Exam Preparatory And Rapid Revision Module For

FORENSIC MEDICINE & TOXICOLOGY

By
Aksh Patel
(Smt. NHL Municipal Medical College, Ahmedabad)

CONTENT / SHORT NOTES COVERED

1. LEGAL PROCEDURE

Inquest ................................................. 2
Summons ............................................. 4
Courts of India ..................................... 6
Witness ................................................ 7
Recording of evidence ......................... 9
Evidence .............................................. 10
Dying declaration ................................ 11

2. FORENSIC PSYCHIATRY

Mental disorders and responsibility . 14

Delusion ........................................... 15
Hallucination .................................... 16
Illusion ............................................. 17
Impulse ............................................ 18
OCD ................................................. 19
PTSD ................................................ 19
Schizophrenia ................................... 20

3. IDENTIFICATION

Age est. from bones .......................... 23

Age est. from skull ........................... 26
Fingerprint ........................................ 27
Dentition in age determination ......... 30
Gustafson method ............................. 33
Identification data ............................. 34
MLI of various age groups ............... 35
Skull, mandible, pelvis ..................... 37
Stature .............................................. 39
Tattoo marks ..................................... 39

4. INFANTICIDE AND CHILD ABUSE

Hydrostatic test ................................ 43

PM findings of Live/dead born ........ 44
Respired vs Unrepaired lungs .......... 46
Shaken baby syndrome .................... 47
Sudden Infant Death Disease ........... 47
 Munchausen Syndrome by proxy ..... 49

5. INJURIES

Injuries classification ..................... 51

Bruise ............................................. 52
Suicidal vs homicidal cut throat ...... 54
Bruise vs PM staining ..................... 55
Defense wounds .............................. 55
Fabricated wounds .......................... 56
Bullet ............................................... 57
Entry vs Exit wounds ...................... 58
Rifled wounds ................................. 59
Shotgun wounds .............................. 61
Cartridge ......................................... 63
Gun powder .................................... 64
Stab wound ..................................... 66
Skull fractures ................................. 68
Thermal injuries classification ........ 70
Burns ............................................... 70
Dry heat vs Moist heat ................... 74
Electrical Injuries ........................... 74
Filigree Burns ................................. 76
Simple vs Grievous hurt ................. 77

6. JURISPRUDENCE

Consent ......................................... 79
Medical negligence ....................... 81
NMC ............................................. 84
Professional misconduct ............... 85
Professional secrecy ..................... 87
SMC ............................................. 87
Vicarious liability ......................... 89
Privileged communication ............ 90

7. PREGNANCY

Criminal abortion ......................... 92

Positive signs of pregnancy ......... 95
Presumptive & Probable signs of pregnancy ... 96
Signs of recent delivery ............... 98
MTP ........................................... 102
Sterility/impotence .................... 103
SQs ........................................... 99, 104

8. SEXUAL OFFENCES

Rape .......................................... 106

Examination of rape victim ....... 107
Sodomy ..................................... 110
Sexual perversion ...................... 112
9. THANATOLOGY

Algor mortis ............................ 115

Brain death ............................. 117
Exhumation ............................ 119
Livor Mortis ........................... 120
Mummification ...................... 121
Putrefaction ........................... 122
Rigor Mortis ........................... 124
Saponification ........................ 126
Signs of death ........................ 127
Types of death ........................ 128

10. ASPHYXIA

Asphyxia classification ........... 131

Drowning ............................... 133
Hanging ................................. 135
Strangulation ......................... 137
Hanging vs strangulation ...... 138
SQs ........................................ 139

11. TOXICOLOGY

Classification of poisoning …. 142

Duties of dr in poisoning ….... 143
Gastric lavage ........................ 144
Management of poisoning ….. 146
Alcohol poisoning .................. 148
Drunkenness ........................... 149
Arsenic poisoning .................. 150
Dhatura Poisoning ................. 154
Lead poisoning ...................... 155
Methanol poisoning ............... 158
Nux vomica ........................... 159
Snake poisoning(ophitoxemia) ......... 161
Snake SQs .............................. 164
Phosphorus poisoning …….... 166
OP poisoning ......................... 168
Carbolic acid poisoning ……. 171
Oxalic acid poisoning ............ 172
Important Toxicology SQs ................ 173
❖ FEATURES
1. This book consists of around 114 short notes including 2
markers, which constitute 95% of whole F.M. syllabus.

2. Reading this entire module is more than sufficient to score good

marks in your respective University Professional Exams.

3. The content given here is crisp, ready-to-write short notes

prepared keeping in mind 10 marker, 6 marker, 2 marker
questions based on previous year papers (taken from Gujarat
University, but more or less the pattern is same in every
University).

4. The author had studied F.M. from FORENSIC MEDICINE &

TOXICOLOGY FOR MEDICAL STUDENTS by GAUTAM
BISWAS, online learning platform MARROW. So his notes are
based on the content given in the respective sources.

5. Students get perfect package from the above two sources all under
one umbrella – ONLY WHAT IS NEEDED TO PASS
UNIVERSITY EXAMS.

6. If a student reads and revises just 10-12 short notes per day,
he/she may complete entire syllabus within 10 days.

❖ USMLE ASPIRANTS – Since third MBBS-1 has only two subjects

(as of 2025), it is a golden time for USMLE aspirants to read their
respective syllabus. This module will greatly reduce their time to
prepare for End-University exams.

❖ NEET PG/FMG – Since F.M. has a very low volume of questions

in PG entrance exams, it can even be skipped if remaining subjects
are left to be covered. This module will make it easy for those who
are willing to do so by concising content PURELY FOR
UNIVERSITY EXAMS. With this module too, students may solve
more than 50% of questions. So, it a win-win module.
 LEGAL
PROCEDURE

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Most Common Viva Que
What is Forensic Medicine - Application of principle and knowledge of medical sciences to legal
purposes and legal proceedings so as to aid in the administration of justice.

INQUEST

Definition: An inquiry or investigation into the cause of death.

Types:
1. Police inquest
2. Magistrate inquest
3. Coroner's inquest
4. Medical examiner system Not done in India
5. Procurator fiscal

❖ POLICE INQUEST:

- Sec. 174 CrPC. / 194 BNSS

- Police inquest is held by a police officer, not below the
rank of senior head constable in all unnatural deaths
(exceptions – mentioned in Magistrate inquest).

Procedure:
- Police officer, takes permission from the nearest
Executive Magistrate empowered to hold inquests.

- He then proceeds to the place of occurrence and

holds an inquiry into the matter, in the presence of
two or more respectable inhabitants of the locality
(witnesses). The witnesses are called panchas.

- The inquest report so prepared is known as

panchnama.

- If no foul play is suspected, the dead body is

handed over to the relatives for disposal. In

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 suspicious cases, the body is sent for postmortem
examination.

- The report is then forwarded to the District

Magistrate or sub-divisional magistrate (SDM).

❖ MAGISTRATE INQUEST:

- Sec 176 CrPC / 195 BNSS

- Conducted by District Magistrate, Judicial Magistrate,
SDM or any Executive Magistrate empowered by State
Government, such as the Sub-Collector or Tehsildar.
- Superior to police inquest.

Indications:

1. Deaths due to police firing.

2. Death of a person in police custody.

3. Death of a convict in jail.

4. Exhumation cases (where the body is dug out of a

grave).

5. Rape alleged to have been committed on any woman

in the custody of the police.

6. Dowry deaths (suicide/death of a woman within 7

years of marriage).

# Coroner (Sq): Coroner is an advocate, attorney or 1st class

Magistrate with 5 years’ experience or a Metropolitan
Magistrate. He is appointed by state government to inquire into
causes of unnatural or suspicious deaths
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# Difference btw M.I & P.I is most important.

[Link] Feature Magistrate Inquest Police Inquest

1 Investigating Conducted by DM, SDM, Conducted by police
officer and Magistrate who is officer (not below head
qualified and experienced constable)
2 Informing Need not inform anyone Needs to inform the
magistrate magistrate of the area
3 Types of cases All cases of suspicious Cannot hold inquest in
handled deaths cases of death in custody,
jail, police firing, dowry
4 Witnesses Police helps the magistrate Panchas (witnesses) help
5 Warrant for Can issue arrest warrant of Cannot issue warrant, but
arrest the accused can arrest in cognizable
offence
6 Exhumation Can order Cannot order
7 Quality of Superior to police inquest Inferior to magistrate
investigation inquest

SUMMONS/ SUBPOENA

Definition:
- Document compelling the attendance of a witness in a court
of law, under penalty, on a particular day, time and place for
the purpose of giving evidence.

Features:
- Sec. 61-67 CrPC / 63-69 BNSS deals with summons.

- It is issued by the court in writing, in duplicate and signed

by the presiding officer of the court and bears the seal of
the court.

- The witness retains one copy (original) and returns the

other one duly signed by him on the back, in
acknowledgement of its receipt.
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 - Summon must be obeyed and if the witness fails to attend
the court, then:

i. In civil cases, he will be liable to pay damages.

ii. In criminal cases, the court may issue notice.
If still ignores, court may sentence him to
imprisonment and/ or fine.

- Witness must bring with him any books, documents or other

things under his control for evidence.

- The witness may be excused from attending the court, if he

has valid and urgent reason.

- If a witness is summoned by two courts on the same day,

one criminal and other civil, he should attend the criminal
court (criminal courts have priority over civil courts).

- If summoned to two courts on the same day, either both

civil or both criminal, he must first attend the higher court.

- If a witness receives two summons on the same date from

the same type of court, he should attend the court from
which he received the summon first and inform the other
court.

Types:

Subpoena
. duces tecum: Subpoena ad testificandum:
Person is required to bring Requires the individual to
certain testify before the court
documents or other evidence to
the court
specified in the subpoena.

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 COURTS OF INDIA
➢ Hierarchy:
Supreme Court

High Court

District & Sessions Court

Civil Criminal

District Court Sessions Court

Sub Court Judicial Magistrate (1st class)

Munsiff Court Judicial Magistrate (2nd class)

➢ Special Magistrates:
- In metropolitan cities with more than one million
population, Chief Judicial Magistrate and First Class Judicial
Magistrate are designated as Chief Metropolitan Magistrate
and Metropolitan Magistrate respectively.
- Judicial Magistrate – to carry out hearings of child offences

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 ➢ Powers of Magistrates:

Imprisonment Fine
Supreme court Any/capital No limit
High Court Any/capital No limit
Chief judicial Upto 7 yrs No limit
Judicial 1st class Upto 3 yrs Upto 10000
Judicial 2nd class Upto 1 yr Upto 5000

➢ Types of Punishments:

- Death (hanged by neck till death)

- Imprisonment for life
- Imprisonment—rigorous, simple or solitary
- Forfeiture of property
- Monetary fine
- Treatment, training and rehabilitation of juvenile
offenders

WITNESS
Definition:
A witness is a person who gives evidence in a court of law.

Types:
i. Common / ordinary witness
ii. Expert or skilled witness
iii. Hostile witness
iv. Unfavourable witness

Expert witness:
A person who has been trained or skilled in technical or
scientific subject.

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 E.g A doctor in field of medicine, pilot in cases of airplane
crash

Hostile witness:
A person who wilfully or with motive (bribe/intimidation)
conceals part of the truth or tells a lie or gives completely
false evidence in a court.

Unfavourable witness:
A witness trying to prove something, but by mistake proves
something else (unfavourable).

# difference btw ordinary and expert witness is [Link]

[Link] Feature Common Expert
Witness Witness
1 Definition Gives evidence Person
about the facts especially
observed or skilled in
perceived by him foreign law,
science, or art
2 Volunteering a Not allowed Can volunteer
statement
3 Drawing Not allowed Can draw
inference from
observations
4 Expressing Not allowed Can express
opinion on
others’
observations
5 Responsibility Less Highly
responsible
6 Conduct money Cannot claim Can claim
7 Examples Any person Handwriting or
fingerprint
expert, doctor,
chemical
examiner

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# Conduct Money (sq): It is the fee offered or paid to an expert
witness in civil cases, at the time of serving the summons to meet
the expenses towards attending the court.
In criminal cases, it is not given.
In simple terms, it is the money given to doctor (lets say) for
travel, accommodaton, food etc. when he travels to the court

RECORDING OF EVIDENCE (just read once)

5 steps:
i. Oath
ii. Examination-in-chief
iii. Cross-examination
iv. Re-examination
v. Court questions

➢ Oath:
- Given in witness box before he gives his evidence.
- He is required to swear by Almighty God/ Geeta that
he will tell the truth, the whole truth and nothing but
the truth

- Perjury (sq): A witness who after taking oath, wilfully

makes a false statement which he knows or believes
to be the false

➢ Examination in chief:
- Examination of a witness by the party who calls him.

- Objectives: To place before the court all the facts that

bear on the case

- No leading questions (any que whose answer is

yes/no) are allowed

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 ➢ Cross Examination:
- Done by opposite party’s lawyer

- Objectives:
o To elicit facts favourable to his case
o To test the accuracy of the statements made by
the witness
o To modify or explain what has been said
o To develop new or old facts
➢ Re-examination:
- Examination again by his own party/lawyer.

- Objectives are: To clear any doubts that may have

arisen during cross-examination.

➢ Court Questions:
- Judge may ask any question to the witness at any stage of
the trial to clear any doubtful point.

EVIDENCE

Definition:
Legal means to prove or disprove any medico-legal issue.

Types:

Oral Documentary
1. Medical Certis – Fitness certi, Insanity
certi etc
2. Medicolegal Certis – Birth/Death certi
etc
3. Dying Declaration ([Link])
4. Dying Deposition
5. Miscellaneous – books, articles

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 DYING DECLARATION

Definition:
It is a written or oral statement of a person, who is dying as a
result of some unlawful act.

Given in Sec. 32 IEA. / Sec 26 BSA (Bhartiya Sakshya Adhiniyam)

Procedure:

- The doctor should certify that the person is conscious and

mentally fit {compos mentis ([Link] sq) – Person is
conscious & mentally fit}

- Oath is not administered because of the belief that a dying

person tells the truth

- Taken in the presence of two witnesses

- Statement of the declarant should be recorded in the form

of a simple narrative, without any alteration or phrases.

- While recording the statement, if the declarant becomes

unconscious, the person recording it must record as much
information as he has obtained and sign it himself.

- Declaration is sent to the Magistrate in a sealed cover.

- If the declarant survives, the declaration is not admitted,

but has corroborative value, and the person is called to give
oral evidence.

Features:
#Refer the difference

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Dying Declaration vs Dying Deposition

[Link] Feature Dying Declaration Dying

Deposition
1 Statement Recorded by a Always
magistrate/doctor/village recorded by a
headman/police Magistrate
2 Oath Not required Must
3 Accused Not present Always present
4 Cross- Not done Done
examination
5 Legal value Comparatively less Much more
6 Admissibility, Not admitted, but has Fully admitted
if declarant corroborative value
survives
7 Role of doctor • Assess compos mentis • May • Assess
record statement in absence of compos mentis
Magistrate, but in presence of • Statement
witnesses always
recorded by
Magistrate
8 Status in India Followed Not followed

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 FORENSIC
PSYCHIATRY

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 MENTAL DISORDER AND RESPONSIBILITY
“ Every person of age of discretion sound until contrary
proved”

➢ Civil Responsibility

1. Management of Property
- Court may appoint guardian to manage properties of
mentally ill.

2. Contracts
- Contract is invalid if party at the time of making it
was mentally ill.
- Valid during Lucid Intervals.

3. Marriage / Divorce

- Hindu Marriage Act

Marriage can be declared null/void if either partner is

mentally ill during ceremony.

- Muslim Marriage Act

Women can obtain divorce on the basis of husband’s

insanity before 2 years of marriage.

4. Adoption
- Taking / Adopting child not allowed if either parent
is insane.

5. Competency as a witness
- Under 118 IEA, mentally ill is not competent to give
evidence.

6. Consent
- See 90 IPC, Insane can’t give consent.

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 7. Testamentary Capacity
- Capacity of a person to make valid will.
- Law defines it as Compos Mentis.

➢ Criminal Responsibilities (McNaughten Rule)

# There is only mild variation in Criminal Responsibilities & McNaughten rule. So
remember them as same

- Nothing is an offence which is done by a person who,

at the time of doing it, by reason of unsoundness of
mind, is incapable of knowing the nature of the act, or
what he is doing is either wrong or contrary to the law

DELUSION
Definition – False personal belief based on incorrect inference
about external reality. (Despite contradictory proof)

➢ Types

1. Delusion of Grandeur
- False belief about one’s wealth, power.

2. Delusion of Persecution
- False belief that someone is mistreating, conspiring
against it.

3. Delusion of Poverty
- It is in belief that he is poor.

4. Delusion of Infidelity
- It believes his spouse is unfaithful.

5. Hypochondriacal Delusion
- It believes of having of some serious issues.

6. Nihilistic Delusion
- It does not believe in his existence.

7. Erotomania
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 - It believes a person of higher status / rich is in love with
her.

8. Delusion of Parasitosis (Ekbom Syndrome)

- Infested with Parasites.

9. Capgras Syndrome
- It believes that someone close to him is replaced by
exact double.

10. Delusion of Disguise

- Strangers are identified as familiar people.

11. Delusion of Control

- People complains that his thoughts / actions are
controlled by some other.

HALLUCINATION
Definition – False perception by senses. (without any external
object or stimulus)

That means a person sees, smells, hears, feels, tastes something

which is actually not present in reality.

➢ Types (just remember types & not its details)

1. Visual Hallucination
- It sees something without anything being present.

2. Auditory
- Seen in schizophrenia.

3. Olfactory
4. Gustatory
- In temporal lobe epilepsy.

5. Tactile
- Crawling of insects on his body.
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 - Cocainism.

6. Psychomotor
- False sensation that parts of body are moving.
- In Alcoholism.

7. Lulliputian
- Persons / objects are reduced in size.
- In Migraine, Epilepsy, Cannabis intoxication.

ILLUSION

Definition – False interpretation by senses of an external object or

stimulus which has real existence.

Example :- Person sees Cat as Tiger.

ILLUSION - Universal (Rail tracks appear to be converging to

all)
Personal (Person sees Cat as Tiger)

➢ Types

1. Completion Illusion
- Brain’s tendency to fill missing part of object.

2. Affective Illusion
- Occurs only when person is in depression or mania.

3. Pareidolic Illusion
- Intense imagery of a poorly defined stimulus.

4. Jamais Vu
- Illusion of unfamiliarity.

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 5. Déjà vu
- Illusion of familiarity.

6. Macropsia
- Illusion of exaggeration of size.

7. Micropsia
- Illusion of reduction in size.

IMPULSE

Definition – Sudden and irresistible force compelling a person to

the conscious performance of some act without motive or fore
thought.

➢ Types

1. Kleptomania
- Impulse to steal articles of low value.

2. Dipsomania
- Drink alcoholic beverages.

3. Oniomania
- Shopping addiction.

4. Trichotillomania
- Irresistible desire to pull out hair. (Hairloss)

5. Pyromania
- Desire to set things on fire.

6. Mutilomania
- Desire to injure and mutilate domestic animals.

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 OBSESSIVE COMPULSIVE DISORDER (OCD)

Definition – Obsessive thoughts OR Compulsive Acts OR Both.

➢ Symptoms – 4 symptoms patterns

1. Contamination
- Most common OCD.
- Washing hands many times a day after
contamination.

2. Pathological
- OCD of doubt.
- Counting money.
- Door has been locked properly or not.

3. Intrusive Thoughts
- Aggressive
without any act.
- Sexual

4. Symmetry
- Need for precession / symmetry.
- Will lead to compulsion of slowness.

Example :- It takes too long to bath.

Take hours to finish meals.

POST – TRAUMATIC STRESS DISORDER (PTSD)

Definition – Psychiatric disorder that can occur in people who

have witnessed traumatic event, nightmares, terrorist attack, etc.

➢ Symptoms – 4 symptoms patterns.

1. Intrusive Thoughts
- Repeated involuntary memories of traumatic act.
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 - Flashbacks.

2. Avoiding Reminders
- Avoiding people, places, objects, associated with
traumatic act.

3. Negative Alternatives in Cognition and Mood.

- Inappropriate blaming of oneself for trauma.
- Persistent negative emotions like. (Guilt, Shame,
Sad, Horror)

4. Arousal and Reactive Symptoms.

- Difficulty in falling asleep.
- Difficulty in concentration.

SCHIZOPHRENIA

Definition – Significant impairment in reality testing and

alterations in behaviour.

➢ Clinical Features
- Positive Symptoms (Addition of new symptoms).
- Negative Symptoms (Loss of normal function).
- Cognitive Symptoms.

1. Positive Symptoms
- Hallucination
- Delusion
- Disorganized speech and thought

2. Negative Symptoms
- Anhedonia:- loss of interest from regular activities.
- Avolition:- lack of positive goals in life.
- Blunted emotions.
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 3. Cognitive Symptoms
- Memory issues.
- Inability to process social cues.
- Impaired sensory perception.

➢ 4 A’s of Schizophrenia
- Autism
- Affect disturbance
- Ambivalence
- Association disturbance

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 IDENTIFICATION

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 AGE ESTIMATION FROM BONES

➢ Basic Rule

1° ossification centre (shaft of long bones)

+
2° ossification centre (Epiphysis)

Bone Ossification is 1 yr earlier in females

➢ Grades of Fusion

0 – unobservable
1 – Beginning
2 – Active
3 – Recent
4 – Complete

1. Mandible
- Two halves fuse at 1 – 2 years of age.

2. Clavicle
- Appearance :- 18-19 years.
- Fusion :- 21-22 years.

3. Sterum

Appearance Fusion

Manubrium 5m old age

5m
Body 7m 15-25 years
7m (below upwards)
10m
Xiphoid 3yrs 40 years

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 4. Shoulder Joint

Appearance Fusion

Head of Humerus 1y conjoint

epiphysis
Gr. Tubercle 1y (18-19 yrs)
Lesser Tubercle 5y
Tip of Acromion 14-15y 17-18 yrs

5. Elbow Joint (Mnemonic CRITOE)

Appearance Fusion

Capitulum 1y
Radial head 5y
Inner Epicondyle 6y 16-17 years
Trochlea 9y
Tip of Olecranon 9y
External/Lateral Epi.. 11y

Conjoint Epiphysis (14yrs) – Capitulum

Trochlea
External Epicondyle
6. Carpal Bones

Appearance

Capitate 2m
Hamate 3m
Triquetral 3 yrs
Lunate 4 yrs
Scaphoid 5 yrs
Trapezium 6 yrs
Trapezoid 6yrs
Pisiform 9-12 yrs

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 7. Pelvis

Pelvis Proper

Appearance Fusion

Iliac Crest 14-16 yrs 18 yrs

Ischial Tuberosity 16 yrs 20-22 yrs
Ischiopubic Ramus 6-9 yrs
Triradiate Cartilage Birth 13-15 yrs

Upper End of Femur

Appearance Fusion

Head of Femur 1 yr
Gr. Tronchanter 4 yr 17-18 yrs
Lesser Trochanter 12-14 yrs

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 AGE ESTIMATION FROM SKULL

Age Estimation done from 1. Fontanelle

2. Suture Fusion
3. Base of Skull

Key Points
- Sagittal suture :- Best for age estimation.
- Endocranial suture fuse earlier than Ectocranial.
- Male sutures fuse earlier.

Base of Skull
- Spheno-Occiput sutures – 18-21 yrs (Fusion).

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 DACTYLOGRAPHY / FINGERPRINTS
Definition – Study of fingerprints for identification. (Most
reliable)

➢ Patterns

1. Loops
- Ridges enter from one side – curve – leave from
same side.
- 1. Radial loop 2. Ulnar loop

2. Worls
- Ridges make 360° turns.
- 30-35% people have this.

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 3. Arch
- No arch, No delta.
- 5-10% people have this.
- Ridges show slight bump.

4. Composite
- At least two different patterns.
- Also known as accidental pattern.
- 2-3% people have this.

➢ Evidentiary Fingerprints Types

1. Patent Print
- Visible
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 - No processing needed
- Example :- Grease, Dark Oil, Blood

2. Plastic Print
- Print on soft surface
- Example :- Soap, Butter, Cheese

3. Latent Print
- Additional processing needed
- Non porous surface (Glass, Metal, Plastic)
i. Fingerprint powders :- Milled aluminium, Brass
ii. Superglue fuming :- Methyl cyanoacrylate
iii. Iodine fuming
iv. Vaccum Metal Deposition (Most sensitive)
- Porous surface (Paper, Cardboard, Matt)
i. Desferrioxamine (Most Sensitive)
ii. Ninhydrin
iii. Black / Magnetic powder
iv. Superglue fuming

➢ Loss of Fingerprint

Temporary Loss Permanent Loss

Bee Sting Leprosy

Dermatitis Electric Injury

Eczema Burns
Atropy Plastic surgery

# Locard’s Principle of Exchange :- “Every contact leaves a

trace”

➢ MLI

1. Identifications :- Criminals, Fugitive, Deceased, Disaster

work.
2. Accidental exchange of new burns.
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 3. Licensing procedure for automobile firearm/aircraft.
4. Biometric attendance
5. Sex determination
6. Detection of drug use

7. Automated fingerprint identification system(AFIS)

- Storage, retrieval, exchange of finger and palm
print.

DENTITION IN AGE DETERMINATION

➢ Age can be determined using:

- Eruption and Calcification.
- Gustafson method
- Stack’s method
- Miles method

➢ Age of eruption depends on:

- Hereditary
- Environment
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 - Nutrition
- Endocrine factors

➢ Two sets of Teeth

- Permanent
- Temporary / milk

Temporary Teeth
- 20 in number :- 4 incisors
2 canines each jaw
4 molars

Permanent Teeth
- 32 in number :- 4 incisors
2 canines
4 premolars
6 molars

➢ Sequence of Eruption

Tooth Milk Teeth Permanent Teeth

(months) (years)

Central Incisors 6-8 (lower) 6-8

7-9 (upper)
Lateral incisors 7-9 (upper) 7-9
10-12 (lower)
First premolar Absent 9-11
Second premolar Absent 10-12
First molar 12-14 6-7 (first to erupt)
Canine 17-18 11-12
Second molar 20-30 months 12-14
Third molar Absent 17-25

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 ➢ Period of Mixed Dentition

- Starting of eruption of 1st molar to eruption of last

permanent canine.
- Both temporary and mixed teeth present.
- Usually between 6-11years.

Developmental classification

Super added
Successional

Do not have deciduous Have deciduous

predecessors
predecessors

Example: - All molars in a jaw Example: -

Permanent
premolars erupt
replacing
temporary molar

➢ Difference

Features Temporary Permanent

Size Smaller Larger

Narrower Broader
Direction of teeth Vertical Inclined forward

Crown colour China white Ivory white

Number 20 in number 32 in number

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 Root Smaller Larger
More divergent Less divergent
Neck More constricted Less constricted

Radiology Prence of tooth germ No such finding

beneath tooth

GUSTAFSON’S METHOD

Definition :- Microscopic examination of longitudinal section of

central part of tooth to access wear and tear in teeth.

Estimate age between :- 25 to 60 years.

Disadvantage:- Useful only in dead body as tooth must be

removed out.

Criteria (Mnemonic – At Paris is Secondary Cement which makes Restaurant

Transparent)

1. Attrition
- Wearing down of teeth surface due to mastication.

2. Peridontosis
- Loosening of tooth from gum.

3. Secondary Dentin
- Growth of another dentin.
- Filling of cavity pulp.

4. Cementum Apposition
- Cementin grows throughout life.
- Increase in thickness.

5. Root Resorption
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 - Least reliable

6. Root Transparency
- Most reliable

➢ Other Methods of Age Estimation from Teeth.

1. Aspartic Acid Racemization

- During aging L-forms are converted to D-forms
(Crown dentin)
- Extent of racemization gives age.

2. Miles Method
- Amount of wear on each permanent molar is
estimated.
3. Chemical Method
- Nitrogen content: Increase with age
- Ions concentration: Increase with age
- Carbonate content: Decrease with age

4. Radiocarbon Dating of Enamel

5. Boyde’s Method
- Counting number of incremental lines from neonatal
line.

IDENTIFICATION DATA

Definition :- Determination of the individuality of a person based

on certain physical characteristics.

➢ Types:- 1. Complete
2. Partial

➢ MLI

Identification is necessary in:

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 Living:-
Criminal Cases
- Persons accused of assault, murder, rape.
- Interchange of newborn.
- Impersonation.

Civil Cases
- Marriage
- Passport / License
- Insurance claim

Dead:- When unknown dead body is found.

- Decomposed body
- Mutilated body
- Skeleton

➢ Identification Data

In living and dead both

- Race, Religion, Sex, Age, Teeth, Fingerprints, Lip
prints, Hair, Blood, DNA, General development and
Stature.
In living only
- Handwriting, Speech & Voice, Gait, Manner, Habit,
Memory & Education.

MLI OF VARIOUS AGE GROUPS

➢ 12 Years
- Age of consent for physical examination including
Medico – legal exams.
- Child under this need not take oath.
- Child under this cannot give valid consent to suffer
any harm.
- If child less than 12 years is guilty then his father
has to pay bond.
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 ➢ 18 Years
- Statutory Rape.
- Judicial punishment:- Below this age no
punishment.
- Age of majority, except person is under
guardianship of court.
- Cast vote.
- Driving license.
- Age of marriage in females.
- Mentally sound can give valid will.
- Employed in factory.
- Valid consent to suffer harm.
- MTP
- Taking out of girl less than 18 years from custody is
called kidnapping.

➢ 21 Years
- Age of marriage in males.
- Girl less than 21 years imported to India for elicit
things through kidnapping.
- Person under guardianship of court attains majority.

SEX – VERIFICATION TESTS (read once)

1. Physical Morphology:- External examination

2. Gonadal Biopsy
- Detection of XY chromosomes (Male)
- Detection of XX chromosomes (Female)

3. Gene – Based Test

- PCR to detect SRY or OYZI regions on Y
chromosome.
4. Testosterone level
- For females, it is less than 10 mmol/l.
5. Nuclear Sexing

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 - Method of sexing cells which helps in determining
sex in doubtful cases, decomposed, mutilated
bodies.

➢ Histological Examination

1. Barr Body
- Condensed, inactive, single X chromosome found in
the nuclei of somatic cells of females.
- It is seen as dark staining, small planoconvex mass
near nuclear membrane.

2. Davidson Smith Body

- In female attachment of drumstick to the nucleus of
neutrophil.

3. Quinacrine Dihydrochloride
- Stains Y chromosome.

SKULL, MANDIBLE, PELVIS

➢ Male / Female Skull

Features Male Skull Female Skull

General Appearance Larger, Heavier marked Smaller, Smooth

muscular ridges.
Cranial Capacity 1450-1550 cc 1300-1350 cc

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 Forehead Sloping Vertical

Orbits Square, Small Rounded, Large

Supraorbital ridge Pronounced Little

Mastoid Blunt Pointed

Zygomatic arch Prominent Not prominent

Palate U - Shaped Parabolic

Foramen Magnum Large oval Small round

➢ Mandible

Features Male Female

General Large thick Small thin

appearance
Chin U - Shaped Rounded

Angle of body Less obtuse More

with ramus (<125°) (>125°)
Angle of Everted Inverted
mandible
Muscular More Less
Markings

➢ Male / Female Pelvis

Features Male Female

General appearance Massive, rougher, Less massive,

more muscular smoother.
markings.
Shape Heart shaped inlet Circular inlet

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Subpubic angle V - Shaped U – Shaped

Greater Sciatic Narrow, Deep, Small Broad, Shallow,

Notch Large
Obturator foramen Large oval Small angle

Body of pubis Narrow triangular Broad rectangular

Pelvic outlet Smaller Larger

STATURE

Definition:- Height estimation from skeletal system.

- Femur (Best bone)
- Done using Osteomatric board

➢ Variations in stature
- Different times of day:- Morning > Evening by 2cm.
- After 30 years, stature decrease by 0.6 mm/yr.
- After death body lengthens by 2 cm.

➢ Estimation of Stature from Bones

Factors Interpretation

Regression Formulae Karl Pearson Equation

Stature = 81.3+(1.88*F)

Multiplication factors Length of bone * Multiplication

Factor
Example:- Femur – 3.7
Tibia – 4.5

Percentile Based on contribution

Humerus 20%
Tibia 22%
Femur 27%
Spine 35%

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 TATTOO MARKS
Definition:- Designs made in the skin by multiple small puncture
wounds with needles dipped in various dyes.

➢ Dyes
- Indigo
- Cobalt
- India Ink
- Prussian Blue
- Carbon
- Vermillion

➢ Classification

1. Traumatic
- Due to injuries.
- Firearm wound.
- Pencil lead wound.

2. Amateur
- Done at home
- India ink applied at various depths.

3. Professional
- Done by artists at salon.
- With modern machines.

4. Cosmetic (Permanent makeup)

- Camouflage skin discolouration.
- Hair like tattoo on bald area.

5. Medical
- Indicating medically relevant condition.
- Example:- Blood group tattoo.
Reconstructive breast surgery.

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 ➢ Erasure of Tattoo

1. Surgical
- Dermabrasion:- Tannic Acid, Silver Nitrate,
Chemical Peels, Zinc Chloride.
- Excision and Skin Grafting.
- CO2 snow.
- Scarification.

2. Electrolysis

3. Using Corrosive Substances:

- Example:- Papin + Glycerine.

➢ Complications:- HIV, TB, Leprosy, Gangrene, Hepatitis B.

➢ MLI

1. Identity
2. Religion / Nationality
3. Political affiliations
4. Race:- Tattoo on chest is common in Japan.
5. Occupation:- Gangster symbols
6. Behaviour

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 INFANTICIDE
&
CHILD ABUSE

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 HYDROSTATIC TEST

Also known as Lung Floatation test, Raygat’s test.

• Principle
- Respired lung specific Gravity – 950.
- Unrespired lung specific Gravity – 1050.
- Respired lung floats on water.
- Unrespired lung sinks.

• Procedure
- Dissect both lungs,
- Tie both lungs at hilum.
- Put them in water.
- Put a piece of liver (as a control)

• Inference
- Squeeze the floating lungs
- Again put in water
- Float – Respired
- Sink – Unrespired

• Explanation

- After squeezing, residual air still remains, Hence

respired lung float.

• False Positive
1. Accumulation of purifying gases.
2. Artificial inflation of lungs.

• False Negative
1. Edema
2. Pneumonia
3. Sypillis

• Hydrostatic Test not needed if

1. Mummified Fetus.
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 2. Umbilical cord separated and scar formed.
3. Stomach contains milk.
4. Braises on lungs in artificial inflation.
5. Fetus born before 180 days of gestation.

PM FINDINGS OF FETUS
OR
PM FINDINGS IN LIVE / DEAD BORN

• External Findings

1. General Findings
- Clothing
- No vernix caseosa (live birth)

2. Chest
- Dead born:- Chest is 2-2 cm less in circumference
than abdomen.
- Live born:- Chest > Abdomen.

3. Umbilical Cord
Changes Time since birth
Drying up of cut 2 hour
Drying up of whole cord 1 day
Mummification 3 days
Detach 5 days
Complete 10-12 days

4. Cephalhematoma and Caput Succedaneum.

Features CH CS
Definition Collection of Sodt tissue
blood between edema between
periosteum and
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 skull due to different layers of
rupture of small scalp.
veins.
Forceps injury.
Occurance Never present at Present at birth.
birth.

Development/ Develop 12-14 Disappear

Disappearance hrs after birth spontaneously
Disappear in 6-8 within 24 hrs.
weeks.
MLI Regression Definite evidence
helps to of fetus being
conclude alive in Uterus.
separate
existence.

• Internal Findings

1. Lungs
- Crepitance – Live born.
- No Crepitance – Still born.
- Surface – Live born – Mottled
Still born – Uniform
- Weight – Fodere’s Test – After respiration weight
becomes double.
- Ploucquet’s Test – Ratio of weight of lung to body.
Live – 1/35
Still – 1/70
- Hydrostatic Test – Lung floatation test
Live born – lung floats
Dead born – sinks

2. Diaphragm
- After respiration, diaphragm descends to 6th – 7th
rib.

3. Middle Ear
- Presence of air – Live born
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 - Also known as Wreden’s test.

4. Stomach
- Milk – Live Born
- Air in stomach / intestine – Live born.

5. Meconium
- Large intestine free of meconium within 24 hrs –
Live born.
- If present – Still born.

6. Incremental Line in Enamel

- Surest sign of Live Birth.

7. Heart
- Closure of foramen ovale by 2-2 months.
8. Blood
- Presence of Fetal lib till 6 months.
- Absence of Nucleated RBC within 24 hrs.

RESPIRED Vs UNRESPIRED LUNGS

Features Unrespired Respired
Colour Uniformly bluish Mottled salmon
red. pink.
Volume Small Large
Consistency Non - crepitant Crepitant
Diaphragm 4th – 5th rib 6th – 7th rib
Plocquest’s test 1/70 of body weight 1/35
Hydrostatic test Sink Float
Alveoli Not expanded Expanded
Margins of lung Sharp Rounded

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 SHAKEN BABY SYNDROME
Definition:- Vigorous shaking of infant causing intracranial
hemorrhage.
- Can occur with 5 second of shaking.

• Trail of Injuries.
SDH

Retinal Hemorrhage Encephalopathy

Subdural

• Other Features
- Bucket handle fracture in metaphysical region.
- Knob fractures.
- Multiple rib fractures
- Heal to form knob

Child presents with

- Convulsions
- Neurological deficit
- Unresponsiveness

Diagnosis
- CT Scan / MRI / X-Ray
- Bloody spinal or Subdural fluid.

SUDDEN INFANT DEATH DISEASE

Definition:
Sudden and unexpected death of seemingly healthy infant whose
death remains unexplained even after complete autopsy.

Etiology:

I. Incidence: 0.2-0.4% of all live births.

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 II. Age: Between 2 weeks to 2 years.
III. Sex: M:F ratio 3:2
IV. Socio-economic status: Low and middle class family with
poor housing condition ^^^ (upward arrow means high)
V. Time of death: In most cases, the infant is discovered dead
VI. Season: Mostly deaths are seen to occur commonly in rainy
and winter seasons.
VII. Twinning: More among twins.
VIII. Addiction: Smoking (pre- or postnatal) and drug abuse by
pregnant women increases risk

Cause:

I. No definite cause is known.

II. Prolonged sleep apnea
III. Respiratory infection
IV. Nasal edema and mucus secretion may narrow upper
respiratory passages
V. Bedclothes and pillow falling accidentally over the
mouth by the movement of the child.

Postmortem Findings:

I. Postmortem findings are negative.

II. Trachea contains milky vomit, sometimes blood stained with
shed epithelial cells.
III. Multiple petechial hemorrhages on heart
IV. Pulmonary edema
V. Milk or bloodstained froth on child's mouth or bedding.

Medico-legal Aspects:

SIDS is a natural death in which the parents may be wrongfully

linked for having criminal involvement or negligence.

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 MANCHAUSAN SYNDROME BY PROXY (SHORT
QUESTION)

Definition: A form of abuse in which parent or guardian

fabricates or produces symptoms of an illness in a child to gain
sympathy or attention for themselves.
Features:
• The child may be brought with vague complaints such as
vomiting, diarrhoea, fever or seizures inflicted by the parent
intentionally and repeatedly, for e.g. bleeding may be caused
by anticoagulants and simulated by exogenous blood
• Seizures can be caused by suffocations, shaking or
intoxications
• Vomiting can be caused by giving ipecac syrup
• Fever triggered by injecting contaminants into IV lines while
the child is in the hospital
• The parent or guardian derives some non-economic benefit
at the expense of the victim

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 INJURIES

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 INJURIES CLASSIFICATION
Injury: - Any harm, illegally, to any person’s body, mind,
reputation, property.

Wound: - Breach in continuity.

• Classification (4 main classifications A,B,C,D)

[A] Causative Factors

1. Mechanical
- Blunt force trauma
• Abrasion
• Laceration
• Confusion
• Fracture

- Sharp force trauma

• Incision
• Stab
2. Thermal
- Due to heat – Burns, Scalds, Heat stroke.
- Due to cold – Frost wite, Trench Foot.

3. Chemical Injuries
- Strong acids
- Strong alkalis
- Plant / Animals extracts

4. Miscellaneous Injuries
- Electrical
- Radiation
- Blast
- Lightening

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[B] Based on Nature of Injury
- Simple
- Grievous

[C] Medico – Legal Classification

- Suicidal
- Homicidal
- Accidental
- Defence wounds
- Fabricated

[D] Based on Time

- Antemortem
- Postmortem

ABRASION / BRUISE
# difference btw true bruise and artificial bruise in given in toxicology sqs. It is also
asked as 6 marker.

Definition:- Removal of superficial layer of the skin (usually the

epidermis) by friction against rough surface.

• Classification

1. Scratch / Linear Abrasion

- By sharp, pointed object like pin, nail.

2. Graze Abrasion
- Tangential friction between skin and rough surface.
- Uneven parallel lines.
- Brush Burn – Graze abrasion with wider area.

3. Friction Burn
- Superficial, reddened, excoriated area with little no
linear mark.

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 4. Pressure Abrasion
- Prolonged pressure with minimal force to crush
epithelium.
- Example:- Abrasion mark of hanging.

5. Imprint / Patterned Abrasion

- Example:- Teeth mark, Car Tyre, Radiator Grill.

• Age {Remember sequence- Bright Red, Red, Reddish Brown, Brown, Blackish
Brown, Black, Falls}

Fresh – Bright red, oozing serum.

2-24hrs – Red scab.
2-3 days – Reddish brown scab.
4-5 days – Dark brown scab.
5-7 days – Brownish black scab, starts falling.
7-12 days – Scab shrinks and falls.
More than 12 days – Epithelium thinner and atrophic.

• AM / PM Abrasion

Features Antemortem Postmortem

Site Anywhere Bony prominence
Colour Red Yellow,
translucent
Exudation More Less
Vital reaction Yes No
Healing Yes No

• M / L Importance

1. Give idea about site of impact and direction of force.

2. Helps identify causative weapon.
3. Age of injury, nature of injury.

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 4. In sexual assaults, abrasions are found on breasts, inside
of thigh.
5. In smothering, abrasions are found around mouth and
nose.

SUICIDAL vs HOMICIDAL CUT THROAT

[Link] Feature Suicidal Cut-Throat Homicidal Cut-

Throat
1 Level High, above the Low, below the
thyroid cartilage thyroid cartilage
2 Direction Obliquely, above Transverse or from
downwards and from below upwards
left to right in right-
handed persons
3 Number of Multiple, may be 20– Multiple, cross
wounds 30, superficial, each other at a deep
parallel and merged level
with main wound
4 Hesitation Present Absent
cuts
5 Tailing Present Absent
6 Severity Less severe More severe
7 Defence Absent Present, unless
wounds taken unaware
8 Weapon at Usually present Usually absent
site
9 Clothes Not cut or damaged May be cut,
corresponding to
injuries in the body

# Hesitation Cuts (SQ) - multiple, small and superficial cuts

often involving only the skin and are seen at the beginning of the
incised wound, presumably hesitating while gaining courage to
make a final decisive cut.

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 BRUISE vs PM STAINING

[Link] Feature PM Staining Bruise

1 Cause Distension of Rupture of vessels
vessels with blood which may be
in dermis superficial or deep
2 Site Most dependent Occurs at the site
parts of the injury;
anywhere
3 Margins Clearly defined Merge with the
surrounding area
4 Color Uniform bluish- Different colors,
purple color depending on the
age of bruise
5 Microscopically Blood cells are Blood cells found
found within the outside vessels;
blood vessels; no evidence of
evidence of inflammation
inflammation present

DEFENCE WOUNDS

Definition - Wounds which result from the immediate and

instinctive reaction of the victim to save oneself from an attack.

Classification

Active Passive
When the victim tries to seize When the victim raises the
the weapon and the injuries hands or arms for protection.
are sustained on grasping the They are located on the extensor
weapon. Injuries are usually or ulnar surfaces of forearms,
located on the palms wrists, knuckles and the back of
the hands

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 F ICTITIOUS / FABRICATED WOUND

Definition:
Produced by a person on his own body or by another with his
consent.

Types:
i. Self-inflicted: Inflicted by a person on his own body.

ii. Self-suffered: Inflicted by another person on the alleged

victim.

Motive:

• By women, to bring a charge of rape.

• Convert simple injury into grievous one.
• By prisoners, to bring a charge of beating against officers.
• By soldiers and prisoners to escape difficult task.
• For insurance frauds.

Diagnosis:
By careful history taking and examination of injuries (person’s
history will not match actual injuries)

Most commonly used object – knife, razor, glass piece, scissors

and ice pick

Body parts where found:

Generally areas where much pain will not occur.

E.g. Top of the head, forehead, neck, outer side of left arm, front
of abdomen and chest.

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 BULLET

Definition: - Projectile of a rifled forearm that leaves muzzle

when discharged.

• Based on Shape
- Round nose
- Wadcutter
- Semi wadcutter

• Based on Jackets
- Jacketed (Envelope made of brass or copper)
Full Jacketed
Semi Jacketed
- Non Jacketed

• Advantages of Jacket

1. Deformation of bullet in barrel from dirt.

2. Fragmentation / Melting.
3. Leading (lead fouling)of barrel.

• Types of Bullet

1. Dum Dum Bullet – Semi Jacketed

2. Tandem Bullet – Piggyback bullet
3. Fragile Bullet (melt after piercing)
4. Poisoned Bullet
5. Tracer Bullet (leaves a foggy trace behind, to know
direction)
6. Rubber Bullet
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 7. Exploding Bullet
8. Non-Toxic Bullet
9. Incendiary Bullet – Causes fire

ENTRY AND EXIT WOUNDS

Features Entry Exit

Definition Wound due to Wound due to

projectile entering projectile exiting
body. body.
Size Smaller than bullet. Larger than bullet.

Edges Inverted Everted

Burning Present Absent

Blackening
Singeing
Abrasion collar
Grease collar
Bruising
Cloth fibres Turned Out

Radiological Lead ring may be Absent

examination seen

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 FIREARM INJURIES

• Classification

1. Rifled weapons
- Revolver
- Rifles
- Machine guns

2. Shotguns
- Single shot and double barrel.
- Auto loading shot gun.

• Rifled Firearms
Definition:- The firearms in which the barrel has spiral
grooves and lands from 2 t0 22 in numbers – most common
being 4,5,6 grooves.
- These grooves are also known as rifling.

Land + Groove is called Rifling.

• Advantages of Rifling
- Stability to bullet.
- Increase accuracy and range.
- Prevents tumbling or wobbling.
- Increase power of penetration.

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 • Characteristics of Rifled Firearm Wound (Its okay if you make
mistake in + or -. No one checks)

Features Contact Close range Mid-range Distant

shot (2-3 inches) (< 2ft) shot (>
2ft)
Wound Large, Small circular Circular Circular
irregular same size smaller
stellate as bullet than bullet
shaped
Margins Everted Inverted Inverted Inverted
Muzzle + - - -
Grease - + + +
collar /
Abrasion
collar
Burning - + + +
Blackening - + + -
Singeing - + - -
Tattooing - + + -

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 SHOTGUN WOUNDS
Definition: - Weapons in which the barrel is smooth.
Smooth bore weapon.

• Choking
- Interior construction of a shotgun bore at the muzzle
for the purpose of controlling pattern of fired shot.
- Types
Cylinder bore chock.
Modified chock.
Improved cylinder chock.
Full chock.

• Shotgun Pellets: - Bird shot (small)

Buckshot (large)

• Caliber of Shotgun (Bore)

- Number of spherical lead balls of size fitting the
barrel which can be made from one round of lead.

• Shotgun Wounds

Features
Contact Close Mid Long
Shot (< 3ft) (< 7ft) (> 7ft)
Wound Circular, Circular, Round rat Uniform
equal to No hole pellets, No
bore. separate appearance, external
pellet satellite appearance.
holes. pattern
pellets.
Muzzle + - - -
Burning - + - -
Blackening - (+ for + - -
head)
Singering - + - -
Tattooing - + +/- -

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 62
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 CARTRIDGE

➢ Definition:
Cartridge is one unit of ammunition.
It consists of:
i. Cartridge case with percussion cap containing primer
ii. Propellant charge (gunpowder)
iii. Projectile (bullets/pellets)
iv. Wads (in smooth bore weapons only)

➢ Use of cartridge case

• Keeps various components together
• Prevents backward escape of gases
• Provides waterproofing for gunpowder

Parts:
• Percussion cap: Base of Cartridge Case. Made of either zinc
or copper, so as to be malleable and deformable under the
blow of the firing pin.
• Cartridge cases: Classified into five types depending on the
configuration of their bases - rimmed, rimless, semi-rimmed,
rebated and belted.
• Wad: Wad is made of some soft material, like disc of felt,
cardboard, cork or straw. It is placed between powder and
shot or over the shot. The cardboard disc behind the shot
charge prevents the pellets from getting lodged in the felt
wad.

➢ Advantages of wad:
a. Allows optimum pressure to develop
b. Seals the bore effectively
c. Helps in lubrication
d. Prevents the escape of gas from the breech end
e. Separates propellant from the projectiles

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 SHOTGUN CARTRIDGE RIFLE CARTRIDGE

GUN POWDER

1. Black powder: It produces flame, smoke and heat, and

consists of granular ingredients, like sulphur, charcoal and
saltpeter (potassium nitrate).

2. Smokeless powder: It is more effective than black powder

as it burns more efficiently and produces much less smoke
resulting in less blackening and tattooing around the entry
wound. Types:
o Single base powder- consists of nitrocellulose
(gun cotton). It is the most common type of
commercial powder, because of its simplicity,
adequate power and low flame temperature.

o Double base powder- consists of nitrocellulose

and nitroglycerin. It is more powerful than
single base because of nitroglycerin, but has a
flame temperature that may melt the steel of the
barrel.

o Triple base powder- consisting of

nitrocellulose, nitroglycerin and
nitroguanidine.

The quantity of nitroglycerin is small, but

sufficient to give power; the nitroguanidine

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Aksh Patel
 lowers the flame temperature while adding an
active explosive constituent.

3. Semi-smokeless powder: It consists of mixture of 80%

black and 20% smokeless type.

SQs OF FIREARM INJURIES

❖ Detection of Gunshot Residues – Detection of gun powder

residues on the hands of the one who fired gun. (Accused)

Materials/ Methods :
• Dermal nitrate or paraffin test
• Harrison and Gilroy test
• Neutron activation analysis
• Modified Greiss test
• Energy dispersive X-ray (EDX)

❖ Riochet Bullet - It is a rebound, deviation or deflection of a

bullet from its course by striking an intermediate surface.
Sometimes, the bullet may strike the surface, but fail to
penetrate and glance off.

❖ Yaw - Deviation between the long axis of the bullet and axis
of the path of the bullet

❖ Tumbling bullet - Bullet rotates end-to-end during its path

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Aksh Patel
 STAB WOUND
Definition: - Penetration with long narrow instruments having
pointed ends.
- Depth is greater than length and width.
- Weapons used:
▪ Knife
▪ Scissors
▪ Ice picks
▪ Screwdriver

• Classification

STAB

Penetrating Perforating

Entry only Entry + Exit

• Characteristics

1. Margins
- Clean cut
- No abrasion
Except hilt mark on skin.

2. Depth greater than length and width.

3. Depth depends on
- Condition of knife
- Resistance
- Clothing
- Force applied
- Location

4. Shapes
- Single edged knife – Wedged shaped.
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 - Double edged knife – Spindle shaped.
- Screwdriver: + or slit like
- Ice pick: o
- Fork: oooo

5. Hill mark Injuries

- Sometimes depth of wound is greater than the length
of knife.

• Cause of Death
- Hypovolemic shock
- Cardiac tamponade
- Embolism
- Aspiration
- Infections

• Suicide v/s Homicide Stab

Suicide Homicide

Location Easily accessible Anywhere

No. of wounds Single Multiple

Grouping Regularly placed Irregularly placed

Exposure Clothes are spared Wound is through

Clothes
Weapon close to Yes No
body

• M / L Importance

1. Shape of wound indicates type of weapon used.

2. Depth indicates force of penetration.
3. Age of injury can be determined.
4. Accident is rare.
May be due to animal attack.
Fall on sharp objects like glass nails.
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 5. Harakiri
- Suicide by Japanese Samurai Warriors.
- L shaped cut from left to right side of abdomen
followed by upward turn.

SKULL VAULT FRACTURES

Type Weapon / Mechanism Characteristics

- Most common type of skull
Heavy weapon with broad fracture
1. Fissure fracture
striking surface - General deformation
- Thin linear fracture line

- Fracture segment is displaced

inward/depressed
- Signature fracture: fracture
pattern represents weapon
- Complications: brain contusion,
Heavy weapon with narrow
laceration, cerebral injury
2. Depressed fracture striking surface (e.g.
- Management:
hammer)
→ If intracranial injury present:
Surgical elevation of fracture
segment
→ If absent: Conservative
management

- Complication of fissure or
Repeated blows causing depressed fracture
3. Comminuted
multiple fracture lines and - Also called mosaic fracture or
fracture
segments spider web fracture (no
displaced segments)

- Fracture line along sutures

4. Sutural/diastatic Blow to skull causing - Most common in young adults
fracture sutural separation - Not seen in elderly due to fused
sutures

- Variant of depressed fracture

- Most common in children (< 4
5. Pond / indented / Trauma on soft skull causing yrs) due to pliable skull
ping pong ball fracture dent (no fracture) - Seen in obstetric forceps
delivery (due to force on either
side of skull)
- Type 1: Injury to outer table
6. Gutter fracture Oblique/glancing bullets
- Type 2: Injury to outer & inner
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Type Weapon / Mechanism Characteristics
table
- Type 3: Keyhole defect
(penetrates skull over small area)

SKULL BASE FRACTURES

Type Weapon / Mechanism Characteristics

- Fall from height

→ Lands on feet → force
via vertebral column - Fracture at base of skull around
1. Ring
→ Base of skull foramen magnum (3–5 cm)
Fracture
- Lands on buttocks → - Fracture in posterior cranial fossa
indirect force
- Heavy weight on head

- Type 1: Fracture lines reach opposite

side through Sella turcica (middle cranial
- Type 1: Sideway impact fossa)
in middle cranial fossa → "Nodding face sign" = abnormal base
2. Hinge
- Type 2: Posterior impact mobility
Fracture
- Type 3: Sideway impact → aka Motorcyclist fracture
in anterior cranial fossa - Type 2: Fracture from posterior to
anterior cranial fossa
- Type 3: Fracture in anterior cranial fossa

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 THERMAL INJURIES (some SQs may be asked from
below classification. Google all definitions)

Frostbite - Injury due to freezing and formation of ice crystals

and obstruction of blood supply within tissues. It occurs due to
exposure to great extremes of cold (–2.5ºC).

Heat Cramps – It due to fluid and electrolyte depletion.

Heat Exhaustion - It results from prolonged strenuous activity

with inadequate water or salt intake in a hot environment and is
characterized by dehydration, sodium depletion or isotonic fluid
loss with accompanying cardiovascular changes.

Heat Stroke – It is a life-threatening medical emergency resulting

from failure of the thermoregulatory mechanism.

BURNS

➢ Definition:
Injury caused by heat or by a chemical or physical agent having
an effect like heat.

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 ➢ Types of Burns
1. Contact burns: There is physical contact between the body
and a hot object, like heated solid or molten metal.
2. Flame burns: There is actual contact of body with flame.
3. Scalds: They are caused by contact with hot liquids, most
commonly water and usually occur on exposed skin.
4. Radiant heat burns: They are caused by heat waves, a type
of electromagnetic wave. There is no contact between the
body and flame or hot surface.
5. Ionizing radiation burns: X-rays, radium, UV rays
6. Chemical burns: By acids, alkalis and strong bases
7. Electric and lightning burns.

➢ Classification:

Degree of damage Dupuytren's Wilson’s

Erythema 1° Epidermal
Vesication with blister formation 2° Epidermal
Destruction of superficial skin 3° Dermo-
epidermal
Destruction of whole skin 4° Dermo-
including dermis epidermal
Destruction of deep fascia, 5° Deep
muscles
Complete charring involving 6° Deep
vessels, nerves and bones

# Here in Wilson’s classification –

• Epidermal is First Degree
• Dermal is Second Degree
• Deep is Third Degree burn

➢ Wallace Rule of Nine (separate S.N may be asked):

• Tells us approx percentage of burns based on body
surface area.

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 Wallace Rule of 9- here
percentage shows how much
area is burnt.

For Children – Head is relatively larger. So Wallace Rule is not

valid.
Lund and Browder described a method for compensating for the
differences – In children < 1 year, head is 18% of TBSA and each
leg is 14% of TBSA.

Trunk and arms represent the same percentages as in adults.

For each year above 1 year old, add 0.5% to each leg and reduce
1.0% to the head until adult values are reached.

➢ Cause of Death

Immediate Delayed
• Asphyxia • Sepsis
• Neurogenic Shock • Hypovolemic Shock
• Laryngospasm • Toxemia
• Edema

➢ PM Findings (write roughly in every S.N):

• External Findings:
• Clothes – Burnt
• Site, Extent – Based on Wallace Rule
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 • Skin – Burnt
• Hair – Singed
• Limbs – Pugilistic Attitude (upper and lower limb
flexed)
• Face – Distorted, Swollen, Lip Protruded

Pugilistic/Fencing/Boxing
Attitude

• Internal Findings:
• Brain – Congested
• Larynx/Trachea – Carbon soot found. Suggests A.M
hanging.
• Heart – Cherry red due to CO
• Pleura/ Lungs – Congested
• Spleen/Liver/Kidney – All soft, necrosed, edematous

➢ AM vs PM Burns: (may be asked as separate que)

[Link] Feature Antemortem Postmortem

Burns Burns
1 Line of redness Present Absent
2 Vesicles Contain serous Contain air
fluid
3 Inflammation and Present along Nil
repair with pus and
slough
4 Soot in upper Present Absent
respiratory tract
5 Carboxyhemoglobin Present Absent
6 Healing Granulation Absent
tissue seen in old
cases
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 BURNS/ DRY HEAT vs SCALDS/ MOIST HEAT

[Link] Feature Dry Heat Moist Heat

1 Skin Dry, wrinkled and may Sodden, bleached
be charred
2 Vesicles At the circumference of Over the burnt area
burnt area
3 Color Black Bleached
4 Scar Thick, contracted Thin, less contracted
5 Clothes Burnt Wet, not burnt
6 Cause Flame, heated body or Solid steam or
X-rays liquid > 60°C
7 Site At or above the site of At and below the
contact site of contact
8 Charring Present Absent
9 Singeing Present Absent
10 Splashing Absent Present

ELECTRICAL INJURIES/ ELECTROCUTION

➢ Two major effects on the body:

• Cellular depolarization of nerves and muscle
• Heat production

➢ Factors affecting electrical injury:

1. Kind of current: Alternating current (AC) is 4-5 times more

dangerous than direct current (DC).
2. Amount of current: Electrocution is rare at < 100 V and
most deaths occur at > 200 V
3. Path of current: Death is more likely to occur, if the
brainstem or heart is in the direct path of the current.
4. Duration of current: Damage is directly proportional.
5. Site of contact: Electrical injuries on the face and arms are
more serious than those on the palms.

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 ➢ Characteristics:
1. Joule Burns/ Entry Mark - These marks are round or
oval, chalky white centrally collapsed blister and have a
raised border.

2. Exit Marks – Blow out type wound.

3. Crocodile skin lesion – High voltage burns cause
numerous individual and confluent areas of third-degree
burns or red/brown punched-out spark lesions.
4. Current pearls - Small balls of molten metal derived
from the metal of the contacting electrode, may be carried
deep into tissues which can be identified by scanning
electron microscopy.
5. Bone pearls - Heat generated by the current may melt the
calcium phosphate which is seen in X-rays of limbs as
typical round dense foci known as bone pearls or wax
drippings.

➢ PM Findings (write roughly)

A. External findings
• Face pale
• eyes congested
• pupils dilated.
• Rigor mortis appears early and dark blue-red
postmortem staining
• Joule burns at the site of entry is diagnostic.

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 B. Internal Findings:
• Lungs
• Heart congested, edema, necrosis, pale, hemorrhages etc
• Kidney
• Brain

MLI:
1. Death is mostly accidental. Rarely homicidal
2. Judicial Electrocution – In USA, death penalty is given by
electrocution.

FILIGREE BURNS / LITCHENBURG FLOWERS

Cause: By lightening/ thunderstorm stroke

Mechanism: Exact not known. Some theories are:

• Static electricity discharges along superficial vasculature.
• Hemoglobin staining the tissues in the pattern of a tree due
to break down of RBCs within the capillaries of the skin.
• Current following lines of perspiration and skin moisture.

PM Findings – Write same as electrical injury (just don’t write

Joule Burns)

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 SIMPLE vs GRIEVOUS INJURY

Simple Hurt/ Injury:

Any hurt that does not lead to permanent or serious damage and
heals rapidly without any deformity.

Grievous Hurt:
Injury that causes permanent damage
IPC 320 / BNS 117
Grievous hurt includes 8 clauses (mnemonic- Every Smart Hero
Jumps 2 High Trampolines)

1 Emasculation Injury that causes male to lose his

muscularity. E.g. injuring testes.
2 Permanent privation Crushing of eye, dislocation of lens
of sight of either eye
3 Permanent privation Injury to tympanum, ear ossicles or
of hearing of either auditory nerves
ear
4 Privation of any Member – organ or limb
member or joint
5 Permanent Here there is no privation (loss),
impairment of the There is only impairment in
powers of any functioning of member
member or joint (limb/organ)
6 Permanent E.g. cutting of ext. ear, nose, big
disfigurement of the scar on the face
head or face
7 Fracture or dislocation
of a bone or tooth -
8 Any other hurt which 1. Endangers life
2. Causes the victim to be in
severe bodily pain for 20 days
3. Unable the victim to follow his
ordinary pursuits for a period
of 20 days

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 MEDICAL
JURISPRUDENCE

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 CONSENT

- Voluntary agreement, compliance or permission.

- Sec 13 of ICA
2 or more ppl are said to consent when they agree upon
the same thing in same sense.

• Classification

Consent

Implied Expressed

Body language / Gesture Verbal Written

For minor t/t Major t/t

E.g.

Anaesthesia
• Other types of consent

1. Surrogate consent
- Someone other than patient.
- Guardian / Teacher

2. Blanket consent
- Consent for all necessary procedure.
- Taken during admission.
- Not valid in India.

• Doctrine of Informed Consent

- Complete information of patient before obtaining
consent.
- Expectations:
1. Emergencies
2. Therapeutic privilege
3. Therapeutic waiver
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 4. Use of placebos
5. Prisoners
6. M/L PM

• Doctrine of Loco Parent’s

- In absence of Parents / Guardians for child < 12 yrs,
consent obtained by person in charge. (Teacher /
Warden)
• Rules for consent

1. Consent should be free, voluntary, clean, intelligent.

- No fraud, No intoxication.

2. Medical examination
- Minimum age for consent
12 yrs for general physical examination.
18 yrs for major procedures.

3. M/L Examination of rape

Victim Accused
Consent is mandatory Not mandatory
184 BNSS 52 BNSS

4. MTP
- Consent mandatory from pregnant woman.
- Minimum age 18 yrs.
- Less than 18 yrs – Legal Guardian.
- Husband’s consent – Not required.

5. Any harm to person in good faith, even without his/her

consent is not offence – BNS 26 (Only for emergency
case).

6. Organ Donation (After death)

- Will of person is enough.

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 - But if relatives deny, then no control of dead over
organ transplantation.

MEDICAL NEGLIGENCE
Definition: - 1 & 2

1. Act of Omission: - Not doing something that reasonable

person do.
2. Act of Commission:- Doing something that a reasonable
person, under normal condition would not do.

Bolman Test:- The test judged by medical practitioner’s

peers to assess standard of core in dealing with case of
medical negligence.

According to Black’s Law Dictionary 4 D’s of Negligence:

1. Duty of case.
2. Dereliction of duty.
3. Damage.
4. Direct causation.

In Medical Negligence

- Patient = Plaintiff
- Doctor = Defendant

• Types

1. Civil
2. Criminal

Features Civil Negligence Criminal

Negligence
Offence Simple lack of Gross, wilful
skill/care – negligence, illegal
Damage act
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 Example Wrong done / Wrong surgery
prescription Criminal abortion
Trial Civil court Criminal court
Consumer court
Punishment Fine Imprisonment /
Fine / Both
Double Jeopardy Can be tried Cannot be tried
twice twice for the same
crime
Parties Patient v/s Doctor v/s
Doctor Prosecution
Evidence Strong evidence Guilt should be
sufficient proved beyond
reasonable doubt

• Contributory Negligence

Negligence of Doctor + Contribution of Patient.

Example:- Not taking medications improper follow up.

Burdon of proof – Doctor

Applicable – Civil Negligence
If proved – Liability of Doctor

• M/L Importance

Endangers life – 125 BNS

Simple Hurt – 125(a) BNS
Grievous Hurt – 125(b) BNS
Death – 106 BNS {punishment 2 yrs + fine}

• Doctrine of RES IPSA LOQUITUR

- Things or facts speak for itself.

- Patient do not need to prove negligence in case
where the rule of res ipsa loquitur applies.

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 Criteria

1. In the absence of negligence, the injury would not have

occurred.
2. Doctor had exclusive control over the injury producing
instruments.
3. Patient was not guilty of contributory negligence.

Examples:
1. Blood transfusion misadventure.
2. Wrong site surgery.
3. Failure to give TT vaccine following injury.

• Defences Against Negligence

Following may be helpful for defence.

1. No doctor patient relationship was established.

2. Informed consent for the act.
3. Error of judgement – Not a negligence
4. Res Judicata
- Once the case is completed between 2 parties, it
cannot be tried again between same parties.
5. Limitation
- Case of negligence must be charged within 2 yrs.
6. Medical Maloccurance
7. Contribution Negligence (Also known as affirmative
defence)
- Not applicable in criminal cases.

• Examples of Medical Negligence

Medicine
1. Failure to refer patient to hospital or specialist.
2. Failure to diagnose MI.

Surgery
3. Retention of instruments in body.
4. Operating wrong side.
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 5. Failed Tubectomy / Vasectomy.

Gynaec
6. Criminal Abortion.
7. Mismanagement of delivery.

Ortho
8. Missed fractures.
9. Prolonged use of plasters.

Anaesthesia
10. Hypoxia resulting in brain damage.

General
11. Failure to immunize.
12. Failure to obtain consent.
13. Making wrong diagnosis.

NMC

NMC was formed in 2019 by repealing Indian Medical Council.

• Autonomous Board
1. Undergraduate Medical Education Board.
2. Postgraduate Medical Education Board.
3. Medical assessment and rating Board.
4. Ethics and Medical Registration Board.
• Medical Advisory Council
Consists of – Chairman of Uni Grant Commission.
- Director of National Assessment and Accreditation
Council.
- Various other members of State Government, Home
Minister.

• Functions
1. Lay down policies to maintain high quality and high
standard in medical education.
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 2. Policies for regulating Medical Education Research.
3. Co-ordinating among autonomous boards.
4. Entrance and exit tests.
5. Recognition of Medical qualifications.
6. Withdrawal of recognition of qualifications granted by
medical institutions.
7. Issuing Good Standing Certificate.

• MARB
8. Rating of Institutions.
9. Permission for new medical colleges.
10. Inspections of Medical Colleges.

• EMRB
11. Maintain National Register.
12. Professional conduct and medical ethics maintenance.

• Schedules Under MCI

First Schedule – Recognised Medical Qualifications granted
by universities in India.
Second Schedule – Recognised Medical Qualifications
granted by universities outside India.
Part I of 3rd Schedule – Qualification not included in
Schedule.
Part II of 3rd Schedule – Qualification not included in 2nd
Schedule.

PROFESSIONAL MISCONDUCT

Definition:- Any conduct of the doctor which might reasonably be

regarded as disgraceful or dishonourable as judged by
professional men of good conduct and competence.
- Violation of Ethics.

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 • Professional Misconducts :-

1. Advertising
- Unusually large banner.
- Solicit patients directly or indirectly through social
media.
- Endorsement with drug company.
- Print Self – Photograph.

2. Rebates or Commissions
- Fee splitting.
- Cut practice.

3. Secret Remedies.
4. No Euthanasia.
5. No prescribing brand names.
6. Physician posted in rural area found absent on more than
2 occasions during inspection.
7. Giving falsified or misleading information to NMC.
8. Should not
- Be drunk in clinic.
- Do sex determinations tests.
- Issue false certificates.
- Commit Adultery.
9. Does not maintain medical records of indoor patients for
3 years and unable to provide information within 72
hours.
10. No supply of addiction forming drugs.
11. No illegal Abortions.
12. Should not disclose professional secret.

Features Professional Negligence Professional Misconduct

Offence Absence of care and skill. Violation of code of

medical ethics.
Damage to person Yes No

Trial Civil or Criminal court State Medical Council.

Punishment Fine, Imprisonment or Erasure of name.

both.

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 Appeal High court EMRB and Central
Government
Duty of care Yes No

PROFESSIONAL SECRECY
Definition:- The doctor is obliged to maintain the secrets that he
comes to know concerning the patient in course of professional
relationship.

• Principles
1. Physician should not answer any query by 3rd parties.
2. If patient is major (> 18 yrs), Doctor should not disclose
information without his/her consent even to
parents/relatives.
3. In case of celebrity, Doctor should not held a press
conference without his consent.
4. Information of dead should not be revealed without
relative’s consent.
5. PM findings should be submitted to police only.

• Punishment
1. Civil action for damages.
2. Complain to SMC/NMC.
3. Defamation case under Sec 499 IPC.

SMC

• Compositions
- Medical teachers from various Universities.
- Elected members of RMP.
- Vice President and President among themselves.

• Functions
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 1. Maintenance of Medical Register.
2. Renewal of Registration every 5 yrs.
3. Removal of name of Medical practitioners.
4. Restoration of name.
5. Disciplinary Control.

Limitation Period – Complaint must be before 2 yrs.

Conviction in court Complaint by public Official

Complaint

Registrar (SMC)

Subcommittee

Dr. Summoned
(Enquiry)

Disciplinary
Committee

Free Warning Suspension Penal

Erasure

Appeal

EMRB / Central Govt.

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 VICARIOUS LIABILLITY / RESPONDANT
SUPERIOR
Definition:- An employer is responsible not only for his own
negligence but also for his employee’s negligence.

- Latin meaning – Let the master answer (Respondent

Superior).

• Criteria

1. There must be employer – employee relationship.

2. Employee’s Conduct must occur within the scope of his
employment.
3. Incident occur while on the job.

• Features

- Also called
o Master Servant rule
o Captain of the ship Doctrine.
- In medical practice, the principal doctor becomes
responsible for his assistant’s negligence.
- When 2 doctor practice as partners
o Each is liable.
o Even though other has no role.
- Physician is responsible for negligence of
o Interns
o Residents
- Borrowed Servant Doctrine
An employee may serve more than one employer.
Example:- Nurse borrowed by the surgeon for OT
assistance may be working for the purpose in the
hospital.

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 PRIVILAGED COMMUNICATION

Definition:
It is a statement, made Bonafide upon any subject matter by a
doctor to the concerned authority, due to his duty to protect the
interests of the community or of the state.

- In simple words, there are few

cases/diseases/instances where doctor should not
maintain secrecy. He must tell to the public or the
government about these diseases/cases to maintain
healthy society and for their benefit

For E.g.
1. Civic benefit
- A bus driver/ pilot suffering from epilepsy must be
told to the authority
- A teacher suffering from T.B must be told to the
principal/ authority

2. Notifiable clauses: Dr. must report births, deaths, abortions

etc

3. Crime: Dr. must report crimes like rape, homicidal attempt,

abortions etc.

4. Court of law: Dr. must disclose all confidential data of

patient if court orders him/her to do so.

5. A doctor can disclose and discuss the medical facts of a case

with other doctors and paramedical staff, such as nurses,
radiologist and physiotherapist to provide better service to
the patient.

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 PREGNANCY

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 CRIMINAL ABORTION

• Abortion
Legally – Expulsion of product of conception from the
uterus at any period before full term.
Medically – Expulsion of embryo / fetus weighing 500g or
less from its mother when it is incapable of independent
living.

• Classification

Abortion

Natural Artificial

Legal
Illegal
(MTP)

Criminal
Abortions

• Natural Abortion
- 10% - 20% of all pregnancies.

Causes:-

1. Genetic – Trisomy, Monosomy, Mutations.

2. Anatomic – Congenital malformations.
3. Endocrine – D.M, Hyperthyroidism, Luteal phase
defect.
4. Infections – Viral – Rubella, CMV, HIV.
Parasitic – Malaria, Toxoplasma.
5. Other
- Blood group incompatibility.
- Cigarette smoking.
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 - Drugs
- X-ray exposure

• Criminal Abortion

Methods of Inducing Criminal abortion:-

1. Abortificient drugs.
2. General violence.
3. Local violence.

❖ Abortificient Drugs

1. Ecbolics
- Increase uterine contractions.
- Example – Ergot preparations, Synthesis Estrogens,
Pituitary extract, Strychnine.
2. Emmenagogues
- Initiate menstrual flow
- Estrogen, Borax, Sanguinarin
3. GIT irritants
- Purgatives, Castor oil, MgSO4.
4. Drugs with systemic toxicity.
- Inorganic – Lead, Copper.
- Organic – Calotropis, Custard Apple.

❖ General Violence
- Intentional or accidental injury to uterus.

Intentional
- Kick on abdomen
- Blows
- Tight bandage
- Cupping – Seperation of placenta
- Violent exercise

Accidental
- General shake up in initial pregnancy

❖ Local Violence
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 1. Syringing (Higginson’s).
- Soap water, Formalin, KMnO4.

2. Syringe Aspiration.
- Suction pull – Rupture gestational sac.
3. Self-Instrumentation
- Stick
- Umbrella rib Rupture membrane
- Pencil, etc
4. Abortion Stick
- With juice of marking nuts, Calotropis.
5. Slippery Elm bark
- Dilation of cervix.
6. Pastes
- Utus paste
7. Electric Current
- 110 V
- Contraction of Uterus.
8. Oral Medicine.
- Chloroquine
- Prostaglandins
- High dose progesterone – estrogen

• Complications of Criminal Abortion

Immediate – Air embolism

Fat embolism
Poisoning
Hemorrhagic shock

Delayed – Septicemia
Toxemia
Tetanus
Local infection

Systemic Complications
- Jaundice
- ARF
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 - Endocarditis
- Shock

Remote Complications – Depression

Ectopic pregnancy
Chronic debility

POSITIVE SIGN OF PREGNANCY

Signs Timing Features
Fetal Movement 20-22 weeks Movements of fetus on
palpation.
Heart sounds 18-20 weeks - With ordinary
stethoscope
- Sounds not heard
in:-
Dead fetus
Obese mother
Hydramnios
<18 week pregnant
Radiographic Imaging 16 week Vertebral dots shadow

Signs of fetal deaths:-

- Spalding
- Halo Duenl sign
- Ball’s sign
- Helix sign
Ultrasonography 4th – 5th week Gestational and yolk sac

5th week TVS – Cardiac activity

10th week Cardiac activity bydoppler

ultrasound

11 weeks Fetal Sex ultrasound

Fetal cells in maternal 6th week Fetal sex
blood Using Rt-PCR by finding
fetal DNA from maternal
blood

Acid Elution test for Fetal Cell detection.

Principle – Acid removes adult Hb but not fetal Hb.

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 • Procedure

Mother’s Blood

Acid bath

Staining

Mother RBC Fetal RBC

No stain Rose Pink

PRESUMTIVE AND PROBABLE SIGNS

• Presumptive Signs:
1. Amenorrhea
- Cessation of menstruation.

2. Breast Changes
- Montgomary tubercles around nipples.
- Colostrum secreted.
- Less/No changes in multiperas.

3. Morning sickness
- By 1st month.

4. Quickening
- Baby movement
- By 18th week

5. Linea Nigra
- Dark line from pubis to umbilicus.
- 20th week
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 6. Chadwick’s Sign
- Mucous membrane of vagina changes from pink to
violet.

7. Frequent Urination
8. Fatigue

• Probable Signs

Sign Time Features

Goodel’s Sign 6th week Cervix becomes soft
and round.
Hegar’s Sign 6-10 week Firm hard cervix felt
by 2 finger test.
Osiander Sign 8th week More pulsation felt
through lateral
fornices.
Palmer’s Sign 4-8th week Regular rhythmic
contractions of
uterus.
Piskacek’s Sign Asymmetrical
enlargement of
uterus.
Braxton – Hick’s 3rd month Painless uterine
Sign Contractions.
Ballottement 4-5th month Toss up like a ball
Vaginal
External
Fundal Enlargement 12 weeks Start

24 weeks Fundus reach

umbilicus
36 weeks Ovoid – Spherical

40 weeks Falls in height

(last 2 months)
Beta HCG Appear in 1 week
Grow
Fall in 3 months

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 SIGNS OF RECENT DELIVERY

1. Uterus
- Size of uterus decrease over first few weeks –
Involution.
- Fundus at level of Umbilicus – 1-12 h
- 1 cm below umbilicus – 1st day
- Midway between umbilicus and pubic symphysis –
6th day
- Symphysis pubis – 10th day
- True Pelvis – 2 weeks
- Normal size – 5-6 weeks

2. Cervix
- Soft, Collapsed
- After delivery – can admit 2 fingers
- By 1 week – 1 finger
- By2 weeks – Normal size

3. Lochia
- Alkaline discharge from uterus, vagina with fishy
odor.

Types:-

1. Lochia Rubra
- 1-4 days postpartum
- Red colour
- Consists of blood, mucosa, vernix caseosa

2. Lochia Sersosa
- 5-9 days
- Pink watery
- Blood, wound exudates, microorganisms

3. Lochia alba
- 10-14 days
- Yellowish
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 - Decidual cells, Cholesterol, Crystals, Leukocytes.

4. Voluminous Breasts
5. Abdomen
- Linea nigra
- Striae Gravidarum

6. Vagina
- Loss of rugosity

• Symptoms
1. Diuresis
2. Transient Depression – Puerperal Psychosis
3. Rise in temperature for first 24 hours.

SHORT QUESTIONS

• Hymen
- Fold of mucus membrane
- 1mm thick
- Tough, fleshy, cartilaginous
- 10 yrs – Tip of little finger
- Puberty – 1 finger

Types:-
- Annular – Central opening
- Crescentic – Ant. Opening
- Cribriform – Multiple small small openings.
- Septate – Two opening separated by ridge.
- Infantile – Small linear opening.
- Fimbriated
- Imperforate – No opening

• Pseudocyesis / Phantom Pregnancy

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 - Psychological disorder where women has false but
firm belief that she is pregnant, although no
pregnancy exists.
- Observed in women who desire child immensely.

Symptoms:-
- Cessation of menstruation.
- More abdominal signs.
- Women feel contractions.

MLI
- Patient may sue doctor of miscarriage.

Features Superfecundation Superfetation

Definition Fertilization of two Fertilization of two
ova discharged ova discharged
from ovary at same from ovary at
period of ovulation different periods of
by different act of ovulation.
coitus at short Fertilization of
interval. already pregnant
mother.
Menstrual Cycle Same Different
Interval between Few days Weeks or months
two coitus
Consequence No much Fetal growth
development disorder.
Difference Fetus papyraceus
MLI Gross variation in Allegation of
Fetus. adultery.
Example:- One Due to negligence
white one Black of sonologist.

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 Nulliparous Parous Uterus
Uterus
Size Small Large

Weight 40-50 g 80-100 g

External OS Circular Transverse

Internal OS Circular, Ill defined, margin

Well defined wrinkled
Shape of cervix Conical Cylindrical

Uterine Cavity Inner walls Inner walls

Convex Concave

True Virgin False Virgin

Basic Difference Woman has not Experienced

experienced
sexual
intercourse.
Hymen Intact Intact
Rigid Loose
Inelastic Elastic
Admits tip of Admits 2 fingers
little finger
Vagina Narrow Capacious
Marked rugosity Less rugosity
Areola and Pink Pigmental
Nipple

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 MTP (Medical Termination of Pregnancy)

Legal termination of pregnancy.

Indications:
1. Therapeutic – If mother’s health is in danger
2. Eugenic – If child is having some genetic defect
3. Social – Contraceptive failure
4. Humanitarian – caused by rape
5. Environmental – If single mother is chronically ill and there
is no one to look after child once born.

MTP 2020 Amendments:

- Upto 12 weeks of pregnancy, it can be terminated on
the opinion of a single doctor.
- Between 12-24 weeks, decision should be taken
jointly by two doctors.
- MTP can be done to unmarried woman too

Qualifications of doctor:
1. For MTP upto 12 weeks: Dr. must have assisted 25 abortions
out of which 5 must be carried out independently.
2. MTP from 12-24 weeks:
- Post-graduate degree/diploma in Obs & Gynae,
- Six months of house surgency in Obs & Gynae
- One year or more in the practice of Obs & Gynae at
any hospital.

Methods of MTP:

1. First Trimester:
o Medical – Mifepristone, Methotrexate
o Surgical – Dilatation & Evacuation, Manual Vacuum
Aspiration.

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 2. Second trimester:
o Dilatation & Evacuation
o Prostaglandins
o Oxytocin infusion
o Hysterectomy

IMPOTENCE / STERILITY IN FEMALES

Impotence – Unable to perform sexual intercourse and achieve

gratification.

Sterility – Unable to reproduce/conceive.

• Male – cannot make female pregnant
• Female – cannot hold baby in its uterus

Sr. Cause Description

No
1 Age No pregnancy before menarche / after
menopause
2 Diseases PID, Prolapse, Gonorrhoea, Lead poisoning
3 Environmental Exposure to excessive heat, X-rays
4 Medications Chemotherapy, cessation of oral contraceptives
(hormonal imbalance may remain for some time
after stopping the pill.)
5 Psychological Fear, pain, disgust, or apprehension for
intercourse may give rise to vaginismus [severe
spasm of the lower one-third of vagina involving
the paravaginal muscles]

IMPOTENCE / STERILITY IN MALES

Sr. Cause Description

No
1 Age Before puberty
2 Diseases Priapism, hydrocele, elephantiasis, phimosis
3 Addiction Morphine, heroin, opium, cannabis, cocaine
and tobacco
4 Medications Antidepressants, antipsychotics, anti-
hypertensives

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 5 Psychological dislike of partner, fear of failure, anxiety or
mood disorder, guilt, low self confidence
SOME MORE SQs

❖ Artificial Insemination:

Process of introduction of semen from the husband or a donor by

instruments into the vagina or uterus of a female to bring about
pregnancy which is not attainable by sexual intercourse.

Types:
i. AIH (artificial insemination homologous/husband)
ii. AID (artificial insemination donor)
iii. AIHD: 'Pooled' donor semen to which semen from husband
has been added. There is technical possibility of husband
being father of the child.

❖ Surrogate Mother

A woman who carries a child for a couple or single person with

the intention of giving that child back to that person/couple, once
it is born.

Types:

- Traditional surrogacy: The surrogate mother is also called

baby's biological mother as her own egg is used for
pregnancy.

- Gestational surrogacy: She may be implanted with someone

else's fertilized egg

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 SEXUAL
OFFENCES

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 RAPE

Definition: - Unlawful sexual intercourse by a man with a

woman.
- IPC 375 / BNS 63.

A man is said to commit rape if he

- Penetrates penis in vagina.
- Any other object in vagina.
- Applies mouth to vagina.

- Against her will

- Without consent
- With consent – When – Fear of death, Intoxication,
Impersonation.

• Explanation of Terms:-
- Penetration – Any extent
- Vagina – Labis majora

• Exceptions
- Medical intervention
- Sexual intercourse by a man with his wife not being
under 15 years.

• Custodial Rape – Rape by persons in authority.

• Gang Rape – By more than one man.
• Statutory Rape – Rape of girl < 18 years.

• Punishment

BNS Criteria Punishment

64 i Raping >= 18 yrs 10 yrs to life
imprisonment.

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 64 ii Custodial Rape 10 yrs to life
imprisonment.
65 i < 16 yrs 20 yrs of life
imprisonment.
65 ii < 12 yrs 20 yrs of life
imprisonment.
OR Death.
70 Gang Rape 20 yrs to life
imprisonment.

Examination of Victim - #Seperate S.N

EXAMINATION OF RAPE VICTIM

• Duties of a Doctor

1. Priority Case
2. Free of cost
3. Senior medical staff should examine sexual assault case.
4. Sample to be preserved as soon as possible.
5. Privacy to be ensured.

• Examination

First Aid – Consent of Examination – History Taking.

• History Taking includes

1. Preliminary data
- Name
- Age
- Marital Status
- Occupation
2. Chief Complaints
- Post Medical History
- Post assault activities
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 - Assailant Information
3. Menstrual / Ob. History
- History of Pregnancy
- Contraception
4. Details of Assault
- Use of weapons
- Alcohol / Drug use
5. Event History
- Date and place of assault
- Use of contraception
- Type of contact

SAFE KIT – Sexual Assault Forensic Evidence Kit.

• Then comes examination

Examination

Physical Local Evidence

Collection

Treat Documentation Packaging and

Sealing

Discharge Hand over to Police

Follow up

• Physical Examination

1. General – Height, Weight, Alcohol intake.

2. Clothes
3. Breasts
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 4. Wood lamp exam – For finding foreign debris or semen.

• Local Examination

1. Genitals
2. Pubic hairs
3. Genital injury
- T – Tears
- E – Ecchymosis
- A – Abrasion
- R – Redness
- S – Swelling

“Two Finger Test – Unethical”

• Specimen Collection

1. Clothing
2. Scraping of dried blood stains.
3. Scraping of dried semen.
4. Hairs
5. Nails
6. Blood
7. Saliva
8. Swabs from soiled area of skin.
9. Radiographs – Age estimation.

• MLI of Rape

1. Date Rape Drugs given before rape

- Roofline
- Ketamine
- No consent
- But not against will
2. False Allegations
- When statement of women is not matching with
results / evidence.
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 3. Rape Trauma Syndrome
- Post – Rape Stress disorder.
- Phase of disorganisation – Headache, GIT problems,
Depression.
- Phase of reorganisation – Phobia of particular event.
4. Marital Rape
5. Battered wife Syndrome – Domestic Violence

SODOMY

Definition: - Anal intercourse between

- 2 males – Homosexual
- Male – Female – Heterosexual

• Pedestary
Anal intercourse between a boy(Catamite – Passive) and
man(Pederast – Active).

• Examination of Passive Partner

Preliminary data
- Name
- Age
- Sex
- Identification marks
Written Authorization
- By magistrate or police in charge.
Written consent of Victim

• General Examination
1. Clothings
- Stains of Blood.
- Pubic Hairs
- Semen
2. Secondary Sexual Characters.
3. Injuries
- Abrasion
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 - Bruise
- Contusion

• Local Examination
1. Built / Size of orifice.
2. Size of penile organ.
3. Time interval between intercourse and examination.
4. Degree of force applied during act.

• Position for Examination

- Non-Habitual – Left lateral position.
- Habitual – Knee chest position.

• Signs of Abuse
1. Non specific
- Erythema
- Perianal abrasions
- Eczema
- Fissures
2. Supportive Signs
- Anal laxity
- Rectal discharge
- Chronic changes – More anal elasticity.
Asymmetry in rugae
3. Diagnostic Signs
- Fresh laceration
- Transection of anus.
- Perforation of recto sigmoid colon.

• MLI

Sex 377 IPC – Same gender sex – Offense

In 2018, Supreme Court decriminalized Sodomy (with
consent)

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 SQs of Sexual Offences

Sexual Perversion

❖ Sadism:
Person gets sexual gratification by infliction of pain or
physical cruelty, like beating, biting, whipping, cigarette
burns or ill-treating the partner. E.g. Male actor in the movie
Fifty Shades of Grey

Lust Murder – Sadism in which full gratification is achieved

after killing the partner. Gratification starts from beating,
biting and ends at killing.

Necrophilia – Sexual activity with dead body

Necrophagia – Eating flesh of that body.

❖ Masochism:
Sexual gratification is obtained only when they receive
painful stimulus from opposite partner.
Exact opposite to sadism.

❖ Transvestic Fetishism:
Sexual gratification is obtained by wearing the dress of
opposite sex

❖ Voyeurism:
There is a morbid desire of the individual to observe
unsuspecting people undress or naked, taking bath, see the
genitalia or watch intercourse secretly to get erotic
excitement and sexual gratification.
For e.g Akshay Kumar watching girl undressing herself from
the hole of the cupboard in the movie ‘DE DANA DAN’

❖ Exhibitionism:

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 It is a desire and intentional exposure of genitalia in public
places while in presence of others (mostly in front of
children or females) to obtain sexual pleasure.

❖ Frotteurism (Toucherism):
Obtaining sexual arousal and gratification by rubbing of
one’s genitals against a non-consenting person in public
places.

❖ Pedophilia:
Urges or behaviors involving sexual activity with a
prepubescent child or children (<13 years) by a person who
is  16 years old and at least 5 years older than the child.

❖ Incest:
Sexual intercourse by a man with a woman who is closely
related to him by blood or by marriage
Examples: Between father and daughter, Between mother
and son, Between brother and sister.

❖ Adultery:
Voluntary natural sexual intercourse between a married man
and someone other than his wife or between a married
woman and someone other than her husband.

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THANATOLOGY

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 ALGOR MORTIS

Definition:- Colling of the body that takes place after death.

- Body temperature = Environment temperature.

• Cause
- Cessation of energy production.
- Inactivity of heat regulating centre after sematic
death.

• Graph
Sigmoid Shaped

37°C

Temp c

Time

a = Isometric phase
b = Intermediate
c = Terminal phase
o Slightly above base due to bacterial activity.

• Site to measure inner core temperature

- Rectum (8-10cm above anus).
- External Auditory Meatus.
- Nostrils up to cribriform plate.
- Intracerebral (through orbit)

• Rate of Temperature Fall

- 0.4 – 0.7°C /h
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 - In 16-2- h, Body temperature = Environment
temperature.

• Time since Death

Normal Rectal Temperature – Measured Rectal Temperature
/ Rate of fall of Temp / h

• Factors Affecting Algor Mortis

1. Environmental Temperature
- Directly proportional
2. Air movement
- Directly proportional.
3. Humidity
- Cooling increases in humid.
- Cooling decreases in dry.
4. Media of Disposal
- Cooling increases in water.
- Cooling decrease in buried.
5. Obese body
- Less cooling.
6. Age and Sex
- More cooling in children and elders because of high
surface area of body.
- Females retain body heat for longer time.
7. Clothing
- Less cooling in well clothed body.
8. Posture of Body
- More cooling in supine.
- Less cooling in curled.

• PM Caloricity
Instead of cooling, body temperature remains high for 2 hrs.

Reason:-
1. PM glycogenolysis.
2. Death due to Septicaemia.
3. Death due to convulsion of Tetanus, Strychnine.
4. High Environmental Temperature.
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 • MLI
1. Time since death.
2. Sign of death.
3. Cooling – Delays rigor mortis decomposition, Heating –
Both start early.

BRAIN DEATH

Definition:- Irreversible loss of cerebral functions.

- Brainstem death is practically considered
Braindeath.

Brainstem Death
▪ Irreversible loss of:
▪ RS
▪ CS
▪ Consciousness

• Mechanism

Brain Injury
(Trauma, Hypoxia, Disease)

Brain Edema

More Intracranial Pressure

Aseptic necrosis

Respirator brain
(liquified brain)

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 • Diagnosis

1. Establishment of cessation of all brain functions.

- Using EEG, SSEP, Laboratory tests.
Three cardinal signs.

Coma Absence of brain reflex Apnea

- No corneal reflex
- No cough reflex
- No gag reflex
2. Exclusion of Reversible Conditions.
- Hypothermia
- Drug intoxication
- Hypoxia
- Hypotension
- Encephalitis

• Brain Death Certificate

- Two doctors should perform brainstem death tests.
- Each doctor should perform tests twice.
- Doctor should be expert.
- Tests should be done only after 24 hrs of brain
injury.
- 2 tests – Minimum 6h interval.

• Organ Donations / Living Cadavers

1. Cornea – 6h
2. Skin – 24h
3. Bone – 48h
4. Heart – 1h
5. Kidney – 45min
6. Liver – 15min

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 EXHUMATION

Definition: - Lawful digging out of already buried body from

grave for PM examination.

• Reasons
1. Criminal Cases
- Cause of death in suspected homicide disguised as
suicide.
- New information suggest that death was homicide.
2. Civil Cases
- Identification of deceased in accidental death for
- Insurance
- Compensation
- Claims
3. Academic
- To investigate historical circumstances
- To study death patterns
- D/s Outbreaks
- Nutritional status

• Authorization
- Either from
o First Class Magistrate
o District Class Magistrate
o Subdivisional Class Magistrate
o Executive Class Magistrate
- No Police can order exhumation (176 CrPC).

• Procedure
1. Should be done in broad day light.
2. In the supervision of Medical Officer, Magistrate, Police
Officer.
3. Soil around coffin should be preserve.
4. Doctor should note position and appearance of body.
5. Grave and Body should be photographed.
6. If body is putrefied,
Bones, Viscera to be preserved for analysis.
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 • Time Limit
India – No time limit.
France – 10yrs.
Germany – 30 yrs.

LIVOR MORTIS
Also known as:-
- PM staining
- PM lividity
- Cogitation
- Suggillation

Definition:- Bluish / Purplish discolouration resulting from

gravitational settling of blood in capillaries and venules of
dependent parts of dead body.

Site: - Undersurface of skin. (Dermis)

Cause: - After stoppage of circulation

- Stagnation of blood in vessels of dependent parts
due to Gravity.

• Development
- Time after death
▪ 30 min-1h – Small patches.
▪ 3-4 h – Patches contesa (Increase size).
▪ 5-6 h – Well developed.
▪ 8-12 h – Fixed (until putrefaction).

• Distribution

Positions
1. Supine
- On neck, back (except contact pallor).
2. Prone
- On chest, Abdomen
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 3. Lying on one side
- On that side
4. Suspended vertically
- Legs
- Lower parts and Forearms
- Genitals
- Upper margin of ligature

5. Drowning
- Face
- Upper part and chest
- Hands, Calves

• Colour of PM Staining

1. Asphyxia – Deep bluish -Violet

2. Perfringens Septicemia – Pale bronze
3. Hypothermia drowning – Bright red
4. Mummified body – Brown / Black
5. CO Poisoning - Cherry

• MLI

1. Sign of death
2. Mistaken with bruise when small patchy.
3. Indicate posture of the body.
4. Cause of death – by colour distribution.
5. Mistaken with Congestion.

MUMMIFICATION

Definition:- Rapid dehydration and shrivelling of dead body from

evaporation of water.
- Modification of Putrefaction, Also known as dry
decomposition.
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 • Features
1. Body loses weight and becomes thin.
2. Normal decomposition retarded.
3. Microorganisms growth retarded.
4. Time required – 3 -12 months. (varies)

• Factors Favouring
1. Hot Environment
2. Dry Atmosphere.
3. Free air movement – Rapid evaporation of body fluids.
4. Poisoning – Arsenic Antimony.

• MLI
Same as Adipocere

Adipocere Mummification

Chemical change of fatty Dehydration

tissues into FA
Rancid smell Odourless

Moist Dry
3 weeks to 3 months for 3 – 12 months
development.

PUTREFACTION
Definition:- Process by which complex body tissues breaks down
into simpler inorganic compounds by saphrophytes.

Putrefaction

By Saprophytic Org. By own enzymes.

- C. perfringens Autolysis
- Staphylococcus
- Non hemolytic Str.
- Diptheroids
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Gases Produced
- H2S
- Ammonia
- CO2
- CO
- Methane
Changes due to Putrefaction
1. External
2. Internal

• External Changes (remember Ds)

- Discolouration – Greenish
- Distension
- Marbling Sign – Greenish staining of superficial
vessels.
- Degradation – Skin slippage, Degloving, Loosening
of hair / nails.
- Dissolution – liquification of body.

• Internal Changes
- Liver softens – Honey comb appearance.
- Brain – Softens within 72h.
- Pink teeth – Due to given hemolysis.
- Heart – Resistant
Shows milliary plaques.

• Factors Affecting Putrefaction

External Factors
1. Environmental Temp – Directly proportional
Decomposition nearly stops
at<0°C and > 48°C.
2. Moisture – Promotes Putrefaction
3. Air – More putrefaction in stagnant air.
Less in flowing air.
4. Clothing – Less putrefaction.

Internal Factors
1. Age –
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 - Slow in unfed infants.
- Fast in children
- Slow in elders
2. Sex – No much influence
3. Cause of death – Less in Anemia, ZnCl poisoning
More in septicemia
4. External injury will increase putrefaction rate as
saphrophytes get path to enter.

• MLI
- Time since death.
- In advanced putrefaction no option can be given as a
cause of death.
- In buried body, Skeletonization takes 1 yr.
- Identity of deceased is impossible in advanced
cases.

RIGOR MORTIS
Definition:- State of muscles in the dead body when they become
stiff / rigid with shortening.

• Mechanism
After death, muscles relax due to lack of signal from
nervous system.

Primary Faccidity

Ca2+ released from its storage

Muscles contract

Unable to relax due to loss of ATP

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 continue Cellular Degradation Starts
(Secondary Flaccidity)

• Muscles involved
All
Involuntary – earlier
Voluntary – later

• Onset
Rule of 12:-
- Commences 1-2h after death.
- Takes 12hrs to develop.
- Persists for 12 hrs.
- 12 hrs to pass off.

• Order of Appearance
Appear first in heart
For voluntary muscles – Nysten’s Law

Eyelids
Jaw
Facial muscles
Neck, Thorax Order of Appearance
Upper limb, Lower limb
Abdomen
Small muscles of fingers

• Factors Affecting R.M

Early Onset Late Onset

High Environmental Temp. Asphyxia (hanging, CO)

Violent exercise prior to Hemorrhage
death
Thin, Wasted body Cold bodies
D/S like TB, cancer, cholera Paralysed muscles
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 Poisoning with OP, Pneumonia
Strychnine
Exhaustion, Heat Stroke

• MLI
1. Sign of death.
2. Indicates position of body.
3. Conditions which imitate RM – Heat /Cold stiffed
putrefaction, cadaveric spasm.

SAPONIFICATION
Definition:- Formation of sweet, rancid, whitish waxy – greasy
material.

Time:-
Tropical Countries – 1 week.
Temperate Countries – 3 weeks.

• Mechanism

PM hydrolysis of body fats

Unsaturated FA converts to saturated FA

Mix with water to form Adipocere

• Distribution
Any site including fatty tissue
- Face, buttocks, breast, etc.

• Factors Influencing
1. Environment – Heat increases saponification.
Cold decreases.
2. Moisture – Increases
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 3. Bacteria influence – Increases
4. Built – More in obese.
5. Age - < 7 yrs do not show adipocere.
6. Air current – Decreases
7. Running water – Decreases

• MLI
1. Time Since Death.
2. Place of disposal of body.
3. Identification – Face is well preserved in adipocere.

SIGNS OF DEATH

• Changes After Death

Immediate Early Late

Brain Function Loss of Skin Elasticity Putrefaction

CS Facial pallor Adipocere
RS Muscles Relax Mummification
Contact pallor and flattening
Loss of corneal reflex
Dilated Pupils
Less IOP Eye
Opacity of cornea
Tache noire
Kevorkian Sign

Livor Mortis
Algor Mortis
Rigor Mortis

• Tache Noire
- If Eyelids remain open for 3-4 hours after death.
- Formation of two yellow triangles on each side.
- Becomes brown / black later
- Black line in French.
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 • Kevorkian Sign
- Blood vessels appear fragmented or segmented
within minutes after death in the retina.
- Persists for about an hour.

• Suspended Animation
- Condition in which vital signs (heartbeat and
respiration) are not detected by routine clinical
methods as they are reduced to minimum.

• Mechanism
- Metabolic rate is greatly reduced.
- Less O2 required by individual cells.

• Types
1. Voluntary – Performers of Yoga.
2. Involuntary – Alcohol, Anemia, Electrocution, Injury
(head), Opium, Uremia.

• MLI
- Necessary for doctor to diagnose suspended
animation before declaring Brain Death.

TYPES OF DEATH

• Thanatology
- Scientific study of death in all aspects including its
cause mechanisms, manner, mode.
- Includes PM changes, MLI of death.

• Difference between Somatic and Molecular Death

- Stages of Death
- Somatic / Clinical Death.
- Molecular / Cellular Death.

Features Somatic Death Molecular Death

Definition Permanent cessation of Progressive

brainstem function. disintegration of body
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 tissues with death of
individual tissues.
Onset Precedes molecular Succeeds somatic death
death. (1-2h)
Occurrence Event Process

Tissues and cells Alive and functioning Dead and Non

functioning
Response to external Muscle responds to No response
stimuli thermal, Electrical,
Chemical Stimuli.
Confirmation Flat ECG, EEG Rigor Mortis, Algor
Mortis, Putrefaction
Organ harvest Possible Not Possible

• Artia Mortis
- Gateways of death.
- Life is like a tripod of Nervous, Circulatory,
Respiratory Systems.
- If one fails, all fail.
Life

NS CS RS

• Whole Brain Death

- Irreversible cessation of all functions of entire brain.

• Higher Brain / Neocortical Death

- Irreversible loss of higher brain function in cerebral
cortex.
- No full brain.

• Brainstem Death
- Irreversible loss of :-
o Respiratory centre
o Circulatory centre
o Consciousness

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 ASPHYXIA

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 ASPHYXIA CLASSIFICATION

❖ Definition:-
- Condition caused by interference with exchange of O2 and
CO2 in body.
- Defective aeration of blood.

❖ Pathophysiology

Asphyxia

Less O2 Less O2 in
Lungs

Less pulmonary blood flow Capillary

dilation

Less venous return Stasis of blood

❖ Classify Asphyxia

- Mechanical
- Chemical
- Pathological
- Environment
- Traumatic
- Positional
- Iatrogenic

• Mechanical Asphyxia
- Smothering
- Hanging
- Drowning
- Gagging, Chocking

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 • Pathological
- Laryngeal edema
- Spasm
- Abscess

• Chemical Asphyxia
- Morphine
- Barbiturates affect respiratory centre
- Strychnine

• Environmental Asphyxia
- High Altitude
- CO
- Sewer Gas
- Pure Helium

• Traumatic Asphyxia
- Pulmonary Embolism
- Pneumothorax Intervene Oxygenation
- Hemothorax

• Positional Asphyxia
- Jack-Knife position – Alcoholics
- Hogtying position (punishment)

Hogtying
position (draw
if possible)

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 DROWNING

Definition: - Respiratory impairment from submersion/immersion

in liquid.

• Classification

Drowning

Typical/1°/Wet Atypical / 2°
Fresh water drowning Dry drowning
Salt water drowning Immersion Syndrome
2° drowning
Shallow water drowning

• PM Examination:

External Findings
1. Face – Pale, Bloated, Cyanosis
2. Tongue – Swollen, Protruded
3. Skin – Tete de negre appearance
4. Froth – AM drowning
5. Cutis Anserina – Goose skin
6. Washerwomen’s hands – Wrinkled, Bleached,
Appearance
7. Rigor mortis appears early

Internal Findings
1. Lungs
- Fresh water – Ballooned, Light, Pink colour,
Crepitus heard, Emphysematous, Shape retained.
- Sea water – Ballooned, Heavy, Purple, Soft jelly
like
2. Larynx
- Prence of mud, sand, diatoms
- AM drowning
3. Heart
- Gettler Test – Chloride content in heart
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 - Fresh water drowning – Chloride in lt. heart < rt.
Heart
- Sea water drowning – Chloride in lt. heart > rt.
Heart
4. Stomach
- Muddy content
- Sehrt’s Sign – Micro rupture of gastric mucosa.
- Wydler’s Sign

---------- Foam
Stomach content --------- Liquid
layers
in Beaker ---------- Sediment
---------

(Heating)
5. Middle Ear
- Water in it – Veno’s Sign
- AM drowning
6. Diatom Test
- Unicellular microscopic algae present in water –
Enters Lungs – Penetrate to whole body.

• Cause of Death

1° - Asphyxia
- Ventricular fibrillation
- Vagal inhibition
- Laryngeal Spasm
2° - Septic aspiration pneumonia

• MLI
- A.M v/s P.M drowning

AM PM
Froth Fine, leathery Absent
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 Trachea Presence of algae, No
Mud
Lungs Ballooned up Collapsed
Diatom Positive Negative
Gettler Positive Negative
Injurious Consistent with Inconsistent
drowning
Water in middle Positive Negative
ear
Others Cutis Anserina No
Washerwomen’s No
hands

HANGING

Definition:- Form of asphyxia caused by suspension of body by

ligature mark around neck, constricting force is body’s own
weight.

• Classification
Based on position of knot
1. Typical – Knot at nape of neck.
2. Atypical – Anywhere other than occiput.
Degree of suspension
1. Complete – Full body suspended.
2. Incomplete – Toes touching ground.

• Cause of death
1. Blockage of jugular vein – 2kg
2. Blockage of carotid A – 5kg
3. Vasovagal shock – Stimulation of carotid body.
4. Blockage of air passage – 15kg
5. Fracture dislocation of C2 – C3
6. Vertebral artery block- 28kg

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 • PM Findings

External Findings
1. Swollen Face

2. La-Facie Sympthique
- Knot pressing cervical sympathetic
That side eye open and dilated
- Ante – mortem hanging
3. Protrusion of tongue
4. Dribbling of saliva – Surest AM death
5. Abrasion / Ligature mark on neck
Non continuous
Inverted V-Shape
6. Involuntary discharge of fecal matters urine
7. Tardiou’s Spots

Triad

Congestion Cyanosis

Internal Findings
1. Congestion of viscera
2. Amussat’s Sign
- Endothelial tear of carotid artery
- AM hanging
3. Simon’s Sign
- Hemorrhages on ventral surface of intervertebral disk
beneath Ant. Lumber ligament in the lumber spine
- AM hanging
4. Hyoid bone fracture
- Divergens of greater horns

• MLI
Most Commonly – Suicide
PM hanging – Branch of tree shows rope has moved from
below upwards.
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 Accidental hanging – Generally in children
- Playing cow boy, Lasso game
Autoerotic hanging – Sexual gratification
- Body is generally nude
- Mirror placed in front
Lynching – Homicidal hanging by a group
Judicial hanging – Fracture of C2 – C3

STRANGULATION

Definition:- Violent Asphyxial death by constricting air passage at

the neck by means of a ligature other than suspension of the body.

• Classification (sq)
1. Ligature Strangulation
2. Throttling – Compressing by palms / hands
3. Mugging – Banding of elbow
4. Bansdola – with Bamboo stick
5. Garrotting – Spanish windlass – Turkey, Spain

(strangulation is caused by compression of the neck by a ligature which is

quickly tightened by twisting it with a lever (rod, stick or ruler) known as
Spanish windlass which results in sudden loss of consciousness and collapse)

• Cause of death
1. Asphyxia
2. Cerebral anoxia
3. Vagal inhibition
4. Fracture dislocation and cervical vertebrae
5. Common in all
Lung – Edema, Congestion
Brain – Hemorrhage in white matter
Other – Necrosis, Patachiae

• PM Examination

External Findings
1. Swollen Face
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Aksh Patel
 2. Tongue may be protruded
3. Ligature mark – Horizontally, Below thyroid, Continuous
4. Fecal discharge / Urine
5. Signs of struggle

Internal Findings
1. Bruising of subcutaneous tissue
2. Fracture of thyroid
3. Hyoid bone fracture – Invergence of greater horns
4. Most of the viscera – Congested, Hemorrhages.

• MLI
1. Suicidal – Rare
2. Homicidal – Always assumed to be homicidal unless
contrary proved.

3. Pseudo Strangulation Groove

o Sometimes seen on child due to skin fold, if buttons,

collars are too tight.
4. Incaprettamento – Homicidal ligature used by Italian
mafia.
- One end of rope to neck and other to legs in prone
position.
5. Long scarf syndrome – Scarf stuck in machine / tyre
- Accidental

HANGING V/S STRANGULATION

Hanging Strangulation

Ligature mark Oblique Transverse

Non Continuous Continuous
Above thyroid Below thyroid
Knot Single Multiple

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 Neck Stretched Not So
Elongated
Suicide Note Yes No

Struggle Absent Always present unless

taken unaware

Face Pale Congested

Hyoid bone fracture Evergence of gr. Invergence of gr.

horns Horns
Tongue protrusion Less More

Signs of Asphyxia Less Well marked

#Draw this figure if

possible in S.N of
hanging/strangulation
Invergence (strangulation) Evergence (hanging)

SHORT QUESTIONS

❖ Suffocation:
Asphyxia caused by mechanical obstruction to the passage of air
into the respiratory tract by means other than constriction of neck
or drowning.

Classification (sqs each)

i. Smothering – Obstructing nose and mouth by hands or
plastic bag
ii. Gagging - asphyxia resulting from pushing a gag (rolled
up cloth or paper balls) into the mouth, sufficiently deep
to block the pharynx.
iii. Traumatic asphyxia - Mechanical fixation of chest, so
that the normal movements of chest wall are prevented.
E.g. house collapse, stampede etc.

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Aksh Patel
 iv. Choking - Obstruction within air passage by fruit, coin
etc.
v. Overlying - Compression suffocation resulting from
compression of the chest, nose, and mouth, to prevent
breathing.
vi. Burking - Combination of homicidal smothering and
traumatic asphyxia.

❖ Café Coronary:
- Condition of accidental choking where a bolus of
food produces complete obstruction of the
larynx. It is called so, because it mimics a heart
attack and is usually seen in an intoxicated
restaurant patron.

❖ Lynching:
Homicidal hanging.
Enemy/accused/suspect is overpowered by several persons,
acting jointly and illegally and hung him by means of a rope
from a tree.

❖ A.M vs P.M hanging:

Features A.M Hanging P.M Hanging

Ligature Mark Non continuous Continuous
Oblique Circular
Above thyroid Below thyroid
Saliva dribbling Yes No
Knot Single Multiple
Cyanosis Present Absent
Signs of struggle Absent Present
PM staining Present Absent
above ligature, at
extremities

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TOXICOLOGY

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 CLASSIFICATION OF POISONING

1. Corrosive:
- Strong acids – HCl, H2SO4
- Strong alkali – Na2CO3, Caustic Soda
- Metallic Salts – ZnCl, AgNO3

2. Irritants:
- Inorganic:
o Metallic – Arsenic, Antimony, Copper.
o Non Metallic – Phosphorous, Chlorine.
- Organic
o Plants – Castor, Croton, Calotropis.
o Animals – Snakes, Scorpion, Spiders.
- Mechanical – Powdered glass, Hair, Diamond dust,
Needles.
3. Neurotics:
Cerebral
- Somniferous – Opioids, Barbiturates.
- Inebriants – Alcohol, Anaesthetics.
- Deliriants – Dhatura, Cannabis, Cocaine.
Spinal
- Nux Vomica
Peripheral
- Curare
Cardiac
- Digitalis
- Oleander
- Aconite
- HCN
Asphyxiants
- CO
- CO2
- H2S
- War Gases
Agrochemicals
- Pesticides – OP, Organochlorines
- Fumigants – Aluminium Phosphide
- Rodenticides – Zinc Phosphide
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 DUTIES OF DOCTOR IN POISONING

Duties

Legal Duties Medical Duties

(High Priority)

• Legal Duties
1. Preservation of Evidences
- Food Samples
- Staining Clothes
- Vomits
- Gastric lavage sample
Noncompliance – Punishable under 238 BNS
2. Adequate Documentation
3. Police Intimation
- In case of Homicidal Poisoning both government
and private doctor report police. (BNS33)
- Fails to inform – Punishable under 211 BNS.
- False information – Punishable under 212 BNS.
- In accidental poisoning private doctor need not
report police government doctor reports.
4. Arrangement for Dying declaration
5. Medical Records
- Maintain records for at least 3 years.
- Provide information within 72 hrs.

• Medical Duties
1. Stabilization of Patient
- Airway
- Breathing
- Circulation
- Depression
2. Decontamination (Removal in Unabsorbed Poison)
- Oral intake – Gastric lavage, Emeris.
- Skin contact – Saline wash.
- Gas inhalation – O2.
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Aksh Patel
 3. Removal of Absorbed Poison
- Hemodialysis Barbiturates, Alcohol,
- Peritoneal dialysis Lithium
- Urinary Alkalinization / Acidification.
4. Neutralization
- Antidotes
o Physical Antidotes – Charcoal, Bulky food.
o Chemical Antidotes – Tanic Acid, Common
Salt.
- Chelating Agents:-
o BAL - As, Pb, Cu, Hg, Au.
o EDTA – As, Hg, pb, Cu, CO
o Desferrioxamine – Fe

5. Elimination
- Whole bowed irrigation – Polyethylene Glycol.
- Cathartics – Sodium Sulphate, Saccharides
(Sorbitol).
- Diuresis

Alkaline Acidic
- Chloramphenicol -Cocaine
- Fluoride -Strychnine

GASTRIC LAVAGE

Also known as Stomach Washing.

- Most useful within 1hour of ingestion of any poison.

• Procedure
- Ewald’s tube is inserted from mouth in the stomach.
- Patient is in left lateral decubitus position.

• Confirmation
- Air is syringed in the tube.
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 - Bubbling sound in the stomach through stethoscope.
- If tube is in trachea:
o Reflex coughing takes place.
o Hissing noise in case of unconscious patient.

• Fluid Used
- Normal Saline (infants)
- Tap water
- 1:5000 KMnO4
- 4% tannic acid

• Complications
- Aspiration
- Gastric Perforation
- Tube misplacement

• Contraindication (remember Cs)

- Corrosive Poisoning (except carbolic acid)
- Convulsant poison (Strychnine)
- Comatose patients
- Compromised unprotected airway

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 MX OF POISONING

Access vital signs

Stable Unstable
(Airway, Breathing, Circulation)

Intubation
Toxicological Analysis Ventilatory
Support
Remove unabsorbed poison Correct
Temperature
Remove absorbed poison Hemodynamic
Support

Prevent further absorption

Activated charcoal
Gastric lavage
Emesis
Dilutions

Enhance Elimination

Chelation
Multiple Dose Activated Charcoal
Diuresis Altered urine pH

• Removal of Unabsorbed Poisoning

Method Use

O2 Supply Inhaled Poisons

Torniquet Injected

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 Saline wash Contact

Gastric lavage Ingested

Emesis Ingested

• Removal of Absorbed Poison

1. Physical Antidote
MDAC, Demulcents – Strychnine, Morphine, Atropine,
etc.
2. Chemical Antidotes
- Potassium permanganate – Alkaloids, Barbiturates.
- Tannic Acid – Silver, Aluminium.
3. Physiological Antidotes
- Atropine – Pilocarpin
- Diazepam – Strychnine
4. Chelating Agents
- BAL – As, Pb, Cu, Hg
- EDTA – As, Pb, Hg, CO, Fe
- Desferrioxamine – Fe

• Enhanced Removal
1. Cathartics
Example:- Sorbitol, Mannitol
2. Whole bowed irrigation
Example:- Polyethylene Glycol

3. Forced Diuresis

Alkaline Acidic

Helps in chlorpropamide, In cocaine, local

fluoride poisoning anaesthetic poisoning

4. Extracorporeal – Hemodialysis, Hemoperfusion.

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 ALCOHOL POISONING

• Signs and Symptoms

1. Stage of Excitement (Blood level 50-150 mg%)
- Euphoric
- Dancing, Thrilling
- Disclose secrets (in vino veritas)
- Less visual activity
2. Stage of Incoordination (Blood level 150-250 mg%)
- Clumsiness
- Nausea, Vomiting
- Flushed Face
- Rapid pulse
- Sense of touch, Taste, Smell decreases
- Breath smells alcohol
3. Stage of Coma (Blood level >250 mg%)
- McEwan’s Sign – Pupils are constricted, but on
stimulation of person dilate.
- Dysarthria
- Speech is slurred
- Hypothermia
- Amnesia
- Coma

#Mellanby effect
- Physiological effect of alcohol is more when alcohol
% is rising in blood as compared to peak level.

• Recovery
- Can cause blackout (Forgetting Past)
- Hangover (Nausea, Headache after sleep)

• Fatal Dose
- 150ml – 250ml of 100% alcohol consumed in 1 hr.
- Compulsory death – BAC >= 500mg/dL.

• Fatal Period
- 12-24h.
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Aksh Patel
 • Diagnosis
- Clinically significant disturbance in consciousness,
cognition.
- No other medical conditions (Mental).
- Breadth of alcohol.

• T/t of Alcohol Poisoning

Access Vital Signs

(ABC)

Stable Unstable

Place patient in quiet environment Intubation ventilator IV

dextrose Vitamin B complex.
Patient lie on left side
to avoid aspiration.

Obtain blood and urine sample to rule out.

Opioid, Hypoglycaemia,
Hepatic failure Diabetic Ketoacidosis.

DRUNKENNESS

Definition:- Condition which results from excessive intake of

alcohol, So, that mental and physical qualities are noticeably
impaired.

• Diagnosis
Clinical Examination:-
- General Appearance – Posture
Manner of dressing
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Physical Examination
- Gait
- Orientation and Memory
- Behaviour
- Face – Red due to vasodilatory effect of Alcohol.
- Smell of alcohol
- Ears – Middle ear d/s has impact on balance.
- Handwriting

Specific Tests
- Horizontal Gaze Nystagmus Test
- Knee Reflex
- One leg stand test
- Finger nose test
- Roomberg test – Keeping eyes closed, person
should tilt head backwards – Drunken falls down.
- Walk and Turn Test

Laboratory Diagnosis
- Blood Alcohol Consent (BAC)
- Urine Alcohol Consent (UAC)
- Breath Alcohol Consent – Breathalyzer
- Gas liquid chromatography
- Alcohol Dehydration Method

ARSENIC POISONING

• Toxic Compounds
- Arsenious Oxide (Fruit sprays, Weed killer)
- Copper Arsenite (Colouring agent).
- Arsenic Sulphate (Depilatory).

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 • Action
Interferes with cellular respiration.

More pyruvate acetyl CoA.

Less citric acid cycle

Less ATP production

Also – Irritant
Carcinogenic

• Signs / Symptoms
GIT – Sweetish metallic taste.
Persistant vomiting
Rice water stool
Renal – Pain during micturition
Oliguria
Albuminuria
Muscle – Pain
Weakness
Skin – Eruptions
Rash
CNS – Headache
Vertigo
Hyperthermia

• Fatal Dose
- Inorganic arsenic – 0.6 mg/kg/day.
- Arsenic Trioxide – 200 mg.
• Fatal Period
- 1-2 days.

• Lab Investigations
- Urine - >50 Mu g/L in 24 hrs. – Recent Poisoning
- Blood – 0.9 Mu g/dL.
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 - Nails
- Hairs
- ECG
• QRS broadening
• QT prolongation
• ST depression
• T wave flattening

• Treatment
- Gastric Lavage
- Demulcents
- Whole body irrigation
- Antidote – BAL 93 mg/kg I.M) – 2 days.
- Glucose – Saline
- Hemodialysis

• Postmortem Exam
External:-
- Emaciated body.
- Rigor mortis appears early.
- Late putrefaction due to antibacterial action of
arsenic.
Internal:-
- Lungs – Congested
- Heart – Patechial hemorrhages
- Stomach – Red velvety appearance congestion
- Brain – Edema + Necrosis

• Difference between Arsenic Poisoning / Cholera.

Arsenic Cholera
Poisoning
GIT Pain in throat Purging

Vomiting Vomiting

Purging Pain in throat

Vomit Contains mucus, No mucus, blood,
blood, bile bile
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 Stool Rice – watery + Not bloody
bloody
Tenesmus Yes No
Lab Radio – opaque V. Cholerae in
shadow (x-ray stool culture.
abd.)
Conjunction Inflamed Not inflamed

CHRONIC ARSENIC POISONING

Same as acute except signs / symptoms.

Skin
- Raindrop Pigmentation.
- Hyperkeratosis of palms and soles.
- Aldrich mees lines (nails).
CNS
- Neuropathy with tingling.
- Numbness of hands.
- Anaesthesia.
CVS
- Hypertension.
- Failure.
Hepatic
- Jaundice
- Cirrhosis
- Hepatomegaly
Hematologic
- Bone Marrow Suppression
- Anemia
GIT
- Nausea, Vomiting, Abd, Pain
Occular
- Watering, Congestion

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 DHATURA POISONING
Common Names :- Thorn apple, Jimson weed, Hell’s bell,
Shivshekhar.

• Active Principles
- Hyosine
- Hyoscyamine
- Atropine

• Action
- Sympathomimetic – Blocks Acetylcholine

• Absorption
- GIT
- Skin
- Conjunction

• Signs and Symptoms

- Dryness of mouth
- Dysphagia
- Dysarthria – Difficulty talking
- Dilatation of cutaneous blood vessels.
- Dry hot skin
- Distension of Urinary Bladder.
- Diplopia
- Drunken Gait
- Delirium
• Pill rolling movement.
• Carphologia (Pulls imaginary thread from
fingertips or clothes.)
• Runs away from bed.

• Fatal Period
- 24 h

• Fatal Dose
- Seeds 75 – 125.
- Hyoscine 15 – 3-mg.
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 • Diagnosis
- Radioimmunoassay
- Thin layer chromatography
- Liquid chromatography

• Treatment
- Emetics
- Gastric Lavage
- Physiological Antidote – Physostigmine
- Bulk purgatives
- Barbiturates
- O2 inhalation
- Hemodialysis

• PM Findings

External:- Signs of asphyxia

Internal:-
- Stomach – Seeds detected
Inflammation
- Heart – Petechial Hemorrhage
- Lungs – Edematous and congested

• MLI
- Stupefying agent – Robbing, Kidnapping.
- Yaqui – Used in Mexico to decrease labour pain.
- Mistaken as chilli seeds.
- Aphrodisiac
- Criminal Abortion

LEAD POISONING

• Toxic Compounds
1. Lead acetate – Sugar of lead Astringent
2. Lead Tetraoxide – Sindoor
3. Tetraethyl – Petrol
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 4. Lead Sulphide – Applied on eyes

• Action
- Interferes with mitochondrial oxidative
phosphorylation.
- Defective – Heme Synthesis
-Tubular function
-Osteoblast function
-Myelination

• At – Risk Group
- Painters
- Plumbers
- Glass Polishers
- Glass Blowers
- Consuming tinned food.
- People using excessive sindoor, hair dyes.

• Signs / Symptoms
1. Anemia
o Basophilic stippling seen
o Karyorrhexis seen
o Hb level – 6.5g %

2. Burton’s Line
o Blue lines Gingival surface due to H2S deposition.
3. Colic – Pain at night
4. Constipation
5. Lead Palsy
o Wrist drop
o Foot drop
6. Lead Encephalopathy
o Learning d/s
o Mental dullness
o Restlessness
o Insomnia
7. Facial Pallor – Earliest Sign

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 8. Fanconi Syndrome
o Abnormal secretion of glucose, phosphates,
amino acid without proteins in urine.
9. Osteopathy
10. Optic Atrophy
11. Alopecia

• Lab Diagnosis

1. Urine Lead > 80 Mug/dL

2. Coproporphyrin in urine > 15 Mug/dL
3. Blood lead levels
4. X-ray – lead lines – Radio opaque lines at metaphysial
plate.

• T/t
1. Remove patient from exposure
2. Sodium Bicarbonate (20-30 g)
3. IV EDTA or BAL
4. Natural Antioxidants – Vit B6, B, C, E
Iron contraindicated during
chelation.
5. Ammonium Chloride – Lead in bones is mobilised to
blood
6. Diazepam – fir seizures
7. Symptomatic T/t

• PM Findings
- Blue line on gums
- Heart – Hypertrophied
- Stomach – Ulcerative
Hemorrhagic
- Brain – Pale (white)
Flattening of Giri

• MLI
1. Homicidal – Rare
2. Chronic poisoning is common
3. Lead oleate – Abortificient
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 4. A person can develop lead poisoning from retained
bullets or projectiles.

METHANOL POISONING

• Absorption
- Stomach
- Intestine 30-90 min
- Lungs
- Skin

• Action / Symptoms
o GIT – Nausea, Vomiting spirit like odour.
o RS – Cyanosis, Dyspnea
o Ocular – Halo vision, Photophobia Scotoma (Tunnel
Vision)
o CNS – Dizziness, Vertigo, Headache

Fetal Dose – 30-240 ml

Fetal Period – 24-36 h

• Diagnosis
Colour test:-
Methanol + KMnO4

Formaldehyde

Chromotropic Acid Sodium Bisulphide and

H2O

Purple Ring

• T/t
1. Gastric Lavage – Preventing absorption
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Aksh Patel
 2. Bicarbonate – Less acidosis
3. Folate Therapy – By leucovorin – More metabolism of
formic acid.
4. Ethanol – Competitive antagonist
5. Fomepizole – Antidote – Competitive inhibitor of alcohol
dehydrogenase
6. Hemodialysis
7. Symptomatic
8. Keep patient in dark room

• PM Findings
External:-
- Cyanosis
- Froth from mouth
Internal:-
1. GIT – Congested / Inflamed
2. Lungs – Edematous
3. Liver – Necrosis
4. Blood – Dark, Fuild
5. CNS, Kidney – Hemorrhagic

• MLI
- Hooch Tragedy
- Accidental
- Suicidal Rare

NUX VOMICA

• Common Name
- Poison nut
- Quaker buttons
- Kuchila Yetti

• Identification
- Flat
- Circular
- Concave 0n one side
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 - Convex on other side
- Grey colour

• Active Principle
- Strychnine
- Brucin
- Loganin

• Action

Strychnine

Antagonizes inhibitory
Neurotransmitter [Glycine]

Constant muscle contraction

• Signs
1. Convulsions
▪ Ricus Sardonicus – Devil Smile
▪ Opisthotonus – Hyperextension of body backward
▪ Emphrosthotonus – Forward bend
▪ Pleurosthotonus – Sideways bend
2. Prodromal Signs
▪ Restlessness
▪ Twitchings
▪ More rigidity of muscles
3. Chocking sensation in throat
4. Relaxation in between convulsion slates (2min)

• Fatal Dose
- 1 crushed seed
- Strychnine (15-50 mg)

• Fatal Period
- 1-2 h

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Aksh Patel
 • Diagnosis
- Thin layer chromatography
- Liquid chromatography
- Mandelin Test
Reagent + Strychnine – Violet – After some time
yellow
- Wenzell Test
Strychnine + KMnO4 in Sulphuric Acid – Colour
change

• T/t
- Diazepam
- Barbiturates
- Gastric Lavage
- Activated charcoal
- Hemodialysis
- Symptomatic

• PM Findings
- Not so characteristic
- Signs of Asphyxia

• MLI
- Arrow poison – To kill cattle
- Death is accidental
- Detected even in decomposed body (as low as 0.01
ppm)

OPHITOXEMIA (SNAKE POISONING)

Also known as Snake Venom.

• Components

Components Effect
Phospholipase A2 Myotoxic
Cardiotoxic
Neurotoxic
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Aksh Patel
 More vascular permeability
Proteases Hemolysis
Hyaluronidase Local tissue destruction
Acetylcholinesterase Neurotoxic
Alpha – bungarotoxin, Postsynaptic inhibition
cobrotoxin
Beta – bungarotoxin, Presynaptic inhibition
crotoxin

• Signs / Symptoms
1. Cobra
Early Symptoms:-
- Vomiting
- Heaviness of eyelids
- Vertigo
- Dizziness
- Burning pain at site of bite
Late Symptoms:-
- Wet gangrene
- Paralysis
- Cyanosis
- Coma
2. Krait
- Similar to Cobra
- Silent / Painless bit – Mistaken for STROKE.
3. Viper
More local Reaction
- Pain and oozing
- Dry gangrene
- Bilateral parotid swelling
- Petechial hemorrhages
Death due to circulatory failure

• Diagnosis
- 20 min whole blood clotting test (20 WBCT)
- Single breath counting test.

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 • Fatal Dose
- Cobra – 15 mg
- Common Krait – 2.5-6 mg
- Russel Viper – 40 mg

• Fatal Period
- Cobra – ½ - 24 hrs
- Viper – 1-4 days
- Krait – 12-24 hrs

• Management
Prevention of snake venom spread
RIGHT Method
- R – Reassurance
- I – Immobilisation – Sutherland wrap, Monash
technique.
- GH – Go to hospital immediately
- T – Tell doctor about systemic symptoms that
occurred on the way.

o Antivenom T/t
- Polyvalent antisnake venom serum – 80-10 ml
serum diluted in 250 ml saline.

o Supportive Care
- Ventilatory support
- Broad spectrum ab.
- Surgical excision
- Anticholinesterase (Elapidae)
- Rehydration

o Assessment of severity of envenomation

- No envenomation – Absence of local / systemic
reaction
- Mild envenomation – Fangs +ve, Moderate pain,
minimal local edema.
- Moderate envenomation – Fang marks +ve, Severe
pain, moderate local edema, ecchymosis, nausea,
vomiting.
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 - Severe envenomation – Moderate + Coma, Paralysis

Snake Bite

Minimal envenomation Severe/Moderate

Envenomation

Observe for 8-12 hrs Local edema Local redness

No progression Immobilization Pressure

Immobilization

ASV not required ASV + Dialysis ASV + Ventilator

+ Blood transfusion + Atropine

Envenomation progress

NO YES

No T/t Repeat
ASV

SNAKE SQs

• Venomous V/S Non-Venomous Snake

Features Venomous Non-Venomous

Head Scales Small Large
Except:-
Heat sensing pit
anteroinferior to
eye (pit viper).
3rd labial (cobra)

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 Belly Large and cover Small and do not
the entire breadth cover entire
of belly. breath.
Fangs Long and Short and solid
canalised
Scales distal to Single row Double row
anal plate
Tail Compressed Not markedly
compressed
Habits Nocturnal Not So
Bite mark Two fangs with or No. of teeth marks
without small in a row.
markof other teeth.

• Cobra v/s Viper

Features Cobra Viper

Head Small, covered by Large, broader than
large scales or the body, triangular.
shields.
Body Long and cylindrical Short with narrow
neck.
Pupils Circular Vertical, Slit like
Maxillary Bone Carries poison fangs Carries only poison
and other teeth ffangs.
Venom Neurotoxic Vasculotoxic
Fangs Grooved, Short and Canalised, long,
fixed movable
Tail Round Tapering
Reproduction Oviparous Ovo-viviparous

• Neurotoxic venom v/s Vasculotoxic venom

N.T V.T
Action Muscular, Coagulation
weakness, disorder
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 paralysis of face, Enzymatic
throat destruct of cell
wall
Site Motor nerve cells Endothelial cells
of blood vessels
RBC
Local symptoms Minimum Severe – Swelling,
oozing, cellulitis
Example Cobra Vipers
Krait

PHOSPHOROUS POISONING

• Types
- White / Crystaline
- Red / Amorphous

• Action

Protoplasmic poison
(affects cellular oxidation)

Metabolism of cells reduces

Necrosis(especially liver)

• Signs / Symptoms
3 stages:
1. First Stage (1/2 to 6 hr)
- Garlic like odour from breath, Vomit, faeces.
- Luminescent ‘smoking’ vomit and faeces are
diagnostic
nd
2. 2 Stage
- 1-4 days
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 - Asymptomatic

3. 3rd Stage
- GIT – Nausea, Vomiting, Diarrhea
- Hepatic – Tender Hepatomegaly, Jaundice
- Renal - Oligura, Hematuria, Cast
- CNS – Restlessness, Anxiety, Insomnia, Headache
- PNS – Laryngeal Stridor, Tetany, Opisthotonus
- Hematologic – Purpura, Epistaxis

• Cause of Death
- Cardia arrhythmias
- Electrolyte abnormalities

• Fatal Dose
- 60-120 mg

• Fatal Period
- Within 24 hrs

• Treatment
1. Life Support
2. Activated charcoal
3. Demulcents
4. Purgatives
5. Vitamin K
6. Hemotransfusion

• PM Examination

External:-
- PM staining – Brown
- Skin Hemorrhages
- Jaundice
Internal:-
- Stomach mucosa – Yellow / Greenish
- Liver – Yellow with hemorrhages
- Lungs – Fat emboli
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 - Kidney – Enlarged, Yellow

• MLI
- Accidental poisoning in children due to chewing of
fireworks.
- Homicidal – Symptoms look like acute live d/s
Poison oxidised in body – Not traced.
Death occurs after few days.
- Abortificient
- Fragments of hand grenades – Inhalation
- Used by Arson (rioters throwing bottles filled with
phosphorus on the road that immediately catches
fire)

ORGANOPHOSPHOROUS (OP) POISONING

# most common que. for clinical section. A patient will mostly be farmer who got
poisoning due to pesticides

➢ EXAMPLES

1. HETP
2. OMPA
3. Parathion
4. Methyl-parathion
5. Chlorthion

➢ INCIDENCE

1. Suicidal poisoning: M/C

2. Accidental poisoning: common (as it is absorbed
even through skin)
3. Homicidal poisoning: uncommon (D/T strong smell)

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 ➢ ODOUR
- Kerosene like (due to petroleum distillate aromax) / garlic
smell (due to Phosphorous)

➢ ABSORPTION

1. Through all routs (intranasal, epidermal)

2. Nerve gases like sarine, tabun, soman.

➢ Mechanism of action

Inhibition of acetylcholinesterase (AChE)

No conversion of acetylcholine to its degradation products—

acetic acid and choline

Acetylcholine accumulates

Over stimulation of muscarinic and nicotinic receptors.

➢ Signs & Symptoms:

System Signs/Symptoms
1. GIT Nausea, vomiting, diarrhoea, more salivation
2. CVS Bradycardia, HTN
3. RS Dyspnea, bronchospasm
4. Ocular Blurred vision, miosis

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 5. Glands More Sweating, chromolacryorrhea (shedding
of red tears due to accumulation of porphyrin
in lacrimal glands),

➢ Fatal dose
- Malathion and diazinon 1 g.
- Parathion: 15-30 mg.

➢ Fatal period
- Within 24 h in untreated cases
- Within 10 days in treated cases, if unsuccessful.

➢ Treatment

#image taken from Fundamentals of Forensic Medicine and Toxicology by Gautam Biswas

➢ Postmortem Findings

External:
- Cyanosis of lips, fingers and nose.
- Congested face.
- Frothy discharge, often bloodstained from the nose and
mouth.
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 - Kerosene-like smell from nostrils and mouth.

Internal:
- Stomach – congested, kerosene like smell
- Respiratory - passages are congested, contain frothy
hemorrhagic exudates, edema of lungs
- Brain – edema

➢ Medico-legal Aspects

- Hospitalizing all symptomatic patients for at least 4-6 days

following resolution of symptoms is recommended, because
of the risk of development of respiratory depression or
intermediate syndrome after resolution of an acute crisis.

- The symptoms of OPC poisoning can mimic other toxicities

and diseases.

- Accidental poisoning occurs in manufactures, packers,

sprayers and in children.

- Suicidal poisoning is common in our country, both in rural

and urban areas.

- Homicidal poisoning does not occur due to detectable smell

of poison

CARBOLIC ACID POISONING (just read once)

#Just remember bold words(which are specific). Rest all you can mix up

Also known as Phenol.

Use: Antiseptic, Disinfectant

Absorption: Ingested, inhaled and absorbed

through skin, per rectum/per vaginum
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Signs/Symptoms
1. Local – Damage to nerve endings, so numbness and
tingling.
2. GIT - Diarrhea, pain in abdomen
3. RS - Odor of phenol in breath. Inhalation of phenolic
vapors causes laryngeal and pulmonary edema.
4. CNS - Headache, giddiness, tinnitus, pupils are
contracted.
5. CVS - Pulse is rapid, feeble and irregular

Fatal dose: 1-2 g.

Fatal period: 3-4 h.

Treatment
- Stomach is washed carefully with plenty of lukewarm water
- Medicinal liquid paraffin
- Demulcents
- Saline containing 7 g of NaHCO3/l is given IV to combat
circulatory depression
- Diuresis.
- Skin cleaned and the area washed with soap and water.

Postmortem Findings
External:
- Greyish or brownish corrosions at the angle of the mouth,
chin, front of the body, arms and hands with phenolic
odor.

Internal:
- Marked corrosion of gastric mucosa.
- Intervening normal mucosal folds appear dark red in color.
- Hardening of the stomach wall—leathery stomach.

OXALIC ACID POISONING (just read once)

A.K.A – Acid of Sugar

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Use: Oxalic acid forms soluble chelates with iron.

Signs and Symptoms:

Poisoning presents in three forms:

1. Fulminating poisoning (high dose taken): Vomiting with
Ground Coffee appearance, throat to stomach burning,
death within minutes

2. Acute Poisoning: All findings are due to hypocalcemia—

tingling and numbness of fingers and limbs, weakness,
parasthesia

3. Delayed poisoning: It is characterized by nephritis—

uremia, scanty urine, hematuria, albuminuria

Fatal dose: 15-20 g.

Fatal period: 1-2 h.

Treatment
- Gastric lavage with calcium lactate
- Specific Antidotes: Limewater, calcium lactate, calcium
gluconate or calcium chloride
- Demulcent drink
- Hemodialysis
- Symptomatic treatment
#PM Findings/MLI – Nothing special. Write common things like necrosis,
edema, congestion, burning of various organs

IMPORTANT SQs

❖ SUIS:
Composition:
- Abrus precatorius
- Dhatura
- opium
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 - onion
Procedure of making:
- 4 components are crushed and made into paste with
spirit and water, and from this paste, small sharp
pointed spikes or needles or ‘suis' are made which are
dried in the sun.

Use: To kill animals

❖ Difference btw TRUE and FALSE bruise

[Link]. Feature Artificial bruise True bruise

1 Cause Juice of marking nut, Trauma
Calotropis or Plumbago
rosea
2 Color Dark brown Typical color changes
3 Shape Irregular Round
4 Site Exposed accessible Anywhere
parts
5 Margins Well-defined and Not well-defined,
regular, covered with diffuse and irregular,
small vesicles no vesicles
6 Redness and Seen in surrounding Seen at the site
inflammation skin
7 Itching Present Absent

❖ Some Poisons with Specific Smell

No. Poison / Source Characteristic Smell
1. Cyanide Bitter almond
2. White Phosphorus Garlic-like
3. Arsenic Garlicky
4. Aluminium/Zinc Phosphide Musty or fishy
5. OP Poisoning Kerosene

❖ Some Poisons with Specific Taste

No. Poison Characteristic Taste

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 1 Aconite Tingling and numbing taste on
tongue and lips
2 Carbolic acid (Phenol) Sweetish
3 Copper salts (e.g., Copper Strong metallic taste
sulphate)
4 Zinc salts (e.g., Zinc sulphate) Strong astringent taste
5 Phosphorus Garlicky

❖ Date Rape Drugs:

Drugs that are usually given to woman before committing rape so
that she doesn’t remember anything.
E.g
- Flunitrazepam (common names: Rohypnol, Roophlin) {used
in famous funny Hollywood movie Hangover}
- Gamma-Hydroxybutyrate (GHB)
- Ketamine (common name – Special K)
- Chloral hydrate

IDEAL SUICIDAL vs HOMICIDAL POISONS

No. Feature Ideal Homicidal Ideal Suicidal Poisoning

Poisoning
1 Taste/Smell Should be tasteless, Doesn’t matter
odorless, colorless →
easily administered
without suspicion
2 Solubility Should be easily Solubility not essential
soluble in food/drink
3 Dose Should act in small, Can be taken in larger
requirement concentrated dose (so quantities
it can be concealed)
4 Speed of action Delayed onset, so Act rapidly (victim seeks
victim doesn’t suspect quick death)
immediately

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 5 Detectability Should be difficult to Detectability not a
detect both clinically concern (victim’s
and chemically intention is self-
destruction)
6 Mode of Mixed surreptitiously Ingested directly by the
administration in food, drink, or victim
medicine
7 Examples (sq) Arsenic, Thallium, Opium,
Polonium, Antimony Organophosphates,
Barbiturates, Cyanide

❖ Vitriolage:
It is the throwing of any corrosive (not necessarily sulphuric acid)
on a person with malicious intent.
- Sulphuric acid (most common)
- Nitric acid
- carbolic acid
- caustic soda
- caustic potash

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