Notes on forensic medicines


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Notes on forensic medicines

  1. 1. Dr Udai Bhan Yadav MBBS DMCH. SMO&Medical Jurist Govt general hospital alwar rajasthan. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan1 FORENSIC MEDICINES NOTES
  2. 2. Lung tuberculoses Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan2  Congested,edematous multiplegray white nodules ranging from pin point size up to 1 cm were diffusely distributed through out the lung parenchyma
  3. 3. AGE OF ABRASION Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan3  Bright red-Fresh  Red scab-12-24 hr  Redish brown scab 2-3days  New growth of epithelium 4-7days  Scab dried shrink and falls off -7days.some time may take 10-15 days
  4. 4. Age of contusion Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan4  Red-Fresh  Blue-After few hours to three days  Bluish black/brown- 4th day  Green 5-7days  Yellow 7-12 days  Normal 2 weeks
  5. 5. Age incised and stab wound Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan5
  6. 6. Detemination of age of injury Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan6  Scab over abrasion and superficial cut-12-24hr  In case of bruse change of color commence from the circumferance by 12-24hr and passes through usual changes  In ordinary wound inflamation sat in within48 hr. If it is not rendered properly aseptic pus also forms by this time  Skin wounds or contused wound on the head will generally heal within a week.if margins is considerably brused,it may take a fortnight.Healing of wound depend much on the constitution of pt and treatment
  7. 7. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan7  In fracture ,inflamation and exudate of blood in soft tissue around the fracture site are noticed from 1st to 3rd days.callus begins to form the third day onwards.If inflamation subsides callus begins to ossify from 2nd to 3rd week on is fully absorbed by about 6-8 weeks  Granulation tissues appears about 1 week  When tooth knocked out.bleeding stops in24 hrs cavity fills in 7-10days time.smooth after 14 days  Dution estimated by color change in bruse if present
  8. 8. Characters of incised and lacerated wounds Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan8  Incised wound – edges are regular, clean cut,retracted,everted,except in neck&scrotum where edges are inverted,spindle shaped ,length is greaterin three dimensions,haemorrage isexcessive,Edge of wound may be irregular in care skin is loose eg neck &scrotum.  Lacerated wound-margins are irregular ragged and inverted.tissues are torn and not cot.bleeding may not be marked due tocrushing of tissues.
  9. 9. PM FINDING IN ELECTRIC BURN(ELECTROCUTION) Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan9  e.g-multiple burn injuries present over an area 6cmx5cm.and contact electric burn of 5cmx3cmon palmar aspect of left hand.  e.g-an oval crater like electric burn mark measuring 2cmx0.4cm with a pale flattened floor and a ridge of elevated skin and blackening around.  e.g-split laceration skin wound 0.75x0.3cm with elevated ridge,seen on middle of the sole of left foot.  Face is pale,eyes congested  Brain congested,oedimatous,multiple petichial haemorrhagic spots in brain substance.
  10. 10. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan10  Larynx and trachea congested  Rt&Lt Lungs congested,oedimatous.  Mouth,pharynx,oesophagus,stomach mucosa.liver,spleen,kidneys all are congested.  OPINION –Post mortem findings are consistent with death due to electrocution.
  11. 11. PM FINDINGS IN BURN(SAMPLE CASE) Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan11  e.g.-body cold and stiff. Face is totally burnt,blackened,swollen,with scalp hairs burnt in patchy area on the front and on the sides of the head,have been trimmed short up to neck level.  Eyes brows &eyelashes are also burnt completely.  Rest body showed infected deep skin burn injuries with greenish black sloughing except a thin strip of intact skin around the waist line 1x30 cm,perineum and inner aspect of both feet(total skin area burnt90%).Suturing venesection wound measuring 1.5x0.25cm were seen one each on the inner aspect of both ankles.  Superficial to deep burn,peeling of skin present,skin line present
  12. 12. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan12  Brain congested,edematous  Pleurae intact healthy.but with an effusion of straw yellow fluid measuring 400ml on rt side and200mlon lt side.  Larynx and trachea intact healthy and showed blakish shoot particals .  Lungs congested,edematous  Mouth,pharynx,oesophagus intact healthy,congested  Stomach mucosa congested and showed submucosal erosion at duodenal end.  Liver,kidney,congested.spleen congested and pulpy  0PINION-DECEASED DIED DUE TOCOMPLICATION OF BURN INJURIES SUSTAINED.
  13. 13. DURATION OF BURN Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan13  Rednss –immediate  Vesication –about 2-3 hours  Pus,Slough –about 36-72 hours  Fall of superficial slough –about 1 week.  Fall of deep slough –about 2 weeks.
  14. 14. CAUSE OF DEATH IN BURN Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan14  Shock –within 2 days  Toxaemia -2 to 4 days  Septecemia –if infection  Rarely MI,and Fat embolism
  15. 15. PM FINDINGS IN HANGING Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan15  Body cold and stiff.  PM Lividity on both fore arms,hands and both legs and feet.  Face congested eyes congested  Subconjunctival haemorrhage.  Blood stained froath at nostrils  Tongue protruded out bitten dry.  Vertical salivary trickle mark on the left side of face and front of chest &abdomen.  Lips and nailbeds bluish  Seminal and faecal discharge present  Brain intact, congested,edematous,with multiple peticheal haemorrhagic spot in substance of brain.
  16. 16. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan16  Larynx trachea congested.  Lungs congested,edematous with blood stained frothy oozing on cut section.  Mouth,pharynx,oesophagus congested.  Liver,spleen,kidney healthy ,congested.  LIGATURE MARK –size ….x….cm eg. 26cm running obliquely above the thyroid cartilage.upward and backward.patterned and grooved,dark dry and parchmentized and with bruised edegs  Dissection of neck. 50%cases no intenal injury.
  17. 17. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan17  Subcutaneous tissues under neath ligature mark is whitish firm and glistening.  Platisma and sternomastoid muscle may show petechial haemorrhage and may rupture occasionally.may be brusing in subcutaneous tissues and muscles deeper to neck.  Rupture or tear of intima of carotid arteries above its point of bifurcation, aroun the sinures with extravasation of blood in their walls.  Trauma to hyoid bone #.both grater cornu in hanging and one in throatling.  OPINION post mortem appearance are suggestive of death due to asphaxia resulting from hanging.
  18. 18. LIGATURE STANGULATION Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan18  Body cold and stiff.PM Lividity on back &fixed.  Face livid.eyes congested with sub conjunctival haemorrhage.  Blood stained fluid flowing out through ears and nostrile.lips and nails bluish.  e.g a jute rope material used for strangulation,measuring1.5mts was found round the neck of victim with a double reef knot on the front of neck over adam’s apple.  Brain congested oedematous with multiple peticheal haemorrhagic spots in brain substance.  L arrynx,trachea intact healthy but contains blood stained froth.
  19. 19. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan19  Lungs congested edematous with blood stained froth oozing on cut section.  Mouth,pharynx,oesophagus, intact healthy,but congested.  Liver,spleen,kidneys intact,healthy.congested.  Injuries bloodless dissection of neck revealed ecchymosis of muscles of neck underneath the ligature mark.  Fracture-the thyroid cartilage in the neck is fractured in mid line.  L igature mark was a pressure abrasion measuring eg 28cmx1.5cm. Continuous and running horizontally encircling the neck at the level of adam’s apple.the rark was grooved discoloured and with bruses at the edges.  OPINION –post mortem appearance are suggestive of death due to asphaxya resulting from ligature strangulation.
  20. 20. PM FINDINGS IN DRAWNING Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan20  Body cold ,wet,rigor mortis well established.  PM lividity on face chest abdomen front of thigh and fixed.  Fine whitish lathery froth seen at mouth and nostrils.  Lips and nails bluish.Hands clenched.  Both palms and soles were soddened bleached.groose skin (cutis anserina) appearance present.  Brain intact healthy but congested,edematous with multiple petecheal haemorrhagic spots in brain substances.  Larynx trachea intact healthy but containing fine whitish leathery froth  Lungs voluminnous ,congested,edematous with fine whitish lathery froth on cut section.  or Lungs are water logged bulge out pit on pressure,moderately congested and feel doughy.  Mouth pharynx oesophagus intact ,healthy congested.  Liver,spleen kidneys congested  OPINION –POST MORTEM APPEARANCE ARE CONSISTENT WITH DEATH DUE TO DRAWING.  Case of death asphaxia,ventriculr fibrillation,laryngeal spasm ,vagal inhibition,injuries etc
  21. 21. PM FINDINGS IN POISONINGS Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan21  Cold, stiff, pm lividity on back and fixed ,face bluish,pinkish frothy fluid flowing out of nose.  Brain congested edematous,multiple petecheal hemorrhagic spots in brain substance.  Larynx trachea intact healthy congested.  Lungs congested edematous with pinkish fine oozing on cut section.  Mouth pharynx oesophagus intact healthy.congested  Stomach mucosa congested and showed submucosal erosion.liver intact healthy congested.spleen intact healthy congested.and pulpy.kidneys congested.  Visceras are collected and sealed in glass jar glass Jar A contains whole stomach and its contents,glass Jar B contains piece of liver,kidney,spleen .lungs. Vial C contain blood.Glass jar A,B ARE preserved in saturated sol of common salt. In Vial C no preservative used
  22. 22. PM FINDINGS IN HEAT STROKE Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan22  No characteristic findings .  Eyes open drying of cornea and pitting.and sinking of eye balls.(appearance of avulsion of eyes.)  Rigor mortis appears early and disappear early.  Putrifaction rapid.lividity is mark.  Degeneration of neurones in cerebral cortex cerebellum and basal ganglion is common  Visceral congestion well mark.Peticheal haemorrhage found in skin ,visceras and in walls of third and fourth ventricle and aquaduct.  Pulmonary oedema is some time found.  Face is flushed and skin is hot and dry.  Brain and membranes congested.peticheal haemorrhage are seen in white matter.
  23. 23. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan23  Respiratory system trachea bronchi contains frothy haemorrhagic fluid.lungs edematous congested,haemorrhage.  Heart dilatation of right auricle.  Lver kidney congested  General peticheal and confluent haemorrhage in most organs.
  24. 24. PM FINDINGS IN THROTTLING Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan24  Ligature mark if throttling done by rt hand from front ,the impressin of thumb will be found ovr upper part of rt side of neck.and on lt side will be found four marks produced by four fingers.  These four marks distributted from above downward and out wards .these marks are really due to bruses or contusions.they are accompaned by cresentic scratches produced by finger nails.  Some time mark on left side may not be discrete but may be clusterd to gether.  This may be reversed in case where lt hand or both hands are used.  When both hands are used there will be several marks on each side of the neck.  SIMPTOMS – ATTEMPTED THROTTLING. Brurse on neck,dysphasia,hoarseness of voice,marks of burse and abrasion on mouth ,nore cheek,fore head ,lower jaw,other part of body.  Fracture of ribs with extravasation of blood in chest wall may be seen in some case.
  25. 25. PM FINDINGS INSUFFOCATION Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan25  Ext –closure of mouth and nostrils.pressure on chest.  Int –clsure of glottis or luman of air tube.,decrease O2 in atmosphere.,inhalation of irritant gases.  PM examinaton –signs of asphaxia well pronounced such as cynosed face, open eyes,prominent eye balls,dilated pupils,deeply injucted conjuctiva,livid lips,protruded tongue,blood stain froth per mouth and nostrils.etc.  Mark of violance-bruses and abrasions round about lips.cheeks, scratches near about nose and mouth,injuries on inner surfaces of lips ,bruses of gums.signs of strugles on other part of body.  Compression of chest –injury on chest,# of ribs,extravasation of blood in subcutaneous tissues.  In overlaying of nose is flattened deviated to one side.  # of cervical vertebrae seen if neck is forcibly wrenched or twisted.
  26. 26. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan26  INTERNAL –  Forign body detected in mouth ,throat.  Larynx and trachea –red congested,blood stained froth in luman.  Death by pressure on chest -#of ribs some times,lungs congested contused or lacerated even without #ribs,superficial air vesicles ruptured,int organs congested,tradieu’s spots on pleurae,meninges,pericardium.
  27. 27. TIME SINCE DEATH Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan27  These are avarage cold wheather they may be doubled or hills they are quite inapplicable.  Less than 1 hour-body is warm  3 hours –patchy post mortem lividity.  6 to 8 hours –lividity fully developed and fixed.  12 hours –rigor mortis all over ,green patch showing over the caecum.  24 to 36 hours –rigor mortis receding/absent, green discolouration over whole abdomen and spreading to chest,abdomen distended with gases ,ova of flies seen.  48 hours –trunk bloated,face discoloured and swollen blisters present.moving maggots seen.
  28. 28. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan28  72 hours –whole body grossly swollen and disfigured.hairs and nails loose.tissue soft and discoloured.  One week –soft viscera putrefied.  Two weeks –only the more resistant viscera distiguishable ,soft tissues largely gone.  One to three month –body skeletonised.
  29. 29. ESTIMATION OF AGE Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan29  Blow 20 years x rays advised-wrist,elbow,pelvis.  21 years – Abve x ray + X ray clavicle  25 years - above + xray strnum ,skull ap lat view.  FOLLOWING X RAY OF RIGHT SIDE ARE TAKEN-  RT side of jaw oblique view.  RT shoulder ap view.  RT elbow ap and lat view.  RT wrist with hand ap view.  Pelvis with upper third of femur ap view.
  30. 30. STANDARD OPINIONS IN DEATH BY SNAKE BITE (PM) Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan30  SNAKE BITE-cobra &similar snake which have neurotic venum. ‘’on perusal of the pm report case sheet and circumstantial evidence I am of the opinion that the death is due to respiratory failure consequent upon snake bite.  In case of vipar and other similar snake which have hemolytic venom. (a) If bleed to death ‘Death is due to shock and haemorrhage as a result of snake bite.’ (b) If there is haemorrhage in brain stem ‘Death is due to coma as a result of brain stem haemorrhage secondary to snake bite, ;
  31. 31. Foetus age determination Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan31  Week length in cm weight  12 wk 9cm 20gm  16wk 16cm 100gm  20wk 25cm 300gm  24wk 30cm 600gm  28wk 35cm 1000gm  32wk 40cm 1800gm  36wk 45cm 2200gm  40wk 50cm 3500gm  Length is more important.
  32. 32. DURATION OF GASTATION Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan32  1st five months of gestation the square root of length, for example foetus of 25cm is five month old.  After 1st five months of gestation the length in cm divided by five gives age in months for example 40cm is eight month old.
  33. 33. ENUMERATION THE SIGN OF RESIPIRATION Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan33  CHARACTERSTIC BEFORE AFTER  Shape of chest Flat Arched  Diaphragm at 4-5 Ribs 6-7 Ribs level  Lungs size Small voluminous  Fodere’s test 500qraim 1000qraim  Ploquet’s test 1:70 1:35  Edge sharp round  Colour reddish brown mottled pinkish red  Consistency Liver like spongy and crepitant  Section Dark blood Red blood  Hydrostatic test Sinks Floats  Stomach Bowel test Sinks Floats.
  34. 34. Various changes in foetus Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan34
  35. 35. Features helping in estimating foetal age Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan35  Length –measure crown – heal (vertex to heal) length by flexible tape.  Weight  Midpoint ofbody in relation to sternom and umbilicus.  Skin wrinkle or presence of fat,presence of fat,presence and amount of vernix.  Nail appeared or not ,extent of growth.  Scalp hairs –appeared or not  Eyelashes and eye brows appeared or not.  Eyelids –adherent or open.  Testicles in male ,ascertain the position by incising the scrotum and inguinal canal.if necessary.  Ossification centre.
  36. 36. Examination of male in sexual offence for impotency Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan36  Name s/o… cast.. Sex.. Age… r/o……  R/o ………..  Sent by ……  MI……….  In presense of ……..  General development …. Ht……..Wt ……Teeth……..  Hairs scalp ……eyebrows….upperlip….axillary….pubic….  Breast….  Injury on body…  BP…. PULSE…. HEART,LUNG ….. UROGENITAL TRACT…H/O DIABETTES,HT…  STAINS OVER EXTERNAL GENITALS.. INJURY…SUPERFICIAL VEINS OVER PENIS…DEVELOPMENTAL ABNORMALITY IF ANY….SORTAL REFLAX….  ON STIMULUS PENIS BECOMES STIFF HARD AND ELONGATED AND ERECTILE.  SEALEAD ENVELOP CONTAINS FOLLOWINGS FOR GROUPING AND CROSS MATCHING IF NEEDED.
  37. 37. Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan37  A –Blood staned dried gauze  B –Saliva staned dried gauze  OPINION- I am the opinion that there is nothing to suggest that the persion is incapable of performing sexual intercourse.
  38. 38. Rape case examination positive finding may be (samlpe case) Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan38  Findings examined by lady doctor  Gait broad based,short paced  Axillary and pubic hairs curly,dark,busy.  Breast developed hemispherical,showed bite marks around the nipple on rt side.  Back abrasion on both shoulders blades regions each mearuring 4x3cm.  Finding on genital examination  Vulva –labia majora,labia minora both contused edematous and inflamed.  Hymen lacerated 1.5cmx0.75x0.5cm at 6.0 clock position  Vagina bruised in posterior region in continuation with lacerated hymen over an area of 3x0.5cm
  39. 39. Rape case samples taken and sealed Dr Udai Bhan Yadav SMO & Medical Jurist GH Alwar Rajasthan39  Sealed envelop contains following for spermatozoa and chemical examination to detect out human seminal stain blood stain and cross matching if needed.  A –blood staied dried gause  B - saliva stain dried gause  C – vulvovaginal swab smear 2  D –vulvovaginal swab stic .  Opinion –regarding recent sexual act kept reserved till receiving FSL report.