Notes on forensic medicines
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Transcript of Notes on forensic medicines
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Dr Udai Bhan Yadav MBBS DMCH.SMO&Medical Jurist
Govt general hospital alwar rajasthan.
1
FORENSIC MEDICINES NOTES
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Lung tuberculoses
2
Congested,edematous multiplegray white nodules ranging from pin point size up to 1 cm were diffusely distributed through out the lung parenchyma
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
AGE OF ABRASION
3
Bright red-FreshRed scab-12-24 hrRedish brown scab 2-3daysNew growth of epithelium 4-7daysScab dried shrink and falls off -7days.some
time may take 10-15 days
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Age of contusion
4
Red-FreshBlue-After few hours to three daysBluish black/brown- 4th dayGreen 5-7daysYellow 7-12 daysNormal 2 weeks
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Age incised and stab wound
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Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Detemination of age of injury
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Scab over abrasion and superficial cut-12-24hrIn case of bruse change of color commence
from the circumferance by 12-24hr and passes through usual changes
In ordinary wound inflamation sat in within48 hr. If it is not rendered properly aseptic pus also forms by this time
Skin wounds or contused wound on the head will generally heal within a week.if margins is considerably brused,it may take a fortnight.Healing of wound depend much on the constitution of pt and treatment
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
7
In fracture ,inflamation and exudate of blood in soft tissue around the fracture site are noticed from 1st to 3rd days.callus begins to form the third day onwards.If inflamation subsides callus begins to ossify from 2nd to 3rd week on wards.it is fully absorbed by about 6-8 weeks
Granulation tissues appears about 1 weekWhen tooth knocked out.bleeding stops in24 hrs
cavity fills in 7-10days time.smooth after 14 days
Dution estimated by color change in bruse if present
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Characters of incised and lacerated wounds
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Incised wound – edges are regular, clean cut,retracted,everted,except in neck&scrotum where edges are inverted,spindle shaped ,length is greaterin three dimensions,haemorrage isexcessive,Edge of wound may be irregular in care skin is loose eg neck &scrotum.
Lacerated wound-margins are irregular ragged and inverted.tissues are torn and not cot.bleeding may not be marked due tocrushing of tissues.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDING IN ELECTRIC BURN(ELECTROCUTION)
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e.g-multiple burn injuries present over an area 6cmx5cm.and contact electric burn of 5cmx3cmon palmar aspect of left hand.
e.g-an oval crater like electric burn mark measuring 2cmx0.4cm with a pale flattened floor and a ridge of elevated skin and blackening around.
e.g-split laceration skin wound 0.75x0.3cm with elevated ridge,seen on middle of the sole of left foot.
Face is pale,eyes congestedBrain congested,oedimatous,multiple petichial
haemorrhagic spots in brain substance.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
10
Larynx and trachea congestedRt&Lt Lungs congested,oedimatous.Mouth,pharynx,oesophagus,stomach
mucosa.liver,spleen,kidneys all are congested.
OPINION –Post mortem findings are consistent with death due to electrocution.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN BURN(SAMPLE CASE)
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e.g.-body cold and stiff. Face is totally burnt,blackened,swollen,with scalp hairs burnt in patchy area on the front and on the sides of the head,have been trimmed short up to neck level.
Eyes brows &eyelashes are also burnt completely.Rest body showed infected deep skin burn injuries with
greenish black sloughing except a thin strip of intact skin around the waist line 1x30 cm,perineum and inner aspect of both feet(total skin area burnt90%).Suturing venesection wound measuring 1.5x0.25cm were seen one each on the inner aspect of both ankles.
Superficial to deep burn,peeling of skin present,skin black.red line present
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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Brain congested,edematousPleurae intact healthy.but with an effusion of straw
yellow fluid measuring 400ml on rt side and200mlon lt side.
Larynx and trachea intact healthy and showed blakish shoot particals .
Lungs congested,edematousMouth,pharynx,oesophagus intact healthy,congestedStomach mucosa congested and showed submucosal
erosion at duodenal end.Liver,kidney,congested.spleen congested and pulpy0PINION-DECEASED DIED DUE TOCOMPLICATION OF
BURN INJURIES SUSTAINED.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
DURATION OF BURN
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Rednss –immediateVesication –about 2-3 hoursPus,Slough –about 36-72 hoursFall of superficial slough –about 1 week.Fall of deep slough –about 2 weeks.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
CAUSE OF DEATH IN BURN
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Shock –within 2 daysToxaemia -2 to 4 daysSeptecemia –if infectionRarely MI,and Fat embolism
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN HANGING
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Body cold and stiff.PM Lividity on both fore arms,hands and both legs and
feet.Face congested eyes congestedSubconjunctival haemorrhage.Blood stained froath at nostrilsTongue protruded out bitten dry.Vertical salivary trickle mark on the left side of face and
front of chest &abdomen.Lips and nailbeds bluishSeminal and faecal discharge presentBrain intact, congested,edematous,with multiple
peticheal haemorrhagic spot in substance of brain.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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Larynx trachea congested.Lungs congested,edematous with blood
stained frothy oozing on cut section.Mouth,pharynx,oesophagus congested.Liver,spleen,kidney healthy ,congested.LIGATURE MARK –size ….x….cm eg. 26cm
running obliquely above the thyroid cartilage.upward and backward.patterned and grooved,dark dry and parchmentized and with bruised edegs
Dissection of neck. 50%cases no intenal injury.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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Subcutaneous tissues under neath ligature mark is whitish firm and glistening.
Platisma and sternomastoid muscle may show petechial haemorrhage and may rupture occasionally.may be brusing in subcutaneous tissues and muscles deeper to neck.
Rupture or tear of intima of carotid arteries above its point of bifurcation, aroun the sinures with extravasation of blood in their walls.
Trauma to hyoid bone #.both grater cornu in hanging and one in throatling.
OPINION post mortem appearance are suggestive of death due to asphaxia resulting from hanging.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
LIGATURE STANGULATION
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Body cold and stiff.PM Lividity on back &fixed.Face livid.eyes congested with sub conjunctival
haemorrhage.Blood stained fluid flowing out through ears and
nostrile.lips and nails bluish.e.g a jute rope material used for
strangulation,measuring1.5mts was found round the neck of victim with a double reef knot on the front of neck over adam’s apple.
Brain congested oedematous with multiple peticheal haemorrhagic spots in brain substance.
L arrynx,trachea intact healthy but contains blood stained froth.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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Lungs congested edematous with blood stained froth oozing on cut section.
Mouth,pharynx,oesophagus, intact healthy,but congested.Liver,spleen,kidneys intact,healthy.congested. Injuries bloodless dissection of neck revealed ecchymosis
of muscles of neck underneath the ligature mark.Fracture-the thyroid cartilage in the neck is fractured in
mid line.L igature mark was a pressure abrasion measuring eg
28cmx1.5cm. Continuous and running horizontally encircling the neck at the level of adam’s apple.the rark was grooved discoloured and with bruses at the edges.
OPINION –post mortem appearance are suggestive of death due to asphaxya resulting from ligature strangulation.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN DRAWNING
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Body cold ,wet,rigor mortis well established. PM lividity on face chest abdomen front of thigh and fixed. Fine whitish lathery froth seen at mouth and nostrils. Lips and nails bluish.Hands clenched. Both palms and soles were soddened bleached.groose skin (cutis anserina)
appearance present. Brain intact healthy but congested,edematous with multiple petecheal
haemorrhagic spots in brain substances. Larynx trachea intact healthy but containing fine whitish leathery froth Lungs voluminnous ,congested,edematous with fine whitish lathery froth on cut
section. or Lungs are water logged bulge out pit on pressure,moderately congested and
feel doughy. Mouth pharynx oesophagus intact ,healthy congested. Liver,spleen kidneys congested OPINION –POST MORTEM APPEARANCE ARE CONSISTENT WITH DEATH DUE TO
DRAWING. Case of death asphaxia,ventriculr fibrillation,laryngeal spasm ,vagal
inhibition,injuries etc
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN POISONINGS
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Cold, stiff, pm lividity on back and fixed ,face bluish,pinkish frothy fluid flowing out of nose.
Brain congested edematous,multiple petecheal hemorrhagic spots in brain substance.
Larynx trachea intact healthy congested. Lungs congested edematous with pinkish fine oozing on cut
section. Mouth pharynx oesophagus intact healthy.congested Stomach mucosa congested and showed submucosal
erosion.liver intact healthy congested.spleen intact healthy congested.and pulpy.kidneys congested.
Visceras are collected and sealed in glass jar glass Jar A contains whole stomach and its contents,glass Jar B contains piece of liver,kidney,spleen .lungs. Vial C contain blood.Glass jar A,B ARE preserved in saturated sol of common salt. In Vial C no preservative used
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN HEAT STROKE
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No characteristic findings .Eyes open drying of cornea and pitting.and sinking of eye
balls.(appearance of avulsion of eyes.)Rigor mortis appears early and disappear early.Putrifaction rapid.lividity is mark.Degeneration of neurones in cerebral cortex cerebellum
and basal ganglion is common Visceral congestion well mark.Peticheal haemorrhage
found in skin ,visceras and in walls of third and fourth ventricle and aquaduct.
Pulmonary oedema is some time found.Face is flushed and skin is hot and dry.Brain and membranes congested.peticheal haemorrhage
are seen in white matter.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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Respiratory system trachea bronchi contains frothy haemorrhagic fluid.lungs edematous congested,haemorrhage.
Heart dilatation of right auricle.Lver kidney congested General peticheal and confluent
haemorrhage in most organs.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS IN THROTTLING
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Ligature mark if throttling done by rt hand from front ,the impressin of thumb will be found ovr upper part of rt side of neck.and on lt side will be found four marks produced by four fingers.
These four marks distributted from above downward and out wards .these marks are really due to bruses or contusions.they are accompaned by cresentic scratches produced by finger nails.
Some time mark on left side may not be discrete but may be clusterd to gether.
This may be reversed in case where lt hand or both hands are used. When both hands are used there will be several marks on each side
of the neck. SIMPTOMS – ATTEMPTED THROTTLING. Brurse on
neck,dysphasia,hoarseness of voice,marks of burse and abrasion on mouth ,nore cheek,fore head ,lower jaw,other part of body.
Fracture of ribs with extravasation of blood in chest wall may be seen in some case.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
PM FINDINGS INSUFFOCATION
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Ext –closure of mouth and nostrils.pressure on chest. Int –clsure of glottis or luman of air tube.,decrease O2 in
atmosphere.,inhalation of irritant gases. PM examinaton –signs of asphaxia well pronounced such as
cynosed face, open eyes,prominent eye balls,dilated pupils,deeply injucted conjuctiva,livid lips,protruded tongue,blood stain froth per mouth and nostrils.etc.
Mark of violance-bruses and abrasions round about lips.cheeks, scratches near about nose and mouth,injuries on inner surfaces of lips ,bruses of gums.signs of strugles on other part of body.
Compression of chest –injury on chest,# of ribs,extravasation of blood in subcutaneous tissues.
In overlaying of nose is flattened deviated to one side. # of cervical vertebrae seen if neck is forcibly wrenched or
twisted.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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INTERNAL –Forign body detected in mouth ,throat.Larynx and trachea –red congested,blood
stained froth in luman.Death by pressure on chest -#of ribs some
times,lungs congested contused or lacerated even without #ribs,superficial air vesicles ruptured,int organs congested,tradieu’s spots on pleurae,meninges,pericardium.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
TIME SINCE DEATH
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These are avarage time.in cold wheather they may be doubled or trebled.in hills they are quite inapplicable.
Less than 1 hour-body is warm3 hours –patchy post mortem lividity.6 to 8 hours –lividity fully developed and fixed.12 hours –rigor mortis all over ,green patch showing
over the caecum.24 to 36 hours –rigor mortis receding/absent, green
discolouration over whole abdomen and spreading to chest,abdomen distended with gases ,ova of flies seen.
48 hours –trunk bloated,face discoloured and swollen blisters present.moving maggots seen.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
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72 hours –whole body grossly swollen and disfigured.hairs and nails loose.tissue soft and discoloured.
One week –soft viscera putrefied.Two weeks –only the more resistant viscera
distiguishable ,soft tissues largely gone.One to three month –body skeletonised.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
ESTIMATION OF AGE
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Blow 20 years x rays advised-wrist,elbow,pelvis.
21 years – Abve x ray + X ray clavicle25 years - above + xray strnum ,skull ap lat
view.FOLLOWING X RAY OF RIGHT SIDE ARE TAKEN-RT side of jaw oblique view.RT shoulder ap view.RT elbow ap and lat view.RT wrist with hand ap view.Pelvis with upper third of femur ap view.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
STANDARD OPINIONS IN DEATH BY SNAKE BITE (PM)
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SNAKE BITE-cobra &similar snake which have neurotic venum. ‘’on perusal of the pm report case sheet and circumstantial evidence I am of the opinion that the death is due to respiratory failure consequent upon snake bite.
In case of vipar and other similar snake which have hemolytic venom. (a) If bleed to death ‘Death is due to shock and haemorrhage as a result of snake bite.’ (b) If there is haemorrhage in brain stem ‘Death is due to coma as a result of brain stem haemorrhage secondary to snake bite, ;
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Foetus age determination
31
Week length in cm weight12 wk 9cm 20gm16wk 16cm 100gm20wk 25cm 300gm24wk 30cm 600gm28wk 35cm 1000gm32wk 40cm 1800gm36wk 45cm 2200gm40wk 50cm 3500gm Length is more important.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
DURATION OF GASTATION
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1st five months of gestation the square root of length, for example foetus of 25cm is five month old.
After 1st five months of gestation the length in cm divided by five gives age in months for example 40cm is eight month old.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
ENUMERATION THE SIGN OF RESIPIRATION
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CHARACTERSTIC BEFORE AFTER Shape of chest Flat Arched Diaphragm at 4-5 Ribs 6-7 Ribs level Lungs size Small voluminous Fodere’s test 500qraim 1000qraim Ploquet’s test 1:70 1:35 Edge sharp round Colour reddish brown mottled pinkish red Consistency Liver like spongy and crepitant Section Dark blood Red blood Hydrostatic test Sinks Floats Stomach Bowel test Sinks Floats.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Various changes in foetus
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Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Features helping in estimating foetal age
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Length –measure crown – heal (vertex to heal) length by flexible tape.
WeightMidpoint ofbody in relation to sternom and umbilicus.Skin wrinkle or presence of fat,presence of
fat,presence and amount of vernix.Nail appeared or not ,extent of growth.Scalp hairs –appeared or not Eyelashes and eye brows appeared or not.Eyelids –adherent or open.Testicles in male ,ascertain the position by incising the
scrotum and inguinal canal.if necessary.Ossification centre.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Examination of male in sexual offence for impotency
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Name s/o… cast.. Sex.. Age… r/o…… R/o ……….. Sent by …… MI………. In presense of …….. General development …. Ht……..Wt ……Teeth…….. Hairs scalp ……eyebrows….upperlip….axillary….pubic…. Breast…. Injury on body… BP…. PULSE…. HEART,LUNG ….. UROGENITAL TRACT…H/O DIABETTES,HT… STAINS OVER EXTERNAL GENITALS.. INJURY…SUPERFICIAL VEINS OVER PENIS…
DEVELOPMENTAL ABNORMALITY IF ANY….SORTAL REFLAX…. ON STIMULUS PENIS BECOMES STIFF HARD AND ELONGATED AND ERECTILE. SEALEAD ENVELOP CONTAINS FOLLOWINGS FOR GROUPING AND CROSS MATCHING IF
NEEDED.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
37
A –Blood staned dried gauzeB –Saliva staned dried gauzeOPINION- I am the opinion that there is
nothing to suggest that the persion is incapable of performing sexual intercourse.
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Rape case examination positive finding may be (samlpe case)
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Findings examined by lady doctorGait broad based,short pacedAxillary and pubic hairs curly,dark,busy.Breast developed hemispherical,showed bite marks
around the nipple on rt side.Back abrasion on both shoulders blades regions each
mearuring 4x3cm.Finding on genital examination Vulva –labia majora,labia minora both contused
edematous and inflamed.Hymen lacerated 1.5cmx0.75x0.5cm at 6.0 clock
positionVagina bruised in posterior region in continuation with
lacerated hymen over an area of 3x0.5cm
Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan
Rape case samples taken and sealed
39
Sealed envelop contains following for spermatozoa and chemical examination to detect out human seminal stain blood stain and cross matching if needed.
A –blood staied dried gauseB - saliva stain dried gauseC – vulvovaginal swab smear 2D –vulvovaginal swab stic .Opinion –regarding recent sexual act kept
reserved till receiving FSL report.