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Forensic Medicine
Dr. Suchita Rawat (MSc, MPhil, PhD)
Unit 2: Medico-legal aspects
Introduction to autopsy and its types; Medico legal aspects: asphyxia, syncope, coma,
suspended animation, death by starvation, drowning, hanging, strangulation, heat and
cold. Causes and mechanism of traumatic death; Classification of traumatic deaths.
Death due to natural causes. Preservation of pathological evidence
Medicolegal Autopsy (autopsy: scientific dissection of the dead body)
● Medicolegal AutoPpsy vs. Hospital Autopsy
● Psychological vs. verbal autopsy
● OBJECTIVES OF A MEDICOLEGAL
AUTOPSY (6 W & 1 H in C)
This Photo by Unknown Author is licensed
under CC BY-NC
● (1) What injuries are present? [description of injuries]
● (2) When did the injuries occur? When did the victim die? [time of injuries
and of death]
● (3) Where did the death occur?
● 4) Which injury caused death? [cause of death]
● (5) Who is the victim? [identification in unknown bodies]
● (6) Why were the injuries produced [Manner of death - suicide, homicide or
accident]
● (7) How were the injuries produced [self-inflicted, by others, which kind of
weapon was involved]
● (8) Collection of evidence (a) External - To collect incriminating evidence from
the dead body (e.g. semen in case of rape, grease and dirt in case of
automobile accidents, rope fibers in case of strangulation) (b) Internal - To
retain relevant organs and tissues as evidenc
EXAMINATION IN MEDICOLEGAL AUTOPSY
A. Clothings (1) List - all clothings (2)
Describe - (i) Burns [if present] (ii) Buttons
[loss of] (iii) Color (iv) Creases [lack of] (v)
Design (vi ) Staining [biological fluids/
grease, mud, vitriolage], (vii) Tears
[indicates struggle] (viii) Type of garment (ix)
wetness [as in drowning] (xi) wrinkles
[presence of].
(1) Record height, weight, age, sex (2)
General features (3) Hands - (a) Trace
evidence (4) Skin (5) Eyes (6) Palpate (a)
Abdomen (b) breasts [In females] (c) testes
[In males].
INTERNAL EXAMINATION
Source: Agrawal, A. (2016).
Source: Agrawal, A. (2016).
(1) Most common
(2) starts from just under
the chin in midline and
goes up to the pubic
symphysis, sparing the
umbilicus
1)Used in neck trauma
2)Starts from the two
mastoid processes, which
form the two limbs of the Y
(1) Used - in females to
preserve appearance
(2) (2) Starts from below both
anterior axillary folds,
goes below the breasts,
meets at xiphoid process
and proceeds down to
symphysis pubis.
(1) Straight incision from
suprasternal notch till the
pubic symphysis,
horizontally till acromion
processes
(2) Used – when exploration of
base of neck is necessary
Method of Removal of Organs
This Photo by Unknown Author is licensed under CC
BY-SA-NC
Virchow’s method
(Rudolph Virchow (1821–
1902), German
pathologist.
(2) Organs are removed
separately one by one and
then studied individually)
Rokitansky’s
method
(Carl Rokitansky
(1804–78), German
pathologist. (2) in
situ dissection)i.e.
infants/children
Ghon’s method
Anton Ghon (1866-1936),
Austrian pathologist. (2)
Compromise between
Virchow’s and Letulle’s.
Cervico-thoracic,
abdominal and pelvic
organs are removed as 3
separate blocks [en bloc
method]
Letulle’s method
(Maurice Letulle
(1853-1929), French
pathologist. (2) organs
oral, cervical, thoracic,
abdominal, pelvic] are
remove en masse in
a single block)
Head
Source: Agrawal, A. (2016).
Source: Agrawal, A. (2016).
Chest (heart)
Source: Agrawal, A. (2016).
Gastrointestinal system
This Photo by Unknown Author is licensed under CC BY-SA-NC
This Photo by Unknown Author is
licensed under CC BY-ND
Genitourinary system
This Photo by Unknown Author is licensed under CC BY-
SA-NC
Spinal cord
Blood
COLLECTION OF SPECIMENS
A. Fresh Bodies [Undecomposed]
•Anal swabs
•Bile
•Bitemarks (saliva moistened in saline )
•Blood from peripheral vessel like iliac, femoral
or subclavian
•Bloodstain for blood grouping
•Bonemarrow for Diatoms
•CerebroSphinal from Lumbar region
• Feces
•Lungs for volatile poisons
•Saliva for oral intercourse
Urine
• Vaginal swabs for spermatozoa
•Vitreous humor
● When Viscera should be Preserved?
● A: aborted fetes and amniotic fluids/adipose tissue (pesticide)
● B:Bile (barbiturates/cocaine/morphine/narcotics) /Blood (all times/
CO,HCN,depressants)/Bone(pesticides/heavy metals)/Brain
(Anesthesia,alchol,barbiturates,CO,Cyanides,opiates,voilatile poison, strychnine)/Breast milk
(thallium/opioids)
● CSF (alcohol)
● F: faeces (GIT poison)
● K: Keratinizsed tissue hair and fingernails (metallic poison)
● Injection site (insect bite/drug injection)
● Kidney/liver (metals) stomach and intestines
● Lungs (alcohol/chloroform/HCN/inhalant abuse)
● Spinal cord (strychnine poison)
● Urine
What Viscera should be Preserved?
Preservatives
 Saturated solution of common salt
 Rectified spirit: (i) acetic acid (ii) alcohol (iii)
chloral hydrate (iv) chloroform (v) ether (vi)
formaldehyde (vii) formic acid (viii) kerosene (ix)
paraldehyde (x) phenol and (xi) phosphorus.
 Preservatives for blood: Sodium floride and
potassium oxalate (100/30mg)
 Blood/ Urine (50 mg phenyl mercuric nitrate or
sodium azide)
 URINE: A)common salt (b) equal quantity of
rectified spirit (c) some fine grains of thymol (d)
one gm of sodium benzoate
 Preservatives for virological analysis
 Formalin
 Conditions when preservative is not
necessary (analysis/ keratinized
tissue/storage/lungs)
Source: Agrawal, A. (2016).
THE AUTOPSY REPORT
(i) Preliminaries –
name, age, sex etc
(ii) History
(iii) Date, Time, Place,
Assistants, Attendees
(iv) Presentation,
Clothing, Personal
Effects, Associated
Items
(v) Evidence of Medical
Intervention
(vi) Postmortem
Changes
(vii) Postmortem
Imaging Studies
(viii) Identification (ix) Evidence of Injury
(x) External
Examination
(xi) Internal
Examination
(xii) Histology samples
Listing
(xiii) Microscopic
Descriptions
(xiv) Toxicology
Results, Laboratory
Results, Ancillary
Procedure Results
(xv) Pathologic
Diagnoses
(xvi) Summary and
Comments
(xvii) Cause of Death
Statement.
References
● Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal
Publication Company, 325.
Violent Asphyxial Deaths
● Asphyxia is the interference of respiration due to any cause, i.e. mechanical,
environmental or toxic, resulting in failure of intake of oxygen by the tissues
together with failure to eliminate carbon dioxide.
● Mechanical asphyxia: Asphyxia due to mechanical force. The causes of
mechanical asphyxia are classified into:
● i. Obstructive causes: Smothering, gagging, choking and café coronary.
● ii. Constrictive causes: Hanging, strangulation, throttling, lynching,
bansdola, mugging .
● iii. Restrictive causes: Traumatic asphyxia, burking and overlaying.
● iv. Replacement causes: Drowning.
Classical signs of
asphyxia:
● “asphyxial triad” and these are:
● i. Cyanosis
● ii. Congestion of organs
● iii. Petechial Hemorrhages.
● Specific sign: • Example: i. Ligature
mark on the neck in hanging and
ligature strangulation,
● ii. Finger nails abrasions on the neck
in manual strangulation (throttling),
● iii. Fluid in the air passage in drowning
● iv. Food bolus in the larynx in café
coronary, etc
● Drowning: Drowning is a form of asphyxia
caused by aspiration of fluid into air-passages,
caused by complete or partial submersion in
water or other fluid.
● Classification
● (Wet drowning: lungs/Dry drowning: no sign.
Fluid
● Near drowning: initial survival at least beyond 24 hours
and secondary drowning:death following near drowning
after a period of relative wellbeing. )
● Immersion syndrome (syn hydrocution, submersion
inhibition]
Asphyxia
Cramps
Exhaustion
Injuries : CNS
Long QT syndrome
posthypoxic encephalopathy
Fresh water drowning versus Sea
water drowning
Fatal period
Four minutes in Fresh water
and Six to Seven minutes in
Sea water
POST MORTEM CHANGES (EXTERNAL)
Picture source: Aggrawal 2016
Picture source: Aggrawal 2016
Wet. Small
aquatic animals
may be found
trapped
SKIN– (A) General - wet, cold, moist,
pale [vascular contraction] (B) Cutis
anserina [CA] [syn, goose flesh, goose
skin] – (i) Appearance – granular and
puckered (ii) Mechanism – spasm of
erector pilae muscles, attached to hair
follicles.
Face – (a) color – cyanotic (b) conjunctiva – congested; show
petechial hemorrhages, especially in lower eyelids
Body and natural orifices [mouth, nostrils,
ears]: coated with algae [including diatoms],
grit, mud, sand, seaweed, silt and waterweed
POST MORTEM CHANGES (INTERNAL)
Picture source: Aggrawal 2016
voluminous, overdistended.
Swollen with flattening of gyri
Water - (i) Present in
stomach in 3/4 th and
in intestines in 1/4 th of
all cases
free liquid in the paranasal
sinuses
Bruising and rupture –
especially of those
around shoulder joint
Hemorrhages - in the
petrous and mastoid
regions of the
temporal bone
Spleen
● Drowning index [DI] - D.I. =
Weight of both lungs and
pleural effusion/ Weight of
spleen
● Values are ≥14.1 in
drowning and much below
this figure in non-drowning
deaths.
Accidental drowning vs. suicidal drowning vs. Homicidal drowning vs. Postmortem
submersion ( signs of drowning /hands tied behind/heavy weight tied to
body/intoxicating drugs/Getler’s test/Diatom test/Injuries/drowning in
shallow water/circumtaintial evidence)
Features Accidental Drowning Suicidal Drowning Homicidal Drowning Post-mortem
Submersion
1.Signs of drowning
(froth, cadaveric spasm, algae and
mud in finer branches of
bronchioles, water in lungs)
yes yes yes No
2.Hands tied behind back no no yes No
3.Heavy weight tied to body No Extremely rare More common Yes to prevent the
body from
surfacing
4.Intoxicating drugs sometimes rare common common
5.Getler test (Mg,cl,br, Strontium)
Left vs. right heart
+ve +ve +ve -ve
6.Diatom Test +ve +ve +ve -ve
7.Injuries Compatible with scene
of drowning e.g.
Hitting against the
walls of well etc.
No injuries.
If all present, they should be
compatible with scene of
drowning
Injuries on head, if person was rendered
unconscious by hitting on head. Marks of
strangulation, throttling, etc. multiple
bruising
Injuries make be
present
8.Drowning in shallow water Possible if the victim is
drunk
Virtually never seen Strongly indicates drowning eg. When
assailants forcibly holds victim’s head
below water
Virtually never
seen
9.Circumtanstial evidence e.g.
Suicide letter, signs of struggle
Findings in favour of
accident
Findings in favour of suicide Fingdings in favour of homicide In favour of
homicide
10.Presence of footwear by side of
well
no yes no no
LABORATORY TESTS FOR DROWNING (DIATOM TEST and GETLER
TEST)
Picture source: Aggrawal 2016
Picture source: Aggrawal 2016
Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal Publication Company, 325.
Vij, K. (2011). Textbook of forensic medicine and toxicology: principles and practice, 5/e. Elsevier India.
References
STRANGULATION
*Pseudostrangulation
PM Appearances [in classical
ligature strangulation]
External
Ligature
Signs of Asphyxia
Abrasions and contusions on face
PM Appearances [in classical
ligature strangulation] Internal
Neck – Hemorrhages ( beneath the
ligature mark under the skin)
fracture of ribs (assailant kneeled
on the chest)
Lungs ( show emphysematous
bullae)
laceration of abdominal organs
liver, spleen, rupture of intestines,
gall bladder (assailant kneeled on
the abdomen)
Source: Aggrawal, A. (2016).
Source: Aggrawal, A. (2016).
Pseudostrangulation refers to a situation, where a ligature mark resembling a
strangulation mark [pseudoligature mark] is seen on the neck, but it is produced by
mechanisms other than antemortem pressure by a ligature.
Suicidal and Homicidal Strangulation
*Incidence/ligature/number of ligature materials/knots/position of
knot/position of knot/injuries around neck/signs of violence and mark
of struggle/suicide note
HANGING
● near hanging.
● Classification
1. According to position of knot
(1) Typical hanging – if knot is at occiput
(2) Atypical hanging – if knot is at any
other position.
2. According to position of feet
(1) Complete hanging – if feet do not
touch ground
(2) Incomplete or partial hanging – if feet
or other parts of the body touch ground
Suicidal hanging : 5-10 min
Judicial hanging: - instantaneous
Delayed deaths – Few days.
HANGING
Judicial hanging Judicial hanging is a
method of execution in which a noose is
tied round the neck of condemned
criminal, and he is made to drop between
1-5 m depending on his weight
Partial hanging : body is supported either by ground,
or some object other than the neck
PM Appearances
If ligature knot presses on
cervical sympathetic, the eye on
the same side is open and its
pupil dilated; the other eye is
closed and its pupil constricted.
It was once believed to be a
hallmark of antemortem hanging
overstretching of the
spine because of free
suspension of the body.
Causes stretching and
tearing of small vessels
within the disks
intervertebral disks in
the lower thoracic and
lumbar vertebrae
Starvation a severe reduction in nutrient, vitamin and energy intake that occurs
either from withholding of food or from administration of unsuitable
food.
Acute Chronic
Causes
(1) Poverty [most common cause in India]
(2) Fasting
(3) Accidental: (i) earthquakes (ii) famine (iii) landslides (iv)
lost in desert or jungle (v) marooned on island (vi) shipwrecks
(vii) trapped in mines and pits etc
. 2. Medical causes (1) Alcohol and drug addicts (2) Anorexia
nervosa /Bulimia nervosa (3) cancer and stricture of esophagus
(4) Coma (5) Diabetes mellitus (6) Digestive diseases (7)
Mental disorder
Forcefully deprivation
(1) In number of days:
(i) Both water and food are
completely withdrawn 10 days
[both adults and newborns]
(ii) Only food withdrawn 60 days
(iii) Only water withdrawn 10 days
[happens rarely when a camper is
lost in desert, has good food supply
but no water]
(1) Skin – dry, inelastic, pigmented, rough, thin,
wrinkled. Shows follicular hyperkeratosis and
trophic skin changes
(ii) hair and nails– brittle, dry, lusterless
2) Fat: (i) Complete absent from around internal
organs, and in mesentery, omentum, and s/c
tissues. (ii) disappears late from – fat of female
breast, around orbit (iii) subepicardial fat –
replaced by watery gelatinous material
3) Muscular system: (i) Muscles - atrophied and
dark
4) Skeletal system:
(i) Children - (a) Dental defects [eg caries,
decalcification] (b) Rickets (c) Spinal curvature
(ii) Adults - (a) Osteomalacia (iii) in both – (a)
Demineralization of bone (b) stress fractures
This Photo by Unknown Author is licensed under CC BY-SA

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MSC IV_Forensic medicine - autopsy.pdf

  • 1. Forensic Medicine Dr. Suchita Rawat (MSc, MPhil, PhD)
  • 2. Unit 2: Medico-legal aspects Introduction to autopsy and its types; Medico legal aspects: asphyxia, syncope, coma, suspended animation, death by starvation, drowning, hanging, strangulation, heat and cold. Causes and mechanism of traumatic death; Classification of traumatic deaths. Death due to natural causes. Preservation of pathological evidence
  • 3. Medicolegal Autopsy (autopsy: scientific dissection of the dead body) ● Medicolegal AutoPpsy vs. Hospital Autopsy ● Psychological vs. verbal autopsy ● OBJECTIVES OF A MEDICOLEGAL AUTOPSY (6 W & 1 H in C) This Photo by Unknown Author is licensed under CC BY-NC
  • 4. ● (1) What injuries are present? [description of injuries] ● (2) When did the injuries occur? When did the victim die? [time of injuries and of death] ● (3) Where did the death occur? ● 4) Which injury caused death? [cause of death] ● (5) Who is the victim? [identification in unknown bodies] ● (6) Why were the injuries produced [Manner of death - suicide, homicide or accident] ● (7) How were the injuries produced [self-inflicted, by others, which kind of weapon was involved] ● (8) Collection of evidence (a) External - To collect incriminating evidence from the dead body (e.g. semen in case of rape, grease and dirt in case of automobile accidents, rope fibers in case of strangulation) (b) Internal - To retain relevant organs and tissues as evidenc
  • 5. EXAMINATION IN MEDICOLEGAL AUTOPSY A. Clothings (1) List - all clothings (2) Describe - (i) Burns [if present] (ii) Buttons [loss of] (iii) Color (iv) Creases [lack of] (v) Design (vi ) Staining [biological fluids/ grease, mud, vitriolage], (vii) Tears [indicates struggle] (viii) Type of garment (ix) wetness [as in drowning] (xi) wrinkles [presence of]. (1) Record height, weight, age, sex (2) General features (3) Hands - (a) Trace evidence (4) Skin (5) Eyes (6) Palpate (a) Abdomen (b) breasts [In females] (c) testes [In males]. INTERNAL EXAMINATION
  • 7. Source: Agrawal, A. (2016). (1) Most common (2) starts from just under the chin in midline and goes up to the pubic symphysis, sparing the umbilicus 1)Used in neck trauma 2)Starts from the two mastoid processes, which form the two limbs of the Y (1) Used - in females to preserve appearance (2) (2) Starts from below both anterior axillary folds, goes below the breasts, meets at xiphoid process and proceeds down to symphysis pubis. (1) Straight incision from suprasternal notch till the pubic symphysis, horizontally till acromion processes (2) Used – when exploration of base of neck is necessary
  • 8. Method of Removal of Organs This Photo by Unknown Author is licensed under CC BY-SA-NC Virchow’s method (Rudolph Virchow (1821– 1902), German pathologist. (2) Organs are removed separately one by one and then studied individually) Rokitansky’s method (Carl Rokitansky (1804–78), German pathologist. (2) in situ dissection)i.e. infants/children Ghon’s method Anton Ghon (1866-1936), Austrian pathologist. (2) Compromise between Virchow’s and Letulle’s. Cervico-thoracic, abdominal and pelvic organs are removed as 3 separate blocks [en bloc method] Letulle’s method (Maurice Letulle (1853-1929), French pathologist. (2) organs oral, cervical, thoracic, abdominal, pelvic] are remove en masse in a single block)
  • 9. Head Source: Agrawal, A. (2016). Source: Agrawal, A. (2016).
  • 11. Gastrointestinal system This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-ND
  • 12. Genitourinary system This Photo by Unknown Author is licensed under CC BY- SA-NC Spinal cord Blood
  • 13. COLLECTION OF SPECIMENS A. Fresh Bodies [Undecomposed] •Anal swabs •Bile •Bitemarks (saliva moistened in saline ) •Blood from peripheral vessel like iliac, femoral or subclavian •Bloodstain for blood grouping •Bonemarrow for Diatoms •CerebroSphinal from Lumbar region • Feces •Lungs for volatile poisons •Saliva for oral intercourse Urine • Vaginal swabs for spermatozoa •Vitreous humor
  • 14. ● When Viscera should be Preserved?
  • 15. ● A: aborted fetes and amniotic fluids/adipose tissue (pesticide) ● B:Bile (barbiturates/cocaine/morphine/narcotics) /Blood (all times/ CO,HCN,depressants)/Bone(pesticides/heavy metals)/Brain (Anesthesia,alchol,barbiturates,CO,Cyanides,opiates,voilatile poison, strychnine)/Breast milk (thallium/opioids) ● CSF (alcohol) ● F: faeces (GIT poison) ● K: Keratinizsed tissue hair and fingernails (metallic poison) ● Injection site (insect bite/drug injection) ● Kidney/liver (metals) stomach and intestines ● Lungs (alcohol/chloroform/HCN/inhalant abuse) ● Spinal cord (strychnine poison) ● Urine
  • 16. What Viscera should be Preserved? Preservatives  Saturated solution of common salt  Rectified spirit: (i) acetic acid (ii) alcohol (iii) chloral hydrate (iv) chloroform (v) ether (vi) formaldehyde (vii) formic acid (viii) kerosene (ix) paraldehyde (x) phenol and (xi) phosphorus.  Preservatives for blood: Sodium floride and potassium oxalate (100/30mg)  Blood/ Urine (50 mg phenyl mercuric nitrate or sodium azide)  URINE: A)common salt (b) equal quantity of rectified spirit (c) some fine grains of thymol (d) one gm of sodium benzoate  Preservatives for virological analysis  Formalin  Conditions when preservative is not necessary (analysis/ keratinized tissue/storage/lungs) Source: Agrawal, A. (2016).
  • 17. THE AUTOPSY REPORT (i) Preliminaries – name, age, sex etc (ii) History (iii) Date, Time, Place, Assistants, Attendees (iv) Presentation, Clothing, Personal Effects, Associated Items (v) Evidence of Medical Intervention (vi) Postmortem Changes (vii) Postmortem Imaging Studies (viii) Identification (ix) Evidence of Injury (x) External Examination (xi) Internal Examination (xii) Histology samples Listing (xiii) Microscopic Descriptions (xiv) Toxicology Results, Laboratory Results, Ancillary Procedure Results (xv) Pathologic Diagnoses (xvi) Summary and Comments (xvii) Cause of Death Statement.
  • 18. References ● Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal Publication Company, 325.
  • 19. Violent Asphyxial Deaths ● Asphyxia is the interference of respiration due to any cause, i.e. mechanical, environmental or toxic, resulting in failure of intake of oxygen by the tissues together with failure to eliminate carbon dioxide. ● Mechanical asphyxia: Asphyxia due to mechanical force. The causes of mechanical asphyxia are classified into: ● i. Obstructive causes: Smothering, gagging, choking and café coronary. ● ii. Constrictive causes: Hanging, strangulation, throttling, lynching, bansdola, mugging . ● iii. Restrictive causes: Traumatic asphyxia, burking and overlaying. ● iv. Replacement causes: Drowning.
  • 20. Classical signs of asphyxia: ● “asphyxial triad” and these are: ● i. Cyanosis ● ii. Congestion of organs ● iii. Petechial Hemorrhages. ● Specific sign: • Example: i. Ligature mark on the neck in hanging and ligature strangulation, ● ii. Finger nails abrasions on the neck in manual strangulation (throttling), ● iii. Fluid in the air passage in drowning ● iv. Food bolus in the larynx in café coronary, etc
  • 21. ● Drowning: Drowning is a form of asphyxia caused by aspiration of fluid into air-passages, caused by complete or partial submersion in water or other fluid. ● Classification ● (Wet drowning: lungs/Dry drowning: no sign. Fluid ● Near drowning: initial survival at least beyond 24 hours and secondary drowning:death following near drowning after a period of relative wellbeing. ) ● Immersion syndrome (syn hydrocution, submersion inhibition]
  • 22. Asphyxia Cramps Exhaustion Injuries : CNS Long QT syndrome posthypoxic encephalopathy
  • 23. Fresh water drowning versus Sea water drowning Fatal period Four minutes in Fresh water and Six to Seven minutes in Sea water
  • 24.
  • 25. POST MORTEM CHANGES (EXTERNAL) Picture source: Aggrawal 2016 Picture source: Aggrawal 2016 Wet. Small aquatic animals may be found trapped SKIN– (A) General - wet, cold, moist, pale [vascular contraction] (B) Cutis anserina [CA] [syn, goose flesh, goose skin] – (i) Appearance – granular and puckered (ii) Mechanism – spasm of erector pilae muscles, attached to hair follicles. Face – (a) color – cyanotic (b) conjunctiva – congested; show petechial hemorrhages, especially in lower eyelids
  • 26. Body and natural orifices [mouth, nostrils, ears]: coated with algae [including diatoms], grit, mud, sand, seaweed, silt and waterweed
  • 27. POST MORTEM CHANGES (INTERNAL) Picture source: Aggrawal 2016 voluminous, overdistended. Swollen with flattening of gyri Water - (i) Present in stomach in 3/4 th and in intestines in 1/4 th of all cases free liquid in the paranasal sinuses Bruising and rupture – especially of those around shoulder joint Hemorrhages - in the petrous and mastoid regions of the temporal bone
  • 28. Spleen ● Drowning index [DI] - D.I. = Weight of both lungs and pleural effusion/ Weight of spleen ● Values are ≥14.1 in drowning and much below this figure in non-drowning deaths.
  • 29. Accidental drowning vs. suicidal drowning vs. Homicidal drowning vs. Postmortem submersion ( signs of drowning /hands tied behind/heavy weight tied to body/intoxicating drugs/Getler’s test/Diatom test/Injuries/drowning in shallow water/circumtaintial evidence)
  • 30. Features Accidental Drowning Suicidal Drowning Homicidal Drowning Post-mortem Submersion 1.Signs of drowning (froth, cadaveric spasm, algae and mud in finer branches of bronchioles, water in lungs) yes yes yes No 2.Hands tied behind back no no yes No 3.Heavy weight tied to body No Extremely rare More common Yes to prevent the body from surfacing 4.Intoxicating drugs sometimes rare common common 5.Getler test (Mg,cl,br, Strontium) Left vs. right heart +ve +ve +ve -ve 6.Diatom Test +ve +ve +ve -ve 7.Injuries Compatible with scene of drowning e.g. Hitting against the walls of well etc. No injuries. If all present, they should be compatible with scene of drowning Injuries on head, if person was rendered unconscious by hitting on head. Marks of strangulation, throttling, etc. multiple bruising Injuries make be present 8.Drowning in shallow water Possible if the victim is drunk Virtually never seen Strongly indicates drowning eg. When assailants forcibly holds victim’s head below water Virtually never seen 9.Circumtanstial evidence e.g. Suicide letter, signs of struggle Findings in favour of accident Findings in favour of suicide Fingdings in favour of homicide In favour of homicide 10.Presence of footwear by side of well no yes no no
  • 31. LABORATORY TESTS FOR DROWNING (DIATOM TEST and GETLER TEST) Picture source: Aggrawal 2016 Picture source: Aggrawal 2016
  • 32. Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal Publication Company, 325. Vij, K. (2011). Textbook of forensic medicine and toxicology: principles and practice, 5/e. Elsevier India. References
  • 33. STRANGULATION *Pseudostrangulation PM Appearances [in classical ligature strangulation] External Ligature Signs of Asphyxia Abrasions and contusions on face PM Appearances [in classical ligature strangulation] Internal Neck – Hemorrhages ( beneath the ligature mark under the skin) fracture of ribs (assailant kneeled on the chest) Lungs ( show emphysematous bullae) laceration of abdominal organs liver, spleen, rupture of intestines, gall bladder (assailant kneeled on the abdomen) Source: Aggrawal, A. (2016). Source: Aggrawal, A. (2016). Pseudostrangulation refers to a situation, where a ligature mark resembling a strangulation mark [pseudoligature mark] is seen on the neck, but it is produced by mechanisms other than antemortem pressure by a ligature.
  • 34.
  • 35. Suicidal and Homicidal Strangulation *Incidence/ligature/number of ligature materials/knots/position of knot/position of knot/injuries around neck/signs of violence and mark of struggle/suicide note
  • 36. HANGING ● near hanging. ● Classification 1. According to position of knot (1) Typical hanging – if knot is at occiput (2) Atypical hanging – if knot is at any other position. 2. According to position of feet (1) Complete hanging – if feet do not touch ground (2) Incomplete or partial hanging – if feet or other parts of the body touch ground Suicidal hanging : 5-10 min Judicial hanging: - instantaneous Delayed deaths – Few days.
  • 37. HANGING Judicial hanging Judicial hanging is a method of execution in which a noose is tied round the neck of condemned criminal, and he is made to drop between 1-5 m depending on his weight Partial hanging : body is supported either by ground, or some object other than the neck
  • 39. If ligature knot presses on cervical sympathetic, the eye on the same side is open and its pupil dilated; the other eye is closed and its pupil constricted. It was once believed to be a hallmark of antemortem hanging
  • 40. overstretching of the spine because of free suspension of the body. Causes stretching and tearing of small vessels within the disks intervertebral disks in the lower thoracic and lumbar vertebrae
  • 41.
  • 42. Starvation a severe reduction in nutrient, vitamin and energy intake that occurs either from withholding of food or from administration of unsuitable food. Acute Chronic Causes (1) Poverty [most common cause in India] (2) Fasting (3) Accidental: (i) earthquakes (ii) famine (iii) landslides (iv) lost in desert or jungle (v) marooned on island (vi) shipwrecks (vii) trapped in mines and pits etc . 2. Medical causes (1) Alcohol and drug addicts (2) Anorexia nervosa /Bulimia nervosa (3) cancer and stricture of esophagus (4) Coma (5) Diabetes mellitus (6) Digestive diseases (7) Mental disorder Forcefully deprivation
  • 43. (1) In number of days: (i) Both water and food are completely withdrawn 10 days [both adults and newborns] (ii) Only food withdrawn 60 days (iii) Only water withdrawn 10 days [happens rarely when a camper is lost in desert, has good food supply but no water]
  • 44. (1) Skin – dry, inelastic, pigmented, rough, thin, wrinkled. Shows follicular hyperkeratosis and trophic skin changes (ii) hair and nails– brittle, dry, lusterless 2) Fat: (i) Complete absent from around internal organs, and in mesentery, omentum, and s/c tissues. (ii) disappears late from – fat of female breast, around orbit (iii) subepicardial fat – replaced by watery gelatinous material 3) Muscular system: (i) Muscles - atrophied and dark 4) Skeletal system: (i) Children - (a) Dental defects [eg caries, decalcification] (b) Rickets (c) Spinal curvature (ii) Adults - (a) Osteomalacia (iii) in both – (a) Demineralization of bone (b) stress fractures
  • 45.
  • 46. This Photo by Unknown Author is licensed under CC BY-SA