyseal
bones
changes


Rule of Hasse:
Estimation of fetal gestational age (GA) from crown to heel length (CHL).
< 5 months > 5 months
25 cm
GA = √ CHL GA = CHL / 5
Crown rump length (CRL) = 23 X CHL
Age estimation from ossification centers 00:16:23
1. Shoulder Joint :
Ossification center Appearance Fusion Tip of acromion
Head of humerus 1 year Head of humerus
Greater tubercle 3 years 18 years. Greater tubercle
Lesser tubercle
Lesser tubercle 5 years
Tip of acromion 14-15 years 17-18 years
2. Clavicle :
Ossification center Appearance Fusion
18-19 years
Medial end of clavicle 21-22 years
(small vertical strip)
3. Elbow Joint : (Mnemonic : CRITOE)

C Capitulum 1 years
R Head of radius 5 years
I Internal/Medial epicondyle 6 years
16 years
T Trochlea 9 years
O Tip of Olecranon process 9 years
E Lateral epicondyle 11 years
Conjoint epiphysis : Capitulum + Trochlea + Lateral epicondyle.
Medial epicondyle
Trochlea Lateral epicondyle
Capitulum
Head of radius Olecranon
11-16 years (Unfused epiphysis)

M v o 5 05 51
4. Wrist : ----- Active space -----

Lower end of radius 2 years 18 - 19 years
Lower end of ulna 5 years 17 - 18 years
1 : Scaphoid.
Carpal bone Appearance 2 : Lunate.
Capitate 6 5 3 : Triquetrum.
2 months 3 8 4 : Pisiform.
(Largest) 7
1 5 : Trapezium.
Hamate 3 months - 1 year 4 2 6 : Trapezoid.
Triquetrum 3 years 7 : Capitate.
9 8 : Hamate.
Lunate 4 years 10
9 : Lower end radius.
Scaphoid 5 years 10 : Lower end of ulna.
Trapezium 18 years
5-6 years
Trapezoid
Pisiform 9-12 years Pisiform
Mnemonic :
She Looks Too Pretty. Try To Catch Her.
Pisiform has appeared → ≥9 years
Some other ossification centers :

The following fuse as a single piece of bone at :
• Spheno-occipital suture : 18-21 years.
• Sacrum : 22-25 years.
• Body of sternum : 25 years.
Age estimation from dentition 00:24:50
Teeth Eruption (< 25 years of age) :

Temporary/Deciduous/ Permanent/ Secondary
Milk/ Primary teeth teeth
20 teeth 32 teeth
Each quadrant : Each quadrant :
M2 M1 C LI CI M3 M2 M1 PM2 PM1 C LI CI
CI : Central incisor.
LI : Lateral incisor.
C : Canine
PM : Premolar/Bicuspid.
M : Molar.
----- Active space ----- Temporary teeth Permanent teeth

Eruption Eruption
Age Age
sequence sequence
Incisor 6 months Molar 1 6 years
Molar 1 12 months Central Incisor 7 years
Canine 18 months Lateral Incisor 8 years
Molar 2 24 months Premolar 1 9 years
Premolar 2 10 years
Lower central incisor 1st to erupt. Canine 11 years
Molar 2 12-14 years
Molar 3
17-25 years
(Wisdom teeth)
Mummy Is In Pain, Pappa Can
Make Medicine
Mixed dentition : 6-11 years.
Total no. of teeth b/w 6-11 years : 24.
Total no. of permanent teeth b/w 6-11 years : (Age - 5) X 4.
Permanent teeth eruption :
• Replacing temporary teeth : Successional teeth (20).
• Additional teeth : Superadded teeth (12).
Gustafson’s method (after 3rd molar eruption) :

Based on secondary changes in the teeth.
Used in dead people >25 years of age.
Components : APSRTC.
• Attrition.
Used in live people
• Periodontosis.
• Secondary dentin (2nd most reliable).
• Root resorption.
• Transparency of root (Most reliable).
• Cementum apposition.
Anterior (Incisors) → Posterior (molars) : Reliability .
Boyde’s method :
Used in infants (Very precise) : Age in days.
Counting number of incremental lines under electron microscope (1 line/day).
1st neonatal line (NL) : 2nd /3rd day of birth. Sign of live birth.

M v o 5 05 53
Dental Charting : ----- Active space -----

• Universal method.
• Palmer’s notation.
• Haderup’s system.
• FDI method (Most internationally used).
Permanent dentition
Temporary dentition
Universal method
Permanent Teeth
Upper Right Upper Left
Lower Right Lower Left

Deciduous Teeth
Upper Right Upper Left
Lower Right Lower Left
Palmer’s notation :
Each quadrant denoted by (LU), (LL), (RL), and (RU).
Haderup’s system :
Similar to Palmer’s notation except :
• ‘+’ : Upper jaw.
• ‘-’ : Lower jaw.


FDI (Federation Dental International) method/Two digit system : Used widely.
Permanent teeth Prefix
Deciduous teeth Prefix
Definitive Identification 00:38:15
Dactylography (fingerprinting) :
Most reliable method.
Fingerprints are different even for monozygotic twins (Superior to DNA
fingerprinting).
Development of ridges Intrauterine life (IUL)

Starts 12th - 16th week of IUL.
Completes 20th - 24th weeks of IUL.
Based on pattern (Galton system) : Lucy Works At Cafe.

1. Loop : M/C (60-65%). Loops
Types :
• Towards Ulna : Ulnar loop.
• Towards radius : Radius loop.
2. Whorls (2nd M/C) : Spiral ridges.
3. Arch (3rd M/C) : Whorls
• Plain arch : Less height.
• Tented arch : More height.
4. Composite (Least common) : Mixture of ≥2 patterns.
Arch
M v o 5 05 55
Ridgeoscopy (Ridge character) : ----- Active space -----

Match each ridge.
For confirming fingerprint : Match at least
12-16 points of comparison.
Alterations of fingerprint :
• Adermatoglyphia : Complete absence of
fingerprint.
• Atrophy :
a. Celiac disease (Complete).
b. Dermatitis (Partial).
• Permanent alteration : Leprosy, Types of ridges
Electrocution, Radiation.
Locard’s Poroscopy :
Study of sweat pores between 2 fingerprint ridges.
Unique to each person.
Useful in partial fingerprints.
Chelioscopy (lip printing) : Poroscopy

Lip print is lifted from glass/cigarette bud/fruit etc.
Suzuki classification : 6 types.
Rugoscopy/Palatoscopy :
Study of pattern/arrangement of rugae in anterior
1/3rd of hard palate.
3 types (Based on length) :
• Primary : 5-10 mm.
• Secondary : 3-5 mm.
Palatoscopy
• Tertiary : < 3 mm.
Tattoo Marks/Tattooing :
Faded tattoo identification method :
• Magnifying glass.
• Infrared photography.
• UV light.
Tattoo invisible : Examination of regional lymph nodes for tattoo pigments.


Superimposition :
Used in cases where bones (skull) are found & the person is reported missing.
Matching of the skull with the antemortem photo/video.
Bony landmarks in the skull and photo are matched.
a. Match : Skull may belong to the person.
b. No match : Does not belong.
Test of exclusion.
+ =
Sexual Jurisprudence 00:46:21
General terms :
Impotence : Inability to achieve and maintain penile erection.
• Towards one particular woman: Impotency quad hanc.
• M/c cause : Psychological.
• M/c organic cause: Vasculogenic.
Lack of sexual arousal in females : Frigidity.
Conception without penile penetration : Fecundation ab extra.
Excessive sexual desire :
• Males : Satyriasis.
• Females : Nymphomania.
Types of hymen :
Annular Septate Fimbrate
Semilunar Cribriform Imperforate

(M/C)

M v o 5 05 57
M/C hymen : Semilunar. ----- Active space -----

Fimbriate hymen : Confused with hymenal tear due to notches.
Position of hymenal tear :

• Posterolateral (4-7 o’clock) : Penile penetration.
• Anterior : Digital/foreign body penetration.
Intact hymen despite sexual intercourse :

• False virgin (Thick/elastic/loose hymen).
• Child (Deep seated hymen).
Twin pregnancy :
Type of pregnancy No. of ova fertilised Ovulatory cycle
Superfecundation Same
2 ova
Superfetation Different
Fictitious/Fabricated/Suppositious child :
a. Woman fakes pregnancy.
b. Shows up with a child which she claims as her own.
c. Done for blackmailing.
Child resembles grandparents : Atavism.
Maceration 00:51:36
Sign of dead born.

Aseptic autolysis.
Early sign : Reddening of skin & skin slippage (As early as 12 hours).
Radiological signs :
• Robert’s sign : Gas shadow in great vessels (As early as 12 hours).
• Overcrowding of ribs.
• Ball’s sign : Hyperflexion of spine.
• Spalding sign : Overriding of cranial vault bones (4-7 days after death).


Dead v/s Live born :
Dead born Live born
Tests to differentiate
(Not respired) (Respired)
Level of diaphragm (1st to open) 3rd-4rth rib 5th-6th rib
Fodere’s test : Static weight of
30g 60g
lungs.
Plocquet’s test :
1 : 70 1 : 35
weight of lung /weight of baby
Wreden’s Test : Gelatin in
Yes No
middle ear.
Breslau’s second life test/
No bubbles Bubbles +
Stomach bowel test.
Hydrostatic Test/Raygat’s test/
Lung sinks Lung floats
Lung flotation test.
Cry of the baby :

Inside the vagina : Vagitis vaginalis.
Inside the uterus : Vagitus uterinus.
Rape 00:56:58
375 IPC : Definition of rape.

Minimum age of consent : 18 years.
Accused : Always male.
Victim : Always female.
Statutory rape : Sex with girl < 18 years.
376 IPC : Punishment for rape (10 years prison to life imprisonment).
376 (2) IPC : Punishment for custodial rape.
Medical examination in rape :

Accused Victim
CRPC • Police request : 53(A) CrPC.
164(A) CrPC.
procedures • Self : 54 CrPC.
Consent Not mandatory. Mandatory.
Lugol’s iodine test : To look for vaginal Toluidine blue test : For
Test
epithelial cells (+ve upto 4 days). recent micro injuries.

M v o 5 05 59
Male doctor can examine victim in presence of female bystander. ----- Active space -----
POCSO act : Examination by female doctor only.
Swab shows motile sperm : Confirms recent intercourse (6-12 hours).
Incest : Sexual relationship b/w close relatives.

• Mother and son : Oedipus complex.
• Father and daughter : Electra complex.
• Brother and sister : Pharoah complex.
Unnatural sexual offenses :

1. Lesbianism/Tribadism : 3. Buccal Coitus :
B/w 2 females. • Oral sex/Sin of Gomorrah.
Active partner : Dyke. • Fellatio : Oral stimulation of
Passive partner : Femme. penis.
• Cunnilingus : Oral stimulation of
2. Sodomy/Greek love/Buggery : vagina.
• Penile-anal intercourse.
4. Bestiality : Sexual intercourse
• Pedarasty : Habitual intercourse b/w
with lower animals.
adult male (Pedarast) & male child
(Catamite).
• Gerontophilia : With older person.
Note : All unnatural sexual offenses are punishable under section 377 IPC when
committed without consent.
Sexual Paraphilias :
When a person achieves sexual gratification without intercourse.
• By infliction of pain : Sadism.
• By suffering of pain : Masochism (Sexual asphyxia).
• By showing private parts in public space : Exhibitionism (Punishable under
294 IPC).
• By watching the private acts of a female : Voyeurism/Peeping Tom/
Scotophilia (Punishable under 354(C) IPC).
• Within inanimate objects : Fetichism.
• By rubbing the private parts of a female : Frotteurism (Punishable under
354(A) IPC).
• By wearing clothes of the opposite sex : Transvestism/Eonism.
• By talking obscenity : Scatologia.

• By taking enema : Klismaphilia.
• By sight/smell of urine : Urophilia.
• By sight/smell of feces : Coprophilia.
Bobbit syndrome : Amputation of male genitalia by female partner.
Tests for seminal and blood stains :

Seminal Stains :
1. Florence Test : Dark brown rhombic crystals of choline iodide.
2. Barberio’s Test : Yellow needle crystals of spermine picrate.
Florence Test Barberio Test
Blood Stains : Confirmatory tests.

1. Teichman’s Test : Dark brown rhombic crystals.
2. Takayama’s Test : Pink feathery crystals.
3. Absorption Spectrometry (Most specific/reliable).
Takayama Test
Important Medicolegal Sections 01:08:40
Sections Relevance
191 IPC Definition of perjury.
193 IPC Punishment for perjury.
269 IPC Negligent act resulting in spread of fatal infection.
270 IPC Malignant act resulting in spread of fatal infection.
299 IPC Definition of culpable homicide.
• Culpable homicide amounting to murder.
300 IPC
• Culpable homicide NOT amounting to murder.
302 IPC Punishment for murder.
304(A) IPC Punishment for patient death d/t negligence.
304(B) IPC Punishment for dowry death.
312 IPC Punishment for criminal abortion with woman’s consent.
313 IPC Punishment for criminal abortion without woman’s consent.
M v o 5 05 61
Sections Relevance ----- Active space -----
314 IPC Punishment for criminal abortion resulting in woman’s death.

319 IPC Definition of hurt.
320 IPC Definition of grievous hurt.
323 IPC Punishment for voluntarily causing hurt.
324 IPC Punishment for hurt with dangerous weapon/means.
325 IPC Punishment for grievous hurt.
326 IPC Punishment for grievous hurt with dangerous weapon/means.
326(A) IPC Punishment for acid attack.
326(B) IPC Punishment for attempted acid attack.
Grievous Hurt (320 IPC) :

• Emasculation.
• Loss of vision.
• Loss of hearing.
• Loss of member/joint.
• Loss of power of member/joint.
• Disfiguration.
• Fracture/dislocation of bone/tooth.
• Any hurt that:
a. Endangers life.
b. Causes severe body pain. For 20 days.
c. Results in inability to do ordinary activities.
Testamentary Capacity : Ability/capacity of a person to make a valid will.
Criminal Responsibility :
Child < 7 years : Not liable (82 IPC).
Child 7-12 years : Depends on maturity (83 IPC).
Mentally ill person : Not liable (84 IPC).
Insanity related tests and rules (globally) : Insane CAN Defend.

I : Irresistible impulse test.
C : Curren’s rule.
A : American law institute.
N : McNaughten’s rule (M/C).
D : Durham’s rule.
----- Active space ----- FORENSIC REVISION 6
Toxicology 00 00 5
Classification (CINCAM) :
• Corrosives (aka Caustics : Maximum tissue damage).
• Irritants.
• Neurotoxic. • Asphyxiants.
• Cardiotoxic. • Miscellaneous.
Poisons 00 02 16
Diagnosis of poisons :
Cholinergic Anticholinergic Opioid Sympathomimetic
Variables
toxidrome toxidrome toxidrome toxidrome
HR & BP
Respiration
Temperature Hypothermia
Pupil Miotic Mydriatic Miotic Mydriatic
Secretions (dry) -
Convulsions, Excitation →
CNS Delirium Comatose
drowsiness Delirium +convulsions
Examples Organophosphates Datura Morphine Cocaine
Triad of morphine poisoning : Pinpoint pupils + respiratory drive + Coma.
Autopsy findings :
Normal color of post-mortem hypostasis : Blue.
Post-mortem staining : Poison PM staining
Carbon monoxide Cherry red
Cyanide Brick/bright red
Hypothermia Pink
Opiates Black
Hydrogen sulphide Bluish-green
Aniline Dark or deep blue/brown
Phosphorous Dark brown
Nitrates Reddish brown

M v o 6 06 63
Based on the smell : ----- Active space -----

Odor Poisoning
Garlic Arsenic/phosphorous/Organophosphate compounds (OPC)
Bitter almond Cyanide
Burnt rope Cannabis
Acrid pear Chloral hydrate (knock out drop or Mickey’s fin).
Fruity Alcohol
Rotten egg Hydrogen sulfide gas
Kerosene OPC (mainly)
Hospital Phenol
Conium Maculatum/Hemlock
Mousy
(Peripheral nerve poison → Ascending paralysis).
Oil of Wintergreen Salicylates
Fishy Zinc phosphate (Rodenticide)
Note : Cranial cavity has to be opened first to determine poisoning by smell.
Based on color of stomach mucosa :

Poison Color
Sulphuric acid Black necrotic mucosa (Wet blotting paper stomach)
Nitric acid Yellow or brown mucosa d/t xanthoproteic reaction.
Thickening of the stomach mucosa → Leathering
Carbolic acid
(Rx : Gastric lavage).
Arsenic Red velvety stomach mucosa (Hemorrhagic gastritis).
Mercury Slate grey d/t corrosive action.
Copper sulphate/
Bluish stomach mucosa.
amytal
Based on discoloration of teeth :
• Sulphuric acid : Chalky white d/t hygroscopic action (Absorbs moisture).
• Nitric acid : Yellow color.
• Copper : Bluish or greenish discoloration of gums → Clapton’s line.
• Bluish discoloration in gums : Lead (Burtonian line), mercury, silver, iron, etc.
Viscera preservation/ Chemical analysis/ Toxicology analysis :

Organs to be preserved in suspected cases of poisoning (Bloody SILK) :
• Most reliable sample : Blood.
• Stomach & all its content.
• Upper part (30cm) of small intestine.
• 500 g of liver.
• Half of each kidney.

Other organs to be preserved :
• Spinal cord : Strychnine & gelsemium. • Fatty tissues : Pesticides.
• Heart : Digitalis/aconite. • Lungs : Volatile gases.
• Brain : Alcohol/OPC/Opiods. • CSF & vitreous : Alcohol.
• Bone, hair, & nail : Arsenic, antimony (Metals). • Spleen : Cyanide/CO.
Preservatives to stop decomposition :
1. M/C : Saturated solution of Sodium chloride (NaCl).
Not to be used in aconite & corrosives (Exception : Carbolic acid).
2. Ideal : Rectified spirit (95% alcohol).
Not to be used in alcohol, phenol, formalin, or phosphorous poisoning.
3. Sodium fluoride + potassium oxalate : Blood.
4. Thymol or NaF : Urine
5. NaF : Vitreous humor.
6. Glycerol : Virology.
Note :
• No preservatives needed for bone, hair, nail, & lungs (Gaseous analysis).
• Formalin : HPE or embalming. Never used in poisoning.
Role of doctors in poisoning :

Compulsory legal duties of a doctor in poisoning :
• Preserve all the evidences (Gastric lavage contents, poisons brought by patient).
Failure to preserve → 201 IPC (Disappearance of evidence).
• Mandatory police intimation (39 CrPC) of suspected poisoning cases/any crime.
If doctor :
• Fails to inform → Punishable under 176 IPC.
• Informs incorrectly → Punishable under 177 IPC.
Medical duties of a doctor in poisoning :
1. Stabilization (Airway, breathing, circulation) + patient management.
2. Decontamination :
• Gastric lavage :
a. Best time <1 hr.
b. C/I of gastric lavage (Mnemonic: C3v2) :
• Corrosives (Absolute C/I d/t risk of perforation) except carbolic acid.
• Convulsant poison (Strychnine).
• Comatose (Risk of aspiration).
• Volatile (Kerosine poisoning).
• Esophageal varices (Bleeding).
• Activated charcoal : Poison binds to activated charcoal (Adsorption)
→ Eliminated via stool.
• Dialysis or urinary excretion : Removal of absorbed poison
a. pH of urine (Alkalinization : M/C) to excrete acidic drugs (barbiturates).
b. pH of urine (acidification) for Aspirin, salicylates.

M v o 6 06 65
Note : ----- Active space -----

• Inhalational route has the most rapid absorption of poisons.
• Multidose activated charcol : Removal of already absorbed poison
(in intrahepatic circulation). Done in poisoning by Digoxin or Carbamazepine.
Antidotes :
Poison Antidotes
Arsenic BAL (Dimercapol) (IM) or DMSA (Succimer) (oral).
Copper d-Penicillamine, DMSA.
Iron Desferrioxamine.
Lead EDTA. Severe : EDTA + BAL/DMSA.
Mercury DMSA, BAL (Only in inorganic cases)
Cocaine Amyl nitrites
Beta blocker Glucagon
Carbon monoxide High-flow O2 or hyperbaric O2
Nitrites (Induce meth-Hb → Excreted by kidney),
Cyanide
Hydroxocobalamin.
Digitalis Digibind (Also used for oleander poisoning).
Morphine Naloxone (Short half life, multiple doses needed).
Methanol Ethanol & Fomepizole (Inhibits alcohol dehydrogenase).
OPC Atropine + oximes (Synergistic).
Carbamates Atropine.
Organochlorine
No specific antidote → Symptomatic treatment
Pyrethroids
Oxalic acid, Hydrofluoric acid, Hypocalcemia → IV calcium gluconate.
Ethylene glycol
Benzodiazepine Flumazenil
Acetaminophen N-acetyl cysteine
Corrosives 00 3 16
Acid Alkali
Coagulative necrosis → Superficial damage. Liquefactive necrosis → Deeper tissue
damage (More dangerous).
Inorganic acids : Only Local effects (except HF). • Sodium hydroxide.
• Sulphuric acid. • Potassium hydroxide.
• Nitric acid. • Potassium carbonate.
• Hydrochloric acid & Hydrofluoric (HF) acid. • Sodium carbonate.
Organic acids : Local + systemic effects.
• Carbolic acid, Oxalic acid, Acetic acid.


Phenol/Carbolic acid :
• Antiseptic property.
• Putrefaction is delayed.
• Can be absorbed through all routes.
• Causes hard leathery stomach → Pyrocatechol & hydroquinone in liver
(Potent CNS depressant + constricted pupil) → Urine excretion : Carboluria
(Green urine due to oxidation).
• Blackish discoloration at tissues (Ochronosis).
• It can cause renal damage → Death.
Oxalic acid/Acid of sugar :
• Ink remover or stain remover.
• Absorbed into body → Calcium oxalate crystals → Excreted in urine
(Envelope-shaped/ dumbbell casts).
• Systemic effect : Oxalic acid combines with calcium → Hypocalcemia
(Tetany) → Rx : Calcium gluconate.
Hydrofluoric acid :
• Local : Liquefactive necrosis → Deep dermal burns.
• Systemic effect is seen even on local absorption.
• Hypocalcemia, hypomagnesemia, hyperkalemia (As it combines with calcium
& magnesium, forming insoluble salts).
Vitriolage :
• Act of throwing acid onto the body of another (Disfigurement).
• Oil of vitriol : Sulphuric acid (Any other acid can still be used).
• Vitriolage : Punishable under 326A.
• Attempted vitriolage : Punishable under 326B.
• 357C CrPC : Doctor has to administer free Rx & inform the police.
If not done → Violation under 166B IPC.
Irritants 00 6 53
Types of irritants :
1. Metallic.
2. Non-Metallic.
3. Plant-based.
4. Animal-based.
Metallic irritants (Accumulative poisons) :
• M/C acute heavy metal poisoning : Arsenic.
• M/C chronic heavy metal poisoning : Lead.
Adults (M/c route : Inhalation) → Industrial areas.
Children (M/c route : Oral) → Wall scrapings).
• Samples collected : Blood (More reliable for lead), urine (More reliable for
arsenic), bone, hair & nail.

M v o 6 06 67
Arsenic : ----- Active space -----

• Most commonly used homicidal poison.
• Most toxic form : Arsine (Gas).
• Most toxic salt : Arsenic trioxide (Odorless & tasteless).
• Acute poisoning : Gastroenteritis (Resembles cholera) & red velvety mucosa.
• Chronic poisoning : Arsenicosis & hydroarsenicism (D/t water).
Arsenicosis : Every system is affected (ARSENIC) :

• A : Aldrich-mees lines (Also seen in thallium poisoning),
alopecia.
Aldrich-mees lines
• R : Raindrop pigmentation (Dark brown skin pigmentation).
• SE : Skin Eruptions (Palmoplantar hyperkeratosis).
• N : Peripheral sensory-motor polyneuropathy (Resembles
GBS), Nasal septum perforation.
• I : Ischemia → Peripheral gangrene (Black foot disease).
• C : Carcinogenic (Basal/squamous cell carcinoma).
Tests for chronic arsenic poisoning : Pigmentation
Old tests : New tests :
1. Marsh test. 1. NAA : Neutron activation analysis.
2. Reinsch test. 2. AAS : Atomic absorption spectrometry.
Mercury (Hydrargyrum) poisoning :

• Seen in two occupations : Hat industry (Olden days) and glass blowing.
• Not absorbed from GIT. Inhale vapours → Toxic (Absorbed).
• Organic mercury : Methyl mercury → More CNS manifestations (Crosses BBB).
• Inorganic mercury : Mercuric salts more dangerous than mercurous salts.
• Most toxic : Organic > mercuric > mercurous.
• Manifestations (Mnemonic: METAL) :
a. M : Minamata disease → Methyl mercury d/t fish consumption
( CNS manifestations)
b. E : Erethism → Emotional instability → Mad hatter syndrome.
c. T : Tremors → Coarse intentional tremors → Hatter’s shakes or Glass
blower shakes.
d. A : Acrodynia/Pink disease → Peeling of skin, painful peripheries, seen
M/C in children.
e. L : Lentis → Mercury deposits on anterior lens capsule → Slit lamp →
Brown color reflex.
Lead (Plumbum) :
• Poisoning : Plumbism or saturnism.
• Most toxic organic lead : Tetra ethyl lead.
• Most toxic inorganic salt : Lead tetroxide.
• Least toxic inorganic salt : Lead sulfide.


• Lead carbonate → Paints.
• Features of plumbism/saturnism :
• A : Anemia (Inhibition of ALA dehyratase & ferrochelatase)
• B : Basophilic stippling of RBCs (Inhibition of 5-pyrimidine nucleotidase).
Burtonian lines (Bluish discoloration of gums).
• Lead line → At metaphyseal region of children (D/t calcium deposition).
• C : Colics, constipation, Cabot’s ring in RBCs (Figure of 8 appearance).
• D : Drop (Wrist drop and foot drop).
• E : Encephalopathy (Tetraethyl lead).
• F : Facial pallor.
• G : Saturnine gout.
Basophilic stippling Burtonian lines Lead lines

Cadmium :
• Replaces calcium from bone → Bone softening → Pathological fracture and
severe bone pain → “Itai itai” or “Ouch ouch” disease.
Thallium (BAND) :
• B : Behaviour change.
• A : Alopecia with madorosis.
• N : Nail → Mees line + sensory-motor polyneuropathy (Resembles GBS).
• D : Dermatitis.
Non-Metallic Irritants :
Phosphorous :
1. Acute poisoning :
a. White phosphorous (Toxic) : → Toxic fumes come out from luminescent
stool and vomitus (Smoky stool syndrome).
b. Red phosphorous → Not that toxic.
2. Chronic poisoning : Phossy jaw or Lucifer jaw
(Osteomyelitis of mandible → Tooth pain & pus discharge
→ Osteonecrosis of mandible).
Phossy jaw

Forensic medicine Revision 7 07 69
Plant irritants 00:00:15
Ricinus communis (Castor/arandi) :

Intact seeds not toxic.
Crushed seeds
Oil (Non toxic) Residue (toxic)

Active principle : Ricin
Abrus precatorius :
Seeds called as Gunchi seeds/ rati seeds/crab’s eyes.
Active principle (AP) : Abrine.
Crushed seeds : Sui needle to kill cattle (Ideal cattle poison)
& site of injection resembles a viper/snake bite.
Abrus seeds
Bhilawa/ semicarpus anacardium (marking nut) :
AP : Semecarpol & Bhilawanol.
Seed juice used for causing artificial bruise.
• Seen on accessible parts.
• Blisters +ve, itching +.
Bhilawa seeds
• Content of blister : Inflammatory fluid.
Croton tiglium (Jamalgota) :

AP : Crotin.
Crushing : Toxic oil & residue (both are toxic).
Croton Seeds Croton tiglium
Madar akdo (calotropis) :
AP : Calotropin, calotoxin, calactin.
All parts are toxic.
Used in : Criminal abortion, artificial bruise, cattle poisoning,
infanticide.
Calotropis
Forensic medicine Revision• v1.0 • Marrow 6.5 • 2023

70 07 Forensic medicine

Capsicum annuum :
Chilli seeds used for robbery & torture.
AP : Capsicin & capsaicin.
Hunan hand : Contact dermatitis on touching chilli powder.
Capsicum annuum
Animal irritants 00 05 31
Snake :
Study of snakes : Ophiology.
Study of snake venom envenomation : Ophitoxemia.
Features Venomous Non-venomous (most snakes)

Head scales Small Large
Except in :
• Cobras (3rd supralabial
scale largest).
• krait (4th infralabial
scale largest).
Belly scales Large & cover entire Small & never cover the entire
breadth of belly breadth
Tail Compressed Not compressed
Bite 2 fang marks Small teeth marks in a row
Families :
• Elapidae : Neurotoxic → King cobra, common cobra, krait.
• Viperidae : Hemotoxic → Russels & saw scaled viper.
• Hydrophidae : Myotoxic → Sea snake.
Big 4 : Common cobra, krait, russels & saw scaled viper.

Anti-snake venom (ASV) available only for these snakes.
King cobra Common cobra (Naja Naja)
No hood Hood
No spectacle mark Spectacle mark
Forensic medicine Revision • v1.0 • Marrow 6.5 • 2023

Krait (Bungarus caeruleus) : ----- Active space -----

• Lowest fatal dose (6 mg of venom).
• Jet black snake.
• No local signs in the bite site.
Krait
Russel’s viper Saw scaled viper
3 rows of markings Saw shaped scales
Snake bite :
Most snakes : Non venomous.
Snake bite
No symptoms (dry bite) Venomous
Local Neurotoxic Hemotoxic
Pain Ptosis DIC

Swelling Descending paralysis Spontaneous bleeding
Bleeding Respiratory failure (death)
Necrosis Renal failure (death)
Local symptoms :
• More prominent with
viper bite.
• None with krait.
20 min whole blood clotting time :

No clotting for 20 mins : Viper bite.
Management of snake bite :

First aid : RIGHT approach.
R : Reassure patient.
I : Immobilisation (Sutherland’s technique : Pressure immobilization).
GH : Get to hospital.
T : Tell doctor symptoms.

Specific management :
• Observation.
• In case of ophitoxemia, 10 vials of IV ASV given (without test dose).
• Neostigmine + Atropine in cobra bite : Reverses neurotoxcity.
Note :
Cobra (post synaptic action)
Neurotoxicity
Krait (pre synaptic action)
Scorpion sting :
M/c in India : Indian red scorpion & black scorpion.
Venom (similar to cobra venom) : Causes autonomic storm.
Symptoms :
Intense pain, tap sign + Indian red scorpion Black scorpion
Cholinergic crisis Adrenergic crisis
↓ BP, HR ↑ HR
Priapism Myocardial dysfunction.
Pulmonary edema.
Renal dysfunction.
Treatment :
• Pain relief.
• Anti scorpion venom.
• Prazosin.
Deliriants 00 1 35
1. Datura :
Roots & seeds : Most toxic.
AP : Hyoscine & atropine.
Patients shows anticholinergic features :
• Dried secretions. Datura fruit/
Datura flower Thorn Apple
• Dilated pupils.
• Delirium : Muttering delirium.
Treatment : Physostigmine.

Datura seeds : ----- Active space -----

Associated with accidental poisoning.
Similar to chilli seeds.
Used as a stupefying agent.
Aka roadside poison, railway poison. Datura seeds
2. Cannabis :
Active principle : THC (tetra hydro cannabinol).
Preparation :
Source Active principle Preparation
Bhang Dried leaves/stem < 15% Majoon
Ganja Dried flowers 15-25 % Joint/ reefer
Hashish/ Dried resin 25-40 %
charas
Hash oil Resin 60-70 %
3. Cocaine :
From leaves of Erythroxylum coca.
Street names : Coke, crack (smokable), snow, she, white lady.
Sympathomimetic action.
Body packer syndrome :

• Rupture of smuggled packs of swallowed cocaine.
• Risk of death due to MI, stroke.
• Treated with Amyl nitrite.
Erythroxylum cocca
Clinical triad of chronic cocaine abuse :
• Septal perforation (d/t snorting).
• Black staining of tongue/ teeth.
• Peripheral gangrene.
Cocaine Bugs/ Magnan symptoms : Tactile hallucination of bugs crawling under
the skin in cocaine addicts.

----- Active space ----- Inebriants 00 26 32
1. Alcohol :
• Toxicity : Isopropyl Alcohol > Methanol > Ethanol.
Ethanol :
• CNS depressants.
• For same quantity more effects seen in females d/t increased fat content.
• Concentration of alcohol in blood & body fluids :
Blood 1 mg % = CSF 1.1 mg % = Vitreous : 1.2 mg % = Urine 1.3 mg % = Alveolar
air 0.0021 mg %.
• BAC >30 mg % while driving is punishable under 185 MVA (Motor Vehicle Act).
Issue of drunkenness certificate :

Smell of Motor coordination
Opinion
alcohol tests
-ve Normal Not consumed alcohol
+ve Normal Consumed alcohol but not under influence
+ve Abnormal Consumed alcohol and under influence
Alcohol withdrawal syndromes :

Time since
Syndrome Significant features
withdrawal
6- 12 hoursAbstinence M/c : Tremors.
syndrome
12-24 hours Hallucinosis Conscious, orientation preserved
24-48 hours Rum fits
2-5 days Delirium State of acute insanity :
tremens Irritable, altered sensorium, visual hallucinations.
A person having delirium tremens committing a crime is not punishable under
Section 84 IPC.
Methanol :
Aka Wood alcohol, illicit liquor.
Responsible for Hooch tragedy.

Metabolism : ----- Active space -----
Alc. dehydrogenase Ald. dehydrogenase

Methanol Formaldehyde Formic acid.
(most toxic)
Clinical features :
• Most specific finding : Visual disturbances (Scotoma/ snow field vision, retinal
defect, optic nerve pathologies).
• Abdominal pain, vomiting.
• High anion gap metabolic acidosis (HAGMA).
• Treatment :
a. Ethanol administration.
b. Fomepizole.
2. Somniferous poisons :
Opium :
Poppy juice Poppy seeds
• Aka papaver somniferum.
• Dried exudate from capsule : Crude opium (morphine, codeine, thebaine are
produced from crude)
• Poppy seeds inside the plant : Non toxic.
• Triad of morphine poisoning :
Coma
Pin point pupil Respiratory depression
• Treatment : Naloxone sodium.
Heroin :
• More potent and addictive semisynthetic derivative of morphine (Diacetyl
morphine).
• Administration :
a. Main lining : Injected into vein.
b. skin popping : Injected into skin.
c. Chasing the dragon : Inhaling vapour.
• Speed Ball : Heroin + cocaine.
• Hot shots : Heroin + Strychnine.

----- Active space ----- Strychnous Nux vomica :

Even a single crushed seed can be fatal.
Seed : K/a Dog button seeds.
AP : Strychnine, Brucine, Loganin.
Nux vomica seeds
MoA :
Strychnine acts on anterior horn cells of spinal cord → Inhibits glycine release
→ Muscle convulsions.
Any of the following tonus can occur :
• Opisthotonus (backward bending).
• Emprosthotonus (hyperflexed spine).
• Pleurosthotonus (lateral bending).
Post death : Opisthotonus

• Post mortem caloricity seen.
• Rigor mortis appears early.
• Delay in putrefaction (also in metal poison & carbolic acid).
3. Cardiotoxic poisons :
Mnemonic : carDONA.
• D : Digitalis.
• O : Oleander.
• N : Nicotine.
• A : Aconite.
Aconite :
• Aka Mithazaher, devil’s helmet,
blue rocket, monk’s hood.
• Most toxic part : Root.
• AP : Aconitine.
Aconite root and plant
• Causes cardiac arrhythmia.
Pink Oleander :
• Aka Nerium odorum.
• AP : Nerin, Folinerin, Oleanderin.

Yellow Oleander : ----- Active space -----

• Aka Cerebra thevetia.
• AP : Cerebrin, thevetin, thevetoxin, peruvoside.
• Causes life threatening hyperkalemia & cardiac arrhythmia.
• Treatment : Digibind.
Digitalis :
• Aka Digitalis purpurea, fox glove.
• Causes cardiac arrhythmias.
Asphyxiants 00 3 2
Carbon monoxide Cyanide

Odourless Smell of Bitter almonds
High affinity towards Hb than Binds to Ferric (Fe3+) ions.
oxygen → Anemic anoxia. Binds to cyt. oxidase in ETC →
Histotoxic anoxia.
Treatent : HFO/ Hyperbaric oxygen. Treatment : Nitrites, hydroxycobalamin.
Cherry red hypostasis Brick red hypostasis
Agricultural poisons 00 3 1
Organophosporous Carbamates Organochlorines Pyrethroids

compounds (OPC) (Endrin, DDT)
MOA Irreversible inhibition of Reversible inhibition Inhibition of Inhibition of
AchE enzyme of AchE enzyme Na+ channels Na+ channels
Antidote Oximes & Atropine Only atropine NA NA

----- Active space ----- OPC related syndromes :

Cholinergic Intermediate Delayed
Onset Occurs within 1-2 days Occurs within 2-4 Occurs within
days 1-4 weeks
Symptoms Symptoms : • Proximal muscle • Distal
1. Muscarinic : weakness. neuropathies.
• D : Diarrhea. • Cranial nerve
• U : Urination. palsy.
• M : Miosis.
• B : Bradycardia.
• B : Bronchorrhea.
• E : Emesis.
• L : Lacrimation.
• S : Salivation.
2. Nicotinic :
• Irritability.
• Convulsion.
• Confusion.
• Coma.
Treatment Atropine + Oximes Symptomatic Symptomatic
Diagnosis of OPC poisoning :

• Mostly clinical.
• Lab tests : Pseudocholinesterase (easy & commonly done) &
RBC cholinesterase (specific).

Forensic Medicine Revision E6.5

Uploaded by

Copyright:

Available Formats

Forensic Medicine Revision E6.5

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Forensic Medicine Revision E6.5

Uploaded by

Copyright:

Available Formats

M v o 1 01 1

FORENSIC MEDICINE REVISION 1 ----- Active space -----

Legal procedures 00:00:30

Summons case Warrants case

Magistrate inquest : Two types.

Judicial magistrate Executive magistrate

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

Hierarchy of criminal courts :

Direct evidence : Proves fact. Indirect evidence :

Circumstantial evidence Hearsay evidence

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

Evidence ----- Active space -----

Oral evidence Documentary evidence

Ad testificandum : Oral evidence. Duces tecum : Documentary evidence.

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

Medical ethics 00:23:06

Ethics : Compulsory moral principles given by NMC.

List of unethical acts/warning notice : Given by state medical council.

a. Temporary : Suspension. ----- Active space -----

Medical negligence/Malpraxis 00:28:46

Essential components of medical negligence :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

2. Respondent superior doctrine (Vicarious liability) :

Defenses in medical negligence :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

2. Expressed consent : ----- Active space -----

Invalid consent (90 IPC) :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space ----- FORENSIC MEDICINE REVISION 2

Abrasions due to perpendicular force :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

Antemortem abrasion Postmortem abrasion

Rupture of dermal vessels

Extravasation of blood (ill defined margins)

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

Raccoon eye sign Battle sign

Livor mortis vs contusion :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space -----

Swallow tailing in a Tailing in an incision.

Lacerated looking incision :

Stab injury with double edged weapon : Oval/spindle shaped.

Type of weapon Shape of injury

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

Type of weapon Shape of injury ----- Active space -----

----- Active space -----

Types of skull fractures :

1. Fissure fracture (Linear crack) :

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

Fracture Image ----- Active space -----

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023

----- Active space ----- Fracture Image

Coup & contrecoup injuries :

Type of intracranial hemorrhage Source of bleed

Forensic Medicine Revision • v1.0 • Marrow 6.5 • 2023