Concise Forensic Medicine and Toxicology Narayan Reddy

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and
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Concise
toxicology
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forensic medicine
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Concise
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forensic medicine
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and
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toxicology
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Fourth Edition
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By
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Dr. K.S.Narayan Reddy, M.D., D.C.P., Ph.D. F.A.M.S.,
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F.A.F.M., F.I.M.S.A., F.A.F.Sc., F.I.A.M.S.
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Honorary Professor of Forensic Medicine,

S.V.S. Medical College, Mahabubnagar.
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(Retired Principal, Osmania Medical College, Hyderabad)

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The Health Sciences Publisher

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New Delhi | London | Philadelphia | Panama

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Jaypee Brothers Medical Publishers (P) Ltd
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Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
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New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: [email protected]
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Overseas Offices
J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc Jaypee Medical Inc
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83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse
SW1H 0HW (UK) Panama City, Panama 111 South Independence Mall East
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Phone: +44 20 3170 8910 Phone: +1 507-301-0496 Suite 835, Philadelphia, PA 19106, USA
Fax: +44 (0)20 3008 6180 Fax: +1 507-301-0499 Phone: +1 267-519-9789
Email: [email protected] Email: [email protected] Email: [email protected]
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Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd
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Mohammadpur, Dhaka-1207 Nepal
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Bangladesh Phone: +977-9741283608
Mobile: +08801912003485 Email: [email protected]
Email: [email protected]
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Website: www.jaypeebrothers.com
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Website: www.jaypeedigital.com
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© 2015, Jaypee Brothers Medical Publishers

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The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent
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those of editor(s) of the book.

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All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their
respective owners. The publisher is not associated with any product or vendor mentioned in this book.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the
subject matter in question. However, readers are advised to check the most current information available on procedures included and
check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and
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duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety
precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property
arising from or related to use of material in this book.
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This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or
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Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If
any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
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Inquiries for bulk sales may be solicited at: [email protected]

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Concise Forensic Medicine and Toxicology

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First Edition: 2001
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Fourth Edition: 2015
ISBN 978-93-5152-823-4
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Printed at
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Preface re
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This is not a textbook. It is the concised version of the book published under the
title “Essentials of Forensic Medicine & Toxicology” 33rd edition, 2014. The
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subject matter has been dealt with concisely, but includes the essentials of all
topics which are dealt in a standard textbook. Students are advised to first master
the material from any one accepted textbook. It is intended to meet the needs and
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enable to review the subject and refresh the memory of undergraduate students
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before appearing for theory, practicals and oral examinations in the subject of
Forensic Medicine. It is hoped that this edition will be warmly welcomed just like
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the previous editions of this book.
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KSN Reddy
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Other Books By the Same Author
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(1) The Essentials of Forensic medicine and
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toxicology
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Thirtythird Edition, 2014, 24cm. x 18cm. PP 6+628, Price ` 425/-
(2) The synopsis of forensic medicine and
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toxicology
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Twentyseventh edition, 2014, 24cm. x 18cm. PP 4+ 233, Price ` 360/-
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(3) Medicolegal manual
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Fifth Edition, 2010, 24cm. x 18cm. PP 4+300, Price ` 250/-
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(Hindi Translation ` 150/-)
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Printed by Andhra Law Times, Hyderabad
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(4) m.c.qs in forensic medicine
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Sixth Edition, 2011, 24cm. x 18cm. PP 236, Price ` 270/-

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Published by Elsevier
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(5) Medicolegal manual for police officers

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Second Edition, 2002, 17cm. x 11cm. PP 4+209, Price ` 60/-

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(6) Medical jurisprudence and toxicology re

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Third Edition, 2010, 24 x 18cm. PP 1344, Price ` 1350/- Ph. 2452930
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Published by Andhra Law Times, Hyderabad.

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Publisher
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Contents re
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Forensic Medicine
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1. Legal Procedure 1
2. Medical Law and Ethics 9
3. Identification 23
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4. Medicolegal Autopsy 40
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5. Death and its Cause 47
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6. Postmortem Changes 52
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7. Mechanical Injuries 64
8. Regional Injuries 86
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9. Medicolegal Aspects of Wounds 95
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10. Thermal Deaths 103
11. Starvation 111
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12. Mechanical Asphyxia 113
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13. Impotence and Sterility 129
14. Virginity, Pregnancy and Delivery 133
15. Sexual Offences 140
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16. Abortion 154

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17. Infant Deaths 159

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18. Blood Stains 167

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19.
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Forensic Psychiatry
Artefacts
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184 re
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21. Forensic Science Laboratory 186
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Toxicology
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22. General Considerations 188

23. Agricultural Poisons 200
24. Corrosive Poisons 206
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25. Metallic Poisons 212

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26. Inorganic Irritant Poisons 221

27. Organic Irritant Poisons 223
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28. CNS Depressants 230

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29. Miscellaneous Poisons 241

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30. Stimulants 243

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x Concise Forensic Medicine
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31. Deliriant Poisons 244
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32. Drug Dependence 248
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33. Spinal Poisons 253
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34. Cardiac Poisons 255
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35. Asphyxiants 257
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36. Food Poisoning 263
Index 267
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Forensic Medicine
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C h a p t e r
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Legal Procedure
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Forensic (legal) medicine deals with application of medical
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knowledge to aid in administration of justice, i.e. it deals with medical
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aspects of law, such as assault, murder, sexual offences, poisoning,
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etc.
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Medical jurisprudence deals with legal responsibilities of
doctor, i.e. with legal aspects of practice of medicine, such as
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medical negligence, consent, professional misconduct, duties of

doctors, etc.
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Inquest : An inquest is an enquiry or investigation into the

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cause of death (S.174, Cr.P.C). It is conducted in cases of unnatural

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and suspicious deaths, such as suicide, murder, accident, etc.

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(1) Police inquest : (1) It is conducted throughout India.

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(2) The officer - incharge of police station, informs the Executive re

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Magistrate, and proceeds to the place where body of deceased person
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is. (3) He conducts investigation (panchanama), in the presence of

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two witnesses (panchas). (4) The report includes the description

of wounds, the nature of weapon and apparent cause of death. (5)
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The report is signed by police officer and witnesses. (6) If foulplay

is suspected, the body is sent for autopsy with a requisition to the
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authorised Government doctor. (7) If no foul play is suspected, the

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dead body is handed over to the relatives for disposal.

(2) Magistrate’s inquest : This is conducted by an Executive
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Magistrate (who are revenue officials), such as District Collector,

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deputy Collector, Tahasildar, etc. It is done in cases of (1) death in

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Ch-01.indd 1 04-03-2015 12:07:10 PM

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2 Concise Forensic Medicine
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prison, (2) death in police custody, (3) death due to police firing, (4)
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dowry death, (5) exhumation, (6) death in a psychiatric hospital (S.
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176, I.P.C).
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Coroner’s inquest is not done in India, but is done in U.K., some

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states in U.S.A and some other countries.
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Medical examiner’s inquest is done in most States of USA.
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Trial by Jury is not done in India.
Courts of law : (1) Civil. (2) Criminal. In India, criminal
courts are of four types.
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(1) Supreme Court is the highest court. It has the power of
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supervision over all courts in India. The law declared by it is binding
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on all courts. It is purely an appellate court in criminal cases.
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(2) High Court is highest court in every state. It may try any
offence and pass any sentence authorised by law.
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(3) Sessions Court can only try cases which have been committed
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to it by Magistrate. It can pass any sentence authorised by law, but
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a sentence of death passed by it must be confirmed by High Court.
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Assistant Sessions Court can pass any sentence except death
sentence and imprisonment not exceeding ten years.
(4) Magistrates’ are of three types.
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Class of Magistrate Imprisonment Fine

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Chief Judicial Magistrate Up to 7 years Unlimited

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I Class Judicial Magistrate Up to 3 years 10,000 rupees

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II Class Judicial Magistrate Up to 1 year 5,000 rupees re

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In Metropolitan cities (population more than one million), Chief

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Judicial Magistrate and First class Judicial Magistrates are designated

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as Chief Metropolitan Magistrate and Metropolitan Magistrate

respectively.
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Cognisable offence is an offence in which a police officer can

arrest a person without warrant from the Magistrate, e.g. rape,
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murder, robbery, dowry death, rash or negligent act, etc. In such offences,
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the person is sent by the police to the doctor for medical examination.
Punishments authorised by law are : (1) death, (2) imprisonment
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for life, (3) imprisonment; (a) rigorous (hard labour), (b) simple, (4)
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forfeiture of property; (5) fine.

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Ch-01.indd 2 04-03-2015 12:07:10 PM

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Legal Procedure 3
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Conduct money : It is fee paid to a witness in civil cases
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only at the time of serving summons to meet the expenses towards
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attending a Court. If the amount is less, the witness can appeal to
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the Judge, who will decide the amount to be paid. In criminal cases
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no fee is paid.
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Subpoena or summons : (1) It is a written document issued
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and signed by the Court in duplicate, and served on the witness
under penalty, for giving evidence on a particular day and time. (2)
It is served on the witness by a police officer, or other public servant.
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(3) It may also be sent by registered post. (4) Apart from giving
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evidence, the witness should produce documents if asked for. (5) If
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the witness fails to attend the Court in a civil case, he will be liable
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to pay damages, and in criminal case, fine or imprisonment. (6) The
witness will be excused from attending the court, if he has valid and
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urgent reason. (7) Criminal Courts have priority over Civil Courts
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and higher Courts have priority over lower. (8) If he is summoned
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from two courts of same status, he must attend the court from where
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he received the summons first, informing the other court about it.
medical Evidence : Evidence means, all legal means
which help to prove or disprove any matter in question.
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Direct evidence is evidence of a fact which is actually in issue,

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e.g. a prescription or a consent form. Indirect or circumstantial

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evidence is evidence of a fact which is not actually in issue, but which

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is derived from the circumstances. Hearsay evidence is any statement re

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made by any person other than the witness giving evidence in Court.
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Documentary evidence is of three types.

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(1) Medical certificates : (1) They refer to ill-health,

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insanity, age, death, etc. (2) They are accepted in a Court of law, only
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when they are issued by a qualified registered medical practitioner. (3)

A doctor is legally bound to give death certificate, stating the cause of
death without charging fee, if a patient being treated by him dies. (4)
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The doctor should not issue death certificate (a) without inspecting the
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body himself, and satisfying that the person is really dead, (b) if he is
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not sure of cause of death, (c) if there is least suspicion of foulplay.

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In such cases, the police should be informed. (5) Death certificate

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Ch-01.indd 3 04-03-2015 12:07:10 PM

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should not be delayed, even if the doctor’s fee is not paid. (6) Issuing
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or signing a false certificate is punishable.
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(2) Medicolegal reports : (1) They are reports prepared
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by a doctor usually in criminal cases, e.g, assault, rape, murder,

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poisoning, etc. (2) The injured person or dead body is examined,
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when there is a requisition from a police officer or Magistrate.
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(3) They consist of (a) facts observed on examination, and (b)
opinion drawn from the facts. (4) They are admitted as evidence
in court only when the doctor gives oral evidence under oath.
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(5) Exaggerated terms, superlatives, etc. should not be used. (6) The
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opinion should be based on the facts observed by the doctor. (7) The
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report will be given to the defence lawyer, as such care should be
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taken in writing the report. (8) The doctor should sign or initial at the
bottom of each page, if the report exceeds one page in length. (9) If
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immediate opinion is not possible, the patient should be kept under
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observation, and investigations done.
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(3) Dying declaration: It is a written or oral statement
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of a person, who is dying due to some unlawful act, relating to
the cause of his death. (1) A Magistrate should be called to record
the declaration. (2) The doctor should certify that the person is
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conscious and his mental faculties are normal. (3) If the patient’s
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condition is serious, the doctor, police, village headman, or any

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other person can record the D.D. in presence of two witnesses, but
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its evidential value is less. (4) Oath is not administered, because re

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it is believed that a dying person will only tell the truth. (5) It is
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recorded in the man’s own words. (6) Leading questions should not
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be put. (7) No influence or outside prompting should be permitted.

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(8) Questions may be put to make points clear. (9) The statement
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made must be of fact and not opinion. (10) If it is made in the form
of an opinion, questions should be put to bring out the facts. (11)
If the dying person is unable to speak, but is able to make signs in
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answer to questions, this can be recorded, which is considered as

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“verbal statement”. (12) The doctor and the witness should sign the
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declaration. (13) Even if the declarant was not under expectation of

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death, it is admissible in the court. (14) If the declarant survives, the

declaration is not admitted but has corroborative value.
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Legal Procedure 5
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Dying deposition is statement of a dying person on oath. It is
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superior to dying declaration, as it is recorded by the Magistrate, and
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the accused or his lawyer can cross-examine the dying person. This
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is not parcticed in India.

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Chain of custody of evidence: It is a method to verify the actual
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possession of an object from the time it was first identified until it
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is offered into evidence in the Court room. Each specimen when
obtained, should be labelled with the victim’s name, the time and
date, the nature of the specimen, identification number, and signed
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by the doctor. This information must be documented, each time the
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material is handled by another person, and that person must give
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receipt for the material and will be included in the chain of custody.
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The evidence must not be damaged, contaminated, or altered in any
significant way. The shorter the chain the better.
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Oral evidence : It is evidence which is given orally by witness
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under oath in a court of law. (1) It is more important than documentary
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evidence, as it admits cross-examination. (2) In all cases, it must
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m
be direct, i.e. evidence of a peroson who saw, heard or prceived
it. (3) A deaf and mute witness may testify by signs, by writing or
through interpreter. (4) If oral evidence refers to any material thing,
om
om
e.g, weapon, blood stained clothing, etc, it must be produced in the

co
court. (5) Documentary evidence is accepted by court only on oral

c
e.
e.
evidence by concerned person.

re
fre
Exceptions to oral evidence : (1) Dying declaration. (2) Expert re

sf
f
opinion expressed in a treatise. (3) Evidence of doctor recorded
ks
ks
k
in a lower Court. (4) Evidence given by a witness in a previous

oo
oo
oo
judicial proceeding. (5) Reports of Chemical Examiner. (6) Reports

eb
eb
eb
of Director of Central and State Forensic Science Laboratories. (7)

m
Reports of Director Finger print Bureau. (8) Report of Serologist to

Government.
Witnesses: (1) Common witness is a person who gives
om
evidence about the facts observed or perceived by him. He must

co
co
show that he was capable of perceiving the fact by one his own senses
e.
e.
and that he actually observed this fact. (3) This is known as “First-
fre
fre
fre
hand knowledge rule”, which may be used to establish the exact

circumstances of the case for the court.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-01.indd 5 04-03-2015 12:07:10 PM

e
e
m
m
om
m
co
co
e.
e.
(2) Expert witness is a person who has been trained or is
re
fre
fre
skilled in technical or scientific subject, and capable or drawing
sf
opinions and conclusions from the facts observed by himself, or
ks
ks
k
noticed by others, e.g doctor, fingerprint expert, handwriting

oo
oo
oo
expert, firearms expert, etc. (2) An expert witness may give his
eb
eb
eb
opinion (a) upon facts which are either admitted, or proved by himself
m
m
or other witnesses at the trial, (b) on matters of common knowledge,
(c) on hypothetical questions based thereon. (3) The main obligation
of an expert is to point out professional facts. (4) The opinion on a
om
m
key question must be given in a guarded manner using terms such as,
co
co
that the findings are consistent with an alleged form of trauma, such
e.
e.
as a fall aginst a hard object, or with the striking of the head with a
fre
fre
fre
blunt instrument. (4) An expert witness may refer to books to refresh
his memory or to correct or confirm his opinion. (5) A doctor can be
ks
ks
ks
both a common and expert witness.
oo
oo
oo
Hostile witness is one who is supposed to have some interest
eb
eb
eb
or motive for concealing part of truth, or for giving completely
m
m
false evidence. (2) The court will declare a witness as hostile on the
suggestion of the lawyer of the party who has summoned the witness or
prosecution lawyer. (3) A hostile witness can be cross- examined by
om
om
the same side lawyer. (4) Common or expert witness can be hostile.
co
Perjury means wilful giving of false evidence by witness while

c
e.
e.
under oath, or failure to tell what he knows or believes to be true

re
fre
(imprisonment up to 7 years). re
sf
f
Record of Evidence : (1) Oath: “I do swear in the name
ks
ks
k
of God (solmenly affirm in case of atheist) that what I shall state,

oo
oo
oo
shall be the turth, the whole truth, and nothing but truth.” (2) Oath
eb
eb
eb
is required by the law which is compulsory. (3) A chid below 12

m
years is not required to take an oath.

(2) Examination - in chief : (1) In this questions are put to the
witness by the lawyer for the side which has summoned him. (2)
om
In criminal trial, Public prosecutor first examines the witness. (3) The
co
co
object is to elicit all relevant medical facts, and the conclusions drawn
e.
e.
from these facts. (4) “Leading questions are not allowed”, except
fre
fre
fre
when witness is hostile. (5) The questions are short and demand
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-01.indd 6 04-03-2015 12:07:10 PM

e
e
m
m
om
m
co
co
Legal Procedure 7
e.
e.
some specific fact and short answer. (6) The answer can be given
re
fre
fre
in narrative form, if it would be more informative and convincing.
sf
A leading question is one which suggests to the witness the
ks
ks
k
answer desired, or which includes the answer implied in the question

oo
oo
oo
itself and admits of a conclusive answer by “Yes” or “No”.
eb
eb
eb
(3) Cross-examination : (1) The witness is questioned by the
m
m
lawyer of the opposite party, i.e. defence lawyer. (2) The main
objects are: (a) to elicit facts favourable to his case, (b) to test the
truthfulness of the statements made by witness, (c) to modify or
om
m
explain what has been said, (d) to develop new or old facts, (e) to
co
co
discredit the witness, (f) to remove any excessive emphasis, which
e.
e.
may have been given to any facts. (2) It need not be confined to the
fre
fre
fre
facts to which witness testified in exam-in-chief. (3) The competence,
credibility and character of the witness may be tested. (4) The judge
ks
ks
ks
can always disallow questions which are irrelevant, incriminating
oo
oo
oo
or scandalous, but if they are relevant to the matter, they cannot be
eb
eb
eb
disallowed. (5) Leading questions are permissible. (6) It has no
m
m
time limit. (7) It may act as double-edged sword, i.e. it may damage
both the prosecution and defence.
(4) Re-examination : (1) This is conducted by the lawyer who
om
om
has conducted examination-in-chief. (2) The objects are: (a) to

co
correct any mistake, (b) to clarify or to add details to statements the

c
e.
e.
witness has made in cross-examination. (3) The witness should not

re
fre
introduce any new subject. If he does so, he will be liable for cross- re
sf
f
examination again. (4) Leading questions are not allowed.
ks
ks
k
(5) Questions by Judge : At any stage of examination, the Judge

oo
oo
oo
may ask any questions to clear up doubts.

eb
eb
eb
Medicolegal Masquerades: Many cases of homicide

m
go undetected because of the lack of suspicion and improper or

inadequate investigation. All cases of death should be regarded as
unnatural, until proved otherwise. Violent deaths may show minimal
om
or no external evidence of injury, and conversely natural deaths can

co
co
occur under such circumstances as to suggest falsely that violence was

e.
e.
used. Accidental deaths and suicides can occur under circumstances

fre
fre
fre
which suggest homicide. In a suicide case, alterations may be made

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-01.indd 7 04-03-2015 12:07:10 PM

e
e
m
m
om
m
co
co
e.
e.
at the scene because of stigma. In a homicide case, the scene may
re
fre
fre
be altered or rigged to suggest that death resulted from suicide or
sf
ks
ks
accident. The doctor must look for any possible inconsistencies
k
between the apparent death scene and his actual scientific findings.
oo
oo
oo
In a case of hanging, the manner in which a ligature is applied to
eb
eb
eb
the neck, or the mode of suspension of a body may be determining
m
m
features in the circumstances. In such cases, the real cause of death
can be established by complete autopsy and police investigation.
conduct and duties of the doctor in witness
om
m
box : (1) Be well prepared. (2) Take all records. (3) Be relaxed
co
co
and calm. (4) Be pleasant, polite and courteous. (5) Never attempt
e.
e.
to memorise. Memory can be refreshed from copies of reports
fre
fre
fre
already submitted. (6) Answer briefly and precisely, but may be
qualified for accuracy and completeness. (7) Be confident. (8) Use
ks
ks
ks
simple language. (9) Avoid superlatives and exaggerations. (10) Do
oo
oo
oo
not evade a question. Say I do not know if it is so. (11) Be honest,
eb
eb
eb
impartial, unbiased. (12) Do not lose temper. (13) Give opinion
m
m
from your own knowledge and experience. (14) Do not volunteer
information which will be liable to cross-examination. Volunteer
only, if you think that injustice will occur if the statement is not made.
om
om
Scene of death : (1) Verify that a crime has been committed,

co
(2) look for signs of how it was committed, (3) recover and preserve
c
e.
e.
evidence.
re
fre
Disadvantages of doctor not visiting scene of crime are: (1) Fresh re

sf
f
abrasions may be produced on body during transit, (2) clothing will
ks
ks
k
be disarranged, and blood stains form on parts of clothes originally

oo
oo
oo
free from them, (3) fresh tears may be produced in clothing, (4) partial
eb
eb
eb
breaking of rigor mortis.

m
Warrant case means, offence punishable with death, imprisonment

for life, or for a term exceeding two years. Summons case is one in
which punishment is less than two years.
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-01.indd 8 04-03-2015 12:07:10 PM

e
e
m
m
om
m
co
co
e. 2
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Medical Law and Ethics
om
m
co
co
e.
e.
Medical ethics deals with moral principles which guide
fre
fre
fre
members of the medical profession in their dealings with each
ks
ks
ks
other, their patients and the State. Medical etiquette deals with the
oo
oo
oo
conventional laws of courtesy observed between members of the
eb
eb
eb
medical profession.
The modernised version of Hippocratic oath is the declaration
m
of Geneva (1948).
m
Homoeopathy Central Council Act, 1973: The act was passed
om
om
to regulate the profession of Homoeopathy and to constitute cetral

co
council. Its functions are almost similar to indian Medical Council.

c
Indian Medicine Central Council Act, 1970: It was enacted

e.
e.
to lay down minimum standards of education and practice of Indian

re
fre
system of medicine. It includes ayurveda, siddha, Unani and re

sf
f
ks
ks
Ashtang.
k
oo
oo
oo
Indian Medical Council Act, 1956: (1) Indian

eb
eb
eb
Medical Council consists of medical doctors elected from each State,

each University and some nominated by Central Government. (2) The
m
routine work is looked after by the Registrar. (3) The First shedule
of the Act contains medical qualifications granted by universities in
om
India, and the second schedule those granted outside India.

co
co
Functions of Indian Medical Council: (1) Medical Register:

In this names of all doctors who are enrolled on any State Medical
e.
e.
Register are entered.

fre
fre
fre
(2) Medical Education : (1) It prescribes standards of

ks
ks
ks
undergraduate and postgraduate medical education for the

oo
oo
oo
eb
eb
eb
m
Ch-02.indd 9 04-03-2015 12:07:21 PM

e
e
m
m
om
m
co
co
e.
e.
guidance of the universities. (2) It prescribes the minimum
re
fre
fre
standards of medical education required for granting recognised
sf
medical qualifications by universities or medical institutions in
ks
ks
k
India. (3) It appoints Medical Inspectors to report to the council on

oo
oo
oo
the adequacy of the standards of medical education including staff,
eb
eb
eb
equipment, accommodation, training and other facilities prescribed
m
m
for giving medical education and on the sufficiency of the every
examination they attended. (4) If the council is not satisfied with
the standards, it can represent to Central Government to withdraw
om
m
recognition of any medical qualification of any university. (5) Prior
co
co
approval of IMC is necessary before starting a medical college, and
e.
e.
for starting a P.G. medical course in any discipline.
fre
fre
fre
(3) Recognition of foreign medical qualifications on reciprocal
basis.
ks
ks
ks
(4) Appeal against Disciplinary action: If the name of any
oo
oo
oo
doctor is removed from State Medical Register, he can appeal to
eb
eb
eb
Central Government, which consults I.M.C. and gives decision, which
m
m
is binding on State Medical Council.
(5) Warning notice : It prescribes standards of professional
conduct, and a Code of Ethics for doctors. It can issue Warning
om
om
Notice containing certain practices, which are regarded as “serious

co
professional misconduct”.
c
e.
e.
State Medical Councils : They are autonomous bodies consisting

re
fre
of members elected by doctors of the state and some nominated by re

sf
f
State Government.
ks
ks
k
Functions: (1) Medical register: The registrar of the SMC grants

oo
oo
oo
a provisional registration to any person having any of the recognised

eb
eb
eb
medical qualification on payment of prescribed fee. After undergoing

m
a period of training, a permanent registration is given.

(2) Disciplinary Control: They have the power to remove the
names of medical practitioners, permanently or for a specific period
om
from their Register, when after due enquiry they are found guilty of
co
co
serious professional misconduct. They can also restore any name so

e.
e.
removed.
fre
fre
fre
(3) Warning Notice: They can issue warning notices similar to

MCI.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 10 04-03-2015 12:07:21 PM

e
e
m
m
om
m
co
co
Medical Law and Ethics 11
e.
e.
Erasure of name: The name of the doctor is removed from the
re
fre
fre
medical register: (1) after death of practitioner, (2) entries made
sf
wrongly or due to fraud, (3) Penal erasure (professional death
ks
ks
k
sentence) is done if the doctor is found guilty of serious professional

oo
oo
oo
misconduct. The doctor will lose the rights and privileges of a
eb
eb
eb
registered medical practitioner.
m
m
Serious professional misconduct (Infamous conduct in
professional respect): It is any conduct of doctor which may be
reasonably be regarded as disgraceful or dishonourable. The
om
m
conduct of doctor is judged by professional men of good repute and
co
co
competence. Duty of care and damage to patient need not be present.
e.
e.
Judicial Procedure of State Council: The proceedings are
fre
fre
fre
started when the doctor is convicted of a cognisable offence or a
complaint made by some person or society against the doctor. The
ks
ks
ks
council has the same powers as civil court. The executive committe
oo
oo
oo
considers the complaint, causes further investigation and takes
eb
eb
eb
legal advice. If no case is made out the complainant is informed
m
m
accordingly. Otherwise, a notice is issued to the practitioner, directing
him to answer the charge in writing and to attend before the council
on the appointed day. After conclusion of evidence, if the charge is
om
om
proved, the council votes again to decide whether the name should
co
be removed or the doctor should be warned.

c
e.
e.
Warning notice: The name of the medical practitioner

re
fre
can be removed from the Register for violation of Code of Medical re

sf
f
Ethics. Some examples are: (1) Adultery (voluntary sexual intercouse
ks
ks
k
between a married person and a person married or not, other than

oo
oo
oo
his or her spouse). (2) Advertisement. (3) Abortion (criminal). (4)

eb
eb
eb
Addiction (drug). (5) Issuing false certificate. (6) Conviction by court

m
of law. (7) Covering, i.e. assisting some one who has no medical
qualification to attend, treat or perform an operation on some person
in respect of matters requiring professional discretion or skill. (8)
om
Dichotomy or fee-splitting, i.e., receiving or giving commission to

co
co
a professional colleague, or a manufacturer or trader in drugs or a

e.
e.
chemist, dentist, etc. (9) Not giving information of notifiable diseases

fre
fre
fre
to health authorities. (10) Selling sheduled poisons to the public. (11)

Refusal to treat on religious grounds. (12) Drunk and disorderly so
ks
ks
ks
as to interfere with skilled practice of medicine.

oo
oo
oo
eb
eb
eb
m
Ch-02.indd 11 04-03-2015 12:07:21 PM

e
e
m
m
om
m
co
co
e.
e.
Rights and privileges of Registered Medical Practitioners:
re
fre
fre
Right to: (1) Choose a patient, (2) to practice medicine, (3) dispense
sf
ks
ks
medicine, (4) possess and supply dangerous drugs to patients, (5)
k
recovery of fees, (6) add title, description, etc. to his name, (7) issue
oo
oo
oo
medical certificates.
eb
eb
eb
Duties of Medical Practitioners: A doctor should
m
m
(1) Exercise reasonable degree of skill and knowledge in treating a
patient. (2) Furnish proper and suitable medicines or give a legible
prescription. (3) Give complete instructions to his patients or their
om
m
attendants regarding use of medicines and diet. (4) Warn patients of
co
co
the dangers involved in use of prescribed drug or device. (5) Attend
e.
e.
a patient as long as he requires treatment. (6) Warn the patient and
fre
fre
fre
third parties, if the patient suffers from infectious disease. (7) Inform
patient of risks. (8) Information should be given about communicable
ks
ks
ks
diseases, births, deaths, etc. to Public Health authorities. (9) Advise
oo
oo
oo
consultation with a specialist when required. (10) In case of poisoning,
eb
eb
eb
assist the police in determining whether the poisoning is accidental,
m
m
suicidal or homicidal. (11) Maintain professional secrecy.
professional Secrecy: (1) It is implied term of
contract between doctor and his patient. (2) Doctor should keep
om
om
secret all that he comes to know concerning the patient in the

co
course of his professional work. (3) If he discloses, it would be a

c
e.
e.
breach of trust and confidence, and the patient can sue the doctor for
re
fre
damages, if the disclosure is (a) voluntary, (b) has resulted in harm re

sf
f
to the patient, and (c) is not in the interest of the public.
ks
ks
k
Some examples are: Without the consent of patient, the doctor

oo
oo
oo
should not disclose the nature of illness of his patient (1) to others,
eb
eb
eb
(2) answer any enquiry by third parties, (3) any facts about the illness
m
to parents or relatives if he is a major, (4) about the illness even when

requested by a public or statutory body, except in case of notifiable
diseases, (5) even in the case of husband or wife to the other, (6)
om
to master even when he is paying the fees, (7) to the employer, (8)
co
co
Government, (9) undertrial prisoner.

e.
e.
A convicted person has no right to professional secrecy. Medical

fre
fre
fre
examination for taking life insurance policy is a voluntary act, and

consent to the disclosure of findings is implied.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 12 04-03-2015 12:07:21 PM

e
e
m
m
om
m
co
co
e.
e.
Privileged Communication: (1) It is a bonafied
re
fre
fre
statement made upon any subject matter, by a doctor to the
sf
concerned authority, due to his duty to protect the interest of the
ks
ks
k
community or of State. (2) To be privileged, the communication

oo
oo
oo
must be made to a person having interest in it, or in reference of
eb
eb
eb
which he has a duty. (3) The privilege fails, if made to more than
m
m
one person, or a person who has no direct interest in it. (4) The
doctor should first persuade the patient to get his consent before
notifying proper authority. Examples of privileged communication,
om
m
or exceptions to professional secrecy are: (1) A cook or waiter in
co
co
hotel, a teacher, children’s nurse, etc. suffers from infectious disease.
e.
e.
(2) If a bus-driver suffers from epilepsy, high blood pressure,
fre
fre
fre
alcoholism, drug addiction, or colour blindness. (3) Notify births,
deaths, infectious diseases, etc. to Public Health authorities. (4) A
ks
ks
ks
person suffering from venereal disease, if he tries to use swimming
oo
oo
oo
pool. (5) If the doctor treats a patient involved in a suspected crime.
eb
eb
eb
(6) Self-interest: In civil and criminal actions by patient against
m
m
doctor. (7) Patient’s interest: If patient suffers form melancholia,
suicidal tendencies, etc. (8) Courts of Law: Doctor has no privilege
in a Court of Law, if it is relevant to inquiry.
om
om
Crimes: A doctor who is aware of commission of crime by his

co
patient, such as murder, docoity, waging war against Govt., etc. is

c
e.
e.
legally bound to report them to the nearest Magistrate or police officer

re
fre
(S.39, Cr.P.C., S.176, I.P.C.). re

sf
f
Duties of Patient: (1) he should give complete history about his
ks
ks
k
illness. (2) Follow instructions of the doctor as regards medicines,

oo
oo
oo
diet, mode of life, etc. (3) Pay a reasonable fee to doctor.

eb
eb
eb
Rights of Patient: Every patient has right to: (1) choose his own
m
doctor, (2) access to health care facilities, (3) to be treated with care,
respect and dignity, (4) privacy during therapy, (5) confidentiality
about his illness, (6) to receive full information about his disease, (7)
om
to know day to day progress, (8) to consent or refuse any specific

co
co
measure, (9) consultation, (10) access to his records, (11) to receive

e.
e.
continuous care of his illness, (12) to complain for redressal of

fre
fre
fre
grievances, (13) obtain compensation for medical negligence.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 13 04-03-2015 12:07:21 PM

e
e
m
m
om
m
co
co
e.
e.
Professional Negligence (Malpraxis):
re
fre
fre
Professional negligence is the absence of reasonable care and skill,
sf
or wilful negligence of medical practitioner, in the treatment of
ks
ks
k
a patient which causes his bodily injury or death.

oo
oo
oo
(1) Civil negligence: It arises: (1) When a patient sues a doctor
eb
eb
eb
for compensation, if he has suffered injury. (2) When a doctor sues
m
m
a patient for realisation of his fees.
Liability arises if the following conditions are satisfied: (1) Duty:
Existence of duty of care by doctor. (2) Dereliction: Failure of the
om
m
doctor to maintain care and skill. (3) Direct causation: Failure to
co
co
exercise a duty of care must lead to damage (proximate cause). (4)
e.
e.
Damage: Damage which results must be reasonably foreseen.
fre
fre
fre
If no damage has occurred, the patient cannot sue a doctor for
negligence. The patient must suffer some loss, e.g. (1) Loss of earning
ks
ks
ks
due to absence from work, or reduction of his ability to work. (2)
oo
oo
oo
Reduction in expectation in life. (3) Loss of limb or sense. (4) Pain
eb
eb
eb
and suffering. (5) Loss of potency. (6) Death.
m
m
Examples of Negligence: Failure to (1) obtain informed consent,
(2) examine patient himself, (3) attend the patient, (4) immunise
patient or to do sensitivity tests, (5) give proper post-operative care,
om
om
(6) warn patient of side-effects, (7) give proper instructions, (8) obtain
co
consultation when necessary, (9) keep abreast of advances in medical

c
e.
e.
sciences, (10) making wrong diagnosis due to absence of care and

re
fre
skill, (11) giving overdose or giving poisonous medicines carelessly, re

sf
f
(12) if his negligence causes others to catch a disease from his patient.
ks
ks
k
The doctor is not negligent for (1) An error of judgement or

oo
oo
oo
diagnosis, if he has secured all necessary data. (2) failure to cure

eb
eb
eb
or bad results, that may follow, if he has exercised reasonable care

m
and skill.
The doctors are expected to be well-informed of new developments
and to follow general lines of treatment. The degree of competence
om
varies according to the status of the doctor, i.e. house surgeon, general
co
co
practitioner, specialist.
e.
e.
Res ipsa loquitur: (1) It means “the thing or fact speaks

fre
fre
fre
for itself. (2) Conditions to be satisfied: (a) The injury would not have
occurred in the absence of negligence. (b) The doctor had exclusive
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 14 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
control over injury-producing treatment. (c) The patient was not guilty
re
fre
fre
of contributory negligence. (3) In such cases medical evidence is
sf
not necessary to prove negligence of the doctor. (4) This is applied
ks
ks
k
both to civil and criminal negligence.

oo
oo
oo
Examples: (1) Failure to give anti-tetanic serum in cases of injury
eb
eb
eb
causing tetanus. (2) Burns from use of hot water bottles or from X-ray
m
m
therapy. (3) Prescribing overdose of medicine producing ill-effects.
(4) Breaking of needles. (5) Blood transfusion misadventure. (6) Loss
of use of hand due to prolonged splinting.
om
m
Medical maloccurrence: Inspite of good medical attention and
co
co
care, patient fails to respond properly in some cases.
e.
e.
Novus Actus interveniens (unrelated action intervening):
fre
fre
fre
(1) “A person is responsible for his actions, and also for its logical
consequences”. (2) This principle applies to cases of assualt and
ks
ks
ks
accidental injury. (3) In these cases, if doctor is negligent in treatment
oo
oo
oo
of the patient, he becomes liable, e.g. leaving a swab or a surgical
eb
eb
eb
instrument in the abdomen after the repair of an internal injury,
m
m
accidental substitution of poisonous drug for therapeutic drug, etc.
(2) Criminal negligence: It arises: (1) When a doctor shows,
gross absence of skill or care during treatment resulting in serious
om
om
injury to or death of patient, (2) when doctor performs an illegal act,

co
(3) when assaulted person dies, defence may attribute death due to
c
e.
e.
negligence of doctor.
re
fre
Conditions to be satisfied: (1) Indifference to an obvious risk re

sf
f
of injury to health. (2) Actual foresight of the risk, but continuation
ks
ks
k
of the same treatment. (3) Appreciation of the risk and intention to

oo
oo
oo
avoid it, but showing a high degree of negligence in the attempted

eb
eb
eb
avoidance. (4) Inattention or failure to avoid a serious risk.

m
(1) It is practically limited to cases in which the patient has died.

(2) Most of such cases occur with drunkenness or with impaired
efficiency due to the use of drugs by doctors. (3) Death resulting
om
from injection of any drug producing anaphylaxis or by performing

co
co
an operation by a quack is considered criminal negligence.

e.
e.
Examples: (1) Amputation of wrong finger or operation on wrong

fre
fre
fre
patient or limb. (2) Leaving swabs, instruments, etc. in abdomen. (3)

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 15 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
Performing criminal abortion. (4) Administration of wrong substance
re
fre
fre
into eye causing loss of vision.
sf
ks
ks
The doctor is prosecuted by the police in a criminal Court under
k
S.304, A.I.P.C. (causing death by rash or negligent act, punishable

oo
oo
oo
with imprisonment up to 2 years). The prosecution must prove all
eb
eb
eb
facts to establish civil negligence (except monetary loss) and gross
m
m
negligence and disregard for life and safety of patient. Contributory
negligence is not a defence in criminal negligence.
Difference between civil negligence and criminal negligence
om
m
co
co
Trait Civil negligence Criminal negligence
(1) Offence: No specific and clear Must have specifically
e.
e.
violation of law need violated a particular
fre
fre
fre
be proved. criminal law in
question.
ks
ks
ks
(2) Negligence: Simple absence of Gross negligence,
oo
oo
oo
care and skill. inattention or lack of
eb
eb
eb
competency.
(3) Conduct of Compared to a generally Not compared to a
m
physician: accepted simple standard single test.

of professonal conduct. m
(4) Consent for act: Good defence; cannot Not a defence; can be
om
om
recover damages. prosecuted.

co
c
(5) Trial by: Civil Court. Criminal Court.

e.
e.
(6) Evidence: Strong evidence is Guilt should be proved

re
fre
sufficient. beyond reasonable re

sf
f
doubt.
ks
ks
k
(7) Punishment: Liable to pay damages. Imprisonment.

oo
oo
oo
Difference between professional negligence and infamous conduct

eb
eb
eb
Trait Professional negligence Infamous conduct

m
(1) Offence: Absence of care and skill Violation of Code of

or wilful negligence. Medical Ethics.
(2) Duty of care: Should be present. Need not be present.
om
(3) Damage to Should be present. Need not be present.

co
co
person:
e.
e.
(4) Trial by: Court; civil or criminal. State Medical Council.

fre
fre
fre
(5) Punishment: Fine or imprisonment. Erasure of name or

warning.
ks
ks
ks
(6) Appeal: To higher Court. To State and Central

oo
oo
oo
Government.
eb
eb
eb
m
Ch-02.indd 16 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
If a doctor performs an unauthorised operation on a patient, he
re
fre
fre
may be sued in a Civil Court for damages and prosecuted in Criminal
sf
ks
ks
Court for assault.
k
Contributory negligence: It is any unreasonable conduct

oo
oo
oo
or absence of ordinary care on the part of patient, which combined
eb
eb
eb
with doctor’s negligence contributed to injury as a direct, proximate
m
m
cause and without which the injury would not have occurred.
Examples: (1) Failure to give the doctor correct medical history.
(2) Refusal to take suggested treatment. (3) Failure to follow
om
m
instructions. (4) Leaving the hospital against advice. (5) Failure to
co
co
seek further medical assistance if symptoms persist.
e.
e.
Defence: (1) It is good defence if both doctor and patient are
fre
fre
fre
negligent at the same time. (2) The doctor has to prove it. (3)
Normally, it is only a partial defence, and the damages awarded vary,
ks
ks
ks
depending on the negligence of each party.
oo
oo
oo
Negligence Prevention: (1) Establish good rapport with the
eb
eb
eb
patient, his family, fellow physicians and paramedical staff. (2)
m
m
Rationale: Carry necessary investigations to make the correct
diagnosis and formulate treatment. (3) Maintain complete, accurate,
legible medical records. (4) Obtain informed consent. (5) Establish
om
om
hospital injury prevention programme. (6) Respect. Treat the

co
patient as the physician would wish himself or a member of his

c
e.
e.
family to be treated. (7) Risks: Inform the patient of all side-effects

re
fre
and anticipated risks, and treat them promptly. (8) participate in re

sf
f
medico-legal seminars.
ks
ks
k
Defences against negligence: (1) No duty owed to patient. (2)

oo
oo
oo
Duty discharged according to prevailing standards. (3) Misadventure.

eb
eb
eb
(4) Error of judgement. (5) Contributory negligence. (6) Res judicata,

m
i.e. if a question of negligence against a doctor has already been

decided by a court, the patient cannot contest the same in another
proceeding. (7) Limitation (case to be filed within two years).
om
Therapeutic misadventure: (1) It is a case in which

co
co
patient is injured or had died, due to some unintentional act by

e.
e.
a doctor or hospital. (2) Almost every therapeutic drug and every

fre
fre
fre
therapeutic procedure can cause death. (3) Ignorance of the possibility

of a reaction or continuation in the prescribing of drug with adverse
ks
ks
ks
reaction is negligence.
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 17 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
Examples: (1) Fatal hypersensitivity reaction caused by
re
fre
fre
penicillin, aspirin, tetracyclin, etc. (2) Prolonged use of stilboesterol
sf
ks
ks
may cause breast cancer. (3) Electric equipment may produce burns.
k
(4) Blood transfusion reactions. (5) Excessive dose of an antidote to

oo
oo
oo
poisoned patient may cause death.
eb
eb
eb
Vicarious liability (liability for act of another): An employer is
m
m
responsible for his own negligence and also for the negligence of his
employees, if such acts occur in the course of employment and within
its scope. This is based on the principle of respondent superior (let
om
m
the master answer).
co
co
Three conditions must be satisfied: (1) There must be an
e.
e.
employer-employee relationship. (2) The employee’s conduct must
fre
fre
fre
occur within the scope of his employment. (3) While on the job.
Examples: (1) In general practice, the principal doctor becomes
ks
ks
ks
responsible for his assistant’s negligence. (2) The doctor will be
oo
oo
oo
responsible for negligence of his non-medical servants. (3) When two
eb
eb
eb
doctors practice as partners, each is liable for negligence of other.
m
m
(4) If a sponge, instrument, etc. is left in the patient’s body after
operation, the surgeon becomes liable. (5) A hospital is responsible
for the negligence of its employees. (6) A hospital is responsible for
om
om
mistakes of resident physicians and interns. (7) Borrowed servant

co
doctrine: The nurse employed by the hospital to assist in operations

c
e.
e.
may be borrowed servant of the independent operating surgeon during

re
fre
operation, and the servant of the hospital for all other purposes. In re
sf
f
this case, the surgeon will be liable for the negligence of the nurse.
ks
ks
k
Products liability: (1) It refers to physical agent which

oo
oo
oo
caused injury or death of patient during treatment by the doctor.

eb
eb
eb
(2) The injury or death may be due to faulty, defective, negligent

m
design, manufacture, assembly, packing of medical or surgical

instruments, or inadequate operating instructions. (3) If the doctor
can prove this, the manufacturer becomes responsible for injury
om
or death. (4) The manufacturer of medicines is liable if a patient is

co
co
injured due to a drug reaction, negligence or breach of warranty, or

e.
e.
contamination of drug. (5) The doctor has to prove that a defect in

fre
fre
fre
the product existed before it left the manufacturer’s hands and that
the defect was the proximate cause of the patient’s harm. (6) If the
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 18 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
physician or hospital misuses manufacturer’s medical products, they
re
fre
fre
become liable. (7) Products liability cases may be brought against
sf
ks
ks
manufacturers, sellers or anyone in the chain of sale.
k
Both the employer and the employee are sued by the patient. The
oo
oo
oo
employer may be ordered by the court to pay compensation. The
eb
eb
eb
employer can engage in “third party proceeding” against the negligent
m
m
doctor or employee asking for repayment.
Medical indemnity insurance: It is contract under
which the insurance company, in exchange for the payment of
om
m
premiums, pays compensation to the patient, for the professional
co
co
negligence of the doctor. In addition: (1) It looks after and protects
e.
e.
professional interest of doctor. (2) Arranges, conducts and pays for
fre
fre
fre
the doctr. (3) Arranges all other professional assistance.
Euthanasia (Mercy Killing): It means causing painless death to
ks
ks
ks
a person suffering from hopelessly incurable and painful disease.
oo
oo
oo
It advocates administration of lethal doses of opium or other narcotic
eb
eb
eb
drugs. It has no legal sanction.
m
m
Types: (1) Active euthanasia is an intentional act (act of
commission), e.g. giving large doses of drugs to hasten death. (2)
Passive euthanasia is discontinuing or not using extraordinary life-
om
om
sustaining measures to prolong life (acts of omission). (3) Voluntary

co
euthanasia means at the will of the person. (4) Involuntary means

c
e.
e.
against the will of the person, i.e. compulsory. (5) Non-voluntary

re
fre
means person incapable of making their wishes known, e.g. persons re

sf
f
in coma.
ks
ks
k
Consent in medical practice: Consent means

oo
oo
oo
voluntary agreement, compliance or permission.

eb
eb
eb
Kinds: (1) Express: specifically stated by the patient. It may

m
be verbal, or written. (2) Implied: Consent is implied when: (1)

patient attends hospital, (2) calls doctor to his house complaining of
illness, (3) patient holds out his arm for injection. Express consent is
om
required for collection of blood, giving an injection, blood transfusion,

co
co
anaesthesia, operation, etc.

e.
e.
Informed consent: It implies an understanding by the patient of:

fre
fre
fre
(1) The nature of his condition, (2) the nature of proposed treatment,
(3) the alternative procedure, (4) risks and benefits involved in
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 19 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
both proposed and alternative procedure, (5) the risks of not taking
re
fre
fre
treatment, (6) the relative chances of success or failure of both
sf
ks
ks
procedures.
k
Full disclosure: In general, patient should be told everything, as

oo
oo
oo
in informed consent.
eb
eb
eb
Therapeutic privilege: (1) This is an exception to rule of full
m
m
disclosure. (2) In case where the patient is emotionally disturbed
and fearful, he may refuse treatment if full disclosure is done. (3)
In such case, the risk should be explained to the patient’s spouse or
om
m
next of kin.
co
co
Paternalism: The doctor does not disclose all the facts to the
e.
e.
patient, so that the patient is unable to make a rational choice. It
fre
fre
fre
deprives the patient of his autonomy, or of his ability to make a
rational choice.
ks
ks
ks
Reasons for obtaining consent: (1) To examine, treat or operate
oo
oo
oo
upon a patient without consent is assault in law. (2) If there is no
eb
eb
eb
informed consent the doctor may be sued for negligence.
m
m
Rules of consent: (1) Written consent should refer to one specific
procedure, and not blanket permission. It helps if the patient sues
the doctor. (2) Oral consent should be obtained in the presence of a
om
om
third party. (3) Any procedure beyond routine physical examination

co
requires express consent. (4) The consent should be voluntary, free,

c
e.
e.
direct and informed. (5) In criminal cases and sexual offences, the
re
fre
victim’s consent is necessary for examination. (6) If a person is re

sf
f
arrested for an offence, and sub-inspector of police gives requisition,
ks
ks
k
the doctor can examine such person without consent, even by using
oo
oo
oo
reasonable force. In case of female, a lady doctor should examine

eb
eb
eb
(S.53, Cr.P.C.). (7) A prisoner can be treated without consent. (8)

m
Consent given for committing an illegal act, such as abortion is not

valid. (9) A person above 18 years can give valid consent to suffer any
harm from an act done in good faith (S.87 & 88, I.P.C.). (10) A child
om
under 12 years and an insane person cannot give valid consent (S.89,
co
co
I.P.C.). (11) A consent given by a person under fear of injury, or under

e.
e.
misconception of a fact or by intoxicated person is not valid (S.90,

fre
fre
fre
I.P.C.). (12) In an emergency, the patient can be treated or operated,

if the person cannot give consent (as in coma, shock, etc) (S.92,
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 20 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
I.P.C.). (13) Loco parentis: In an emergency involving children,
re
fre
fre
if parents are not available, consent is taken from person-in-charge
sf
ks
ks
of child, e.g. warden of a hostel, headmaster of a residential school,
k
etc. (14) Professional secrets cannot be revealed without consent of

oo
oo
oo
the patient. (15) When an operation is made compulsory by law, e.g.
eb
eb
eb
vaccination, law provides consent. (16) Consent of one spouse is not
m
m
necessary for an operation or treatment of other. (17) Consent is not
a defence in cases of professional negligence. (18) Organs of dead
persons cannot be removed for transplantation, without the consent of
om
m
legal heirs, even though the person has consented before death. (19)
co
co
Pathological autopsy should not be conducted without the consent of
e.
e.
legal heirs. (20) For medicolegal autopsies (statutory authorisation)
fre
fre
fre
consent is not required.
Medical records: Objects: (1) To serve as the basis for
ks
ks
ks
patient’s care and for continuity of treatment. (2) To serve as
oo
oo
oo
documentation for reimbersement. (3) To provide data for use in
eb
eb
eb
medical education and clinical research. (4) To assist in protecting
m
m
legal interests of patient and the doctor. (6) To follow up the patients
and evaluation of drug therapy.
Patient has a right to know what is in his records, and is entitled
om
om
to a copy of his hospital record on discharge on payment.

co
Malingering (shamming): (1) It means conscious, planned

c
e.
e.
feigning or pretending of a disease for the sake of gain. (2) The

re
fre
diseases that might br feigned are many, e.g. ophthalmia, dyspepsia, re

sf
f
intestinal colic, spitting of blood, ulcers, burns, rheumatism, lumbago,
ks
ks
k
neurasthenia, aphasia, sciatica, vertigo, epilepsy, insanity, artificial

oo
oo
oo
bruises, etc. (3) Patients can distort or exaggerate their symptoms

eb
eb
eb
which do not conform to any known disease. (4) The history of

m
the case should be taken from the person himself, and his relatives
or friends. (5) It can be diagnosed by keeping the person under
observation and watching him without his knowledge.
om
Consumer Protection Act (cpa) 1986: (1) It provides for

co
co
the protection of the interests of the consumer, and simple redressal

e.
e.
to consumers disputes. (2) District Forum, State Commission, and

fre
fre
fre
Central Commission are quasi-judicial bodies, and they are deemed

to be Civil Courts which observe the principles of natural justice.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 21 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e.
e.
District forum entertains claims up to 20 lakhs, State Commission
re
fre
fre
between 20 lakhs to one crore and national Commision over rupees
sf
ks
ks
one crore. (3) The consumer can file a complaint within two years for
k
any defect or deficiency of service in any product. (4) The dispute is

oo
oo
oo
settled on the basis of evidence provided by the parties. (5) Doctors
eb
eb
eb
and hospitals can be sued for medical negligence, provided the service
m
m
has not been given free. (6) The patient is required to pay fixed court
fee. (7) The cases are settled within three months. (8) The defect is
that the doctor cannot produce medical expert as witness to defend
om
m
himself. (9) Non-compliance of the order by the doctor, trader, etc.,
co
co
may be imprisonment ranging from one month to three years. (10) If a
e.
e.
person is aggrieved by the decision of District Forum, he can appeal to
fre
fre
fre
State Commission within 30 days from the date of order. (11) Further
appeal lies with National Commission and finally Supreme Court.
ks
ks
ks
Transplantation of Human Organs Act, 1994: objects: (1) to
oo
oo
oo
prevent live unrelated transplants, (2) in live related transplant, the
eb
eb
eb
donor and recipient should be genetically related, except in cases of
m
m
prior approval of Authorisation Committee, (3) it accepts brainstem
death criterion, (4) death should be certified by a panel of experts.
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-02.indd 22 04-03-2015 12:07:22 PM

e
e
m
m
om
m
co
co
e. 3
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Identification
om
m
co
co
e.
e.
Identification is recognition of an individual based on certain
fre
fre
fre
physical characters, which are unique to the individual.
ks
ks
ks
Corpus delicti: (body of offence, essence of crime): It means
oo
oo
oo
the elements of any criminal offence, e.g. murder. The main part
eb
eb
eb
is the determination of identity of the dead body and causing of
violence in a particular way, at a particular time and place, which
m
m
are conclusive of death by foul play, by the persons charged with
the crime. It also includes a bullet or a broken knife-blade found in
om
om
the body, clothing and photographs of the deceased showing fatal

co
injuries. The identification of a dead body and proof of corpus delicti

c
is important before a sentence is passed in murder trials.

e.
e.
Maximum breadth of skull

re
fre
Race : Cephalic index =

Maximum length of skull
× 100 re
sf
f
ks
ks
k
oo
oo
oo
Type of skull Cephalic Index Race

Dolico-cephalic (long-headed) 70 to 75 Aryans, aborgines
eb
eb
eb
Negroes.
m
Mesati-cephalic (medium-headed) 75 to 80 Europeans and

Chinese.
Brachy-cephalic (short-headed) 80 to 85 Mongolian.
om
Sex: Sex chromatin is a small plano-convex mass (Barr body),

co
co
which lies near nuclear membrane in the cell. Usually buccal smear
e.
e.
is used for sex determination. It is found in 20 to 80% of cells in

fre
fre
fre
females and 0 to 4% in males.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 23 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
Characters of both sexes (in varying degree) are
Intersex:
re
fre
fre
present in one individual including physical form, reproductive
sf
organs and sexual behaviour. It occurs due to some defect in
ks
ks
k
embryonic development.
oo
oo
oo
(1) Gonadal agenesis: Nuclear sex is negative. The testes or
eb
eb
eb
ovaries have never developed.
m
m
(2) Gonadal dysgenesis: External sexual structures are present,
but at puberty testes and ovaries fail to develop. (A) Klinefelter’s
syndrome: Anatomical structure is male, but nuclear sexing is
om
m
female (chromatin positive). The sex chromosome pattern is XXY
co
co
(47 chromosomes). (B) Turner’s syndrome: Anatomical structure
e.
e.
is female, but nuclear sexing is male (chromatin negative). Sex
fre
fre
fre
chromosome pattern XO (45 chromosomes). Ovaries do not contain
primordial follicles (ovarian dysgenesis).
ks
ks
ks
(3) True hermaphroditism (bisexuality). : An ovary and testis
oo
oo
oo
or two ovotestis are present with external genitalia of both sexes.
eb
eb
eb
Traits diagnostic of sex
m
Trait Male
Skull
Female
m
om
om
(1) General size: Larger, longer, Smaller, lighter,

rounded. rounded.
co
c
(2) Capacity: 1500 to 1550 ml. 1350 to 1400 ml.

e.
e.
(3) Architecture: Rugged. Smooth.

re
fre
(4) Forehead: Steeper, less rounded. Vertical, round, full, re

sf
f
ks
ks
infantile.
k
oo
oo
oo
(5) Orbits: Square, lower, Rounded, higher,

relatively smaller, relatively larger,
eb
eb
eb
rounded margins. sharper margins.

m
(6) Cheek bones: Heavier, laterally Lighter, more

arched. compressed.
(7) Zygomatic arch: More pronounced. Less pronounced.
om
(8) Occipital area: Protuberance marked. Protuberance not

co
co
marked.
e.
e.
(9) Mastoid process; Medium to large, Small, medium,

round, blunt. smooth, pointed.
fre
fre
fre
(10) Palate: Large, broader, Small, parabola.

ks
ks
ks
U-shape.
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 24 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 25
e.
e.
Pelvis
re
fre
fre
(1) Bony frame work: Massive, rougher; Less massive, gracile,
sf
ks
ks
stands higher and smoother.
k
more erect.
oo
oo
oo
(2) General: Deep funnel. Flat bowl.
eb
eb
eb
(3) Ilium: Less vertical; curve More vertical; distance
m
m
of iliac crest reaches between iliac crests
higher level and is is less; iliac fossae
more prominent. shollow; curve of crest
well-marked.
om
m
(4) Preauricular Not frequent, narrow, More frequent, broad,
co
co
sulcus: shallow. and deep.
e.
e.
(5) Acetabulum: Large, directed Small directed
fre
fre
fre
laterally. anterolaterally.
ks
ks
ks
(6) Obturator Large, often oval with Small, triangular with
foramen: base upwards. apex forwards.
oo
oo
oo
(7) Greater sciatic Lower, deeper. Larger, wider,
eb
eb
eb
notch: shallower.
m
m
(8) Ischial tuberosity: Inverted. Everted.
(9) Body of pubis: Narrow, triangular. Broad, square.
(10) Subpubic angle: V-shaped, sharp angle U-shaped, rounded,
om
om
70° to 75°. broader angle 90° to

co
100°.
c
(11) Pelvic brim or Heart-shaped. Circular or elliptical;

e.
e.
inlet: more spacious;

re
fre
diameters longer. re
sf
f
ks
ks
(12) Pelvic cavity: Conical and funnel- Broad and round.
k
shaped.
oo
oo
oo
(13) Sacroiliac Larger extends to small, oblique, extends

eb
eb
eb
articulation: two- and- half to three 2 to two-and-half

vertebrae. vertebrae.
m
(14) Sacrum; Longer, narrower, Shorter, wider; upper

with more evenly half almost straight,
distributed curvature; curve forward in lower
om
promontory well half; promontory less

co
co
marked. Body of first marked. Body of first

e.
e.
sacral vertebra larger. sacral vertebra small.

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 25 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
(4) Pseudohermaphroditism: Gonadal tissue of only one
re
fre
fre
sex is seen, but external appearance is of opposite sex. (A) Male
sf
pseudohermaphroditism: Nuclear sex is XY, but sex organs
ks
ks
k
and characteristics deviate to female form, because of testicular

oo
oo
oo
feminisation. (B) Female pseudo-hermaphroditism: Nuclear sex
eb
eb
eb
is XX, but sex organs and characters deviate towards male, due to
m
m
adrenal hyperplasia.
Skeleton: Before puberty, bones do not show sex differences
except pelvis, and accuracy from this bone is 75 to 80%. Sex is
om
m
determined mainly from pelvis, skull, sternum and long bones.
co
co
Male skeleton weighs 4.5 kg. and female 2.75 kg. Accuracy; Entire
e.
e.
skeleton 100%, pelvis 95%, skull alone 90%, pelvis + skull 98%,
fre
fre
fre
long bones alone 80%. Ischiopubic index, sciatic notch index, and
strenal index are more in female, but corporobasal index of sacrum
ks
ks
ks
is less. Greater sciatic notch is the ideal feature to determine the
oo
oo
oo
sex of a female child.
eb
eb
eb
Age: Age is determined from: (1) teeth, (2) ossification of bones,
m
m
(3) secondary sex characters, (4) general development (children).
Teeth: (1) At birth, rudiments of all temporary teeth and of
first permanent molars are found in the jaws. (2) Root formation
om
om
begins after completion of crown and as root becomes longer, crown

co
erupts and comes out of jaw. (3) During eruption of permanent tooth,
c
e.
e.
overlying root of its deciduous predecessor gradually undergoes

re
fre
resorption, due to which unsupported crown is shed. re

sf
f
Temporay (deciduous) teeth are 20 : (1) 4 incisors, 2 canines and
ks
ks
k
4 molars in each jaw. (2) Dentition may be delayed in ill-nourished

oo
oo
oo
children, especially in rickets. (3) In syphilis eruption is early, or

eb
eb
eb
even present at birth. (4) Spacing between teeth is seen at 4 years. (5)
m
First permanent molar teeth erupt behind second temporary molars

between 6 to 7 years. (6) After this temporary teeth begin to shed.
(7) Mixed dentition is present from 6 to 12 years.
om
Permanent teeth are 32. (1) 4 incisors, 2 canines, 4 premolars,

co
co
6 molars in each jaw. (2) Superadded permanent teeth erupt behind

e.
e.
temporary teeth. All the permanent molars are superadded. (3)

fre
fre
fre
Successional permanent teeth erupt in place of deciduous teeth. (4)

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 26 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 27
e.
e.
Permanent premolars erupt in place of deciduous molars. (5) In both
re
fre
fre
deciduous and permanent teeth, dentition occurs earlier by about
sf
one year in lower jaw, except lateral incisors. (6) Third molar first
ks
ks
k
erupts on the left side of lower jaw. (7) The dental and skeletal
oo
oo
oo
ages are almost same in the male, but in the female skeletal age
eb
eb
eb
is usually one year ahead of the dental age. (8) Eruption occurs
m
m
earlier in warmer climates and in urban areas. (9) Eruption of
temporary teeth is more regular than permanent. (10) Eruption
is not always bilaterally symmetrical. (11) Heredity, environment,
om
m
endocrine reactions and nutrition affect eruption and calcification.
co
co
(12) In ill-nourished children and rickets, dentition is delayed, but
e.
e.
in syphilis dentition appears early or may be present at birth. (13)
fre
fre
fre
Stunted and notched upper central incisors are seen in syphilis.
ks
ks
ks
Deciduous tooth Eruption Resorption of Calcification of
oo
oo
oo
root begins root completed
Central incisor:
eb
eb
eb
Lower: 06 to 08 months 4th year 1.5 to 2 years
m
m
Upper: 07 to 09 months 5th year 1.5 to 2 years
Lateral incisor:
Upper: 07 to 09 months 5th year 1.5 to 2 years
om
om
Lower: 10 to 12 months 5th year 1.5 to 2 years

co
c
First molar: 12 to 14 months 6th year 2 to 2.5 years

e.
e.
Canine: 17 to 18 months 8th year 2.5 to 3 years

re
fre
Second molar: 20 to 30 months 7th year 3 years re

sf
f
ks
ks
k
Premanent tooth Eruption Calcification

oo
oo
oo
completed
eb
eb
eb
First molar 06 to 07 years 09 to 10 years

Central incisor 06 to 08 years 10 years
m
Lateral incisor 07 to 09 years 11 years

First bicuspid 09 to 11 years 12 to 13 years
om
Second bicuspid 10 to 12 years 12 to 14 years

co
co
Canine 11 to 12 years 12 to 13 years

e.
e.
Second molar 12 to 14 years 14 to 16 years

fre
fre
fre
Third molar 17 to 25 years 18 to 25 years

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 27 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
Difference between temporary and permanent teeth
re
fre
fre
Trait Temporary teeth Permanent teeth
sf
ks
ks
(1) Size: Smaller, lighter, Haevier, stronger,
k
oo
oo
oo
narrow, except broader, except
temporary molars permanent premolars
eb
eb
eb
which are longer than replacing temporary
m
m
permanent premolars molars.
replacing them.
(2) Direction: Anterior teeth are Anterior teeth are
om
m
vertical. usually inclined a little
forward.
co
co
(3) Crown: China-white colour. Ivory-white colour.
e.
e.
(4) Neck: More constricted. Less constricted.
fre
fre
fre
(5) Root: Roots of molar smaller Roots of molars
ks
ks
ks
and more divergent. are larger and less
oo
oo
oo
divergent.
(6) Ridge: A ridge or thick edge No ridge.
eb
eb
eb
at the junction of the
m
m
crown with the fangs
present.
Temporary teeth are smaller, lighter, narrower, china-white
om
om
colour, neck is more constricted, and a ridge is seen at junction of

co
crown with root.

c
e.
e.
Permanent teeth are (1) heavier, stronger, broader, ivory-white

re
fre
colour, neck is less constricted, no ridge at junction of crown with re

sf
f
ks
ks
root. (2) Permanent incisors and canines have single root, premolars
k
one or two, and upper molars 3, and lower molars two roots. (3) The
oo
oo
oo
crown of incised is chisel-shaped, canine large and conical, premolars

eb
eb
eb
circular and molars cubicle. (4) The chewing surface of premolars

m
have two cusps and molars 3 to 5.

07 years : 24 teeth (20 deciduous and 4 permanent).
09 years : 24 teeth (12 deciduous (molars and canines):
om
12 permanent (8 incisors and 4 first molars).

co
co
11 years : 24 teeth (4 diciduous (canines) and 20

e.
e.
permanent: (8 incisors, 8 premolars and 4

fre
fre
fre
molars).
14 years : 28 permanent teeth.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 28 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 29
e.
e.
After eruption of second permanent molar teeth, the body of jaw
re
fre
fre
grows posteriorly, and ramus is elongated. If third molars are fully
sf
erupted, the age is above 17.
ks
ks
k
Gustafson’s method: After 21 years, age is estimated by teeth

oo
oo
oo
from physiologic age changes in each of dental tissues. (1) Attrition.
eb
eb
eb
(2) Periodontosis: Regression of the gums and periodontal tissues
m
m
occurs in old age, gradually exposing necks and roots. (3) Secondary
dentin: It develops from walls within the pulp cavity and diminishes
its size. (4) Cementum apposition, especially near end of root occurs
om
m
continuously throughout life, and forms incremental lines. (5) Root
co
co
resorption starts at apex and extends upwards. (6) Transparency of
e.
e.
root is seen after 30 years. The canals in dentin are filled by mineral
fre
fre
fre
and dentin becomes transparent. It is the most reliable of all criteria.
Error is said to be ± 4 to 7 years.
ks
ks
ks
Growth in Individual Bones : (1) Bones develop from a number
oo
oo
oo
of separate centres of ossification, which is spread over a long period
eb
eb
eb
of time.(2) A large number appear in foetal life and few after birth. (3)
m
m
806 centres are present in foetus at eleventh week. (4) 450 centres are
present at birth. (5) Adult skeleton has 206 bones. (6) Ossification
begins centrally in an epiphysis which is amorphous, rounded and pin-
om
om
head sized. (7) Most bones are ossified from several separate centres.
co
(8) Carpal and tarsal bones ossify from a single centre. (9) Hyaline
c
e.
e.
cartilage is present between the diaphysis and epiphysis (epiphyseal

re
fre
plate or growth plate or growth cartilage). (10) The bone increases re

sf
f
in length at the epiphyseal plate, until its final dimensions are attained.
ks
ks
k
(11) The process of union of epiphysis and diaphysis is called fusion.

oo
oo
oo
(12) Union of epiphyses in cartilaginous bones occurs earlier by

eb
eb
eb
about one year in the females than in males, but the opposite is
m
seen is suture closure of the skull. (13) Ossification occurs earlier

in tropical conditions than in temperate areas. (14) Metacarpals,
metatarsals, phalanges, clavicles and ribs have epidhysis at one end
om
only. (15) Ageing of bones is more accurate with respect to the

co
co
appearance of centres of ossification than the union of epiphyses.

e.
e.
(16) Head of humerus is the last long bone epiphysis to unite.

fre
fre
fre
(17) In upper limb, union occurs earlier at the elbow and later at
the wrist and shoulder. (18) In lower limbs, union occurs later at
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 29 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
the knee joint and earlier at the hip and ankle joints. (19) Variations
re
fre
fre
occur in individuals depending on health, hereditary, nutritional,
sf
endocrine and environmental factors. (20) Skeletal development in
ks
ks
k
the female can be in advance of the male up to one year, while

oo
oo
oo
dental development may differ only from one to 4 months. (21)
eb
eb
eb
The opinion of age based on X-rays must be expressed in plus or
m
m
minus terms, e.g 10±1. (22) The union of epiphyses as seen in X-rays
appear earlier by about 6 months as compared to anatomical evidence.
Symphysis pubis : It is the best single criterion for age
om
m
determination from third to fifth decades.
co
co
Sternum : The four pieces of body of sternum fuse with one
e.
e.
another from below upwards between 14 to 25 years. Xiphoid unites
fre
fre
fre
with body at 40 years and manubrium in old age.
Hyoid : Greater cornu unites with body between 40 to 60 years.
ks
ks
ks
oo
oo
oo
Age Appearance of centre of Union of bone and
ossification epiphysis
eb
eb
eb
5th year : Head of radius, trepezium, Greater tubercle fuses
m
m
trapezoid, scaphoid. with head of humerus.
6th year: Lower end of ulna. Rami of pubis and
ischium unite.
om
om
6th to 7th year: Medial epicondyle of the

co
humerus.
c
e.
e.
9th year : Olecranon.

re
fre
9th to 11th year : Trochlea of humerus.

re
sf
f
10th to 11th year : Pisiform.
ks
ks
k
11th year : Lateral epicondyle of

oo
oo
oo
humerus.
eb
eb
eb
13th year : Separate centres in

triradiate cartilage of
m
acetabulum.
12th to 14th year : Lesser trochanter of femur.
14th year : Crest of ilium; head and Medial epicondyle
om
tubercles of ribs. of humerus; lateral

co
co
epicondyle with
e.
e.
trochlea; patella
complete.
fre
fre
fre
Contd...
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 30 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 31
e.
e.
Contd...
re
fre
fre
15th year : Acromion. Coracoid with
sf
scapula; triradiate
ks
ks
k
cartilage of
oo
oo
oo
acetabulum.
eb
eb
eb
16th year : Ischial tuberosity. Lower end of
humerus; olecranon
m
m
to ulna; upper end of
radius; metacarpals;
proximal phalanges.
om
m
18th year : Head of femur;
co
co
lesser and greater
trochanter of femur;
e.
e.
acromion; lower end
fre
fre
fre
of ulna
18th to 19th year : Inner end of clavicle. Lower end of femur;
ks
ks
ks
upper end of tibia
oo
oo
oo
and fibula, head of
humerus; lower end of
eb
eb
eb
radius.
m
m
21st year : IIiac crest; inner end
of clavicle; ischial
tuberosity.
om
om
Sacrum : Intervertebral discs ossify from below upwards after

co
puberty and sacrum becomes single bone between 21 to 25 years.

c
e.
e.
Skull : (1) It consists of 22 bones. (2) Anterior fontanelle closes

re
fre
and two halves of mandible unite at second year. (3) Condylar portion re
sf
f
ks
ks
of occipital bone fuses with squama at third year, and with basi-
k
occipital at the fifth year. (4) Metopic suture closes about third year.
oo
oo
oo
(5) Basi-occiput fuses with basi-sphenoid between 18 to 21 years.

eb
eb
eb
(6) Closure of the sutures begins on the inner side and proceeds
m
externally. (7) Inner side union occurs 5 to 10 years earlier than

on outer side. (8) On the outer side fusion occurs : 30 to 40 years :
Posterior 1/3 of sagittal; 40 to 50 years : Anterior 1/3 of sagittal and
om
lower half of coronal. 45 years : Lambdoid suture. 50 to 60 years

co
co
: Middle sagittal and upper half of coronal. 60 years: Squamous

e.
e.
temporal. (9) the order of reliability of suture closure : Sagittal,

fre
fre
fre
lambdoid and then coronal.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 31 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
Secondary sex characters: Male: 14 years: Fine hair on pubis;
re
fre
fre
testes become large and penis begins to enlarge. 15 years: Modest
sf
growth of hair on pubis, axillary hair. 16 years: Well grown hair on
ks
ks
k
pubis; genitals adult appearance. 16 to 18 years: Hair on face and

oo
oo
oo
hoarse voice.
eb
eb
eb
Female: 12 years: Breasts begin to develop; 2 months later fine,
m
m
downy hair on mons veneris. Labia develop and menstruation starts.
14 to 15 years: Well grown pubic hair, hair in axilla.
Other changes: 35 to 50 years: Ossification of laryngeal and
om
m
costal cartilages and hyoid bone starts. Lipping and reduction of
co
co
joint space; margins of bodies of lumbar vertebrae and inner border
e.
e.
of ischial tuberosity, wrinkless about eyes, eyebrows and in front of
fre
fre
fre
ears appear 35 to 40 years. Arcus senilis appears around 50 years,
and is complete by 60 years. It is a grey opaque ring surrounding the
ks
ks
ks
margin of cornea, due to degenerative changes, but separated from
oo
oo
oo
the margin by an area of clear cornea. Greying of hair starts after 40
eb
eb
eb
years, but is very variable. Pubic hair does not become grey before
m
m
50 to 55 years.
For determination of age between 6 to 12 years take X-rays of
(1) elbow joint, (2) wrist joint. 06 years : lower end of ulna (A); 6
om
om
to 7 years : medial epicondyle of humerus (A) ; 9 years : olecranon

co
(A): 9 to 11 years : trochlea of humerus (A) ; 11th to 12th year :

c
e.
e.
pisiform (A) : 11th year : lateral epicondyle of humerus (A).

re
fre
12 to 14 years : X-rays of pelvis and elbow. 13th year : Centre re

sf
f
in triradiate cartilage of acetabulum (A); lesser trochanter of femur
ks
ks
k
(A). 14th year : Centre for iliac crest (A); fusion of lateral and
oo
oo
oo
medial epicondyles of humerus with trochlea. 15th year : Fusion

eb
eb
eb
of triradiate cartilage of acetabulum. 16th year : Centre for ischial

m
tuberosity (A); fusion of lower end of humerus; olecranon to ulna;

upper end of radius.
Fusion of Bones/Joints :
om
16 years : elbow joint.

co
co
16 to 17 years : ankle joint.

e.
e.
17 to 18 years : hip joint.

fre
fre
fre
18 to 19 years : knee, shoulder and wrist joints.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 32 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 33
e.
e.
20 to 21 years : fusion of ischial tuberosity, iliac cres and inner
re
fre
fre
end of elavicle.
sf
m.l. importance of age :
ks
ks
k
7 months of intrauterinc life : Not viable below 7 months.

oo
oo
oo
5 years : Liable for punishment for unlawful act under Indian
eb
eb
eb
Railways Act.
m
m
7 years : No criminal responsibility below 7 years (S.82, IPC.).
7 to 12 years : Criminally responsible, if he had sufficient
maturity of understanding and judgement (S.83, IPC).
om
m
12 years : Can give consent for medical examination.
co
co
15 years : (a) Can work in a factory as adult if found medically
e.
e.
fit. (2) Age of consent for sexual intercourse by wife.
fre
fre
fre
16 years : (1) Kidnapping from lawful guardianship in case of
a boy under 16.
ks
ks
ks
18 years : (1) A person becomes major. (2) A girl can contract
oo
oo
oo
marriage. (3) Juvenile in case of a boy or girl up to 18 years. (4)
eb
eb
eb
Can give consent to suffer any harm from an act not intended or not
m
m
known to cause death or grievous hurt (S.87, IPC). (5) Kidnapping
from lawful guardianship in case of girl under 18. (6) Procuring a
girl below 18 years for prostitution. (7) Age of consent for sexual
om
om
intercourse by a girl.
co
21 years : (1) Attainment of majority when a person is under

c
e.
e.
guardianship of court of wards. (2) To import a girl from foreign

re
fre
country for prostitution is kidnaping. (3) A boy can contract marriage. re

sf
f
Age of foetus : (1) End of seventh month : Length 35 cm;
ks
ks
k
weight, 0.9 to 1.2 kg; thick nails; eyelids open, pupillary membrane
oo
oo
oo
disappears. Meconium in whole of large intestine; testes at external

eb
eb
eb
inguinal ring; gall bladdder contains bile; caecum in right iliac fossa.
m
(2) End of eighth month: Length 40 cm.; weight 1.5 to 2 kg.

Nails reach tips of fingers, skin not wrinkled; left testis in scrotum.
(3) End of ninth month : Length 45 cm; weight 2.5 to 3 kg.
om
Scalp hair 4 cm long. Meconium at end of large intestine. Both testes

co
co
in scrotum.
e.
e.
(4) Full term (10 months): (1) Length 50 to 53 cm; weight 2.5 to
fre
fre
fre
5 kg., average 3.4 kg. (2) Male infants weigh 100 g more than female.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 33 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
(3) Head circumference 33 to 36 cm. (4) Anterior fontanelle is 4x2.5
re
fre
fre
cm. (5) Brain surface shows convolutions. (6) Scalp hair is dark, 3 to
sf
ks
ks
5 cm. long. (7) Skin is pale and covered with vernix caseosa. (8) Face
k
is not wrinkled. (9) Lanugo hair absent except on shoulders. (10) Nails
oo
oo
oo
project beyond end of fingers. (11) Nose and ear cartilages formed.
eb
eb
eb
(12) Vulva closed; labia majora fully develolped and cover labia
m
m
minora. (13) Meconium in rectum. (14) Placenta 22 cm. in diameter,
1.5 cm. thick, weight 500 g. Umbilical cord 50 to 55 cm. long and
one cm. thick. (15) Umblicus between xiphoid cartilage and pubis.
om
m
Ossification centres: (1) Sternum: Manubrium appears at fifth
co
co
month; six centres in body appear between fifth month to tenth month.
e.
e.
(2) Lower end of femur appears at 36 weeks; its diameter is 4 to 5
fre
fre
fre
mm. at 38 weeks, and 8 mm. at full term. (3) Upper end of tibia:
In 80% of full term infants, centre present. (4) Calcaneum: end of
ks
ks
ks
fifth month. (5) Talus: end of seventh month. (6) Cuboid may or
oo
oo
oo
may not be present at birth.
eb
eb
eb
Rule of Haase: (1) It is a rough method of calculating the age
m
m
of foetus. (2) During the first five months, the square root of length
gives age of foetus in months. (3) During last five months, length in
cm. divided by five gives age in months.
om
om
Length of child : At birth 50 cm; 6 months 60 cm; one year 68

co
cm; 4 years 100 cm. (doubles).

c
e.
e.
Birth weight doubles by 5 months and triples by one year.

re
fre
Head circumference increases by 12 cm. at one year. re

sf
f
STATURE: (1) It varies by 1.5 to 2 cm. at different times of the
ks
ks
k
day. (2) It is less in evening. (3) Malnutrition and advancing years

oo
oo
oo
reduce stature. (4) After 30 years it decreases by 0.6 mm. every year.
eb
eb
eb
(5) On lying it increases by 1 to 3 cm. (6) After death stature increases

m
by 1.5 cm. in the male and 2 cm. in female. (7) The symphysis
pubis lies about half way up the body at the age of 14 years. (8) In
a dismembered body approximate stature is obtained from: (1)
om
length from sternal notch to symphysis pubis multiplied by 3.3. (2)

co
co
length of forearm is equal to 5/19 of stature, (3) height of head from

e.
e.
top to tip of chin is 1/7 of stature. (4) twice the length of one arm+
fre
fre
fre
34 cm. equals height. (5) length of entire skeleton + 2 to 4 cm.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 34 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 35
e.
e.
Anthropometry (Bertillon system): It was used for personal
re
fre
fre
identification. It includes : (1) description of eyes, nose, ears, etc,
sf
ks
ks
(2) body marks, such as moles, etc. (3) eleven body measurements,
k
(4) photographs. It is absolete. As a sole means of identification,

oo
oo
oo
photographs are not always reliable.
eb
eb
eb
dactylography (Fingerprint system; Galton system;
m
m
Dermatoglyphics): They are impressions of patterns formed by
papillary or epidermal ridges of the fingertips. Types : (1) Loops
(60 to 70%). (2) Whorls (25 to 35%). (3) Arches (6 to 7%). (4)
om
m
Composite (1 to 2%).
co
co
(1) Identification is made by comparison of many details of
e.
e.
characteristics occurring through the ridge and by their sequence. (2)
fre
fre
fre
10 to 12 points of fine comparison are accepted as proof of identity.
(3) The patterns are not inherited, and are different even in
ks
ks
ks
identical twins. (4) The patterns are distinctive and permanent.
oo
oo
oo
(5) A person can be identified 100%. (6) They can be teleprinted. (7)
eb
eb
eb
Sweat contains fats, which leaves a greasy impression on a smooth
m
m
surface. (8) They can be latent (invisible), visible, and plastic (on
soap, cheese, etc). (9) Prints can be obtained from dermis. (10)
Sections up to a depth of 0.6 mm. give satisfactory finger prints. (11)
om
om
Impressions may presist for years if not disturbed. (12) They can
co
be mutilated by burns and application of corrosives. (13) Leprosy,

c
e.
e.
electric injury, exposure to radiation impair finger prints. (14) Finger

re
fre
prints reader (FINDER) is a computerised automatic fingerprint re

sf
f
reading system which records print in half second.
ks
ks
k
Poroscopy: (1) Ridges contain microscopic pores, formed

oo
oo
oo
by mouths of ducts of subepidermal sweat glands. (2) 9 to 18

eb
eb
eb
pores are present in each mm. of ridge. (3) They vary in size, shape,
m
extent and number over a given length of ridge. (4) These pores
are permanent and do not change during life. (5) It is useful when
fragments of fingerprints are available.
om
M.L. Imp: (1) Establish identity of criminal by prints on weapons,

co
co
furniture, clothes, etc. (2) Identification of suicides, deserters, dead or

e.
e.
unconscious persons, and decomposed bodies. (3) Identification of

fre
fre
fre
accidental exchange of newborns. (4) Prevention of impersonation.

(5) To maintain identity records.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 35 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
skull-photo superimposition: It is the technique
re
fre
fre
to determine whether the skull is that of the person in the
sf
photograph. (1) Photograph of head and face is enlarged to natural
ks
ks
k
size, and negative is prepared. (2) A life size negative of the skull
oo
oo
oo
is prepared. (3) The negative of the photograph and the skull are
eb
eb
eb
superimposed by aligning characteristic points in the negative. (4)
m
m
The superimposed negatives are photographed on bromide paper. (5)
If contours and size of skull accurately correspond to the face of the
photograph, the test is positive. (6) If they do not tally identification is
om
m
excluded (negative value). (7) If they tally it is corroborative evidence.
co
co
Video superimposition: The skull is fixed on a rotatable
e.
e.
universal stand. The photograph is also fixed with the same orientation
fre
fre
fre
parallel to the skull. One camera is directed at the skull and a second
camera directed at the photograph of the face. Images of the skull
ks
ks
ks
and photographs are projected on a monitor placed near the skull.
oo
oo
oo
By performing a series of blending, fading and sweeping (vertical,
eb
eb
eb
horizontal and diagonal), the image of the skull and photograph
m
m
are superimposed and analysed for conformity. All the anatomical
landmarks are compared. This is an exclusionary method.
Computer pictures : Depending on the description of the person,
om
om
hundreds of varieties of face can be drawn on the screen within a few

co
minutes. Additions and alterations can be made.

c
e.
e.
Skull : If previous X-ray films are available, skull measurement

re
fre
and comparison of frontal, sphenoidal and maxillary sinuses, sella re

sf
f
turcica and mastoid area are useful in identification.
ks
ks
k
SCARS : (1) A scar is fibrous tissue covered by epithelium

oo
oo
oo
without hair follicles, sweat glands or pigment. (2) Injury to

eb
eb
eb
dermis produces scar, but not injury to epidermis. (3) Faint scars
m
become visible by application of heat, filtered ultraviolent light or

surface friction. (4) Scars produced in childhood grow in size with
development of the person. (5) Incised wounds produce linear scars;
om
lacerated wounds produce firmer, irregular, prominent scars attached

co
co
to deeper tissues. (6) Stab wounds produce oval, elliptical, triangular

e.
e.
or irregular scars. (7) Bullet wounds produce circular scars. (8)

fre
fre
fre
Corrosive acids and burns cause irregular scars. (9) Age : (A) 5 to 6
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 36 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 37
e.
e.
days: firm union producing a reddish or bluish scar. (B) Two weeks
re
fre
fre
to 2 months: Pale soft and sensitive. (C) 2 to 6 months: White,
sf
ks
ks
glistening, tough, wrinkled. No further change.
k
M.L. Importance : (1) Identification. (2) Shape may indicate

oo
oo
oo
nature of weapon or agent that caused injury. (3) If age of scar
eb
eb
eb
corresponds with date of attack, it may have circumstantial value. (4)
m
m
Disfiguration of face or head is grievous hurt. (5) Linea albicantes
may indicate previous pregnancy.
tattoo marks : (1) They are the designs imprinted in
om
m
the skin by multiple small puncture wounds with needles dipped
co
co
in colouring matter, such as Indian ink, carbon, cinnabar, indigo,
e.
e.
cobalt, prussian blue, etc. (2) Lymph nodes near tattoo mark show a
fre
fre
fre
deposit of pigment. (3) Permanent pictures are made when the dye
penetrates dermis. (4) If the pigment is deposited below the epidermis,
ks
ks
ks
it may disappear after ten years. (5) Tattoos on hands disappear early
oo
oo
oo
due to constant friction. (6) A faded tattoo mark becomes visible by
eb
eb
eb
use of ultraviolet lamp, infrared photography or rubbing the part. (7)
m
m
In decomposed body, it is seen after removal of epidermis.
M.L. Imp: (1) Identity. (2) Religion. (3) God of worship. (4)
Indecent designs point to perversions. (5) Designs may indicate a
om
om
particular country or region. (6) Drug addicts tattoo to cover needle

co
puncture marks.
c
e.
e.
HAIR: (1) Cuticle is outer layer and consists of thin, nonpigmented

re
fre
cells. (2) Cortex is middle layer and consists of longitudinally re

sf
f
arranged, elongated cells without nuclei. (3) Medulla is inner layer
ks
ks
k
composed of keratinised remains of cells. (4) Barr bodies are found

oo
oo
oo
in hair follicles, 29± 5% in females and 6 ± 2% in males. (5) Hair

eb
eb
eb
of foetus and the new born is fine, soft, non-pigmented and non-
m
medullated (lanugo). (6) Bleached hair is brittle, dry and straw-

yellow. (7) Scalp hair grows 1 to 3 mm. a week (average 2.5 mm).
(8) ABO group can be determined in a single hair from any part of
om
body by modified absorption elution technique. (8) If the hair falls

co
co
naturally, root will be shapeless and atrophied. (9) If hair is pulled out,
e.
e.
hair bulb will be larger, irregular and swollen and sheath ruptured.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 37 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
e.
e.
Difference between human and animal hair
re
fre
fre
Trait Human hair Animal hair
sf
ks
ks
(1) General: Fine and thin. Coarse and thick.
k
oo
oo
oo
(2) Cuticle: Cuticular scales are Cuticular scales are
short, broad, thin and very large and have
eb
eb
eb
irregularly annular. step-like or wavy
m
m
projections.
(3) Cortex: Thick, well-striated, Thin, rarely more
and 4 to 10 times as than twice as broad as
om
m
broad as medulla. medulla.
co
co
(4) Medulla: Varies considerably, Continuous and wider.
usually narrow;
e.
e.
continuous,
fre
fre
fre
fragmented, or entirely
absent.
ks
ks
ks
(5) Pigment: Evenly distributed. Mostly present near
oo
oo
oo
medulla.
eb
eb
eb
(6) Precipitin test: Specific for human. Specific for animal.
(7) Medullary index: Below 0.3 Above 0.5
m
m
M.L. Imp : (1) Helps in crime investigation, for it remains on
clothes, body and weapon. (A) In rape, sodomy, bestiality and traffic
om
om
accident. (B) Stains indicate the nature of assault, e.g. seminal stains
co
in sexual offences, salivary stains in asphyxial deaths, blood stains in

c
e.
e.
injury. (2) Nature of weapon can be made out from injuries of hair
re
fre
and hair blubs. (3) Singeing indicates burns. (4) Differentiates scalds re
sf
f
from burns. (5) Sex may be determined. (6) Identification. (6) Heavy
ks
ks
k
metals can be detected.

oo
oo
oo
Teeth : (1) In antemortem tooth loss, bony rim of alveolus

eb
eb
eb
is sharp and feathered. (2) A blood clot forms and in one to two
m
days there is early organisation. (3) In a week, socket is filled with

organised clot. (4) In 2 to 3 weeks soft tissues are healed and socket
partially filled with new bone. (5) In 6 months socket is filled with
om
new bone, but the location of root outline is visible, and in one year
co
co
whole socket is filled with new bone. (6) If entire tooth was knocked
e.
e.
out, irregular edges of remaining bone, splintering of buccal plates,

fre
fre
fre
areas of compressed bone, or fracture of roots or crowns of adjacent

teeth are seen.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 38 04-03-2015 12:14:08 PM

e
e
m
m
om
m
co
co
Identification 39
e.
e.
The usual methods of charting of teeth are : (1) Universal system.
re
fre
fre
(2) Palmer’s notation. (3) Haderup system. (4) FDI two-digit system.
sf
Bite marks: (1) Human bites rarely cause tearing of the skin, but
ks
ks
k
usually produce semicircular or crescentic patterned obrasions with

oo
oo
oo
extensive haemorrhages under the skin. (2) The mark consists of a
eb
eb
eb
central area of bruising with a surrounding area, which may show
m
m
separate bruises and abrasions. (3) Bites are always contaminated
with saliva. (4) They may be found anywhere on the body. (5) They
may be found in the materials left at the place of crime, e.g. cheese,
om
m
bread, butter, fruit, etc. or in humans involved in assaults.
co
co
M.L. Importance of teeth : (1) Identification. (2) Dentures
e.
e.
in identification. (3) Criminals identified by bite marks. (4) Age
fre
fre
fre
estimation. (5) Fracture or loss of tooth due to assault is grievous hurt.
(6) Sex can be determined. (7) Heavy metal poisoning can be detected.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-03.indd 39 04-03-2015 12:14:08 PM

e
e
m
m
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co
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e. 4
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
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eb
eb
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m
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Medicolegal Autopsy
om
m
co
co
e.
e.
Objects: To find out (1) Cause of death (natural or unnatural). (2)
fre
fre
fre
Manner of death (suicide, homicide, accident). (3) Time since death.
ks
ks
ks
(4) Establish identity. (5) To collect physical evidence to identify
oo
oo
oo
the weapon and criminal. (6) In new born to determine liverbirth
eb
eb
eb
and viability.
Rules: (1) Conducted in mortuary only, except spot P.M. (2)
m
m
Requisition from police or Magistrate necessary. (3) Avoid delay. (4)
Collect information from inquest, accident register, case sheet, etc.
om
om
(5) Conducted in day-light as far as possible, because colour changes,

co
such as jaundice, P.M. hypostasis and colour of contusions cannot

c
be made out in artificial light. (6) Body should be identified by the

e.
e.
police constable. (7) No unauthorised person should be present. (8)

re
fre
Assistant should note findings. (9) Autopsy must be complete and re

sf
f
ks
ks
never partial.
k
oo
oo
oo
Incision: I-shaped incision extending from chin down to

eb
eb
eb
symphysis pubis in midline.

To demonstrate pneumothorax, a pocket is dissected on the
m
affected side between the chest wall and skin, and is filled with water,
and the wall punctured with knife under the water. Air if present will
om
bubble out of the opening through water.

co
co
Air embolism: (1) Open the head first, and examine surface
vessels of brain for gas bubbles. (2) Cut the apex of heart with knife.
e.
e.
The left ventricle will contain frothy blood. (3) The heart will float
fre
fre
fre
in water if the right ventricle contains air. (4) Pericardial sac is filled
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 40 04-03-2015 12:08:03 PM

e
e
m
m
om
m
co
co
Medicolegal Autopsy 41
e.
e.
with water and heart punctured with a scalpel and twisted a few times.
re
fre
fre
Bubbles of air will escape if air is present.
sf
Heart is opened in the direction of flow of blood.
ks
ks
k
Subendocardial haemorrahges: (1) They are seen in the left

oo
oo
oo
ventricle, on the opposing papillary muscles and adjacent columnae
eb
eb
eb
carnae. (2) The haemorrhages are flame- shaped, confluent and tend
m
m
to occur in one continuous sheet rather than patches. (3) They are
seen (a) after sudden severe hypotension due to severe loss of blood
or from shock, (b) after intracranial damage, such as head injury,
om
m
cerebral oedema, surgical craniotomy or tumours, (c) death from
co
co
ectopic pregnancy, ante-partum or post-partum haemorrhage, (d)
e.
e.
various types of poisoning, especially arsenic.
fre
fre
fre
Stomach is removed by appliying double ligature at both ends.
It is opened along greater curvature. Small intestine is opened along
ks
ks
ks
the line of mesenteric attachment, and large intestine along anterior
oo
oo
oo
taenia. Liver and spleen are cut in long axis, pancreas at right angles
eb
eb
eb
to long axis, and kidney is sectioned longitudinally through convex
m
m
border into hilum. Testis is removed by incising inguinal canal and
pulling loop of vas through it. Duodenum is the widest and most
fixed portion of small bowel.
om
om
A.M. blood clots are dark red, firm and on section show alternate
co
layers of platelets and thrombi. Postmortem clots are moist, smooth,

c
e.
e.
rubbery, homogeneous, loosely or not attached to wall, and there are

re
fre
no lines of Zahn. re
sf
f
Fluid blood in a dead body is seen in: (1) septicaemia, (2)
ks
ks
k
CO poisoning, (3) rapid death from asphyxia, (4) amniotic fluid

oo
oo
oo
embolism, (5) puerperal sepsis, (6) retained abortion.

eb
eb
eb
Head: A coronal incision is made in the scalp, which starts from

m
the mastoid process just behind one ear, and carried over the vertex
of the scalp to the back of the opposite ear. The skull is cut by sawing
horizontally. Undertakers fracture is tearing of intervertebral disc
om
around C-6 or C-7.

co
co
For fixation of brain, lateral fissures are opened with the fingers
e.
e.
and a long sagittal cut is made in the corpus callosum and kept in
fre
fre
fre
10% formalin for one week.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 41 04-03-2015 12:08:03 PM

e
e
m
m
om
m
co
co
e.
e.
Spinal cord is not examined routinely. An incision is made on
re
fre
fre
the back in midline extending from the occipital protuberance to the
sf
ks
ks
lower end of the sacrum. The laminae are sawed through the entire
k
length of spine on each side and separated with chisel.

oo
oo
oo
Preservation of viscera: In all cases of poisoning preserve: (1)
eb
eb
eb
Stomach and its contents. (2) Upper part of small intestine (about
m
m
30 cm) and its contents. (3) Liver half kg. (4) Kidney half of each.
(5) blood 30 ml. (6) Urine 30 ml.
Preservatives: (1) Saturated sodium chloride soultion except in
om
m
cases of poisoning by corrosive acids and alkalis, corrosive sublimate
co
co
and aconite. (2) Rectified spirit, except in cases of poisoning by (a)
e.
e.
alcohol, (b) acetic acid, (c) phenol, (d) paraldehyde, (e) phosphorus.
fre
fre
fre
Never preserve viscera in formalin.
Minimum of 10 ml. of blood should be preserved, to which
ks
ks
ks
10mg/ml. of sodium or potassium fluoride is added. Blood should be
oo
oo
oo
collected from femoral, jugular, subclavian or iliac veins, but never
eb
eb
eb
from pleural or abdominal cavities.
m
m
Instructions : (1) Stomach and intestine are put in one bottle and
liver and kidney in another bottle. Separate bottles are used for blood
and urine. (2) Stomach and intestine are opened, liver and kidney are
om
om
cut into small pieces. (3) Quantity of preservative should be equal to

co
viscera in bulk. (4) Two-thirds of bottle only should be filled. (5) Seal
c
e.
e.
the bottles. (6) Label the bottles with all particulars of the case. (7)
re
fre
Sample of preservative should also be sent for analysis. (8) Samples re

sf
f
are kept in a box, locked and sealed. (9) A copy of inquest and P.M
ks
ks
k
report are also sent. (10) The box is handed over to police constable
oo
oo
oo
after obtaining a receipt, who hands it over in the laboratory.

eb
eb
eb
In decomposed bodies, bullet wounds, large incised wounds,

m
valvular lesions of heart and fractures can be made out.

Effacement of Identity : (1) Purposive removal
of identifying features. (2) Attack by animals. (3) Burning or
om
incineration. (4) Advanced putrefaction. (5) Dismemberment and

co
co
burying different parts in different places. (6) Chemical destruction

e.
e.
by corrosives. (7) Bomb explosion.

fre
fre
fre
Virtual autopsy (Virtopsy): It is a non-invasive

technique of examining dead bodies to find out the cause of
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 42 04-03-2015 12:08:04 PM

e
e
m
m
om
m
co
co
e.
e.
death. It is a combination of CT and MR imaging. CT images
re
fre
fre
give information about morbid anatomical findings and MR imaging
sf
ks
ks
focuses on soft tissue, e.g. muscles, bone, blood vessels, tissues
k
and organs. MR spectroscopy measures metabolites formed due

oo
oo
oo
to decomposition, which help to estimate time since death. Two
eb
eb
eb
dimensional and three dimensional imaging is done with multislice
m
m
CT. Emphysema, air embolism, pneumothorax, hyperbaric trauma
and decompression effects can be better appreciated. When an injury
is caused by a weapon, using a computer software, virtual model
om
m
of an injury with the 3D image of a simulation can be created by
co
co
using a similar weapon. The track of the projectile inside the brain
e.
e.
or other internal organs with haemorrhage and damage to tissues can
fre
fre
fre
be viewed with CT scanning.
Psychological autopsy: Psychological autopsy is a set
ks
ks
ks
of postmortem investigative procedures (gathering all the relevant
oo
oo
oo
information from the past life of the victim of suicide), that help
eb
eb
eb
ascertain and evaluate the role that physical and psychological
m
m
factors play in the death of an individual, thus to determine the
manner of death to as high a degree of certainty as possible.
Description of scene of death, position of body, evidence at the scene,
om
om
such as weapons, poison and notes, etc. are necessary. It involves

co
systematic collection of psychological data (mental state) through

c
e.
e.
structured interviews of the deceased’s family members, friends,

re
fre
co-workers, employers and fellow students, who had dealt with the re
sf
f
deceased are helpful, to reconstruct the habits of the victim as regard
ks
ks
k
to his background, habits, character, personality traits, general life

oo
oo
oo
style and method of death. It is most commonly introduced in those

eb
eb
eb
involving custodial care-taking (police custody and prisons), and those

m
of contested life insurance claims. They have also been introduced in

criminal cases (suicide or homicide), workers compensation (unsafe job
conditions), and professional negligence (proximate cause of suicide).
om
The psychological autopsy cannot validly inform an expert that a

co
co
suicide definitely occurred, but it significantly improves manner

e.
e.
of death determination.
fre
fre
fre
Examination of Bones
ks
ks
ks
General Description : (1) Keep the bones in anatomic

arrangement and draw a skeletal chart, indicating which bones
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 43 04-03-2015 12:08:05 PM

e
e
m
m
om
m
co
co
e.
e.
are present. (2) Photographs of all bones are taken. (3) Note the
re
fre
fre
attachment of the soft tissues to bones if any, and their stage of
sf
ks
ks
putrefaction. (4) Note whether the bones are moist and humid, or
k
dry and their smell. (5) The bones are then washed by brushing with
oo
oo
oo
lukewarm water, and are placed under shelter to dry slowly.
eb
eb
eb
(1) Human or animal : (1) If the bone is fairly fresh, and some
m
m
of the blood constituents are still present, the precipitin test is useful.
(2) Bones of the hand and wrist of the bears may be confused with
human bones. (3) Human and animal bones can also be distinguished
om
m
by chemical analysis of bone-ash. (4) Microscopic structure is also
co
co
useful.
e.
e.
(2) One or more individuals : (1) This can be determined by
fre
fre
fre
reconstructing the skeleton. (2) If there is no disproportion in the
size of various bones, or reduplication, articulation is correct, and
ks
ks
ks
if the age, sex and race of all the bones is same, they belong to one
oo
oo
oo
individual. (3) If mixing of bones from more than one skeleton is
eb
eb
eb
suspected, they can be separated by the use of short wave ultraviolet
m
m
lamp.
(3) Sex : (1) Recognisable sex differences are not present
before puberty. (2) After puberty, the sex can be determined by
om
om
examination of the pelvis, skull, diameter of head of femur and

co
humerus and measurements of femur, tibia, humerus and radius.

c
e.
e.
(4) Age at death : (1) It can be determined from examination

re
fre
of teeth, ossific centres, amount of wear and tear in teeth, length re

sf
f
of long bones, epiphyseal union, pubic symphysis, closure of skull
ks
ks
k
sutures, cortical resorption, bony lipping, osteoporosis, calcification,

oo
oo
oo
osteoarthritic changes, etc. (2) After the completion of bony union,

eb
eb
eb
age cannot be determined accurately.

m
(5) Race: There are certain racial differences in the skeleton,

chiefly in the skull and face measurements, teeth and lower
extremities.
om
(6) Stature: (1) When the skeleton is incomplete, or severely

co
co
disintegrated, the stature may be calculated by applying mathematical

e.
e.
formulae to the length of the long bones. (2) Long bones must be
fre
fre
fre
measured by means of osteometric board, measurement by use of the

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 44 04-03-2015 12:08:05 PM

e
e
m
m
om
m
co
co
e.
e.
tapes or calipers are not accurate. (3) Pearson’s formulae or Trotter
re
fre
fre
and Gleser formulae are used. (3) The principle of these formulae
sf
is to measure the length of long bone and multiply it with a
ks
ks
k
given factor, and then adding a fixed factor. (4) The formulae are
oo
oo
oo
different for dry bones and wet bones, for white persons and Negroes,
eb
eb
eb
and for males and females.
m
m
Osteometric Board: (1) This has a rectangular base with a ruler
fixed along one of its long sides. An upright is fixed at one end of
the board, and a second one slides along the board. (2) The bone is
om
m
placed with one of its ends against the fixed upright and the movable
co
co
upright is brought up to the other end of the bone. (3) The distance
e.
e.
between the uprights is then shown on the ruler. (4) Weight bearing
fre
fre
fre
long bones are used for applying these formulae. (5) Femur and tibia
give more accurate results than humerus or radius. (6) Useful rule of
ks
ks
ks
thumb is that humerus is 20%, tibia 22%, femur 27% and spine
oo
oo
oo
35% of the individual’s height in life.
eb
eb
eb
(7) Identification: (1) Identity may be established from
m
m
teeth, disease and deformities of the bone, old healed or healing
fractures, orthopaedic surgical procedures, regional atrophy, spinal
deformities, flat feet, supernumerary ribs, congenital defects, etc. and
om
om
by superimposition technique using the skull. (2) Dental charts and

co
dental radiographs are also useful.

c
e.
e.
(8) Nature of injury: (1) The ends of the long bones should
re
fre
be examined carefully to find out if they have been cut by sharp re

sf
f
instruments or hacked or sawn or bitten by animals. (2) If the body
ks
ks
k
disintegrates naturally, articular surfaces are smooth.

oo
oo
oo
(9) Time since death : (1) After the soft tissues disappear, pieces
eb
eb
eb
of cartilage and ligaments remain attached to bone for three to four

m
months. (2) Traces of marrow and periosteum may remain in, or

attached to the bones for several months. (3) A fairly recent bone is
slightly greasy to the touch and heavy. (4) Odour is a good indication
om
of relatively recent death. (5) After the bones have lost the covering
co
co
tissue, and the odour of decomposition is lost, the bones still appear
e.
e.
fresh. (6) Repeated freezing and thawing of the bones when buried
fre
fre
fre
superficially may cause a bone to expand and crack within few months.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 45 04-03-2015 12:08:05 PM

e
e
m
m
om
m
co
co
e.
e.
(10) Cause of death : (1) The cause of death cannot be made out
re
fre
fre
unless there is evidence of fracture or injuries which usually cause
sf
ks
ks
death, e.g. fractures of skull bones, upper cervical vertebrae, hyoid
k
bone, several ribs, or marks of deep cuts in long bones or marks of

oo
oo
oo
burning. (2) The bones should be examined for firearm injuries or
eb
eb
eb
any disease, e.g caries or necrosis. (3) The type of the weapon can
m
m
be known from the type and depth of the cut in the bone. (4) Metallic
poisons, e.g., arsenic, antimony, lead or mercury can be detected in
burnt bones.
om
m
Exhumation : (1) It is digging out of an already buried
co
co
body legally from grave. (2) There is no time limit in India. It is
e.
e.
done in cases of homicide, suspected homicide disguised as suicide,
fre
fre
fre
suspicious poisoning, criminal abortion, criminal malpractice,
survivorship and inheritance claims, workmen’s compensation claims,
ks
ks
ks
insurance claims, disputed identity, etc. (3) The body is exhumed only
oo
oo
oo
when there is a written order from Executive Magistrate. (4) It is
eb
eb
eb
exhumed under supervision of medical officer in the presence of
m
m
police and Magistrate. (5) In cases of suspected mineral poisoning,
half kg sample of earth in contact with body and from above, below,
and from each side is collected. (6) Any fluid or debris in coffin, a
om
om
portion of coffin and burial clothes are collected for chemical analysis.
co
(7) Viscera should be preserved for chemical examination. Arsenic is

c
e.
e.
most likely to be detected in exhumed bodies. (8) Disinfectants should

re
fre
not be sprinkled on the body. (9) Autopsy is done in usual manner. re

sf
f
(10) If the body is reduced to skeleton, the bones should be examined.
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-04.indd 46 04-03-2015 12:08:05 PM

e
e
m
m
om
m
co
co
e. 5
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Death and Its cause
om
m
co
co
e.
e.
Thanatology deals with death in all its aspects.
fre
fre
fre
Somatic death is the complete and irreversible stoppage of
ks
ks
ks
circulation, respiration and brain functions (tripod of life). There is
oo
oo
oo
no legal definition of death. The question of death is important in
eb
eb
eb
resuscitation and organ transplantation. Molecular death is death of
cells and tissues individually, which occurs 1 to 2 hours after stoppage
m
of vital functions.
Brain death consists of (1) deep unconsciousness, (2) no
m
om
om
movements, no spontaneous breathing, (3) stoppage of spontaneous

co
cardiac rhythm, (4) no reflexes, (5) bilateral dilatation and fixation

c
of pupils, (6) flat EEG, provided all of above are present (a) for 24
e.
e.
hours, (b) body temperature is not below 320C. (c) no metabolic and
re
fre
endocrine disturbances. re
sf
f
ks
ks
For transplantation, cornea can be removed from dead body
k
oo
oo
oo
within 6 hours, skin in 24 hours, bone in 48 hours and blood vessels

eb
eb
eb
in 72 hours. Kidneys, heart, lungs and liver must be removed soon

after stoppage of circulation
m
Modes of Death : (1) Coma. (2) Syncope. (3) Asphyxia.

Coma is insensibility which involves central portion of brain
om
stem. Syncope is sudden stoppage of action of heart, which may be

co
co
fatal.
Asphyxia : (1) It is a condition caused by interference with
e.
e.
respiration, or due to lack of oxygen in respired air (and failure to

fre
fre
fre
eliminate Co2), due to which organs and tissues are deprived of

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-05.indd 47 04-03-2015 12:08:17 PM

e
e
m
m
om
m
co
co
e.
e.
oxygen, which may cause unconsciousness and death. (2) Neurons
re
fre
fre
of cerebral cortex will die in 3 to 7 minutes of complete oxygen
sf
deprivation. (3) Breathing stops within 20 seconds of cardiac
ks
ks
k
arrest, and heart stops within 20 minutes of stopping of breathing.

oo
oo
oo
Anoxia means lack of oxygen. (1) Anoxic anoxia : It occurs due
eb
eb
eb
to (a) breathing in contaminated atmosphere, e.g exposure to gases in
m
m
wells and tanks, sewer gas, (b) mechanical obstruction to breathing.
This type is usually known as asphyxia or mechanical asphyxia.
(2) Anaemic anoxia: It occurs due to reduction in oxygen carrying
om
m
capacity of blood, e.g. acute massive haemorrhage, acute poisoning
co
co
by Co, nitrates, chlorates, coaltar derivatives. (3) Stagnant anoxia:
e.
e.
Impaired circulation causes reduction of oxygen delivery to tissues,
fre
fre
fre
e.g. heart failure, embolism, shock. (4) Histotoxic anoxia: Enzymatic
processes by which oxygen in the blood is used by tissues are blocked,
ks
ks
ks
e.g. cyanide poisoning.
oo
oo
oo
Types of Asphyxia: (1) Mechanical : Due to mechanical
eb
eb
eb
blocking of air- passages, such as smothering, hanging, strangulation,
m
m
drowning, traumatic asphyxia. (2) Pathological : due to disease
of upper respiratory tract, e.g. acute oedema of glottis, laryngeal
spasm and abscesses. (3) Toxic : (A) Use of oxygen is prevented,
om
om
e.g. Co. (B) Enzymatic processes are blocked, e.g cyanides. (C)
co
Paralysis of respiratory centre, e.g poisoning by opium, barbiturates,

c
e.
e.
strychnine. (D) Paralysis of respiratory muscles by gelsemium. (4)

re
fre
Environmental: (A) Insufficient oxygen in air, e.g. enclosed places, re

sf
f
trapping in disused refrigerator or trunk. (B) exposure to irrespirable
ks
ks
k
gases, e.g. CO, CO2, sewer gases. (5) Traumatic : (a) pulmonary
oo
oo
oo
embolism, (b) pulmonary fat embolism, (c) pulmonary air embolism,

eb
eb
eb
(d) bilateral pneumothorax. (6) Postural asphyxia : It occurs when

m
an unconscious person lies with upper half of body lower than the
remainder, and also from forcible flexion of the neck on the chest.
(7) Iatrogenic is associated with anaesthesia,
om
Pathology: Asphyxia ......reduction in oxygen tension...capillary

co
co
dilation ...capillary stasis... capillary engorgement..... stasis of blood

e.
e.
in organs..... diminished venous return to heart ..... reduced pulmonary

fre
fre
fre
flow.... deficient oxygenation in lungs.... asphyxia (vicious cycle).

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-05.indd 48 04-03-2015 12:08:17 PM

e
e
m
m
om
m
co
co
Death and Its Cause 49
e.
e.
Asphyxial stigmata: The triad of (1) cyanosis, (2) facial
re
fre
fre
palpebral, subpleural and subepicardial petechiae, (3) visceral
sf
ks
ks
congestion, are consistent with, but not diagnostic of asphyxia.
k
Reliable local indications of fatal obstructing trauma must be present,

oo
oo
oo
to conclude that death occurred from asphyxia.
eb
eb
eb
Cyanosis occurs due to diminished oxygen tension in blood and
m
m
an increase of reduced haemoglobin. The cyanotic colour of blood
will be seen if there is at least 5 g/100 ml. of reduced haemoglobin
in capillary blood. Petechial haemorrhages (Tardieu spots) are
om
m
caused due to raised venous pressure from impaired venous return,
co
co
and not due to hypoxia of the vessel walls. A minimum of 15 to 30
e.
e.
seconds is required to produce congestion and petechiae.
fre
fre
fre
P.M. appearances in asphyxia : External : (1) P.M lividity
is well developed. (2) Face is pale in slow asphyxia. (3) Face is
ks
ks
ks
distorted, congested, often cyanosed and sometimes swollen and
oo
oo
oo
oedematous. (4) Fingernails are bluish. (5) Tongue protruded. (6)
eb
eb
eb
Frothy and bloody mucus escapes from mouth and nose. (7) Eyes are
m
m
prominent, conjuctivae congested and pupils are dilated. (8) Tardieu
spots (petechial haemorrhages) are seen in conjunctivae, and in the
zone above the level of compression of neck.
om
om
Internal : (1) Blood is fluid and dark. (2) Larynx and trachea
co
congested and contain frothy mucus. (3) Lungs are dark-purple and
c
e.
e.
congested and oedematous. (4) Internal organs are congested. (5)

re
fre
Tardieu spots are usually present in subconjunctival tissues, under re

sf
f
pleural and pericardial membranes, but they can be seen in internal
ks
ks
k
organs. The spots are dark, round and well-defined; size varies from
oo
oo
oo
pinhead to 2 mm. (6) Asphyxia causes medullary suboxia causing

eb
eb
eb
vomiting, due to which air-passages may be filled by inhaled vomit.

m
(7) If heart failure occurs before respiratory failure, asphyxial

signs will be less marked.
Negative autopsy : No cause of death is found after
om
autopsy and laboratory investigations. 2 to 5% of autopsies are

co
co
negative.
e.
e.
Causes : (1) Inadequate history : Deaths from vagal inhibition,

fre
fre
fre
status epilepticus, hypersensitivity reactions, dry drowning show

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-05.indd 49 04-03-2015 12:08:17 PM

e
e
m
m
om
m
co
co
e.
e.
no anatomical findings. (2) Inadequate external exam : Burns in
re
fre
fre
electrocution, injection marks, snake bite marks may be missed.
sf
(3) Inadequate internal exam : Air embolism and pneumothorax
ks
ks
k
may be missed. (4) Lack of toxicological analysis. (5) Insufficient

oo
oo
oo
laboratory exam. (6) Lack of training of doctor.
eb
eb
eb
Obscure autopsy: Deaths due to following causes may
m
m
be missed : (1) Natural : (a) Death precipitated by emotion, work
stress, (b) functional failure, such as epilepsy, paroxysmal fibrillation.
(2) Biochemical: (a) Uraemia, diabetes, potassium deficiency. (3)
om
m
Endocrine dysfunction: Adrenal insufficiency, (b) thyrotoxicosis,
co
co
myxoedema. (4) Concealed trauma: (a) Concussion, (b) self-reduced
e.
e.
neck injury, (c) blunt injury to heart, (d) reflex vagal inhibition.
fre
fre
fre
(5) Poisoning: (a) Narcotic poisoning, (b) neurotoxic or cytotoxic
poisons, (c) plant poisoning, (d) anaesthetic overdose. (6) Allergy
ks
ks
ks
and drug idiosyncrasy.
oo
oo
oo
Inhibition of heart (vagal inhibition or instantaneous physiological
eb
eb
eb
death) : (1) Death occrs suddenly, within seconds or in 1 to 2 minutes
m
m
due to minor trauma or relatively simple or harmless peripheral
stimulation. (2) Some persons have marked hypersensitivity to
stimulation of carotid sinuses, which causes bradycardia and
om
om
cardiac arrhythmias and arrest. (3) Death occurs due to pressure

co
on neck, particularly on carotid sinuses as in hanging or strangulation,

c
e.
e.
a blow on the abdomen or testicles, unexpected blows to the larynx,

re
fre
chest, abdomen and genital organs, impaction of food in larynx, re

sf
f
unexpected inhalation of fluid into the upper respiratory tract as in
ks
ks
k
drowning, sudden immersion of body in cold water, insertion of an

oo
oo
oo
instrument into bronchus, uterus, bladder or rectum, sudden distension

eb
eb
eb
of hollow muscular organs, e.g during attempts at criminal abortion,

m
sudden evacuation of pathological fluids, e.g. ascitic or pleural. (4)

Death is accidental and initiated by microtrauma. (5) The stimulus
should be sudden and abnormal for the reflex to occur. (6) The reflex is
om
exaggerated by high emotional tension, mild alcoholic intoxication and

co
co
hypoxia. (7) Autopsy is negative. (8) The cause of death is inferred

e.
e.
from the circumstances of death.

fre
fre
fre
Sudden death : (1) Death is sudden when a person not known

to have been suffering from dangerous disease, injury or poisoning is
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-05.indd 50 04-03-2015 12:08:17 PM

e
e
m
m
om
m
co
co
Death and Its Cause 51
e.
e.
found dead or dies within 24 hours after onset of terminal illness. (2)
re
fre
fre
About 50% deaths occur due to diseases of cardiovascular system. (3)
sf
ks
ks
The major cause of deaths is myocardial infraction due to coronary
k
thrombosis, embolism and obliteration of lumen of coronaries by the

oo
oo
oo
atherosclerosis. (4) Most common cause of death due to CNS lesion
eb
eb
eb
is intracerebral hemorrhage in the region of internal capsule due to
m
m
rupture of lenticulostriate artery.
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-05.indd 51 04-03-2015 12:08:17 PM

e
e
m
m
om
m
co
co
e. 6
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
PostMortem changes
om
m
co
co
e.
e.
Complete loss of circulation and respiration for more than 4 to 5
fre
fre
fre
minutes is accepted as death. P.M changes help in rough estimation
ks
ks
ks
of death.
oo
oo
oo
Suspended animation : (1) Signs of life are not found as
eb
eb
eb
functions are impaired for some time or reduced to minimum.
(2) However, life continues and resuscitation is succssful in such
m
m
cases. (3) The metabolic state is so reduced that the requirement
of individual cell for oxygen is satisfied through the use of oxygen
om
om
dissolved in body fluids. (4) In freezing of the body or in severe drug

co
poisoning of the brain, the activity of the brain can completely stop,
c
and in some cases start again. (5) It can be produced voluntarily

e.
e.
as in yoga. (6) Involuntary suspension of animation for few seconds

re
fre
to half-an-hour or more may be found in newborn infants, drowning, re

sf
f
ks
ks
electrocution, cholera, shock, sunstroke, cerebral concussion, after
k
oo
oo
oo
anaesthesia, insanity, etc.

eb
eb
eb
Skin becomes pale, ashy-white and loses elasticity within few

minutes.
m
Eyes : (1) Loss of corneal reflex. (2) Opacity of cornea occurs

due to drying. If eyelids are closed, cornea will be clear for 2 hours.
om
(3) If eyelids are open for a few hours after death, a film of cell debris
co
co
and mucus forms two yellow triangles on sclera each at side of iris,
which becomes brown and then black, called “tache noir”, upon
e.
e.
which dust settles and surface becomes wrinkled. (4) The eyes look
fre
fre
fre
sunken and become flaccid. (5) Pupils are slightly dilated soon after
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 52 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
Postmortem Changes 53
e.
e.
death due to relaxation of muscles of iris. Later, they are constricted
re
fre
fre
due to rigor mortis of constrictor muscles. (6) Retinal vessels show
sf
ks
ks
fragmentation or segmentation of blood columns within minutes after
k
death, which persists for an hour. (7) A steady rise in the potassium
oo
oo
oo
value occurs in vitreous humour.
eb
eb
eb
Cooling of Body (Algor mortis) : (1) For half to one hour
m
m
after death, rectal temperature falls little or not at all. (2) The curve
of cooling is sigmoid in pattern. (3) Body heat is lost by conduction,
convection and radiation and small fraction by evaporation of fluid
om
m
from skin. (4) In serious illness, circulation begins to fail before
co
co
death and hands and feet become cooler, which gradually extends
e.
e.
towards trunk. (5) A laboratory thermometer is inserted 8 to 10 cm
fre
fre
fre
into rectum for two minutes, or under the liver through small midline
opening, or into nose up to cribriform plate or in the ear through
ks
ks
ks
tympanic membrane to record temperature. (6) A marked rise in
oo
oo
oo
temperature occurs in case of fat or air embolism, infections, heat
eb
eb
eb
stroke, pontine haemorrhage, and exercise or struggle before death.
m
m
(7) Low temperature occurs in cases of collapse, congestive heart
failure, massive haemorrhage, secondary shock. During sleep rectal
temperature is half to 1ºc lower. (8) In tropical climates the heat
om
om
loss is roughly 0.4ºc to 0.6ºc per hour. (9) Rectal temperature of

co
naked body reaches that of environment in about 20 hours. (10) Time

c
e.
e.
in hours of death can be obtained by the formula

re
fre
Normal body temperature minus rectal temperature re

sf
f
ks
ks
Rate of tem
mperature fall per hour.
k
oo
oo
oo
Rate of cooling is affected by : (1) Difference in temperature

between body and medium. (2) The build of cadaver : Children
eb
eb
eb
and old people cool rapidly. (3) Physique of cadaver : Fat bodies
m
cool slowly. (4) Environment of body : Cooling is rapid in a well

ventilated room, humid atmosphere, body immersed in cold water,
om
and buried in earth. Cooling is slow when the body is clothed.

M.L Importance: It helps in estimation of time of death in cold
co
co
and temperate climates only, but not in tropical countries.

e.
e.
Postmortem Caloricity: (1) The temperature of body remains

fre
fre
fre
raised for two hours or so after death. (2) This occurs when the
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 53 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
regulation of heat production has been severely disturbed before
re
fre
fre
death, as in (a) sunstoke and some nervous disorders, (b) great
sf
ks
ks
increase in heat production in muscles due to convulsions, e.g.
k
tetanus and strychnine poisoning, (c) excessive bacterial activity, e.g.

oo
oo
oo
septicaemic condition, cholera and other fevers.
eb
eb
eb
Post mortem hypostasis (Postmortem staining): (1)
m
m
It is bluish-purple or purplish-red discolouration which appears
under skin in the most superficial layers of dermis of dependent
parts of body after death, due to capillo-venous distension. (2)
om
m
The intensity of the colour depends upon the amount of reduced
co
co
haemoglobin in blood. (3) The upper portions of the body are pale.
e.
e.
(4) It begins soon after death, but is visible half to 1 hour after death
fre
fre
fre
in normal persons, and 1 to 4 hours in anaemic persons. (5) In early
stages mottled patches are seen, which later enlarge and unite to
ks
ks
ks
produce extensive discolouration. (6) It is well-developed in 4 hours
oo
oo
oo
and reaches maximum between 6 to 12 hours. (7) When it first
eb
eb
eb
develops, it disappears when pressed by finger, and reappears after
m
m
pressure is released. (8) It is well marked in asphyxia, but is less
marked in death from wasting diseases, haemorrhage, anaemia and
lobar pneumonia. (9) Any pressure prevents capillaries from filling,
om
om
such as collar band, belt, wrinkles in clothes, etc. and such areas are
co
seen as pale strips, resembling marks of beating. (10) As the vessel

c
e.
e.
walls become permeable due to decomposition, blood leaks through

re
fre
them. At this stage, hypostasis does not disappear if finger is firmly re

sf
f
pressed against the skin.
ks
ks
k
Distribution: It depends on position of body : (1) In a body lying

oo
oo
oo
on its back, it first appears in neck and then spreads over entire
eb
eb
eb
back, except on the parts directly pressed on, i.e. occipital scalp,
m
shoulder-blades, buttocks, posterior aspects of thighs, calves and

heels. (2) It is absent under collar bands, belts, wrinkles in clothes,
etc. which are seen as strips and bands callled vibices. (3) If the body
om
is in prone position, lividity appears in front, colour is intense and

co
co
Tardieu spots are common. (4) If the body is inverted as in drunken

e.
e.
perosns, hypostasis appears in head and neck. (5) If the body is

fre
fre
fre
lying on one side, blood will settle on that side. (6) If the body is
suspended as in hanging, hypostasis will be marked in legs, external
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 54 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
genitalia, lower parts of forearms and hands. (7) In drowning, it is
re
fre
fre
found on the face, upper parts of chest, hands, lower arms, feet and
sf
ks
ks
calves. If the body is constantly moving its position, as in moving
k
water, it may not develop. (8) If the body is moved before blood
oo
oo
oo
clots in capillaries, hypostatic patches will disappear and new ones
eb
eb
eb
will form on dependent parts. (9) Fixation of postmortem staining
m
m
occurs in about 6 hours, due to blood coagulation in capillaries.
(10) Hypostatic congestion resembling P.M hypostasis may be seen
a few hours before death in persons dying slowly with circulatory
om
m
failure, e.g. cholera, typhus, tuberculosis, uraemia, congestive cardiac
co
co
failure, morphine poisoning and asphyxia, which becomes marked
e.
e.
shortly after death.
fre
fre
fre
Distinct colouration of hypostasis is seen in : (1) Co poisoning:
cherry -red. (2) HCN poisoning : bright-red. (3) Poisoning by nitrites,
ks
ks
ks
potassium chlorate, potassium bicarbonate, nitrobenzene, aniline
oo
oo
oo
(causing methaemoglobinaemia): dark brown or red. (4) phosphorus
eb
eb
eb
poisoning: dark brown. (5) Asphyxia: deeply bluish-violet or
m
m
purple. (6) Hypothermia: bright pink. (7) Clostridium perfringens
septicaemia: bronze.
Internal : (1) All internal organs show hypostasis in the
om
om
dependent parts. (2) In heart it can simulate myocardial infarction, in

co
lungs pneumonia and dependent coils of intestine appear strangulated.

c
e.
e.
(3) In early stages of decomposition, haemolysis of blood occurs with

re
fre
diffusion of pigment into surrounding tissues. (4) Blood stained fluid re

sf
f
collects in chest and abdomen. (5) With progress of decomposition,
ks
ks
k
the lividity becomes dusky, brown and green and disappears with
oo
oo
oo
destruction of blood. (6) In mummification, colour is brown to black.

eb
eb
eb
M.L. Imp : (1) Sign of death. (2) Its extent helps is estimating
m
time of death. (3) Indicates posture of the body at time of death. (4)
In some cases, colour may indicate cause of death.
Muscular changes: I. Primary flaccidity: (1) Death is
om
somatic. (2) It lasts for one to two hours. (3) All muscles of the body
co
co
begin to relax soon after death. (4) Body flattens over areas which are
e.
e.
in contact with the surface on which it rests (contact flattening). (5)

fre
fre
fre
Lower jaw falls, eyelids loose tension. (6) Muscular irritability and
response to mechanical or electrical stimuli persist. (7) Anaerobic
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 55 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
chemical process may continue. (8) Pupils react to atropine or
re
fre
fre
physostigmine. (9) Peristalsis may occur in bowel.
sf
II. Rigor Mortis : It is a state of stiffening of muscles, with
ks
ks
k
slight shortening of fibres.

oo
oo
oo
Mechanism : (1) A voluntary muscle consists of bundles of long
eb
eb
eb
fibres. (2) Each fibre is formed of densely packed myofibrils, which
m
m
are protein filaments of two types, actin and myosin. (3) In relaxed
condition, actin filaments interdigitate with myosin filaments to a
small extent. (4) If there is a nerve impulse, arrays of actin filaments
om
m
are drawn into arrays of myosin filaments, rather like pistons into
co
co
cylinders which causes muscles to contract. (5) After death, ATP
e.
e.
is progressively and irreversibly destroyed leading to increased
fre
fre
fre
accumulation of lactates and phosphates in mucles. (6) Membrane
disruption and lack of ATP after death results in increased calcium
ks
ks
ks
level in the sarcomeres and muscle contraction occurs. (7) When
oo
oo
oo
ATP is reduced to 85% of normal, overlapping portions of myosin
eb
eb
eb
and actin filaments combine as rigid links of actomyosin, which is
m
m
sticky and inextensible, and causes rigor. (8) Simultaneously, a rise
in lactic acid and fall in hydrogen ion concentration occurs. (9) When
lactic acid concentration reaches a level of about 0.3%, muscles go
om
om
into irreversible state of contraction. (10) Rigor mortis persists until

co
decomposition of proteins of muscles occur.

c
e.
e.
Order of appearance: (1) It first appears in involuntary muscles

re
fre
(myocardium in one hour). (2) It begins in eyelids, lower jaw and re

sf
f
neck, and passes upwards to muscles of face and downwards to
ks
ks
k
muscles of chest, upper limbs, abdomen, lower limbs and lastly

oo
oo
oo
in fingers and toes (proximo-distal progression). (3) In the limbs

eb
eb
eb
it extends from above downwards. (4) It disappears in the same order

m
in which it appeared. (5) It always sets in, increases and decreases

gradually.
Development : (1) When rigor is developing limbs can be moved,
om
which later develops in the new position, although rigidity is less. (2)
co
co
If force is applied when rigor is fully developed, stiffness is broken

e.
e.
up permanently. (3) When rigor is fully developed, the entire body is

fre
fre
fre
stiff, muscles shortened, hard and opaque, knees, hips, shoulders and
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 56 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
elbows are slightly flexed and fingers and toes often show a marked
re
fre
fre
degree of flexion. (4) Pupils are partially contracted. (5) It develops
sf
ks
ks
independent of integrity of nervous system. (6) Rigor is tested by
k
trying to lift eyelids, depressing jaw and gently bending neck and
oo
oo
oo
various joints of body.
eb
eb
eb
Cutis anserina or goose skin is caused by rigor of erector pilae
m
m
muscles.
Time of onset : In India, it begins one to two hours after death
and takes further one to two hours to complete, i.e 2 to 4 hours. In
om
m
temperate countries, it begins in 3 to 6 hours and takes further 2 to 3
co
co
hours for complete development.
e.
e.
Duration : In India it lasts for 24 to 48 hours in winter, and 18
fre
fre
fre
to 36 hours in summer.
Conditions altering onset and duration: (1) Age : It does not
ks
ks
ks
occur in a foetus of less than 7 months. In healthy adults it develops
oo
oo
oo
slowly, and is well-marked; in children and old people it is feeble
eb
eb
eb
and rapid. (2) Nature of death: In deaths from diseases causing great
m
m
exhaustion and wasting, e.g. cholera, typhoid, tuberculosis, cancer,
etc. and in violent deaths, e.g. cut-throat, firearms, electrocution onset
is early and duration short. Onset is delayed in deaths from asphyxia,
om
om
severe haemorrhage, apoplexy, pneumonia, and paralysis of muscles.

co
(3) Muscular state: Onset and duration long if muscles are healthy
c
e.
e.
and at rest.Onset rapid, if there is fatigue or exhaustion before death.

re
fre
(4) Atmosphere: In cold weather onset is slow and duration long. In re

sf
f
hot weather onset is rapid and duration is short.
ks
ks
k
M.L.Imp: (1) Sign of death. (2) Time since death can be made
oo
oo
oo
out. (3) Indicates position of body at time of death.

eb
eb
eb
Conditions simulating rigor mortis: (1) Heat stiffening: When

m
body is exposed to temperatures above 65ºC, stiffness occurs which

is more marked than RM, e.g. deaths from burning, high voltage
electric shock, fall into hot liquid (pugilistic attitude). It remains until
om
muscles soften from decomposition, and normal RM does not occur.

co
co
(2) Cold stiffening : When exposed to freezing temperatures,

e.
e.
all the body tissues become frozen and stiff. If the body is shifted to
fre
fre
fre
hot atmosphere, stiffness disappears, and later normal R.M occurs.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 57 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
Difference between rigor mortis and cadaveric spasm
re
fre
fre
Trait Rigor mortis Cadaveric spasm
sf
ks
ks
(1) Production : Freezing and exposure Cannot be produced
k
to temperature. by any method after

oo
oo
oo
death.
eb
eb
eb
(2) Mechanism : Known. Not clearly known.
m
m
(3) Predisposing Nil. Sudden death,
factors : excitement, fear,
exhaustion, nervous
om
m
tension, etc.
co
co
(4) Time of onset : One to two hours after Instantaneous.
death.
e.
e.
(5) Muscles involved: All the muscles of the Usually restricted
fre
fre
fre
body, both voluntary to a single group of
ks
ks
ks
and involuntary. voluntary muscles.
(6) Muscle stiffening: Not marked; moderate Marked; very great
oo
oo
oo
force can overcome it. force is required to
eb
eb
eb
overcome it.
(7) Molecular death : Occurs. Does not occur.
m
(8) Body heat : Cold.

(9) Electrical stimuli : Muscles do not
Warm.
m
Muscles respond.
om
om
respond.
co
(10) Medicolegal Indicates time of Indicates mode of

c
importance : death. death, i.e, suicide,

e.
e.
homicide or accident.
re
fre
(3) Cadaveric Spasm or Instantaneous rigor : re

sf
f
ks
ks
It is very rare (1) In this, muscles that were contracted during life,
k
oo
oo
oo
become stiff and rigid immediately after death, without passing

eb
eb
eb
into stage of primary relaxation. (2) The change preserves the exact
attitude of person at the time of death. (3) It occurs in cases of sudden
m
death, excitement, fear, severe pain, exhaustion, severe haemorrhage,

injury to nervous system, firearm wound of head, convulsant poisons,
om
etc. (4) It is usually limited to a single group of muscles, and usually

co
co
involves hands, but very rarely whole body is affected. (5) It cannot
be produced artificially. (6) Stiffness is more than as seen in R.M.
e.
e.
(7) It passes without interruption into normal R.M and passes off when
fre
fre
fre
rigor disappears. (8) Its mechanism is obscure. (9) At the time of its
ks
ks
ks
development molecular death does not occur, and the body is warm.
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 58 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
M.L. Imp : (1) Rarely, in case of suicide, weapon is seen firmly
re
fre
fre
grasped in the hand. (2) In drowning, firm grasping of weeds, grass,
sf
ks
ks
gravel, etc. in the hand, indicates that victim was alive on entering the
k
water. (3) In cases of assault, some part of clothing, hair, etc. from
oo
oo
oo
the assailant will be found firmly grasped in the hands.
eb
eb
eb
Putrefaction : (1) Putrefaction or decomposition is final
m
m
stage following death, produced mainly by bacterial enzymes,
mostly anaerobic organisms derived from the intestines. Other
enzymes are derived from fungi and insects. (2) “Cl welchii is the chief
om
m
destructive agent”, which causes marked haemolysis, liquefaction of
co
co
P.M clots and fresh thrombi and emboli, disintegration of tissue and
e.
e.
gas formation in blood vessels and tissues. (3) Lecithinase produced
fre
fre
fre
by C1 welchii is important, which hydrolyses lecithin in all cell
membranes and causes haemolysis of blood.
ks
ks
ks
(I) Colour changes : (1) The first external sign of putrefaction
oo
oo
oo
in a body lying in air is greenish discolouration of the skin over the
eb
eb
eb
region of caecum, where contents of bowel are more fluid and full of
m
m
bacteria. (2) Internally it is seen on undersurface of liver which is in
contact with transverse colon. (3) Green colour is due to conversion
of haemoglobin into sulphmethaemoglobin, by hydrogen sulphide
om
om
formed in large intestine. (4) Green colour appears in 12 to 18 hours

co
in summer and one to two days in winter. (5) Colour spreads over
c
e.
e.
abdomen, external genitalia and then patches appear on chest, neck,

re
fre
face, arms and legs. (6) Patches become dark-green and later purple re
sf
f
and dark-blue. (7) Marbled appearance is due to greenish-brown
ks
ks
k
or reddish-brown staining of superficial veins over roots of limbs,

oo
oo
oo
chest and neck. This is prominent in 36 to 48 hours. (8) Clotted blood

eb
eb
eb
becomes fluid due to which position of P.M staining is altered and

m
fluid blood collects is serous cavities. The effusion in pleural cavities

does not exceed 60 to 70 ml. (9) Reddish-brown discolouration of
inner surface of vessels, especially of aorta is the earliest internal
om
change. (10) The colour of viscera varies from dark-red to black,

co
co
rather than green, and viscera become softer and greasy.

e.
e.
(II) Foul-smelling Gases : (1) Gases are non-inflammable in

fre
fre
fre
early stages, but when enough hydrogen sulphide is formed they can
burn with a blue flame. (2) Gases collect in intestines in 6 to 12
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 59 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
hours in summer and the abdomen distends. (3) Eyeballs become
re
fre
fre
soft, cornea becomes white and flattened. Later the eyes collapse. (4)
sf
ks
ks
Discoloured natural fluids and liquefied tissues are made forthy by
k
gas. (5) Gas in abdomen pushes the diaphragm upwards compressing

oo
oo
oo
heart and lungs and blood-stained froth exudes from mouth and
eb
eb
eb
nostrils (P.M. purge). (6) Food from the stomach may be forced due
m
m
to pressure of gases, and this food may fall into the larynx. (7) Gas
bubbles accumulate in the tissues. (8) From 18 to 48 hours, gases
collect in tissues, cavities and hollow viscera under pressure, and
om
m
features become bloated and distorted. (9) Subcutaneous tissues
co
co
become emphysematous, due to which the body appears obese. (10)
e.
e.
Eyes bulge, tongue protrudes. (11) Sphincters relax. (12) Blisters
fre
fre
fre
are formed due to gas in blood vessels forcing fluid, air or liquid fat
between epidermis and dermis. Blisters are formed first on lower
ks
ks
ks
surfaces of trunk and thighs, where tissues contain more fluid due to
oo
oo
oo
hypostatic oedema. Blisters, enlarge, unite and rupture. (13) After 2
eb
eb
eb
to 3 days anus and uterus may porlapse. (14) A.M or P.M wounds
m
m
cannot be made out. (15) After 3 days face is so much discoloured
and bloated that identification is not possible. (16) The hairs
become loose and can be easily pulled out. (17) In 3 to 5 days sutures
om
om
of skull (especially in children) are separated and liquid brain comes

co
out. (18) Teeth become loose and may fall off. (19) Skin of hands and
c
e.
e.
feet may come off in a “glove and stocking” fashion.

re
fre
(III) Liquefaction of tissues : (1) After 5 to 10 days colliquative re

sf
f
liquefaction begins. (2) The abdomen bursts. (3) The tissues become soft,
ks
ks
k
loose and are converted into a thick, semi-fluid, black mass and fall off.
oo
oo
oo
Gas rigidity : Body becomes rigid due to inflation of tissues

eb
eb
eb
when changes of decomposition are well marked. (2) The lower

m
limbs are abducted, flexed and rigid, arms are flexed and rigid, hands
are open, and fingers are wide apart. (3) This is usually seen in bodies
recovered from water. (4) The rigidity persists till the escape of gases.
om
Skeletonisation: (1) In India, an uncoffined buried body is

co
co
reduced to a skeleton within about a year. (2) In deeply buried body,

e.
e.
lower temperature, exclusion of air, absence of animal life, etc. delay

fre
fre
fre
decomposition markedly. (3) In hot climates bones on the ground

surface may decay in 5 to 10 years.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 60 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
Internal Changes: As blood decomposes, haemoglobin transudes
re
fre
fre
into the tissues, which gradually change to greenish-yellow, greensih-
sf
ks
ks
blue and finally black. The viscera become greasy and softened.
k
Conditions affecting rate of putrefaction : (A) External : (1)

oo
oo
oo
Temperature: (a) Putrefaction begins above 10°C and is optimum
eb
eb
eb
between 21 to 38°C. It is arrested below 0°C and above 48°C. (b)
m
m
Rate of decomposition is about twice as rapid in summer as in winter.
(2) Moisture: decomposition is rapid in generalised oedema and in
bodies recovered from water if left in the air. (3) Manner of burial:
om
m
(a) It is rapid in bodies buried in a damp, marshy or shallow graves.
co
co
(b) It is delayed if buried in dry, sandy soil or in grave deeper than
e.
e.
2 metres, when body is covered and placed in a coffin, and when
fre
fre
fre
buried in lime.
(B) Internal : (1) Age : Bodies of children putrefy rapidly
ks
ks
ks
and of old people slowly. (2) Sex has no effect. (3) Condition of
oo
oo
oo
body : Fat bodies puterfy quickly. (4) Cause of death : Bodies
eb
eb
eb
of persons dying from septicaemia, peritonitis, inflammatory and
m
m
septic conditions, general anasarca, asphyxia decompose rapidly. In
wasting disease, anaemia and debility it is delayed. (5) Mutilation :
Bodies having wounds, or suffered from violence putrefy rapidly. In
om
om
dismemberment, limbs putrefy slowly and trunk rapidly.

co
Casper dictum states that a body decomposes in air twice as

c
e.
e.
rapidly as in water, and 8 times as rapidly as in earth. It is more rapid

re
fre
in warm, fresh, stagnant water, than in cold, salty, running water. re

sf
f
AdiPocere (Saponification) : (1) Gradual hydrolysis
ks
ks
k
and hydrogenation of pre-existing fats, such as olein, into higher

oo
oo
oo
fatty acids, which being acidic, inhibit putrefactive bacteria. (2)

eb
eb
eb
Ultimately, whole of fat is converted into palmitic, oleic, stearic

m
and hydroxystearic acids, and a mixture of these substances forms

adipocere. (3) Intrinsic lipases start the process, which is continued
by bacterial enzymes, especially clostridia group. (4) Water required
om
for hydrolysis is obtained mainly from body tissues. If body is in

co
co
water, this fluid contributes to hydrolysis of subcutaneous fat. (5) It

e.
e.
is delayed by cold and formed rapidly from heat.

fre
fre
fre
Properties : (1) It has offensive or sweetish smell, but in early

stages it has penetrating ammoniacal odour. (2) Fresh adipocere
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 61 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
is soft, moist, whitish, translucent, and old is dry, hard, cracked,
re
fre
fre
yellowish, brittle. (3) It is inflammable.
sf
Distribution : (1) It first forms in subcutaneous tissues. (2)
ks
ks
k
Face, buttocks, breasts and abdomen are usual sites. (3) Rarely
oo
oo
oo
entire body is converted into adipocere. (4) Fatty tissues in viscera
eb
eb
eb
and muscles are also affected. (5) Epidermis disappears as adipocere
m
m
forms. (6) Liver is prominent and retains shape. (7) Sometimes, gross
features of organs may be made out from histology.
Time required : (1) In India, it may be seen within 3 to 4 days. (2)
om
m
In temperate countries, it starts in 3 weeks. (3) Complete conversion
co
co
in an adult limb occurs in 3 to 6 months. (4) Foetuses of less than 6
e.
e.
months do not show adipocere.
fre
fre
fre
M.L Imp : If face is affected identification can be established.
(2) Cause of death and time of death can be determined.
ks
ks
ks
Mummification : (1) Dehydration or drying and
oo
oo
oo
shrinking of cadaver occurs from evaporation of water, but
eb
eb
eb
natural appearance and features are preserved. (2) It begins in
m
m
exposed parts of body like face, hands and feet and then extends to
entire body including internal organs. (3) Skin is contracted, shrunken,
dry, brittle, leathery, rusty-brown in colour and adheres to bone.
om
om
(4) Liquid oil is forced into dermis, which becomes translucent.

co
(5) Tissues are dry, leathery and brown. (6) Face is distorted.
c
e.
e.
(7) Whole body loses weight, becomes thin, stiff and brittle. (8) If
re
fre
protected it is preserved for years. (9) Body is odourless. (10) It re

sf
f
takes 3 months to 1 to 2 years for mummification of whole body.
ks
ks
k
(11) Absence of moisture in air and continued action of dry or warm

oo
oo
oo
air is necessary for its production. (12) Marked dehydration before

eb
eb
eb
death favours its development. (13) It is seen in bodies buried in

m
shallow graves in dry sandy soils, where evaporation of body fluids

is rapid. (14) Rarely body may show mummification in some parts
and adipocere in others.(15) M.L Importance is same as for adipocere.
om
EMBalming : (1) It is a method to preserve body. (2) Contents

co
co
of G.I tract, bladder and blood vessels are removed through a wound
e.
e.
of abdomen. (3) Venous drainage is done through internal jugular or

fre
fre
fre
axillary vein. (4) Embalming fluid consists of formalin (6% to 10%)

sodium borate, sodium citrate, sodium chloride and eosin. (5) 8 to
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 62 04-03-2015 12:08:32 PM

e
e
m
m
om
m
co
co
e.
e.
10 litres of this fluid is injected through the axillary, cartoid or
re
fre
fre
femoral artery by : (a) gravity feed injector, (b) bulb syringe, (c)
sf
ks
ks
hand pump, or (d) motorised pump injector. (6) By this proteins are
k
caogulated, tissues are fixed, organs are bleached and hardened and
oo
oo
oo
blood is converted into a brownish mass. (7) It produces chemical
eb
eb
eb
stiffening similar to rigor mortis, and normal R.M does not
m
m
develop. (8) Blood groups cannot be made out. (9) Thrombi and
emboli will be dislodged and washed away. (10) If done within 6
hours of death body will be well preserved.
om
m
The following conditions preserve the body after death : (1)
co
co
Embalming. (2) Mummification. (3) Adipocere. (4) Freezing. (5)
e.
e.
Bodies buried in soil containing antiseptic substances.
fre
fre
fre
If body is refrigerated, onset of rigor is delayed, reddish patches
appear especially in hypostatic region, blood is bright red, tissues
ks
ks
ks
become hard, and abrasions and contusions become prominent.
oo
oo
oo
P.M. interval is important (1) to know when crime was
eb
eb
eb
committed, (2) gives police starting point for their inquiries, (3) to
m
m
exclude some suspects, and, (4) to check on a suspect’s statement.
Entomology : (1) Flies deposit eggs between lips or eyelids,
nostrils or wounds soon after death. (2) Larvae or maggots are produced
om
om
from eggs in 8 to 12 hours in summer, which crawl into interior of body,

co
and produce proteolytic enzymes and destroy soft tissues. (3) Maggots
c
e.
e.
become pupae in 4 to 5 days and adult flies in 3 to 5 days.

re
fre
G.I. Tract : (1) There is considerable variation in emptying of re

sf
f
the stomach in the same and different persons even if the same meal
ks
ks
k
is ingested. (2) Bulk of meal leaves stomach in 2 hours. (3) A light

oo
oo
oo
meal leaves stomach within 2 hours, medium-sized meal 3 to 4 hours.

eb
eb
eb
heavy meal 4 to 6 hours. (4) In head injury causing coma, it may

m
not empty in 24 hours. (5) Any illness or emotional stress prolongs

emptying time for many hours. (6) Carbohydrate meal empties earlier
than protein meal, which empties earlier than fatty meal. (7) Head
om
of meal reaches hepatic flexure in 6 hours, splenic flexure in 9 to 12

co
co
hours, and pelvic colon in 12 to 18 hours.

e.
e.
In vitreous humour, there is gradual linear increase in potassium

fre
fre
fre
concentration up to 120 hours after death. Hair does not grow after
death. Beard hair grows at the rate of 0.4 mm per day.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-06.indd 63 04-03-2015 12:08:32 PM

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e
m
m
om
m
co
co
e. 7
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Mechanical Injuries
om
m
co
co
e.
e.
An injury is any harm, illegally caused to any person in body,
fre
fre
fre
mind, reputation or property (S.44, I.P.C).
ks
ks
ks
(I) Classification: Medical: (I) Mechanical Injuries: (A)
oo
oo
oo
Due to blunt force: (1) Abrasions. (2) Contusions. (3) Lacerations.
eb
eb
eb
(4) Fractures and Dislocations. (B) Due to sharp force: (1) Incised
wounds. (2) Chop wounds. (3) Stab wounds. (C) Firearms: (1)
m
Firearm wounds.
m
(II) Thermal Injuries: (1) Due to cold. (a) Frostbite. (b) Trench
om
om
foot. (c) Immersion foot. (2) Due to heat. (a) Burns. (b) Scalds.
co
(III) Chemical Injuries: (1) Corrosive acids. (b) Corrosive

c
alkalis.
e.
e.
(IV) Miscellaneous: Electricity, lightning X-rays, radioactive

re
fre
substances, etc. re
sf
f
ks
ks
(V) Explosions
k
oo
oo
oo
Legal : (1) Simple. (2) Grievous.

Medicolegal : (1) Suicide. (2) Homicide. (3) Accident. (4)
eb
eb
eb
Fabricated. (5) Defence. (6) Undetermined.

m
Abrasions : (1) Abrasion is destruction of skin, usully

involving superficial layers of epidermis only. (2) They are caused
om
by lateral rubbing action by a blow, a fall on rough surface, being

co
co
dragged in vehicular accident, fingernails, throns or teeth-bite. (3)

Some pressure and movement by agent on the surface of skin is
e.
e.
essential. (4) Abrasion has only length and breadth.

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 64 04-03-2015 12:08:52 PM

e
e
m
m
om
m
co
co
Mechanical Injuries 65
e.
e.
(I) Scratches : (1) They are caused by sharp object passing across
re
fre
fre
the skin, such as fingernails, pin or thorn. (2) It shows clean area at
sf
ks
ks
the start and tags at the end, which tails off. (3) Fingernails produce
k
curved scratch.
oo
oo
oo
(II) Grazes : (sliding, scraping or grinding abrasions) : (1)
eb
eb
eb
They are most common type. (2) They are caused when there is
m
m
horizontal movement between skin and rough surface. (3) They
show longitudinal parallel lines (grooves or furrows) with tags at
the end. (4) The furrow may be broad at one end and narrow in
om
m
opposite direction. (5) Glancing kick produces a graze. (6) Brush
co
co
burn is caused by violent rubbing against a broad rough surface, as in
e.
e.
dragging over ground. (7) Friction burn is an extensive superficial,
fre
fre
fre
reddened, excoriated area with little or no linear mark, which occurs
when skin is covered with clothing.
ks
ks
ks
(III) Pressure abrasion (crushing or friction abrasion) : (1) They
oo
oo
oo
are caused by crushing of superficial layers of epidermis, and show
eb
eb
eb
bruising of surrounding area. (2) It occurs when the movement of
m
m
instrument is around 900 to skin. (3) Movement is slight and largely
directed inwards, such as ligature mark of hanging and strangulation,
and teeth bite marks.
om
om
(IV) Impact abrasions (contact or imprint) : (1) They are caused

co
by impact with rough object, when force is applied at or near right

c
e.
e.
angle to skin, such as when a person is knocked down by a motor car,

re
fre
the pattern of which is left on the skin. (2) The abrasion is slightly re
sf
f
depressed. (3) If impact is forcible, dermis is damaged with an
ks
ks
k
underlying bruise, e.g. in traffic accident, radiator grille, tyre tread

oo
oo
oo
impressions, etc. are seen.

eb
eb
eb
Patterned abrasions are (a) impact, (b) pressure.

m
Age : Fresh: Bright red. 12 to 24 hours : Bright scab due to

drying of blood and lymph. 2 to 3 days : Reddish-brown scab. 4 to
7 days: Epithelium covers defect. 7 days: Scab dries, shrinks and
om
falls off.
co
co
Antemortem abrasions occur (a) any where on body, (b) bright

e.
e.
reddish-brown, (3) scab slightly raised, (4) vital reaction present.

fre
fre
fre
P.M. abrasions occur over bony prominences, (b) yellowish,

translucent, (c) scab often depressed, (d) no vital reaction.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 65 04-03-2015 12:08:52 PM

e
e
m
m
om
m
co
co
e.
e.
M.L.Imp : (1) Site of impact and direction of force is indicated.
re
fre
fre
(2) They may be only external sign of serious internal injury. (3)
sf
ks
ks
Patterned abrasions indicate the object causing them. (4) Age of injury
k
can be made out. (5) Scene of crime may be known from presence of
oo
oo
oo
dust, dirt, sand, etc. in the open wounds. (6) Character and manner of
eb
eb
eb
injury may be known from distribution, e.g., in throttling, smothering,
m
m
sexual assault, struggle, etc.
Differential diagnosis : (1) Erosion of skin by ants. (2)
Excoriation of skin by excreta. (3) Pressure sores.
om
m
Contusions (Bruises) : (1) Contusion is an effusion of
co
co
blood into tissues due to rupture of venules and arterioles due
e.
e.
to blunt violence. (2) There is a painful swelling and crushing and
fre
fre
fre
tearing of subcutaneous tissues. (3) They are caused by blunt force,
such as fist, stone, stick, boot, etc. (4) Skin is not usually damaged.
ks
ks
ks
(5) It also occurs in deeper structures and viscera. (6) They may
oo
oo
oo
be associated with abrasions (abraded contusions) or lacerations.
eb
eb
eb
(7) Haematoma (tumour-like mass) is produced when large blood
m
m
vessel is injured. (8) Fresh bruise is tender and slightly raised. (9)
The colour is lighter in the centre. (10) Size varies from pinhead to
large collections, and slightly larger than the surface of agent which
om
om
caused it. (11) The size and shape are modified by: (1) Condition
co
and type of tissue : (a) If part is vascular and loose, such as face,
c
e.
e.
vulva, scrotum, slight violence may cause a large bruise. (b) If tissues
re
fre
are strongly supported, contain firm fibrous tissues and covered with re
sf
f
thick dermis, such as abdomen, back, scalp, palms and soles, a blow
ks
ks
k
of moderate violence may produce a smaller bruise. (c) Bruising does

oo
oo
oo
not occur if injured part is thickly covered, or if weapon is yielding

eb
eb
eb
one, such as sand bag, or if pressure is continued until death occurs.

m
(d) Chronic alcoholics bruise easily (e) Bruising is more marked on

tissues overlying bone. (2) Age : Children and old persons bruise
more easily. (3) Sex : Women bruise easily. (4) Natural Disease:
om
Bruising is more in arteriosclerosis, scurvy, leukaemia, purpura, and

co
co
haemophilia. (5) Gravity shifting of blood : Sometimes, bruise may

e.
e.
not appear at the site of impact, but may appear at a relatively distant
fre
fre
fre
place, where the fascial plane arrangement permits it to reach the

surface (ectopic bruising), e.g. in fracture of femur bruise is seen
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 66 04-03-2015 12:08:52 PM

e
e
m
m
om
m
co
co
e.
e.
on the outer side of lower part of thigh; kick on calf of leg it is seen
re
fre
fre
around the ankle.
sf
Black eye: Haemorrhages in the soft tissues around the eyes and
ks
ks
k
in the eyelids (spactacle haematoma, black eye) may be caused by

oo
oo
oo
: (1) punch in the eye, (2) blunt impact to forehead, (3) fracture of
eb
eb
eb
anterior cranial fossa.
m
m
Patterned bruising : (1) A bruise is usually round, but it may
indicate the nature of weapon. (2) If person is living, it may become
obscure as area of bruising tends to extend and merge with adjacent
om
m
structures. (3) A blow from hammer or first produces a round bruise.
co
co
(4) A blow with a rod, stick or whip produces two parallel linear
e.
e.
haemorrhages. The intervening skin is unchanged. The edges may
fre
fre
fre
be irregular and width may be greater due to infliltration of blood
in the surrounding tissues along the edges of the bruise. (5) A blow
ks
ks
ks
with a broad flat weapon, such as plank, produces two parallel bruises
oo
oo
oo
separated by a normal tissue. (6) Bruises by blows from whips are
eb
eb
eb
elongated, curved over prominences, and may partially encircle a
m
m
limb or body. (7) Bruises from straps, belts or chains have a definite
imprint. (8) Motor car accidents may produce patterned bruises.
Internal: (1) All organs can be contused. (2) Contusions of
om
om
internal organs may cause rupture of organ and death. (3) Bruises not
co
visible to naked eye, can be detected by ultraviolet light.

c
e.
e.
Delayed bruising : (1) Superficial bruise may appear immediately

re
fre
as a dark red swelling. (2) Deep bruise may take several hours, or one re
sf
f
to two days to appear, and deeper extravasation of blood may never
ks
ks
k
appear. (3) Rarely, when injury is produced before death, bruise may
oo
oo
oo
appear some time after death due to further escape of blood from the
eb
eb
eb
ruptured vessels due to gravitation and rapid heamolysis of stagnant

m
blood, the pigment diffusing locally.

Age : It is determined by colour change, which starts at the
periphery and extends to centre. At first : Red. Few hours to 3
om
days: Blue. 4th day : Bluish-black to brown (haemosiderin). 5 to

co
co
6 days : Greenish (hamatoidin). 7 to 12 days: Yellow (bilirubin). 2

e.
e.
weeks: Normal
fre
fre
fre
M.L. Imp : (1) Size may indicate degree of violence. (2) Patterned
bruises may connect victim and object or weapon. (3) Age of injury.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 67 04-03-2015 12:08:52 PM

e
e
m
m
om
m
co
co
e.
e.
(4) In case of fall, sand, dust, gravel, etc. may be found on the body.
re
fre
fre
(5) Character and manner of injury may be known from its distribution
sf
ks
ks
as in case of abrasions.
k
Bruises are of less value than abrasions because : (1) Their

oo
oo
oo
size may not correspond to size of weapon. (2) They may become
eb
eb
eb
visible several hours or one to two days after injury. (3) Direction of
m
m
force cannot be made out.
Difference between hypostasis and bruise
Trait Hypostasis Bruise
om
m
(1) Cause : Due to distension of vessels with Due to ruptured vessels which
co
co
blood in the dermis. may be superficial or deep.
e.
e.
(2) Site: Occurs over extensive area of the Occurs at the site of and
most dependent parts. surrounding the injury; may
fre
fre
fre
appear anywhere on the body.
ks
ks
ks
(3) Appearance: No elevation of the involved area. Often swollen because of
extravasated blood and oedema.
oo
oo
oo
(4) Epidermis : Not abraded. May be abraded.
eb
eb
eb
(5) Margins : Clearly defined. Merge with surrounding area.
(6) Colour: Uniform bluish-purple. Old bruises are of different
m
m
colour. Fresh bruises may appear
more intense than the adjacent
hypostatic area.
om
om
(7) Incision : On incision blood is seen in blood Shows extravasation of blood into
vessels, which can be easily washed the surrounding tissues which
co
away. Subcutaneous tissues are pale. is firmly clotted and cannot

c
be washed by gentle stream of

e.
e.
water. Subcutaneous tissues are

re
fre
deep reddish-black.
re
sf
(8) Effect of Absent in areas of the body which Little lighter over the area of
f
ks
ks
pressure: are even under slight pressure. pressure or support.
k
oo
oo
oo
Complications : (1) Contusion can contain 20 to 30 ml blood. (2)

eb
eb
eb
Multiple contusions can cause death from shock and haemorrhage.

(3) Gangrene and death of tissue. (4) Pulmonary embolism is rare.
m
Artificial bruise : (1) It is caused by juice of marking nut,

calotropis, or plumbago rosea. (2) Seen on exposed accessible parts.
om
(3) Colour is dark-brown. (4) Shape irregular. (5) Margins well-

co
co
defined and regular, covered with small vesicles. (6) Redness and
inflammation is seen in the surrounding skin. (7) Contain acrid serum.
e.
e.
(8) Itching is present. (9) Vesicles may be found on fingertips and on

fre
fre
fre
other parts of the body due to scratching.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 68 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
Lacerations (tears or ruptures) : (1) Lacerations are
re
fre
fre
tears or splits of skin, mucous membrane, muscle or internal organs
sf
caused by application of blunt force to broad area of body, which
ks
ks
k
crushed or stretched tissues beyond the limits of their elasticity.

oo
oo
oo
(2) If there is bleeding into adjacent tissues, it is called contused-
eb
eb
eb
laceration or bruised -tear. (3) If the margins are abraded, it is called
m
m
abraded laceration. (4) If there is extensive bruising and laceration
of deeper tissues, it is called crush injury.
Types : (I) Split laceration : (1) Splitting occurs by crushing of
om
m
skin between two hard objects, such as scalp being crushed between
co
co
skull and some hard object. (2) Incised-like or incised-looking
e.
e.
wounds are lacerated wounds. (3) They are caused by blunt force
fre
fre
fre
which does not cause excessive skin crushing. (4) Margins appear
sharp. (5) This is seen in areas where skin is close to bone, and
ks
ks
ks
subcutaneous tissues are scanty, e.g. scalp, eyebrows, cheek bones,
oo
oo
oo
lower jaw, iliac crest, perineum, shin. (6) A wound produced by a fall
eb
eb
eb
on knee or elbow with limb flexed, and by a broken glass, or sharp
m
m
stone also looks like incised wound.
(II) Stretch laceration : (1) Overstretching of skin causes
laceration. (2) There is localised pressure with pull which increases
om
om
until tearing occurs and produces the ‘flap’. (3) They are seen in run
co
over by a motor vehicle, kicking and in compound fractures.

c
e.
e.
(III) Avulsion : (1) It is caused when sufficient force is applied

re
fre
at an acute angle to detach (tear off) a portion of skin or organ re

sf
f
from its attachment. (2) The shearing or grinding force by weight,
ks
ks
k
such as lorry wheel passing over a limb, may produce separation

oo
oo
oo
of skin from underlying tissues (avulsion) over a large area. This is

eb
eb
eb
called ‘flaying’. (3) Underlying muscles are crushed and bones may
m
be fractured. (4) The separated skin may show extensive abrasions.

(IV) Tears : Skin and tissues are torn from impact by or against
irregular objects, such as door handle of car. This is another form of
om
overstreching.
co
co
Lacerations of internal organs may be caused by : (1) injury

e.
e.
of viscera from fragments of fractured bone, (2) traction shears in

fre
fre
fre
viscera, (3) stretching of visceral attachments, (4) hydrostatic forces.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 69 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
Characters : (1) Margins are ragged, irregular and uneven.
re
fre
fre
Over bony areas, e.g skull, edges are undermined due to crushing
sf
and tearing force of the impact. Swallow tails are tears at ends of
ks
ks
k
lacerations, at angles diverging from the laceration. (2) Margins are

oo
oo
oo
contused and sometimes abraded. (3) Deeper tissues are unevenly
eb
eb
eb
divided with tags of tissue (nerves, blood vessels, connective tissue
m
m
fibres) at the bottom of wound bridging across the margins (tissue
bridges). (4) Hair bulbs are crushed. (5) Hair and epidermal tags may
be driven deeply in the wound. (6) Heamorrhage is less. (7) Foreign
om
m
matter may be found in the wound. (8) Depth varies according to the
co
co
thickness of soft parts. (9) Skin of wound opposite to direction of
e.
e.
motion is torn free or undermined.
fre
fre
fre
Complications : (1) Multiple lacerations may cause death due to
shock. (2) Pulmonary or systemic air embolism. (3) Infection.
ks
ks
ks
Sometimes, a single blow with a blunt weapon may cause
oo
oo
oo
abrasion, contusion and laceration.
eb
eb
eb
Incised wounds (cut, slice) : It is a clean cut through
m
m
tissues, which is longer than it is deep. It is produced by pressure
and friction over a very narrow area of tissue by any object having
a sharp- cutting edge.
om
om
Characters : (1) Margins are clean-cut, well-defined and

co
everted. (b) Margins may be inverted if a thin layer of muscle fibres

c
e.
e.
is adherent to skin as in scortum. (c) Edges are free from abrasions

re
fre
and contusions. (d) Wounds by glass are lacerated, but resemble re

sf
f
incised and stab wounds. Margins show tiny side-cuts. (2) Width is
ks
ks
k
greater than edge of weapon causing it. (3) Length is greater than its
oo
oo
oo
width and depth. (4) When skin becomes folded under cutting edge
eb
eb
eb
of weapon, a single movement of weapon may produce a series of

m
incised wounds separated from one another by normal skin. (5) Shape
is usually spindle-shaped. Gaping is more if underlying tissues are cut
transversely or obliquely. Wound may be zig-zag, if skin is loosely
om
attached as in axillary fold. (6) Haemorrhage is more. Spurting of

co
co
blood occurs if an artery is cut. (7) Direction : They are deeper at

e.
e.
beginning because more pressure is exerted on knife at this point.

fre
fre
fre
This is known as head of wound. At the end of the cut the wound
is shallow, known as tailing of wound. (8) Bevelling cut : If blade
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 70 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
enters obliquely, tissues will be visible at one margin, and the other
re
fre
fre
margin will be undermined, and if blade is nearly horizontal, a flap
sf
ks
ks
of wound is caused. Bevelling can be produced by sharp weapon
k
only. It is usually homicidal and may indicate relative position of

oo
oo
oo
victim and accused.
eb
eb
eb
Difference between incised and lacerated wounds
m
m
Trait Incised wound Lacerated wound
(1) Manner of By sharp objects or By blunt objects or
production : weapons. weapons.
om
m
(2) Site: Anywhere. Usually over bony
co
co
prominences.
e.
e.
(3) Margins : Smooth, even, clean-cut Irregular and often
fre
fre
fre
and everted. undermined.
ks
ks
ks
(4) Abrasion on edges : Absent. Usually present.
(5) Bruising : No adjacent bruising of Brusing of
oo
oo
oo
soft tissues. surrounding and
eb
eb
eb
underlying tissues.
(6) Shape : Linear or spindle- Varies, usually
m
(7) Dimensions:
shaped.
Usually longer than
irregular.
m
Usually longer than
deep; often gaping. deep.
om
om
m
co
(8) Depth: Structures cleanly cut Small strands of tissue

c
to the depth of wound. at the bottom bridge

e.
e.
across margins.
re
fre
(9) Haemorrhage : Usually profuse and Slight except scalp re

sf
f
external. Spurting of and external.
ks
ks
k
blood may be seen.

oo
oo
oo
(10) Hair bulbs: Cleanly cut. Crushed or torn.

eb
eb
eb
(11) Bones : May be cut. May be fractured.

m
(12) Foreign bodies: Absent. Usually present.

Difference between suicidal and homicidal cut-throat wounds
Trait Suicidal wounds Homicidal wounds
om
(1) Situation: Left side of the neck Usually on the sides.

co
co
and passing across the

front of the throat;
e.
e.
rarely on both sides.

fre
fre
fre
(2) Level: High; above the thyroid Low; on or below the

ks
ks
ks
cartilage. thyroid cartilage.

Contd...
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 71 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
Contd...
re
fre
fre
(3) Direction: Above downwards and Transverse or from
sf
from left to right in below upwards. If
ks
ks
k
right-handed person. attacked from the
oo
oo
oo
Sometimes, horizontal right side of vicitm,
cuts are seen which do the wound runs
eb
eb
eb
not show variation in from left to right; if
m
m
depth at either end. from behind, it may
resemble suicidal
wound.
om
m
(4) Number of wounds: Multiple, may be 20 to Multiple, cross each
co
co
30, superficial, parallel other at a deep level;
and merged with the not repeated in depths
e.
e.
main wound; rarely of the main wound.
fre
fre
fre
single.
(5) Edges: Usually ragged due to Sharp and clean-cut;
ks
ks
ks
overlapping of multiple bevelling may be seen.
oo
oo
oo
superficial incisions.
eb
eb
eb
(6) Hesitation cuts: Present. Absent.
(7) Tailing: Present. Absent.
m
(8) Severity: Usually less severe.

One wound severe but
m
More severe; all the
tissues including the
sometimes 2 to 3. vertebrae may be cut.
om
om
(9) Wounds in other Often present across No wounds on wrists,

co
c
parts of body: wrists, groin, thighs, etc. but severe injuries

e.
e.
ankles, or knees; and usually on the head

re
fre
rarely on the back of and neck.

re
sf
neek.
f
ks
ks
k
(10) Defence wounds: Absent; unitentional Present.

oo
oo
oo
cuts may be found on

the fingers if a blade
eb
eb
eb
has been used.

m
(11) Hands: Weapon may be Fragments of

firmly grasped due to clothing, hair, etc.,
cadaveric spasm. may be grasped.
om
(12) Weapon: Usually present. Usually absent.

co
co
(13) Vessels: As head is thrown back, Jugular vein and

e.
e.
carotid artery is drawn carotid artery are

beneath sternomastoid likely to be cut.
fre
fre
fre
and against the spine and

ks
ks
ks
usually escapes injury.

oo
oo
oo
Contd...
eb
eb
eb
m
Ch-07.indd 72 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
Contd...
re
fre
fre
(14) Blood Stains: If standing, stains If asleep, blood runs
sf
on the mirror and down on both sides of
ks
ks
k
on front of body and the neck and collects
oo
oo
oo
clothes running from behind the neck and
above downwards and shoulder; stains found
eb
eb
eb
splashes on feet. on both palms, for
m
m
the victim attempts to
cover the wound.
(15) Clothes: Not cut or damaged. May be cut
om
m
corresponding
co
co
in position to
those in the body;
e.
e.
disarrangement, tears
fre
fre
fre
and loss of buttons.
(16) Circumstantial Quiet place, such as Disturbance at
ks
ks
ks
evidence: bedroom or locked the scene, such as
oo
oo
oo
bathroom; usually disarrangement
stands in front of a of furniture in a
eb
eb
eb
mirror in order to room; trampling and
m
m
direct the hand better; crushing of vegetable
suicidal note or farewell matter and shrubs, or
letter may be found. confused foot-prints
om
om
outside.
co
Age : Fresh : Haematoma. 12 hours : Edges red, swollen and

c
e.
e.
adherent with blood and lymph. 24 hours : Crust or scab of dried clot
re
fre
is seen. Epithelium begins to grow at edges. 72 hours : Vascularised re

sf
f
granulation tissue is formed. 4 to 5 days : New fibrils are formed.
ks
ks
k
One week : Scar formation in small wounds.

oo
oo
oo
Suicidal incised wounds are : (1) Multiple, and parllel in any

eb
eb
eb
area. (2) Uniform in depth and direction. (3) Relatively trivial. (4)
Fatal wounds are present on several limited, easily reached areas of
m
the body, such as neck, wrist, groin, etc. (5) Hesitation marks or
tentative cuts or trivial wounds are present, which are multiple,
om
small and superficial, and are seen at the beginning of incised wounds.
co
co
When a safety razor blade is used unintentional cuts are found

e.
e.
on the fingers, where the blade has been gripped.

fre
fre
fre
M.L Importance : Indicates: (1) Nature of weapon. (2) Direction

of force. (3) Age of injury. (4) Mode of production, i.e. suicide,
ks
ks
ks
homicide, accident.
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 73 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
Cut-throat wounds cause immediate death from haemorrhage, air
re
fre
fre
embolism, or inhalation of effused blood.
sf
Chop Wounds: (1) They are deep gaping wounds caused
ks
ks
k
by blows with sharp-cutting edge of a fairly heavy weapon like

oo
oo
oo
axe, butcher’s knife, etc. (2) Mrgins are sharp with slight abrasion
eb
eb
eb
and contusion. (3) If the edge is blunt, the margins are ragged and
m
m
bruised. (4) Usually lower end (heel) strikes the body first, which
produces a deeper wound than the upper (toe) end wound. (5) The
deeper end indicates position of assailant. (6) There may be complete
om
m
amputation of fingers or other bones, and the joints may be separated
co
co
or disarticulated. (7) Wounds on the head and trunk are usually
e.
e.
associated with injuries to important structures and are fatal. Cranium
fre
fre
fre
may be depressed or piece of skull may be removed. (8) These injuries
are usually homicidal.
ks
ks
ks
Stab Or puncture wounds: (1) They are produced
oo
oo
oo
from penetration by long narrow instruments with blunt or pointed
eb
eb
eb
end into depths of body, such as knife, dagger, nail, needle, arrow,
m
m
etc. (2) It is deeper than its length and width on skin. (3) They are
called penetrating wounds, when they enter cavity of body. (4)
When weapon enters body on one side, and comes out on other
om
om
side, they are called perforating wounds or through-and-through

co
puncture wounds. (5) Wound of entry is larger with inverted edges

c
e.
e.
and wound of exit smaller with everted edges.

re
fre
Characters: (1) Margins are clear-cut, without abrasion or re

sf
f
bruising, but in full penetration of blade, bruising may be produced by
ks
ks
k
hilt or hilt-guard. The wound will gape, if a muscle is cut across. (2)
oo
oo
oo
Length is slightly less than width of weapon, because of stretching of

eb
eb
eb
skin. If the weapon is withdrawn with cutting edge dragging against

m
one end, wound would be extended superficially producing a tail.

(3) Depth: (1) It is greater than width and length of external wound.
(2) Depth is usually equal to, or less than length of blade, but on
om
yielding surfaces like anterior abdominal wall, it may be greater. (3)

co
co
A thin, slender, double-edged knife will penetrate more deeply than

e.
e.
an equally sharp, wide, single-edged blade inserted with same force.

fre
fre
fre
(4) Skin is most resistant to knife penetration. (5) Stretched skin is

easier to penetrate than lax skin. (6) When instrument strikes skin at
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 74 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
right angle, it goes deeper than when it strikes from acute angle. (4)
re
fre
fre
Shape: It usually corresponds to weapon used. The wound will gape
sf
if cleavage lines (Langer’s lines) are cut transversely or obliquely.
ks
ks
k
(1) If a single-edged weapon is used skin wound will be triangular

oo
oo
oo
or wedge-shaped, and one end will be sharp and other blunt or torn.
eb
eb
eb
Blunt end may have small splits in skin (fish-tailing). Sometimes
m
m
both ends may be sharp. (2) If double-edged weapon is used, wound
will be elliptical or slit-like and both angles will be sharp. (3) A round
object (spear) may produce circular wound. (4) A round blunt-pointed
om
m
object (pointed stick) may produce a circular wound with inverted,
co
co
irregular and bruised edges. (5) A pointed square weapon may
e.
e.
produce cross-shaped injury, each of four edges tearing the tissues.
fre
fre
fre
(6) A screw dirver will produce a slit-wound with square ends and
abraded margins. (7) If knife is twisted as it is withdrawn, wound may
ks
ks
ks
be cruciate. (8) Irregularly-shaped wounds are produced by stabbing
oo
oo
oo
and cutting (rocking). (5) Direction: If kinfe penetrates at an angle,
eb
eb
eb
one margin will be bevelled and other undermined.
m
m
M.L. Imp: (1) Type of weapon known from shape of wound.
(2) Depth indicates amount of force. (3) Age of injury. (4) Broken
fragment of weapon if found will identify weapon. (5) Manner of
om
om
production. (6) Direction of wounds indicate relative positions of

co
victim and assailant.

c
e.
e.
Complications: (1) Internal haemorrhage. (2) Infection. (3)

re
fre
Air embolism if jugular veins are damaged. (4) Pneumothorax. (5) re

sf
f
Asphyxia due to inhalation of blood.
ks
ks
k
Concealed puncture wounds: (1) They are seen in concealed

oo
oo
oo
parts of the body, such as nostrils, fontanelle, fornix of upper

eb
eb
eb
eyelid, axilla, vagina, rectum, nape of neck. (2) A careful search

m
is necessary to detect them. (3) Fatal injuries may be caused without

leaving any external marks, e.g. thrusting a needle or pin into the
brain through the fontanelles, through the inner canthus of the eye,
om
or into the medulla through the nape of the neck.

co
co
Defence wounds: (1) They are caused due to immediate and

e.
e.
instinctive reaction of victim to save himself, either by raising arm

fre
fre
fre
to prevent the attack or by grasping the weapon. (2) If weapon

is blunt, bruises and abrasions are produced on extensor or ulnar
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 75 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
surfaces of forearm or back of hands and fingers. (3) If the weapon
re
fre
fre
is sharp, cuts will be seen on hands, wrists, fingers and forearms.
sf
ks
ks
(4) If a single-edged weapon is grasped, a cut is produced on the
k
palm or fingers. (5) If the weapon is double-edged cuts are seen on

oo
oo
oo
fingers and palm. (6) The cuts are irregular and ragged and irregular
eb
eb
eb
in depth and distribution. (7) Rarely, they may be found on the shins
m
m
and feet if the victim was lying on the ground usually face up, as he
kicks at the assailant, or tries to cover vital areas with his legs. (8)
Defence wounds indicate homicide. (9) They are absent if the victim
om
m
is unconscious or is taken by surprise, or attacked from the back or
co
co
under the influence of alcohol or drugs.
e.
e.
Selfinflicted and fabricated wounds: (1) Self-inflicted wounds
fre
fre
fre
are those inflicted by a person on his own body. (2) Fabricated
(fictitious, forged or invented) wounds are those which may be
ks
ks
ks
produced by a person on his own body or by another with his
oo
oo
oo
consent. (3) Fabricated wounds are mostly incised, and sometimes
eb
eb
eb
contusions, stab wounds and burns. (4) Lacerated wounds are rarely
m
m
fabricated. (5) Incised wounds are usually superficial, multiple and
parallel. (6) Stab wounds are multiple and superficial. (7) Burns
are superficial. (8) Clothes are not cut. (9) The history of assault is
om
om
incompatible with the injuries.

co
Firearms
c
e.
e.
Classification: (I) Smooth-bored (shotguns). (II) Rifled. (1) Air

re
fre
and gas-operated. (2) 0.22 rifles. (3) Military rifles. (4) Revolvers. re
sf
f
ks
ks
(5) Pistols. (6) Automatic weapons.
k
Rifling: (1) The bore is cut internally with a number of

oo
oo
oo
shallow, spiral grooves (2 to 20), most common being 6, which

eb
eb
eb
run parallel to each other, but twisted spirally, from breach to

m
muzzle. (2) These grooves are called rifling, and projecting ridges
between grooves are called lands. (3) Rifling vary in number,
direction, depth and width. (4) Rifling gives the bullet a spin, greater
om
power of penetration, a straight course, and prevents it from unsteady

co
co
movement as it travels in the air.

e.
e.
Bore, calibre or gauge: (1) The dimension of rifled weapon is

fre
fre
fre
measured between a pair of diametrically opposed lands in decimals

ks
ks
ks
of an inch or in millimetres. (2) In smooth bored weapon, the internal

oo
oo
oo
eb
eb
eb
m
Ch-07.indd 76 04-03-2015 12:08:53 PM

e
e
m
m
om
m
co
co
e.
e.
dimension is measured up to 1.27 cm (half inch). (3) For larger bores,
re
fre
fre
the size is determined by the size of lead ball which will exactly fit
sf
ks
ks
the barrel, and number of such balls of equal size and weight as can
k
be made from 545 gm. (one pound) of pure lead. (4) 12 bore gun is
oo
oo
oo
one in which one of the 12 balls made from one pound of lead will
eb
eb
eb
fill exactly.
m
m
Choking of the shotgun: (1) The distal 7 to 10 cm. of barrel is
narrowed. (2) Different degrees are known as full-choke, half-choke,
quarter-choke or imporved cylinder. (3) Choking lessens rate of
om
m
spread of shot after it leaves muzzle, increases explosive force
co
co
and velocity.
e.
e.
Paradox guns have small portion of their bore near the muzzle
fre
fre
fre
end rifled. Musket is a military shoulder firearm of 0.410 bore,
which is effective up to 90 metres. Shot guns are effective upto 30
ks
ks
ks
to 35 metres.
oo
oo
oo
Carbine is a short-barreled rifle, which is effective up to 300
eb
eb
eb
metres. Military rifle is effective up to 3000 metres. In revolvers
m
m
ammunition is put in chambers (5 to 6) in metal cylinder (magazine)
which revolves or rotates before each shot, to bring the next cartridge
opposite the barrel. Effective range is 100 metres. In automatic pistol
om
om
when catridge is fired, the empty cartridge case is thrown out, and a
co
new cartridge slips into breech automatically by spring. The cartridges

c
e.
e.
(6 to 10) are contained in vertical magazine in the stock. The effective

re
fre
range is 100 metres. In air rifles and air pistols, compressed air is re
sf
f
used to fire lead slugs.
ks
ks
k
Shotgun cartridge: (1) Length 5 to 7 cm. (2) A short metal

oo
oo
oo
cylinder is continuous with a card board or plastic cylinder. (3) The

eb
eb
eb
case is rimmed. (4) It is filled as follows from base: percussion cap

m
(primary battery cup, detonator cap), gun powder, thick wad with
cardboard discs lying in front and behind the shot, and cardboard disc.
(5) the shot consists of single ball or up to several hundred small lead
om
shots. (6) Rifled slugs are single missiles and are used in shotguns
co
co
for big game hunting. They are similar in shape to blunt bullet with
e.
e.
a deep hollow cavity in base. (7) The spiral grooves on slugs impart
fre
fre
fre
a spinning effect. (8) Some cartridges contain power piston which

holds the shot inside a polythene cup.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 77 04-03-2015 12:08:53 PM

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e
m
m
om
m
co
co
e.
e.
Rifled weapon cartridge: (1) It consists of metal cylinder with
re
fre
fre
flat base which projects as a rim, except pistol. (2) The primer cup
sf
ks
ks
(percussion cap) is fitted in circular hole, usually in the centre of the
k
base. (3) The cylinder is elongated and its distal end tightly grips the
oo
oo
oo
base of projectile (bullet). (4) Gun powder lies in between detonator
eb
eb
eb
and bullet. (5) Usually there is no wad. (6) Many bullets have
m
m
circumferential groove called cannelure near the base, into which
the end of case is compressed.
Primers: Detonator caps are small metal cups containing priming
om
m
mixture and anvil. The mixture contains lead peroxide, lead styphnate,
co
co
tetrazene, barium nitrate, etc.
e.
e.
Powder: (1) Black powder consists of potassium nitrate 75%,
fre
fre
fre
sulphur 10% and charcoal 15%. Powder grains are black, coarse or
fine without particular shape. One gram of powder produces 3,000
ks
ks
ks
to 4,000 c.c of gas.
oo
oo
oo
(2) Smokeless powder: (1) Nitrocellulose (single base),
eb
eb
eb
nitrocellulose and nitroglycerine (double base), nitrocellulose,
m
m
nitroglyrine and nitroguanidine (triple base) produce much less flame
and smoke. (2) One gram produces 12 to 13 thousand c.c of gas.
(3) The colour varies from bright-orange to bluish-black and shape
om
om
from minute globules, flakes, squares, rectangular, irregular disks,

co
cylinders or threads. Semi-smokeless powder is a mixture of 80%

c
e.
e.
black, and 20% smokeless type.

re
fre
Bullets: (1) Traditional bullet consists of soft metal (lead and re

sf
f
antimony) and has rounded nose. (2) In revolver and pistol, the bullet
ks
ks
k
is short and the point ogival or rounded. (3) In rifle, the bullet is
oo
oo
oo
elongated with pointed end. (4) The full metal jacket bullet is covered
eb
eb
eb
with a tough heavy jacket (steel, copper, nickel, zinc) except at the
m
base. (5) In semi-jacketed bullet a relatively thin jacket covers the

base and cylindrical portion of bullet, leaving the nose partly or fully
exposed. This is designed to expand or mushroom. (6) Incendiary
om
bullets contain phosphorus.

co
co
Wounds from shotguns: Smoke extends up to 30 cm., flame

e.
e.
up to 45 cm., unburnt and partially burnt powder grains up to 60 to

fre
fre
fre
90 cm., cards travel for 2 metres, and wad 2 to 5 metres. Character

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 78 04-03-2015 12:08:53 PM

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e
m
m
om
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co
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e.
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of wound depends on: (1) Distance from which weapon is
re
fre
fre
discharged: (A) Contact wound: (1) Single, round or oval, large,
sf
ks
ks
often ragged because of tearing due to gases. Margins are charred by
k
flame; contused, and abraded border is soiled with powder residue.

oo
oo
oo
(2) Severe disruption of deeper tissues occur due to expanding gases.
eb
eb
eb
(3) Smoke, flame and carbon particles are driven into the wound
m
m
causing burning and tattooing. (4) If the contact is tight, muzzle
impression (copy or recoil abrasion) is seen. (5) If muzzle is not
pressed firmly, and also due to recoil of gun, flame, gas and soot
om
m
escape sideways and cause burning and blackening. (6) If the part
co
co
is clothed, smoke will escape sideways and may be found in each
e.
e.
layer of clothing and skin. Cloth is singed at the margins. (7) Wound
fre
fre
fre
of entry and track appear pink due to CO in gases combining with
Hb. (8) Cruciate, stellate or ragged lacerations are seen, especially
ks
ks
ks
if there is a thick bone immediately under skin. (9) Contact wounds
oo
oo
oo
on head produce marked disruption of margins, cruciate tearing of
eb
eb
eb
skin, often subsidiary linear tears in skin, extending from the margins
m
m
of the wounds. (10) In contact or near contact wounds of abdomen,
coils of small intestine may come out of the abdomen due to entry
of gases into abdomen.
om
om
(B) Close range: (1) Within a distance of 30 cm, the skin around
co
wound is singed by flame, blackened by smoke and tattooed by

c
e.
e.
unburnt or partially burnt powder granules. (2) The deposit of smoke

re
fre
is known as smudging, fouling or blackening. This can be wiped re

sf
f
of by wet cloth. (3) Tattooing is known as stippling or peppering.
ks
ks
k
(4) The hair is singed. (5) If gun is fired at right angle to the body,
oo
oo
oo
burnt area is circular, and if fired at an angle it is oval, the direction

eb
eb
eb
of fire being indicated by nearness of wound to one or other end

m
of burnt area. The end nearer the wound is the direction towards
which the shot travelled. (6) The wound is similar to contact wound,
though blackening and tattooing are more extensive. (7) If powder
om
is smokeless, there may be greyish or white deposit on skin round

co
co
the wound. (8) Wads will be found in the depth of the wound. (9)
e.
e.
In the skull there is less destruction than at contact range. Bursting

fre
fre
fre
open of the skull is not seen. (10) The plastic cup type wad opens
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 79 04-03-2015 12:08:53 PM

e
e
m
m
om
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co
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e.
e.
up between 30 to 60 cm. so that four petals stick out, and a circular
re
fre
fre
entrance wound is produced with a maltese cross pattern of abrasion
sf
ks
ks
encircling it. By 90 cm. air resistance folds back the petals and a
k
single hole of entrance will be produced. (11) At distance of 60 to 90

oo
oo
oo
cm. single, circular wound 3 to 4 cm in diameter is produced. There
eb
eb
eb
is no burning and blackening, but some amount of tattooing is seen.
m
m
(12) The shots are scattered after entering the body and cause much
damage. (13) Shotgun wounds at contact and close range cause much
more destruction of tissues than rifled weapons.
om
m
(C) Near range: (1) Between 1 to 2 metres, single round hole, 3
co
co
to 4 cm; margins abraded and show some scalloping, often referred to
e.
e.
as “rat hole”. (2) At two metres wound of entry is irregular, shot mass
fre
fre
fre
begins to spread and individual pellet holes may be detected, which
are round and show rim of abrasion at their margins. (3) As distance
ks
ks
ks
increases, main entrance defect becomes progressively smaller, and
oo
oo
oo
individual pellet holes increase in number.
eb
eb
eb
(D) Long range: (1) At a distance of 4 metres, shots spread widely
m
m
and enter body as individual pellets producing separate openings in
an area of 10 to 15 cm. (2) Spread is almost double from unchoked
barrel. (3) At 30 mts the pellets only penetrate skin or muscle. (4) If
om
om
shotgun pellets pass through any target before striking the body, the
co
pellets spread, e.g. window glass, screen or layers of clothing.

c
e.
e.
(2) Size of shot: Larger shot have greater penetrating power.

re
fre
(3) Nature of explosives: Smokeless powder causes lesser re

sf
f
blackening and tattooing. Shorter barrels produce greater deposits
ks
ks
k
over larger areas.

oo
oo
oo
A rough indication of range of discharge for cylindrical barrel

eb
eb
eb
is obtained by measuring diameter of wound, from outermost of

m
individual pellet wounds in cm. and dividing by three, which gives

result in metres.
Exit wounds: Usually shotgun pellets do not exit except: (1)
om
Contact wounds. (2) Tangential wounds where some pellets have

co
co
short track through the body. (3) Thin part of the body. (4) Wounds
e.
e.
caused by buckshot or rifled slugs. Small separate wounds made by

fre
fre
fre
individual pellets may be seen.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 80 04-03-2015 12:08:53 PM

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e
m
m
om
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co
co
e.
e.
Wounds from revolvers and pistols: Flame
re
fre
fre
extends up to 8 cm., smoke up to 30 cm; unburnt and partially burnt
sf
ks
ks
powder grains 60 to 90 cm.
k
(A) Contact shot: (1) The wound is similar to that caused by

oo
oo
oo
shotgun. (2) In loose or near contact shot, some gases escape with
eb
eb
eb
scattering of muzzle blast and an unusual arrangement of soot is
m
m
seen on skin known as corona. Corona consists of circular zone of
soot deposit surrounding the bullet defect, but separated from it by a
band of skin without deposit of soot. This is due to the gas expanding
om
m
about the muzzle, first at a velocity too high to allow for settling of
co
co
soot, with subsequent loss of velocity at a shorter distance from the
e.
e.
muzzle, allowing the soot to finally deposit on the skin. (3) Muzzle
fre
fre
fre
blast and negative pressure in the barrel following discharge may
suck blood, hair, tissue fragments and cloth fibres several cm. back
ks
ks
ks
inside the barrel called “back spatter”. (4) On the head, wound is
oo
oo
oo
large and irregular because of expansion of gases between scalp and
eb
eb
eb
skull. This results in undermined, ragged, curciform opening with
m
m
everted margins. (5) Soot may be deposited on the bone, and also
on inner surface of skull around bullet hole and on dura mater. (6)
Fissured fractures radiate from skull defect.
om
om
(B) Close shot (up to 8 cm.): (1) The term “point blank” is used
co
when the range is very close to or in contact with surface of the skin.
c
e.
e.
(2) Wound is circular with inverted edges, surrounded by blackened,

re
fre
tattooed and burnt area. (3) Spread of smoke with a short-barreled re

sf
f
weapon is much more than with a weapon having long barrel. (4)
ks
ks
k
Wound track may be pink due to Co. (5) Hair is singed. (6) Abraded
oo
oo
oo
and grease collar are present.

eb
eb
eb
(C) Near shot (60 to 90 cm.): (1) At 15 cm. lacerating and burning
m
effects of gases are usually lost due to dispersion cooling of gases

before they reach skin. (2) Wound is round, about the size of bullet
with a bruised margin. (3) Blackening and tattooing is spread out
om
over a large area, but there is no singeing of skin. (4) Abrasion and
co
co
dirt collar are present.

e.
e.
(4) Distant shot: Entrance wound is smaller than bullet, circular,

fre
fre
fre
margins are inverted, there is no burning, blackening and tattooing.

Abrasion, contusion and dirt collar are present.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-07.indd 81 04-03-2015 12:08:53 PM

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e
m
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om
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e.
e.
Difference between entrance and exit wounds
re
fre
fre
Trait Entrance wound Exit wound
sf
ks
ks
(1) Size: Smaller than diameter Bigger than bullet.
k
of bullet.
oo
oo
oo
(2) Edges: Inverted. Everted, puckered or
eb
eb
eb
torn.
m
m
(3) Contusion, abrasion Present. Absent.
and grease collar:
(4) Burning, May be seen around Absent.
om
m
the wound.
co
co
(5) Bleeding: Less. More.
e.
e.
(6) Fat: No protrusion. May protrude.
fre
fre
fre
(7) Tissues within May be cherry red Absent.
wound: due to CO of explosive
ks
ks
ks
gases.
oo
oo
oo
(8) Fibres of clothing: Turned in and may Turned out.
be carried into the
eb
eb
eb
wound.
m
m
(9) Lead ring or metal May be seen Absent.
ring: around the wound
by radiological
om
om
examination.
co
(10) Spectrography: More metal is found The exit wound may

c
around entrance contain more metal if

e.
e.
wound, if bullet has a bone is struck nearer

re
fre
only passed through to it. re

sf
f
the soft tissues.
ks
ks
k
Abrasion collar: (1) As bullet strikes skin, it first indents and then
oo
oo
oo
stretches skin which is perforated. (2) The skin is abraded around the
eb
eb
eb
hole due to rubbing of gyrating body of the bullet against inverted

m
epidermis (abrasion collar). (3) Bullet lubrication, gun oil from barrel,
lead from surface of bullet, barrel debris, etc. produce a narrow ring
on skin, around the defect (grease or dirt collar). (4) The abrasion
om
collar sorrounds dirt collar. (5) Some contusion is present in abraded

co
co
collar, and as such, it is also called contusion collar. (6) If bullet

e.
e.
strikes body at right angle, abrasion collar is circular and uniform,

fre
fre
fre
and if it strikes at an angle, the wound is round but marginal abrasion

ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-07.indd 82 04-03-2015 12:08:53 PM

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m
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m
co
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e.
e.
is oval due to increased width on one side. (7) The collar is wider on
re
fre
fre
the side from which bullet comes.
sf
Skull: (1) Wound of entrance shows a punched-in hole in outer
ks
ks
k
table. (2) on inner table a cone-shaped piece of bone is detached

oo
oo
oo
forming a crater that is larger than the hole on outer table, and shows
eb
eb
eb
bevelling (sloping surface). (3) Fissured fractures often radiate from
m
m
defect. (4) At the point of exit, punched-out opening is produced in
inner table and bevelled opening on outer table. (5) The exit wound
is larger due to deformity and tumbling of bullet after entering the
om
m
skull. (6) Asymmetry of bevelling indicates angle of fire.
co
co
Exit wounds: The variation in the shape and size of exit wounds
e.
e.
are dut to: (1) Bullet tumbles in the body and fails to exit nose-end
fre
fre
fre
first. (2) Bullet is deformed. (3) Bullet breaks up in the tissues and
exits as several pieces. (4) Fragments of bone are blown out of body
ks
ks
ks
with the bullet. (5) Unsupported skin at the exit tears and breaks up
oo
oo
oo
into pieces.
eb
eb
eb
shored or supported exit wound: If the skin at the exit
m
m
wound is firmly supported by an object, e.g. a belt, wrist band of
trousers, brassiere, collar and tie, etc. or if the body is leaning against
a wall, back of chair, etc. the exit wound appears as circular defect,
om
om
surrounded by margin of abrasion resembling wound of entrance.

co
A bullet travelling in an irregular fashion instead of travelling

c
e.
e.
nose on is called a yawning bullet. A bullet that rotates end-on-end

re
fre
during its motion is called tumbling bullet. re

sf
f
ks
ks
k
oo
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eb
eb
eb
m
m
om
m
co
co
Ricochet bullet: (1) Ricochet bullet is one which before

e.
e.
striking the object aimed at, strikes some intervening object first,
fre
fre
fre
and then after rebounding from these hits the object. (2) Bullet may
ks
ks
ks
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oo
eb
eb
eb
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Ch-07.indd 83 04-03-2015 12:08:54 PM

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m
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om
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e.
e.
ricochet before or after striking the body, and may produce a non-
re
fre
fre
penetrating or a penetrating injury. (3) It may occur with inferior
sf
ks
ks
firearms and low velocity bullets. (4) The bullet may be deformed and
k
flattened and produce a large, irregularly-oval, triangular or cruciate

oo
oo
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entrance wound with ragged margins. (5) Abrasion collar, burning,
eb
eb
eb
and blackening are absent. (6) Soil, fibres, paint, etc. may be found
m
m
on nose of bullet. (7) Ricochet may occur inside the skull producing
several tracks.
Multiple wounds (4 entrance and 4 exit) may be caused by a
om
m
single shot, if the person is running or sitting in an unusual position.
co
co
In some cases, only entrance wound is present, but bullet is
e.
e.
not found in the body due to (1) entering stomach may be vomited,
fre
fre
fre
(2) entering windpipe may be coughed up, (3) entering mouth may
be spit out. (4) entering G.I. tract may be passed in faeces.
ks
ks
ks
Tandem bullet: (1) Rarely, two bullets are found in body
oo
oo
oo
with only one entrance wound. (2) This occurs due to defect in
eb
eb
eb
weapon or due to faulty ammunition or with loaded firearm unused
m
m
for several years. (3) When weapon is fired bullet does not come out.
(4) When it is fired again, the second bullet may go off carrying the
lodged bullet with it, and enter body through same wound. This is
om
om
called tandem or piggyback bullet. The features caused by flame,

co
smoke and gunpowder may be diminished or absent and the wound

c
e.
e.
may appear as if caused by long range fire.

re
fre
Souvenir Bullet: If a bullet is present for a long time in the body, re

sf
f
there is no fresh bleeding in the surrounding area. A dense fibrous
ks
ks
k
tissue capsule usually surrounds it. A tiny scar indicates the original
oo
oo
oo
entrance wound.
eb
eb
eb
Identification of Weapon: (1) The firearms leave their signature

m
on the cartridge case and on the bullet. (2) With all rifled firearms,
the bullet is slightly larger than the barrel, and as it passes through the
barrel, its sides are marked by rifling of barrel (primary markings).
om
(3) They are most useful in identifying make and model of gun
co
co
involved. (4) The surface of bullet is also grooved by irregularities

e.
e.
on inner surface of barrel itself (secondary markings), which are

fre
fre
fre
specific for that particular weapon. (5) These irregularities are

produced by sticking of particles of bullet to bore when shots are
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 84 04-03-2015 12:08:54 PM

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e.
e.
fired, and is known as “metallic fouling”. (6) Bullet found in the body
re
fre
fre
called crime bullet or exhibit bullet is compared under a comparison
sf
microscope with the one fired from suspected weapon known as test
ks
ks
k
bullet. (7) The suspected weapon is fired using the same brand and
oo
oo
oo
type of ammunition into a roll of wool, or a bag of rags, or sand bag,
eb
eb
eb
or against white blotting paper. (8) Fresh pork skins, cleanly shaven
m
m
are ideal for comparison with patterns on human skin.
BOMB EXPLOSION WOUNDS: When explosion occurs, a large
volume of gas and energy are produced. (1) Disruptive effects:
om
m
Severe damage or traumatic amputations are caused. When the
co
co
victim is a few metres away or with smaller explosions, mutilation
e.
e.
of a localised area occurs. (2) Burns are extensive which involve
fre
fre
fre
irregular areas of skin to different degrees. Tight clothing protects,
so that beneath collars, bras, waist bands, socks and shoes the skin
ks
ks
ks
may be quite normal. (3) Air blast: A shock wave is produced
oo
oo
oo
which can toss the person through the air causing blunt injuries.
eb
eb
eb
Alveolar septa are torn producing haemorrhage and pulmonary
m
m
oedema (blast lung). Homogeneous tissues like liver and muscle are
not damaged. Intracranial haemorrhage, contusions of brain, heart
injuries, ruptured stomach and bowel may occur. Death may occur
om
om
from air embolism. (4) Flying missiles: Bomb pieces, gravel, glass,
co
wood, brick, etc. cause bruises, abrasions and puncture lacerations

c
e.
e.
intimately mixed on the skin. This triad of injury is diagnostic. (5) CO

re
fre
may cause asphyxia. (6) Falling masonry causes multiple injuries re

sf
f
and traumatic asphyxia.
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-07.indd 85 04-03-2015 12:08:54 PM

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e
m
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e. 8
e.
re
fre
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sf
ks
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C h a p t e r
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m
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Regional Injuries
om
m
co
co
e.
e.
Scalp: (1) Bruising of scalp is better detected by touch than by
fre
fre
fre
sight. (2) Multiple contusions of the scalp may fuse together, and
ks
ks
ks
often it is difficult to determine the number of blows inflicted. (3) Its
oo
oo
oo
firm edge often feels like the edge of a depressed fracture. (4) Scalp
eb
eb
eb
wound by blunt weapon resembles an incised wound.
Skull: Fractures: (1) Fissured fractures: (1) These are linear
m
m
fractures or cracks in bone involving whole thickness or inner or
outer table only. (2) They are caused by forcible contact with broad
om
om
resisting surface like ground, or agent having a relatively broad

co
striking surface or from a fall on feet or buttocks. (3) They do not cross
c
bony buttresses. (4) Temporal bone is most fragile and commonly

e.
e.
fractures. (5) About 20% are not detected by X-ray.

re
fre
(2) Depressed fractures: (1) They are caused by blows from re

sf
f
ks
ks
heavy weapon with a small striking surface, e.g. stone, stick, hammer,
k
oo
oo
oo
axe. (2) The outer table is driven into diploe, inner table is fractured
eb
eb
eb
irregularly and to a greater extent and may be comminuted. (3)

They are also called “fracture a la signature” (signature fractures),
m
as the pattern resembles the weapon or agent which caused it. (4)
Sometimes, it may involve outer table only. (5) Rarely, inner table
om
only may be fractured.

co
co
(3) Comminuted fractures: (1) The bone is fractured into 3

or more pieces. (2) They are caused by a fall from a height on hard
e.
e.
surface, vehicle accidents, and from blows by weapons with a large

fre
fre
fre
striking surface, e.g. axe, thick stick, etc. (3) They may result from
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-08.indd 86 04-03-2015 12:09:16 PM

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e
m
m
om
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co
co
Regional Injuries 87
e.
e.
kick, etc. (4) When there is no displacement of fragments, it resembles
re
fre
fre
a spider’s web or mosaic. (5) Fissured factures may radiate from area
sf
ks
ks
of comminution.
k
(4) Pond or indented fractures: (1) This is simple dent of skull,

oo
oo
oo
which is caused by obstetric forceps blade, a blow from a blunt object,
eb
eb
eb
or forcible impact against protruding object. (3) They occur in skulls
m
m
which are elastic, i.e. infants. (3) Inner table is not fractured, but
fissured fractures may occur in outer table.
(5) Gutter fractures: These are formed when part of thickness of
om
m
bone is removed to form gutter, e.g. in oblique bullet wounds. Inner
co
co
table may show irregular depressed fractures.
e.
e.
(6) Ring or foramen fracture: (1) (A) Fissured fracture encircles
fre
fre
fre
the skull and separates anterior third with middle and posterior third.
(B) Usually, fracture runs 3 to 5 cm. outside foramen magnum at
ks
ks
ks
back and sides of skull and passes through middle ears and roof of
oo
oo
oo
nose, due to which skull is separated from spine. (2) They are rare
eb
eb
eb
and occur after falls from a height on to feet or buttocks. (3) A severe
m
m
blow to vertex or foreceful blow on chin in traffic accident may
produce ring fracture.
(7) Perforating fractures: They are caused by firearms and
om
om
pointed sharp weapons like daggers or knives and axe.

co
(8) Diastatic or sutural fracture: Separation of suture of skull

c
e.
e.
occurs alone only in young persons due to a blow on head with blunt
re
fre
weapon, but is often associated with fracture. re

sf
f
Mechanism of cerebral injury: (1) A fatal brain injury may be
ks
ks
k
caused without any damage to scalp or skull. (2) Brain injury may be
oo
oo
oo
caused by: (a) Penetration by a foreign object. (b) Distortion of the

eb
eb
eb
skull. When a localised segment of the skull undergoes deformation,

m
shear strains may develop in brain tissue under the indentation,

and a contusion may be produced in the surface layers of the brain.
(3) Shaking of the infant as in child abuse may cause subdural
om
haemorrhage. (4) The brain is easily distorted, but is incompressible.

co
co
(5) Change in velocity, either acceleration or deceleration, with

e.
e.
a rotational element causes brain damage. (6) Contusions and

fre
fre
fre
lacerations of brain are two degrees of same process. (7) Cerebral

lacerations are caused by stretching and shearing forces within the
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-08.indd 87 04-03-2015 12:09:16 PM

e
e
m
m
om
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co
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e.
e.
tissues produced by blunt force. (8) Lacerations are usually seen
re
fre
fre
underneath skull fractures. (9) When parenchyma is completely
sf
ks
ks
disorganised it is termed pulpefaction.
k
Contrecoup injuries: (1) Coup (blow, impact) means

oo
oo
oo
that the injury is located under the area of impact and is caused directly
eb
eb
eb
by impacting force. (2) Contrecoup means that the lesion is present
m
m
in an area opposite the side of impact. (3) They are produced mainly
due to local distortion of the skull and sudden rotation of the head
resulting from blow, which causes shear strains due to pulling apart
om
m
of constituent particles of the brain. (4) A certain amont of shear may
co
co
occur below the point of impact, particularly if the skull is fractured,
e.
e.
which causes coup. (5) They are not seen if the head is well fixed and
fre
fre
fre
cannot rotate. (6) Contrecoup injury is caused when moving head
is suddenly decelerated by hitting a firm surface, e.g. striking of
ks
ks
ks
the head on the ground. (7) When the head is suddenly arrested,
oo
oo
oo
the brain will be still in motion and strikes the skull. (8) Occipital
eb
eb
eb
injuries produce severe and extensive contreocoup injuries in the
m
m
frontal region. The irregular bony prominences, especially orbital and
cribriform plates, and lesser wings of sphenoid, contuse or lacerate
the base of frontal lobes and tips of temporal lobes. (9) The second
om
om
factor causing contrecoup injury is formation of a cavity or vacuum in

co
the cranial cavity on opposite side of impact as the brain lags behind
c
e.
e.
the moving skull. The vacuum exerts a suction effect which damages
re
fre
the brain. (10) A blow to the head produces coup contusions, while re
sf
f
contrecoup contusions are either small or absent. (11) A fall on the
ks
ks
k
head produces contrecoup contusions while coup contusions or small

oo
oo
oo
or absent. (12) Before 3 years, contrecoup injuries are rare.

eb
eb
eb
Concussion of Brain: (1) Concussion is a state of

m
temporary unconsciousness (due to complete or partial paralysis of

cerebral function), due to head injury, comes on immediately after
injury, is always followed by amnesia, and tends to spontaneous
om
recovery. (2) It occurs due to acceleration/deceleration of head.

co
co
(3) The violent head movement causes shearing or stretching of nerve

e.
e.
fibres and axonal damage. (4) The person behaves automatically,

fre
fre
fre
but not rationally or responsibly. (5) the person has no recollection

of accident or injury, although he can remember events up to or
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-08.indd 88 04-03-2015 12:09:16 PM

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within a few minutes of accident. (6) A post-traumatic amnesia from
re
fre
fre
few minutes to days is seen. (7) Blows to neck or cervico-cranial
sf
ks
ks
junction produce brainstem concussion. (8) Diffuse axonal injury
k
(functional abnormality of nerve cells and of their connections)

oo
oo
oo
causes concussion. (9) Death may occur without the patient regaining
eb
eb
eb
consciousness, or he may recover partially and then die suddenly.
m
m
(10) The victim may exhibit automatism and may commit some
violent or criminal act. (11) Autopsy is usually negative, but in
some cases petechial haemorrhages may be found in the brain. (12)
om
m
The confused mental state may resemble acture alcoholic intoxication.
co
co
Cerebral oedema is due to: (1) (a) Increase in intravascular
e.
e.
pressure. (b) Increased permeability of cerebral vessels. (c) Decrease
fre
fre
fre
in plasma colloid osmotic pressure. (2) There is localised or diffuse
abnormal accumulation of water and sodium, which increases the
ks
ks
ks
volume of the brain. (3) Focal oedema in the brain stem is usually
oo
oo
oo
fatal.
eb
eb
eb
Extradural haemorrhage: (1) At the movement of impact the
m
m
skull moves relative to the dura underneath it, dura is stripped from
bone, and an empty extradural space is produced. (2) The vessel
injured depends upon the site of trauma. (a) Injury to middle
om
om
meningeal artery is the commonest cause, which occur due to a

co
blow to the lateral convexity of the head. Less commonly, posterior

c
e.
e.
meningeal artery near foramen magnum or anterior meningeal artery

re
fre
near cribriform plate are injured. (b) A blow over foreheard involves re
sf
f
anterior ethmoidal artery. (c) A blow on vertex may cause damage
ks
ks
k
of sagittal sinus. (4) It is the least common type of meningeal

oo
oo
oo
bleeding (1 to 3%). (5) It is not common in first 2 yeasrs of life, but

eb
eb
eb
is common between 20 to 40 years. (6) Bleeding may occur due to

m
fall from a small height or after a minor accident. (7) Fissured fracture
is seen in 90% cases, but sometimes it is depressed. (8) Haematoma
is directly under the site of surface injury, and usually covers motor
om
area of brain and tends to run in middle fossa. (9) Clot is localised and
co
co
causes localised concavity of surface of brain. Clot is oval or circular,

e.
e.
10 to 20 cm. in diameter, 2 to 6 cm. thick, weighs 30 to 300 g. and is

fre
fre
fre
adherent to dura. (10) Usually, 200 ml. is the minimum to cause death.
(11) Injury causes bleeding and temporary unconsciousness. (12) This
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-08.indd 89 04-03-2015 12:09:16 PM

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e.
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is followed by a period of normal consciousness (lucid interval) of
re
fre
fre
few hours to a week. (13) As pressure on brain increases, patient is
sf
ks
ks
first confused and may appear to be drunk. (14) Death occurs due to
k
respiratory failure due to compression of brain stem.

oo
oo
oo
Subdural haemorrhage: Causes: (1) Rupture of bridging or
eb
eb
eb
communicating veins. (2) Rupture of inferior cerebral veins. (3)
m
m
Rupture of dural venous sinuses. (4) Injury to cortical veins. (5)
Lacerations and contusions of brain and dura. (6) Drugs, such as
heparin, warfarin, etc.
om
m
(1) Haemorrhage may occur from relatively slight trauma. (2)
co
co
They may occur after fights or falls, especially in alcoholics, old
e.
e.
persons and children. (3) It is commonly seen over upper lateral
fre
fre
fre
surface of cerebral hemispheres, and is usually supratentorial. (4) It is
essentially venous or capillary and not arterial. (5) Volume of blood
ks
ks
ks
varies from few drops to 150 ml. (6) It is of three types: (a) Acute.
oo
oo
oo
(b) Subacute. (c) Chronic.
eb
eb
eb
Subarachnoid haemorrhage: Causes: (1) Rupture of saccular
m
m
Berry aneurysm, due to sudden rise in blood pressure due to emotional
stress, etc. In an alcoholic involved in fight aneurysm may rupture. (2)
Angiomas and arteriovenous malformations. (3) Rupture of vessels
om
om
on surface of cerebral hemisphere. (4) Injuries to side of upper neck

co
and jaw region producing damage to vertebral artery causes basal

c
e.
e.
subarachnoid haemorrhage. (5) Blood dyscrasias.

re
fre
(1) This is the most common form of traumatic intracranial re

sf
f
haemorrhage. (2) In all cases of significant brain injury, some degree
ks
ks
k
of subarachnoid haemorrhage is found. (3) It is mostly venous. (4)

oo
oo
oo
In mild form, it is present as splashes of haemorrhage over areas of

eb
eb
eb
contusion. (5) A slightly yellow discolouration of leptomeninges is

m
seen as the subarachnoid haemorrhage becomes older. (6) It can be

unilateral or bilateral, localised or diffuse. (7) In most cases it is diffuse
overlying the cerebral hemispheres. (8) Mild or moderate subarachnoid
om
haemorrhage does not produce any significant damage. (9) It is usually

co
co
found over the orbital surface of the frontal lobes and the anterior third
e.
e.
of the temporal lobes. (10) The blood mixes with C.S.F.

fre
fre
fre
Intracerebral haemorrhage: Causes: (1) Capillary haemorrhages.

(2) Angioma or malignant tumour. (3) Hypertension. (4) Laceration of
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-08.indd 90 04-03-2015 12:09:16 PM

e
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m
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om
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e.
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the brain. (5) Spontaneous haemorrhages in the region of basal ganglia
re
fre
fre
by rupture of lenticulostriate artery commonly in middle aged and old
sf
ks
ks
persons. (6) Blow on the head.
k
(1) Bleeding is slow and in nature of oozing from venules or

oo
oo
oo
capillaries. (2) Haemorrhage into the brain due to trauma usually
eb
eb
eb
occurs near the surface. (3) Isolated haemorrhages in the frontal or
m
m
occipital lobes are more likely to be due to trauma. (4) A single deep-
seated haemorrhage is usually due to some disease.
Violence or disease: (1) Extradural haemorrhage is always
om
m
caused by mechanical violence. (2) Subdural haemorrhage is almost
co
co
always traumatic but may be caused by local inflammation. (3)
e.
e.
subarachnoid haemorrhage often occurs spontaneously from rupture
fre
fre
fre
of congenital aneurysms. (4) When a disease is present, sudden rise
of B.P. due to physical exercise or excitement may rupture vessels
ks
ks
ks
and precipitate haemorrhage. (5) Usual source of haemorrhage is
oo
oo
oo
rupture of lenticulostriate branch of middle cerebral artery. (6) Rarely,
eb
eb
eb
bleeding occurs in pons or cerebellum. (7) Intracranial haemorrhage
m
m
due to violence may occur without any fracture of skull or wound
of scalp.
Post-traumatic automatism: (1) It is intimately associated
om
om
with amnesia. (2) After an accident, the patient may speak and act
co
in purposive manner, but does not remember them afterwards. (3)

c
e.
e.
Amnesia following head injury is quite common and is usually

re
fre
associated with concussion. re

sf
f
Spinal Cord: (1) Fracture of spine need not injure cord,
ks
ks
k
but cord is rarely injured without associated fractures of vertebral

oo
oo
oo
colum. (2) Whiplash injury is an exception to this rule. This is the

eb
eb
eb
injury sustained commonly by occupants of front seat. (3) When a

m
vehicle suddenly stops, the forward thrust produces a state of acute

hyperflexion, but this is converted into acute hyperextension as the
forehead strikes windscreen which causes injury to cervical column.
om
(4) In such cases, and also due to sharp blow against spinous process
co
co
of an upper cervical vertebra (rabbit punch), fatal contusions and

e.
e.
lacerations of spinal cord may occur without fracture of spine.

fre
fre
fre
Concussion of spinal cord commonly occurs in railways and

motor car collisions, and is knows as “railway-spine”. It occurs from
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-08.indd 91 04-03-2015 12:09:16 PM

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om
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e.
e.
blows, compression from dislocation or fracture of vertebrae, damage
re
fre
fre
by effusion of blood, fall from a height or a bullet injury. It produces
sf
ks
ks
temporary paralysis, affecting the arms and hands or bladder, rectum
k
or lower extremities.
oo
oo
oo
Liver is the most frequently damaged abdominal organ and is
eb
eb
eb
second only to brain in overall visceral susceptibility.
m
m
Lungs: (1) Major blows to chest produce contusions of lung
surface, internal lacerations, small areas of bleeding in the lungs and
traumatic cavitation. (2) After severe head injuries, where victim has
om
m
been maintained for some time in a respirator, areas of collapse and
co
co
haemorrhage with formation of hyaline membrane is seen “respirator
e.
e.
lung”. (3) Sudden compression of chest may produce contrecoup
fre
fre
fre
contusions.
Heart: (1) Contrecoup contusions are seen over posterior wall
ks
ks
ks
of left ventricle. (2) Blunt trauma insufficient to produce gross or
oo
oo
oo
microscopic damage can cause ventricular fibrillation or asystole. (3)
eb
eb
eb
For death to occur due to cardiac tamponade 300 to 400 ml. of blood
m
m
in pericardial sac is necessary. (4) Cardiac injuries may cause death
due to ventricular fibrillation, haemothorax, and cardiac tamponade.
Fall: (1) In fall from a height, tibias may be driven through
om
om
soles of feet. (2) Calcaneum is usualy fractured if heel is struck. (3)

co
Sometimes, hip joints, pelvis or sacroiliac joint and lumbo-dorsal

c
e.
e.
vertebrae are injured. (4) A fall on extended palm will produce

re
fre
fracture of head of radius or lower end of humerus. re

sf
f
Traffic Accidents: Pedestrians: Three patterns
ks
ks
k
of injury are seen: (1) primary impact injuries (first part struck). (2)
oo
oo
oo
Secondary impact injuries (further injuries caused by vehicle). (3)

eb
eb
eb
secondary injuries (injuries caused by victim’s striking objects, such

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as ground).
(1) Primary impact injuries depend on position of person in
relation to vehicle when struck, and relative heights of various part
om
of the vehicle. (2) If a person is struck from behind, and the foot
co
co
is fixed, bumper injuries (fracture of tibia) occur. The fracture is

e.
e.
usually spiral or wedge-shaped. (3) Frequently, bumper injuries are

fre
fre
fre
at different levels on two legs. (4) An impact against a mudguard

or headlamp may result in fracture of pelvis or fracture-dislocation
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-08.indd 92 04-03-2015 12:09:16 PM

e
e
m
m
om
m
co
co
e.
e.
of sacroiliac joint. (5) If person is facing vehicle, intra-abdominal
re
fre
fre
and thoracic injuries are produced. (6) When he is thrown clear of
sf
ks
ks
the vehicle soon after the impact, he may sustain secondary injuries
k
(abrasions, contusions, fractures, etc.) which vary greatly in severity.

oo
oo
oo
(7) Direct impact to the thorax may cause rupture of the aorta below
eb
eb
eb
the arch, and sometimes laceration or rupture of the heart. (8) If the
m
m
vicitm is struck from behind, linear superficial tears of abdomen or
inguinal regions are seen due to overstretching of skin. If the victim
is run over by the vehicle, similar injuries may be produced due to
om
m
overstretching of the skin. (9) If the pedestrian is thrown into the
co
co
centre of the roadway, the person can be run over. (10) Tearing
e.
e.
wounds may be caused by protruding objects, such as door handles,
fre
fre
fre
or with cuts from broken glass. (11) If a fast moving bus, truck or
van having a straight and high front end hits an adult, the impact is
ks
ks
ks
higher, at hip or even shoulder level, and the victim will be pushed
oo
oo
oo
directly forwards in front of the vehicle. (12) In pedestrians, the head
eb
eb
eb
is injured by direct impact with the vehicle and also by striking the
m
m
road. Both impacts produce fractures involving almost all parts of
the skull, especially the base.
If the person is run over there may be (1) tyre marks, (2) grazes,
om
om
(3) avulsion of skin, (4) burning of skin, (5) deep crushing of internal
co
organs, (6) amputation of an extremity may occur.

c
e.
e.
Occupants of vehicle: (1) The driver slides forward. (2) Legs

re
fre
strike fascial parcel shelf and abdomen or lower chest strikes lower re
sf
f
edge of steering wheel. (3) There is flexion of cervical and thoracic
ks
ks
k
spines. (4) Head strikes windscreen and the person may be ejected. (5)
oo
oo
oo
The wheel rim may crush liver, spleen or kidney. (6) In some cases
eb
eb
eb
lungs are lacerated. (7) The throat may be crushed across horn ring or
m
top of steering-wheel. (8) These are known as steering-wheel impact

type of injury”. (9) The front seat passengers will show same injuries
execpt those caused by steering wheel. (10) Whiplash injury may
om
be seen in front seat occupants. (11) There may be occupant ejection

co
co
due to the door getting opened, and sustain multiple injuries. (12)
e.
e.
Rarely, tail-gating may occur.

fre
fre
fre
(1) Rolling inuries are produced when a vehicle with a low

chassis rolled the victim along the roadway as it passed over him.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-08.indd 93 04-03-2015 12:09:16 PM

e
e
m
m
om
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co
co
e.
e.
(2) They are mostly abrasions, grease soiling and burns from the
re
fre
fre
exhaust system. (3) There may be fractures of various bones and
sf
ks
ks
patterned imprints caused by parts on the undersurface of the chassis.
k
Cyclists or motorcyclists: (1) cycle is hit and the person is

oo
oo
oo
thrown violently to the ground. (2) In being thrown, they may injure
eb
eb
eb
groins or legs due to protruding objects. (3) Crash helmet reduces
m
m
friction of the head against ground and makes deceleration less
drastic. (4) When crash helmet is worn, crown may be protected, but
whole head may be “egg-shelled” on to base or cervical spine. (5)
om
m
Rarely chin strap may be drawn upwards and cause strangulation. (6)
co
co
About 50% of helmetless motorcyclists sustain head injury. (7) The
e.
e.
classical fatal injury in both motor cyclist and pillion passengers is
fre
fre
fre
fracture of skull. (8) The base is divided into two halves, each moving
independently of each other like a hinge, the so-called motor cyclist’s
ks
ks
ks
fracture. (9) The motor-cyclist may drive into back of a large vehicle,
oo
oo
oo
e.g. truck, known as “underrunning” or “tail-gating”. (10) This may
eb
eb
eb
occur due to sudden and unexpected stoppage of the truck or when
m
m
motor cyclist is at high speed in darkness.
Boxing injuries: (1) Subdural haemorrhage occurs in about one-
third of fatal cases. (2) Deterioration in speed and co-ordination are
om
om
chief symptoms of onset of punchdrunk (traumatic encephalopathy)

co
condition. This is caused probably due to repeated blows to head

c
e.
e.
which produce small haemorrhages and degenerative changes in

re
fre
brain. In extreme cases, there is slurred speech, defective memory, re

sf
f
slow thought process, stiff limbs and finally dementia.
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-08.indd 94 04-03-2015 12:09:16 PM

e
e
m
m
om
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co
co
e. 9
e.
re
fre
fre
sf
ks
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C h a p t e r
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oo
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eb
eb
eb
m
m
Medicolegal Aspects of Wounds
om
m
co
co
e.
e.
Homicide: It is killing of a human being by another human being.
fre
fre
fre
Type: (I) Lawful: (1) Justifiable. (2) excusable. (II) Unlawful:
ks
ks
ks
(1) Murder. (2) Culpable homicide, (a) amounting to murder, (b) not
oo
oo
oo
amounting to murder. (3) Rash or negligent homicide.
eb
eb
eb
Justifiable homicide: This is the homicide which is justified in
the circumstances which led to the killing of person. This may occur
m
m
(1) in the administration of justice, like execution of death sentence,
(2) the maintenance of justice, e.g. in suppressing riots or executing
om
om
arrest or killing in course of violent crime, e.g. a woman who kills a

co
person who attempts to rape her.

c
Excusable homicide: This is the homicide caused unintentionally

e.
e.
by an act done in good faith. This includes (1) killing in self-defence

re
fre
when attacked, provided there is no other means of defence, (2) re

sf
f
ks
ks
causing death by accident or misadventure, (3) death following lawful
k
oo
oo
oo
operation, (4) homicide committed by an insane person.

eb
eb
eb
Culpable homicide: Culpable homicide is causing death by doing

an act (1) with the intention of causing death, or (2) with the intention
m
of causing such bodily injury as is likely to cause death, or (3) with

the knowledge that such act is likely to cause death (S.299, I.P.C.).
om
Explanations: (1) A person who causes bodily injury to another

co
co
who is suffering from a disorder, disease, or bodily infirmity which

accelerates the death of a person, shall be deemed to have caused
e.
e.
his death. (2) Where death is caused by bodily injury, the person
fre
fre
fre
who caused such bodily injury shall be deemed to have caused

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 95 04-03-2015 12:09:26 PM

e
e
m
m
om
m
co
co
e.
e.
death, although by using proper remedies and skilful treatment, the
re
fre
fre
death might have been prevented. (3) The causing death of a child
sf
ks
ks
in mother’s womb is not homicide.
k
Murder: Culpable homicide is murder (1) if the act by which the

oo
oo
oo
death is caused is done with intention of causing death, (2) if it is done
eb
eb
eb
with the intention of causing such bodily injury as is likely to cause
m
m
death, (3) if it is done with the intention of causing bodily injury which
is sufficient in the ordinary course of nature to cause death, or (4) if
person commiting the act knows that it is so dangerous that it must in
om
m
all probability cause death or is likely to cause death (S.300, I.P.C.).
co
co
Exceptions: Culpable homicide does not amount to murder, if
e.
e.
the act by which it is caused is done: (1) under grave and sudden
fre
fre
fre
provocation, (2) in good faith in right of private defence of person
or property, (3) for advancement of public justice, (4) without
ks
ks
ks
premeditation, and (5) when person above the age of 18 years takes
oo
oo
oo
risk of death with his own consent.
eb
eb
eb
Suicide: Attempt to commit suicide is punishable with
m
m
imprisonment up to one year (S.309, I.P.C.) and abetment of suicide
is punishable with imprisonment up to 10 years (S.306, I.P.C.).
Dowry Deaths
om
om
S. 304-B, I.P.C.: Where the death of a woman is caused by any

co
c
burns or bodily injury, or occurs under abnormal circumstances within

e.
e.
seven years of her marriage, and it is shown that soon before her death
re
fre
she was subjected to cruelty or harassment by her husband or any re

sf
f
ks
ks
relative of her husband, for or in connection with, any demand for
k
dowry, such death shall be called “dowry death”, and such husband
oo
oo
oo
or relative shall be deemed to have caused her death. The punishment

eb
eb
eb
shall be imprisonment of not less than seven years, but may extend
m
to life imprisonment.
S. 498-A, I.P.C.: Whoever being the husband or the relative of
the husband of a woman, subjects such woman to cruelty shall be
om
punished with imprisonment up to three years.

co
co
Dowary deaths occur either by murder of a married woman or

e.
e.
she herself committing suicide being unable to bear harassment or

fre
fre
fre
cruelty for not fulfilling the promises by her parents or her relatives
ks
ks
ks
or of those interested in her marriage. Such murders are invariably

oo
oo
oo
eb
eb
eb
m
Ch-09.indd 96 04-03-2015 12:09:26 PM

e
e
m
m
om
m
co
co
Medicolegal Aspects of Wounds 97
e.
e.
committed secretly, either in the house or at a place where outsiders
re
fre
fre
may not witness it. The bride may be burnt or killed by various
sf
ks
ks
methods. The usual defence in all dowry death cases is that either
k
the woman committed suicide, or death occurred accidentally due to

oo
oo
oo
burns while cooking food.
eb
eb
eb
Inquest should be conducted by a Magistrate or police officer
m
m
not below the rank of Deputy Superintendent of Police, and autopsy
should be carried out by two doctors.
Torture
om
m
The World Medical Association (Declaration of Tokyo, 1975)
co
co
defined torture in relation to detention and imprisonment as “The
e.
e.
deliberate, systematic or wanton infliction of physical or mental
fre
fre
fre
suffering by one or more persons acting alone or on the orders of
ks
ks
ks
any authority, to force another person to yield information, to make
a confession or for any other reason”.
oo
oo
oo
Torture may be carried out by (1) Criminal and terrorist groups,
eb
eb
eb
and (2) By the police or other security force personnel during the
m
m
detention and interrogation of prisoners and suspects.
Objects: (1) To obtain information if a person is suspected
to have committed a crime or indulged in antinational or terrorist
om
om
activities. (2) To obtain testimony incriminating others. (3) To sign a

co
c
document confessing a crime. (4) To take revenge against a person or

e.
e.
his family members, by rape, kidnapping, etc. (5) To spread terror in

re
fre
the community by militant groups or by dictators ruling the country. re

sf
f
ks
ks
(6) To destroy the personality of individuals who raise their voices
k
against dictatorial rule, or oppression in the society.

oo
oo
oo
Methods: (I) Physical abuse: (1) Beating. (2) Telefons. (3)

eb
eb
eb
Beating on abdomen and head (4) Twisting of fingers. (5) Chewing

m
hard on pieces of metals, stones. (6) Mutilation. (7) Disfiguring face

or other parts of body. (8) Use of continuous high pitched sounds.
(9) Forced immersion of head. (10) Tying plastic bag over head. (11)
om
Suspension of the body by wrists. (12) Suspension of body by arms

co
co
or neck. (13) Making to stand in hot sun on one leg for prolonged
e.
e.
periods. (14) Burns. (15) Electric shock. Heated metal skewer inserted
fre
fre
fre
into the anus. (16) Perianal or rectal burns. (17) Dehydration. (18)
ks
ks
ks
Animal bites.
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 97 04-03-2015 12:09:26 PM

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e
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om
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co
co
e.
e.
(II) Mental Torture: (1) Solitary confinement in a dark
re
fre
fre
place. (2) Blindfolding for a long time, or frequent transfer from one
sf
ks
ks
place to another blindfolded. (3) Starving the victim. (4) Causing
k
mental anguish by giving false information to victim regarding

oo
oo
oo
tragedy involving wife and children.
eb
eb
eb
(III) Sexual Torture: (1) Infliction of injuries to private
m
m
parts or introducing foreign bodies into the rectum or vagina, or
mutilation of breasts or genitals. (2) Raping the victim or undressing
before others, or sexually tortured by trained animals, etc.
om
m
Hurt: Hurt means bodily pain, disease or infirmity caused to any
co
co
person (S.319, I.P.C.).
e.
e.
Grievous Hurt: According to S.320. I.P.C. any of the
fre
fre
fre
following injuries are grievous. (1) Emasculation (loss of potency).
(2) Permanent privation (loss) of sight of either eye. (3) Permanent
ks
ks
ks
privation of hearing of either ear. (4) Privation of any member or joint.
oo
oo
oo
(5) Destruction or permanent impairing of the power of any member
eb
eb
eb
or joint. (6) Permanent disfiguration of the head or face. (7) Fracture
m
m
or dislocation of a bone or tooth. (8) Any hurt which endangers life,
or which causes the victim to be in severe bodily pain, or unable to
follow his ordinary pursuits for a period of twenty days.
om
om
Simple injuries: All injuries which are not grievous are simple.
co
Dangerous weapon or means: According to S.324 & 326, I.P.C.

c
e.
e.
dangerous weapons or means include any instrument for shooting,

re
fre
stabbing or cutting or any instrument which used as weapon of re

sf
f
offense is likely to cause death; fire or any heated substance; poison
ks
ks
k
or corrosive substance; explosive substance.

oo
oo
oo
Dangerous injuries are those which cause imminent danger

eb
eb
eb
to life, either by involvement of important organs or structures, or

m
extensive area of the body. If no surgical aid is available, such injuries

may prove fatal. Examples of injuries which endanger life are: stab
on the abdomen or head or vital part, hurt causing rupture of spleen,
om
squeezing testicles, incised wound on the neck, compound fracture of

co
co
the skull, rupture of an internal organ, injury of a large blood vessel.

e.
e.
Assault: An assault is an offer or threat or attempt to apply force

fre
fre
fre
to body of another in a hostile manner (S.351, I.P.C.).

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 98 04-03-2015 12:09:26 PM

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e
m
m
om
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co
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e.
e.
Wound Certificate: All details of examination of injured
re
fre
fre
person are entered in an Accident Register, which is a confidential
sf
ks
ks
document. The preliminaries like name, age, sex, date, time and
k
place of examination, name of police constable accompanying, two

oo
oo
oo
identification marks, and brief statement of injured person is entered.
eb
eb
eb
(1) Nature of each injury: (1) Abrasion, contusion, incised
m
m
wounds, fracture, etc. are noted. (2) A lens should be used to examine
wounds, and any foreign material should be noted.
(2) Size, shape and direction of each injury. (1) Tape should
om
m
be used for measurements. (2) The shape of the wound, e.g. circular,
co
co
oval, triangular, elliptical, etc., and bevelling of the edges noted. (3)
e.
e.
The direction of the wound, i.e. horizontal, vertical, oblique, etc.
fre
fre
fre
should be noted with regard to the anatomical position of the body.
(3) On what part of body inflicted: Note with reference to an
ks
ks
ks
anatomical landmark, e.g. the midline, a bony structure, a joint, navel
oo
oo
oo
or nipple. Technical terms should be avoided as far as possible.
eb
eb
eb
(4) Simple or grievous: If nature of any injury cannot be made
m
m
out, such as head or abdominal injury, the patient should be kept
under observation, and investigations carried out. In all injuries when
a fracture of a bone is suspected, an X-ray examination should be
om
om
done for confirmation.

co
(5) By what weapon inflicted, i.e. blunt, sharp, pointed, firearm,

c
e.
e.
etc. In many cases, the examination of the wound and clothes give a
re
fre
fairly definite information about the kind of weapon. A foreign body re

sf
f
found in a wound, e.g. a piece of glass, a piece of wood, the broken
ks
ks
k
point of knife or bullet, etc. may help to identify the type of weapon.
oo
oo
oo
(6) Whether weapon was dangerous or not.

eb
eb
eb
(7) Remarks: General condition, such as conscious or

m
unconscious, B.P., pulse, bleeding from ears, nostrils, mouth, etc.,

paralysis, shock, age of injuries should be noted.
When a dead body is brought to a hospital, it should not be
om
examined for injuries, but it should be reported to police.

co
co
Causes of death from wounds: (A) Immediate:

e.
e.
(1) Haemorrhage. 10 to 40% loss of total blood volume is fatal. (2)

fre
fre
fre
Reflex vagal inhibition. (3) Injury to a vital organ. (4) Shock. (a)
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 99 04-03-2015 12:09:26 PM

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e
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om
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co
co
e.
e.
Traumatic shock is most common type. (b) Burn shock is caused
re
fre
fre
from loss of plasma, absorption of necrotic tissue, and bacterial
sf
sepsis. (c) Surgical shock is due to combination of anaesthesia, loss
ks
ks
k
of blood and plasma, emotional reactions, and infection. (d) Cardiac

oo
oo
oo
due to decreased cardiac output, reduced blood flow and deficient
eb
eb
eb
supply of oxygen to tissues. (e) Septic shock due to severe infection.
m
m
(f) Endotoxic occurs in patients having Gram-negative infections.
(B) Remote causes: The victim may die after a varying period
from remote causes. Assailant will be responsible if the victim dies
om
m
of complications.
co
co
(1) Infection: Staphylococcus is the commonest organism of
e.
e.
infection in wound resulting from trauma. Specticaemia is the
fre
fre
fre
presence of bacteria or their toxins in blood. Bacteraemia is the
presence of bacteria in blood.
ks
ks
ks
(2) Gangrene or necrosis.
oo
oo
oo
(3) Neglect of injured person.
eb
eb
eb
(4) Crush syndrome: Severe crushing of muscles, especially
m
m
those involving the lower limbs, e.g.fallen masonry, vehicular
accidents, etc. cause traumatic tubular necrosis.
(5) Surgical operation: (1) The assaulted person is not bound to
om
om
submit himself for operation. (2) The assailant will be responsible if it

co
is proved that the victim would have died even without operation, and
c
e.
e.
operation was necessary, and was performed by competent surgeon

re
fre
with reasonable care and skill. (3) If the wound is not fatal and if it re
sf
f
is proved that death was caused by application of harmful medicines,
ks
ks
k
this cannot be regarded as murder.

oo
oo
oo
(6) Natural disease: In a person suffering from fatty heart,

eb
eb
eb
miliary aneurysms, etc. slight injury may precipitate death.

m
(7) Supervention of disease from trauma, such as stricture or

obstruction from fibrous scar in a hollow muscular organ, paraplegia,
septic cystitis, etc.
om
(8) Thrombosis and embolism: (1) The most common sites

co
co
of thromobosis are in deep femoral, popliteal and posterior tibial

e.
e.
veins, and usually occur in trauma to lower limbs, esp. fractures

fre
fre
fre
of long bones leading to immobility and bed rest. (2) Thrombus

develops in 10 to 20 days, detaches in part or whole and travels to
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 100 04-03-2015 12:09:26 PM

e
e
m
m
om
m
co
co
e.
e.
pulmonary artery. (3) Bullet and stab wounds of carotid arteries
re
fre
fre
may injure intima, a thrombus may develop, followed by embolus
sf
ks
ks
of middle cerebral arteries. (4) Pulmonary embolus may cause death
k
in few minutes due to vagal inhibition, acute asphyxia or right-sided

oo
oo
oo
heart failure. (5) Pulmonary emboli are cylindrical with parallel
eb
eb
eb
contours, often branch and frequently curved, and their shape does
m
m
not correspond to shape of vessel.
(9) Fat embolism: Causes: (1) (a) Fracture of long bones, (b)
injury to adipose tissue, (c) injection of oil into circulation, e.g. in
om
m
criminal abortion, (d) in sickle cell anaemia. (2) The emboli enter
co
co
pulmonary vessels. (3) Frozen sections of lungs are stained for fat
e.
e.
with Sudan III, Scharlach R or osmic acid. (4) Pulmonary vessels
fre
fre
fre
are filled with globular fat emboli and obstruct the flow of blood
through the lungs. (5) Death usually occurs about the tenth day from
ks
ks
ks
asphyxia due to impairment of gaseous exchange in the lung, but may
oo
oo
oo
be delayed up to 3 weeks. (6) Cerebral fat embolism develops when
eb
eb
eb
the fat emboli are forced through the pulmonary capillaries into the
m
m
systemic circulation in sufficient quantity to affect the brain.
(10) Air embolism: Causes: (1) Incised wouds of lower cervical
or clavicular region involving jugular or subclavian veins. (2) Wound
om
om
of superior longitudinal sinus. (3) Crush injuries of chest. (4) Faulty

co
technique in giving I.V. injection with gravity apparatus. (5) Injection

c
e.
e.
of air and fluid into uterus for criminal abortion.

re
fre
(1) Air is churned into frothy mixture in the right heart, which re
sf
f
is driven into pulmonary artery and lung capillaries. (2) 100 ml.
ks
ks
k
is necessary to produce fatal pulmonary air embolism. (3) Right

oo
oo
oo
ventricle is distended with air under pressure, and bright-red frothy

eb
eb
eb
blood is found in right side of heart. (4) Blood is fluid, viscera are
m
congested, and petechiae are present in serous surface and white

matter of brain. (5) Systemic air embolism occurs when air enters a
vein of pulmonary system and carried to heart, brain, etc. This occurs
om
in penetrating wounds of chest. (6) One to two ml. of air is enough to

co
co
produce death. (7) Death occurs within a few minutes and is usually
e.
e.
not delayed beyond 45 minutes. (8) Amniotic fluid embolism causes

fre
fre
fre
death by consumption coagulopathy.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 101 04-03-2015 12:09:26 PM

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e
m
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om
m
co
co
e.
e.
Difference between antemortem and postmortem wounds
re
fre
fre
Trait Antemortem wound Postmortem wound
sf
ks
ks
(1) Margins: The edges are swollen, Edges do not gape but
k
everted, retract and closely approximated.

oo
oo
oo
wound gapes.
eb
eb
eb
(2) Haemorrhage: Abundant and usually Slight or more, venous.
m
m
arterial.
(3) Spurting: Signs of spurting of No spurting of blood.
arterial blood on the
om
m
body, clothing or in its
vicinity present.
co
co
(4) Extravasation: Staining of the Edges and cellular
e.
e.
edges of the wound tissues are not deeply
fre
fre
fre
and extravasation stained.
in neighbouring
ks
ks
ks
subcutaneous and
oo
oo
oo
interstitial tissues
which cannot be
eb
eb
eb
removed by washing.
m
m
(5) Coagulation: Firmly coagulated No clotting or soft clot.
blood in wounds and
tissues present.
om
om
(6) Vital reaction: Signs of vital No signs of vital

co
reaction present, i.e., reaction.

c
inflammation and
e.
e.
repair.
re
fre
(7) Enzyme Increased activity of Diminished or no re

sf
f
ks
ks
histochemistry: ATP, amino-peptidase, enzyme activity.
k
acid and alkaline

oo
oo
oo
phosphatase.
eb
eb
eb
m
The signs of vital reaction are: swelling, effusion of lymph,

leucocytic infiltration, pus formation, evidence of repair. Healing
by first intention means, union of two granulating surfaces without
om
infection.
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-09.indd 102 04-03-2015 12:09:26 PM

e
e
m
m
om
m
co
co
e. 10
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Thermal Deaths
om
m
co
co
e.
e.
Hypothermia is oral or axillary temperature of less than 35°C.
fre
fre
fre
Trench foot and immersion foot occur due to prolonged
ks
ks
ks
exposure to severe cold (5 to 8°C) and dampness; seen in soldiers
oo
oo
oo
in winter warfare, especially in trenches, and in persons exposed to
eb
eb
eb
prolonged immersion. The extremities are affected.
Frostbite occurs due to exposure to extremes of cold (-2.5°C),
m
m
and affects extremities, nose, ears and face. Necrosis with blister
formation and gangrene occurs. Body temperature of 27°C or less,
om
om
if maintained for 24 hours causes death from failure of vital centres

co
due to anoxia.
c
Neonatal cold injury results from failure of metabolism to

e.
e.
prevent a fall in temperature in a body exposed to cold environment.

re
fre
(1) There is swelling of extremities, particularly hands, feet and re

sf
f
ks
ks
eyelids. (2) Respirations slow, shallow, irregular; face, hands, and
k
oo
oo
oo
feet are red. (3) Widespread pitting oedema of extremities. (4) There
eb
eb
eb
is haemorrhagic tendency, and localised hardening of skin, and

subcutaneous tissue overlying oedematous parts.
m
Heat hyperpyrexia (heat stroke): (1) Rectal temperature is

more than 41°C. (2) Neurological disturbances, such as psychosis,
om
delirium, stupor, coma and convulsions. (3) If there is direct exposure

co
co
to sun it is called sunstroke. (4) Precipitating factors are: high

temperature, increased humidity, minor infections, muscular activity,
e.
e.
and lack of acclimatisation. (5) If humidity is 100%, a temperature

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 103 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
e.
e.
of 32° C may lead to heat stroke. (6) The mechanism is failure of
re
fre
fre
cutaneous blood flow and sweating, leading to breakdown of
sf
heat-regulating centre in hypothalamus. (7) Onset is sudden with
ks
ks
k
collapse and loss of consciousness. (8) Skin is dry, hot and flushed,
oo
oo
oo
with complete absence of sweating. (9) Pupils contracted, pulse rapid,
eb
eb
eb
later irregular, breathing rapid, deep and of Kussmaul type, B.P.
m
m
low. (10) Convulsions, coma and death in 5 minutes to 3 days. (11)
Differential diagnosis of heat stroke includes, pontine haemorrhage,
cerebral malaria, and meningitis. (12) The classic triad of heat
om
m
stroke consists of: hot, dry skin, hyperthermia (41 to 43°C), and
co
co
neurologic disturbances.
e.
e.
Burns: A burn is an injury caused by application of heat or
fre
fre
fre
chemical substances to the external or internal surfaces of body
which causes tissue destruction. Burn is caused by exposure to 44°C
ks
ks
ks
for 5 to 6 hours. At 65°C., 2 seconds are sufficient to produce burns.
oo
oo
oo
Varieties: (1) Heated solid body produces blister and reddening.
eb
eb
eb
If contact is for some time, destruction or charring occurs. Epidermis
m
m
is blackened, dry, wrinkled and hair singed. (2) Flame always
causes singeing of hair and blackening of skin. Roasted patches of
skin or deeper parts may be seen. (3) Kerosene, etc. causes sooty
om
om
blackening. (4) Explosions (in mines, bombs) cause extensive burns

co
and blackening and tattooing. (5) X-ray and radium burns vary
c
e.
e.
from redness to dermatitis with shedding of hair and epidermis and

re
fre
pigmentation of surrounding skin. Severe exposure may produce re

sf
f
burns with erythema, blistering or dermatitis, or ulceration with
ks
ks
k
delayed healing and ill-formed scars. (6) U.V. rays produce erythema
oo
oo
oo
or acute eczematous dermatitis. (7) (a) Corrosives cause ulcerated

eb
eb
eb
patches, no blisters, hair is not singed and red line of demarcation

m
absent. (b) They are uniform in character and have distinct colour.
(c) Strong acids produce dark leathery burns. (d) Strong alkalis cause
skin to slough and leave moist, slimy, greyish areas.
om
Degrees of Burns : (1) Epidermal : (a) Part is red. (b) Usually

co
co
blister is formed covered by white, avascular epidermis and bordered

e.
e.
by red, hyperaemic skin. (c) Hair is singed, pain is great. (d) Blister
fre
fre
fre
contains gas and protein containing fluid.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 104 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
Thermal Deaths 105
e.
e.
(2) Dermo-epidermal : (a) Whole thickness of skin is destroyed.
re
fre
fre
(b) Burns are wrinkled, depressed areas of coagulated tissue, colour is
sf
ks
ks
brown or black, bordered by reddish, blistered skin. (c) Necrotic tissue
k
separates within a week; pain and shock greater than epidermal burns.
oo
oo
oo
(3) Deep : (a) There is gross destruction of skin, muscle, and
eb
eb
eb
even bone. (b) Burns are painless as nerve endings are destroyed. (c)
m
m
Appearances are similar to second degree but more severe. (d) The
burnt part may be completely charred.
For cremation, a body has to be incinerated for one-and-half
om
m
hours at 1000°C. Ashes weigh 3 to 4 kg and contain bone fragments.
co
co
Estimation of surface area of body involved is worked out by
e.
e.
rule of nine. 9% for head, and each upper limb, 9% for front of each
fre
fre
fre
lower limb, 9% for back of each lower limb, 9% for front of chest, 9%
for back of chest, 9% for front of abdomen, 9% for back of abdomen,
ks
ks
ks
and 1% for external genitalia.
oo
oo
oo
Causes of death : (1) Primary shock. (2) Secondary shock :
eb
eb
eb
50% of deaths occur within 48 hours. (3) Toxaemia. (4) Sepsis. (5)
m
m
Biochemical disorders. (6) Acute renal failure. (7) Oedema of glottis.
(8) Accidents. (9) Pyaemia, gangrene, etc.
Autopsy : External : (1) Flame burns usually have a patchy
om
om
distribution and vary in size and shape. (2) Flash burns occur due
co
to sudden ignition or explosion of gases or fine particulate material,

c
e.
e.
e.g. explosions of gases or ignition of highly inflammable liquids. All

re
fre
exposed surfaces are burned uniformly .(3) The burnt areas will be re
sf
f
reddened and blistered and charred. (4) Blisters may be present either
ks
ks
k
in main burn or as islands beyond the periphery. (5) Hair is singed.

oo
oo
oo
(6) Heat rigor may be found. (7) Portions of body where clothing is
eb
eb
eb
tight are comparatively unaffected. (8) Face is swollen and distorted,

m
tongue protruded. (9) Skin detaches as glove. (10) Blisters of second

degree cannot be distinguished from blisters seen in CO poisoning,
deep coma, exposure to gasoline and putrefaction.
om
Pugilistic attitude (boxing, fencing or defence attitude) : (1) If

co
co
body is exposesd to great heat, legs are flexed at hips and knees, arms
e.
e.
are flexed at elbows and held in front of body, all fingers are hooked
fre
fre
fre
like claws. (2) Opisthotonus is seen due to contraction of paraspinal

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 105 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
e.
e.
muscles. (3) Flexor muscles being bulkier than extensors contract
re
fre
fre
more due to which joints of all limbs are flexed. (4) It occurs whether
sf
ks
ks
the person was alive or dead at the time of burning. (5) Stiffening is
k
due to coagulation of proteins of the muscles and dehydration.

oo
oo
oo
Heat ruptures: (1) occur either before or after death, due to
eb
eb
eb
splitting of soft parts. (2) Splits may be anywhere, but are usually
m
m
seen over extensor surfaces and joints. (3) They are several cm.
in length and resemble lacerations or even incised wounds. They
can be differentiated by: (a) There is no bleeding in wound and no
om
m
extravasation. (b) Intact vessels and nerves are seen. (c) Margins are
co
co
irregular. (d) Bruising and vital reaction are absent.
e.
e.
In death due to burns it is difficult to assess body temperature,
fre
fre
fre
P.M hypostasis, and rigor mortis.
Internal : Heat haematoma (1) occurs when heat is sufficient to
ks
ks
ks
cause charring of skull. (2) It resembles extradural haemorrhage,
oo
oo
oo
but there will not be any signs of blunt force injury. (3) It consists
eb
eb
eb
of soft, friable clot of light chacolate colour, honeycomb appearance,
m
m
1 to 15 mm thick, and volume up to 120 ml. (4) Its distribution follows
charring of outer table of skull. (5) The most common site is parieto-
temporal region. (6) The blood may come from venous sinuses or
om
om
diploic veins.
co
Thermal fractures of skull occur due to (1) Rapid increase in

c
e.
e.
intracranial steam pressure; fragments are displaced outwards. (2)

re
fre
Rapid drying of bone with contraction; outer table is only involved. re

sf
f
They are seen above temples. (3) They consist of several lines which
ks
ks
k
radiate from a common centre. (4) They may cross a suture line.
oo
oo
oo
(1) CO levels in the blood will be more than 10% and may reach
eb
eb
eb
70 to 80%. (2) The blood is cherry-red which may change to brownish

m
due to heat. (3) In death from suffocation, aspirated blackish coal

particles are seen in nose, mouth, larynx, trachea, bronchi,
oesophagus and stomach. (4) Such particles are embedded in frothy
om
mucus which covers the congested mucosa. (5) Presence of carbon

co
co
particles and elevated CO saturation together are absolute proof

e.
e.
that victim was alive when the fire occurred. (6) Laryngeal oedema
fre
fre
fre
is caused by inhalation of flame or superheated air or inhalation of

irritant gases. (7) The amount of oedema will decrease with P.M
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 106 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
Thermal Deaths 107
e.
e.
interval, and only wrinkling of mucous membrane may be seen.
re
fre
fre
(8) Haemoconcentration is present and there is some tissue oedema
sf
ks
ks
and excess of fluid in serous cavities. (9) Even in cases of severe
k
external charring, the internal organs are usually well preserved. (10)
oo
oo
oo
Sometimes, brain, liver, lungs, etc. may be cooked, i.e. hardened and
eb
eb
eb
discoloured. (11) Inflammation and ulceration of Peyer’s patches
m
m
and solitary glands in intestines may be seen. (12) Rarely, ulcers
are seen in duodenum (Curling ulcers) about tenth day, which are
punched-out mucosal defects, which may be superficial or deep. (13)
om
m
Petechiae of stomach and duodenum, often with erosions is a more
co
co
common finding. (14) The spleen is enlarged and softened. (15) The
e.
e.
liver may show cloudy swelling. (16) Kidneys may show cloudy
fre
fre
fre
swelling, capillary thrombosis and infarction. (17) The adrenals may
be enlarged and congested. (18) Hemoglobinuria occurs when more
ks
ks
ks
than 30% of skin is burnt. (19) Cyanide levels in blood are less than
oo
oo
oo
0.3 mg.%.
eb
eb
eb
Age of burns : (1) Redness appears immediately and vesication
m
m
in about one hour. (2) Exudate begins to dry in 12 to 24 hours. (3)
Dry, brown crust is formed in 2 to 3 days. (4) Red inflammatory zone
disappears in 36 to 72 hours, and pus may form under sloughs. (5)
om
om
Superficial sloughs fall in 4 to 6 days and deeper sloughs within two

co
weeks. (6) Scar is formed after several weeks.

c
e.
e.
Difference between antemortem burns and postmortem burns

re
fre
Trait Antemortem burns Postmortem burns re

sf
f
ks
ks
(1) Line of redness : Present. Absent.
k
oo
oo
oo
(2) Blister : Contains serous fluid Contains air and thin

with proteins and clear fluid. Base is dry
eb
eb
eb
chlorides. Base is red hard and yellow.

m
and inflamed.
(3) Vital reaction : Marked cellular Absent.
exudation and reactive
om
changes in the tissue

co
co
cells present.
(4) Enzymes : Peripheral zone of Peripheral zone does
e.
e.
burns shows increase not show increase in

fre
fre
fre
in enzyme reaction enzyme reaction.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 107 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
e.
e.
Scalds : (1) Scalds are produced by the application of liquid
re
fre
fre
above 60ºC or from steam. (2) Redness appears immediately, and
sf
ks
ks
blisters occur within a few minutes. (3) If blistered skin is removed,
k
it will leave a pink raw surface which later becomes brownish, hard
oo
oo
oo
and dry. (4) Superheated steam soddens the skin which has dirty-
eb
eb
eb
white colour. (5) It is of 3 degrees (a) Erythema by vasoparalysis.
m
m
(b) Blister formation. (c) Necrosis of dermis. (6) Scalded area is
large but may be small if caused by splashing. (7) Streaks of liquid
run downwards from main area causing lines of blisters. (8) Skin is
om
m
sodden and bleached. (9) Red line present. (10) Vesicles over burnt
co
co
area only. (11) Charring, singeing and ulceration are not seen. (12)
e.
e.
Scar is thin and less contracted.
fre
fre
fre
Electrical injuries : Alternating current is 4 to 5 times as
dangerous as an equal voltage of direct current. Most deaths occur
ks
ks
ks
at more than 200 volts.
oo
oo
oo
(1) Electric mark (Joule burn) : (1) It is specific and diagnostic
eb
eb
eb
of contact with electricity, and is found at point of entry of current.
m
m
(2) It is round or oval, shallow crater, 1 to 3 cm. in diameter, and
has a ridge of skin of about 1 to 3 mm high, around part or whole of
their circumference. (3) Crater floor is lined by pale flattened skin.
om
om
(4) In some marks, skin may break within or near margin of crater,
co
resembling a broken blister. (5) Skin of mark is pale, but if contact is

c
e.
e.
prolonged it may be brown or even black. (6) Rarely, mark may be

re
fre
seen as a circular hole penetrating up to bone simulating a bullet hole. re

sf
f
(7) These marks are produced by conversion of electricity into heat
ks
ks
k
within tissues. (8) It is usually found on the palmar side of the hand.
oo
oo
oo
(2) Flash or spark burns (1) Resemble thermal burns. (2) They
eb
eb
eb
may be pinpoint or deeply seated and contracted. (3) Death may occur
m
without any visible burning (a) when a hot wire is grasped with a
wet hand, or (b) when a person is electrocuted in bath tub. (4) High
tension electrical current may produce discrete lesions due to arcing
om
from conductor to body without direct contact. (5) Multiple burns or

co
co
punched-out lesions are produced due to arc dancing over large areas
e.
e.
which present crocodile flash burns. (6) There can be blast effect
fre
fre
fre
from very high voltage discharges.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 108 04-03-2015 12:09:38 PM

e
e
m
m
om
m
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Thermal Deaths 109
e.
e.
(3) Electrical burns or splits : (1) These splits are dry, hard,
re
fre
fre
firm, charred, insensitive with ragged edges, and their shape is
sf
ks
ks
round, oval,linear, or irregular. (2) Skin may be wrinkled. (3) Rarely,
k
localised oedema of a limb is seen. (4) Aseptic necrosis and sloughing

oo
oo
oo
occurs.
eb
eb
eb
Autopsy : (1) Scene examination is much more important than
m
m
autopsy. (2) Rigor mortis appears early. (3) Usually there are external
marks of electric burning and contusion and laceration at the point
of entrance and exit of the body. (4) In some cases, the lesions may
om
m
extend through subcutaneous tissues and involve muscles and bone.
co
co
(5) Severe convulsions may cause fractures of spine or limbs. (6) Any
e.
e.
metallic object on the body will produce corresponding burns on the
fre
fre
fre
skin. (7) Asphyxial signs are present. (8) Petechial haemorrhages
may be seen along line of passage of current, under endocardium,
ks
ks
ks
pericardium and pleurae. (9) There may be necrosis of intima or of
oo
oo
oo
complete wall of blood vessels. (10) Small balls of molten metal,
eb
eb
eb
derived from conducting electrode, so-called current pearls may
m
m
be carried deep into tissues. (11) Heat will melt calcium phosphate,
which is seen on X-ray as typical round density foci (Bone pearls
or wax drippings).
om
om
Cause of death : (1) Paralysis of respiratory centre. (2)

co
Ventricular fibrillation. (3) Cardiac arrest. (4) Rarely vagal inhibition.

c
e.
e.
Judicial electrocution : (1) In some states of U.S.A., death

re
fre
penalty is carried out in electric chair. (2) Person is strapped to a re

sf
f
wooden chair and one electrode is put on shaven scalp, and other on
ks
ks
k
right lower leg, and current of 2,000 volts and 7 amperes is passed
oo
oo
oo
for one minute. (3) After tetanic spasm and loss of consciousness,
eb
eb
eb
the same current is passed again for one minute.

m
Lightning stroke : (I) Arborescent or filigree burns

(Lichtenberg’s flowers) : (1) They are superficial, thin, irregular
and tortuous, erythematous markings on skin resembling branches
om
of tree, usually found over shoulders or flanks. (2) It may be caused

co
co
due to (a) slight staining of the tissues by haemoglobin from lysed

e.
e.
red cells along the path of electric current, or (b) rupture of smaller
fre
fre
fre
blood vessels at several places, or (c) due to minute depositions of

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 109 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
e.
e.
copper in the dermis. (3) They indicate the paths taken by discharge
re
fre
fre
and disappear in 1 to 2 days if person survives. (II) Linear burns
sf
ks
ks
vary from 3 to 30 cm, in length, and 0.3 to 2.5 cm. in width, and are
k
often seen in moist creases and folds of skin. (III) Surface burns
oo
oo
oo
are true burns and occur beneath metallic objects. Death is always
eb
eb
eb
due to accident.
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-10.indd 110 04-03-2015 12:09:38 PM

e
e
m
m
om
m
co
co
e. 11
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Starvation
om
m
co
co
e.
e.
Acute starvation occurs from complete stoppage of food, and
fre
fre
fre
chronic starvation from gradual deficient supply of food.
ks
ks
ks
Acute : (1) Feeling of hunger for 30 to 48 hours, followed by
oo
oo
oo
pain in epigastrium. (2) After 4 to 5 days, general emaciation and
eb
eb
eb
absorption of subcutaneous fat begins to occur. (3) Eyes sunken,
pupils dilated, lips dry and cracked, tongue coated and dirty, saliva
m
m
thick and scanty, voice whispering, skin dry, rough, thin, inelastic,
wrinkled, pigmented, abdomen concave, limbs thin, flaccid,
om
om
progressive cardiovascular insufficiency, subnormal temperature,

co
constipation, urine scanty, turbid with evidence of acidosis, extreme

c
emaciation, offensive odour before death. (4) Intellect clear till death.
e.
e.
(5) Loss of 40% of body weight is fatal.

re
fre
Chronic : Hunger-pains, mental and physical lethargy, re

sf
f
ks
ks
progressive loss of weight, polyuria, pigmentation, hypothermia,
k
oo
oo
oo
gross mental retardation, loss of self-respect, oedema of lower limbs.

eb
eb
eb
Death occurs from exhaustion, circulatory failure or intercurrent

infection.
m
Fatal period : 10 to 12 days if both water and food are completely

withdrawn : 6 to 8 weeks or more if food alone is withdrawn.
om
Autopsy : (1) All organs and tissues show changes similar to

co
co
premature senility. (2) All organs are reduced in size, fat is completely
absent in subcutaneous tissues, omentum, mesentery, and about
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-11.indd 111 04-03-2015 12:09:57 PM

e
e
m
m
om
m
co
co
e.
e.
internal organs, which is never seen in wasting diseases. (3) Heart
re
fre
fre
is small from brown atrophy; lungs collapsed, pale; G.I. tract shows
sf
ks
ks
atrophy of all coats; non-specific ulceration of bowel; gall bladder
k
distended with bile, and urinary bladder empty; blood volume reduced
oo
oo
oo
with marked anaemia; osteomalacia.
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-11.indd 112 04-03-2015 12:09:57 PM

e
e
m
m
om
m
co
co
e. 12
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Mechanical Asphyxia
om
m
co
co
e.
e.
Hanging : (1) It is a form of asphyxial death caused by
fre
fre
fre
suspension of a person by ligature which encircles neck, the
ks
ks
ks
constricting force being weight of body. In partial hanging, bodies
oo
oo
oo
are partially suspended or are in a sitting, kneeling, lying down, prone
eb
eb
eb
or any other position. In typical hanging, ligature runs from midline
above thyroid cartilage symmetrically upwards on both sides of neck
m
to occipital region.
Causes of Death : (1) Asphyxia : Air is blocked due to
m
om
om
compressive narrowing of lumens of larynx and trachea and forcing

co
of tongue against posterior wall of pharynx and folding of epiglottis

c
over entrance of larynx. (2) Venous congestion : Jugular veins are

e.
e.
blocked, if ligature is broad and soft. (3) Combined asphyxia and

re
fre
venous congestion (commonest cause). (4) Cerebral anaemia, re

sf
f
ks
ks
occurs with ligature made of thin cord which sinks deeply into
k
oo
oo
oo
tissues. (5) Vagal inhibition. (6) Fracture or dislocation of cervical

eb
eb
eb
vertebrae.
Delayed deaths occur due to : (1) Aspiration pneumonia. (2)
m
Infections. (3) Oedema of lungs. (4) Oedema larynx. (5) Hypoxic

encephalopathy. (6) Abscess brain. (7) Infarction brain.
om
Fatal period : 3 to 5 minutes.

co
co
Autopsy : External : Ligature mark in the neck is specific and

important, which depends on : (1) Composition of ligature. (2) Width
e.
e.
and multiplicity of ligature. (3) Weight of body suspended and degree

fre
fre
fre
of suspension. (4) Tightness of encircling ligature. (5) Length of

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 113 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
time body has been suspended. (6) position of knot. (7) Slipping of
re
fre
fre
ligature during suspension.
sf
Ligature mark is a groove or furrow in tissues which is pale,
ks
ks
k
but on drying becomes yellowish or yellow-brown and hard like

oo
oo
oo
parchment. In case of fixed loop with (1) a single knot in midline
eb
eb
eb
at back of head, mark is seen on both sides of neck, and is directed
m
m
obliquely upwards towards knot, (2) a single knot in midline under
chin, mark is seen on back and both sides of neck and is directed
obliquely forwards towards knot, (3) when the knot is in region
om
m
of one ear, on side of knot mark is directed obliquely upwards
co
co
towards knot, and other side it is directed toward knot transversely.
e.
e.
Horizontal ligature mark is produced (1) When running noose is
fre
fre
fre
applied (above level of thyroid cartilage). (2) In hanging from low
point of suspension. (3) In partial hanging when body leans forward.
ks
ks
ks
If a running noose fails to tighten, mark may resemble one produced
oo
oo
oo
by a fixed loop.
eb
eb
eb
(1) Mark is above level of thyroid cartilage in 80%, at the level in
m
m
15% and below cartilage in about 5% of cases. (2) Width of groove
is about, or slightly less than width of ligature. (3) The mark may be
patterned. (4) Fresh mark is less clear but becomes prominent after
om
om
drying for several hours. (5) Hanging may occur without visible
co
ligature mark. (6) When nylon, silk or terylene clothes are used,
c
e.
e.
mark may be only 2 to 3 mm wide. (7) A loop made of soft material,

re
fre
e.g towel may not produce mark. (8) A thin line of congestion or re
sf
f
haemorrhage may be seen along the edges of groove at some point.
ks
ks
k
This does not indicate whether hanging was caused during life. (9)
oo
oo
oo
Abrasions with haemorrhage along the edges suggest suspension

eb
eb
eb
during life. (10) Hanging may occur when pressure is applied at

m
front of neck. (11) Ligature mark is produced if a body is suspended

within two hours after death. (12) Mark may disappear after several
hours following removal of ligature. (13) Decomposition obliterates
om
ligature mark.
co
co
Other signs : (1) Asphyxial signs present in 50% cases. (2) Neck
e.
e.
stretched, elongated. (3) Face pale. (4) Asphyxial signs are marked
fre
fre
fre
if noose was placed high up. (5) In complete suspension, apshyxial

signs are slight, petechial haemorrhages less common. (6) Saliva
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 114 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
Mechanical Asphyxia 115
e.
e.
may be found dribbling from angles of mouth, which is an important
re
fre
fre
sign. (7) P.M lividity is seen in lower limbs and hands. (8) Eyes are
sf
ks
ks
protruded and firmer, conjunctivae congested and pupils dilated. (9) If
k
the ligature knot presses on cervical sympathetic, the eye on the same
oo
oo
oo
side may remain open and its pupil dilated. It indicates antemortem
eb
eb
eb
hanging (le facie sympathique).
m
m
Internal : (1) Incision of groove may show small haemorrhages
in the underlying layers of skin. (2) Tissues under mark are dry,
white and glistening. (3) Platysma and sternomastoid rupture and
om
m
intima of carotid arteries show transverse splits with extravasation
co
co
of blood in 5 to 10%. (4) Hyoid bone is fractured in 15 to 20% of
e.
e.
cases. Fracture is common in persons above 40 years and involves
fre
fre
fre
greater horns at junction of inner two-thirds and outer one-third. (5)
Superior horn of thyroid cartilage is fractured in about 40% of
ks
ks
ks
cases. (6) Lungs are congested and oedematous. (7) Trachea is usually
oo
oo
oo
congested. Petechial haemorrhages may be found on epiglottis, in the
eb
eb
eb
larynx and trachea. (8) Internal organs are congested. (9) Subpleural
m
m
ecchymoses may be found.
Unusual positions, e.g. where parts of body touched ground,
kneeling or reclining, are almost diagnostic of suicide.
om
om
In postmortem hanging, marks of violence and signs of dragging

co
may be found on body, but dribbling of saliva is not seen and fibres
c
e.
e.
from the rope are not found on hands of victim.

re
fre
Lynching : It is homicidal hanging. The name is derived from re

sf
f
captain william lynch who used to order hanging on the spot without
ks
ks
k
trial in U.S.A. where a black rapist was used to be lynched by angry

oo
oo
oo
white mob. Sometimes, a suspect, accused or enemy is hanged by a

eb
eb
eb
rope from a tree, etc. by the mob.

m
Judicial hanging : (1) In India, legal death sentence is carried

out by hanging the criminal. (2) The face is covered with dark mask,
and person is made to stand on a platform which opens downwards
om
when a bolt is drawn. (3) A rope to allow a drop of 5 to 7 metres is

co
co
looped round neck with knot under angle of jaw. (4) On drawing
e.
e.
the bolt, the person drops. (5) The stoppage of the moving body
fre
fre
fre
causes fracture-dislocation at the level of second and third, or third

and fourth cervical vertebrae. (6) Upper cervical cord is stretched or
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 115 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
torn across, resulting in immediate unconsciousness, but heart beats
re
fre
fre
and respiratory movements may continue up to 10 to 15 minutes,
sf
ks
ks
and spasmodic muscular jerking may occur for a considerable time.
k
Strangulation : It is a case of asphyxial death caused

oo
oo
oo
from constricting the neck by ligature without suspending the
eb
eb
eb
body.
m
m
Autopsy : External : (1) Ligature mark is well-defined, slightly
depressed and seen about the middle or below thyroid cartilage. (2) It
completely encircles the neck transversely and is more prominent
om
m
at front and sides. (3) The mark may be interrupted at the front by
co
co
presence of clothing or by victim’s fingers. (4) A narrow ligature
e.
e.
will produce a mark slightly narrower than diameter of ligature. (5)
fre
fre
fre
When nylon, silk or terylene fabrics are used, the mark may be
only 2 to 3 mm wide. (6) The mark may be oblique as in hanging,
ks
ks
ks
if the victim was sitting and assailant applied ligature on neck while
oo
oo
oo
standing behind him, thus using force backwards and upwards, or if
eb
eb
eb
the victim has been dragged by a cord after he has been strangled
m
m
in lying down posture. (7) The base is soft and pale or reddish. (8)
Petechial haemorrhages are usually found immediately adjacent
to mark, which is a confirmation that the mark was produced
om
om
during life. (9) Reddening and congestion are also common

co
immediately above and below the groove. (10) If the ligature used
c
e.
e.
is soft and yielding and if it is removed soon after death, the mark
re
fre
in the neck may be very slight or absent. (11) If a rough ligature is re

sf
f
used and if there is some movement of the rope on the skin during
ks
ks
k
a struggle, the skin may show marked abrasions and haemorrhages.

oo
oo
oo
(12) The ligature mark is not obliterated by putrefaction, but is better

eb
eb
eb
preserved than the skin beyond it. (13) Even if mark is obscured,
m
subcutaneous haemorrhages in relation to mark may be found.

Pseudo-strangulation : (1) Marks are produced from folds in the
skin due to bending of head in infants and children in whom neck is
om
short. (2) In short-necked adults on front of neck. (3) Decomposing

co
co
bodies with tight collars, buttoned shirt at the neck, or other clothing
e.
e.
round the neck. (4) In these cases, a deep groove resembling ligature
fre
fre
fre
mark of strangulation is produced due to the swelling of the tissues

around the tight -fitting garment, as the body decomposes.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 116 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
Internal : (1) Severe congestion and haemorrhage into
re
fre
fre
tissues in and above the area constricted is seen. (2) There may be
sf
ks
ks
superficial haemorrhages under the ligature mark. (3) Neck muscles
k
are usually lacerated. (4) Rarely, there is no external mark, but

oo
oo
oo
extensive bruising of deeper tissues may be found. (5) If ligature is
eb
eb
eb
tightly applied on the neck until death occurs, bruising will be absent.
m
m
(6) Intima of carotid arteries is not damaged. (7) Hyoid bone may be
fractured in older persons in 10 to 15% cases. (8) Fracture of thyroid
cartilage is more common. (9) Bruising of tongue and floor of mouth
om
m
occur. (10) Larynx, trachea and bronchi are congested, may show
co
co
haemorrhagic infiltration, and contain forthy, blood stained mucus.
e.
e.
(11) The lungs are markedly congested, oedematous, and show
fre
fre
fre
ecchymoses and larger subpleural haemorrhages. Silvery-looking
spots under pleural surface are seen in more than 50% cases. (12)
ks
ks
ks
Internal organs are congested.
oo
oo
oo
Difference between hanging and strangulation
eb
eb
eb
Trait Hanging Strangulation by
m
m
ligature
(1) Ligature mark : It is oblique, does not It is transverse,
completely encircle the completely encircling
om
om
neck. usually seen high the neck below the

co
up in the neck between thyroid cartilage.

c
the chin and larynx. The base is soft and

e.
e.
The base is pale, hard reddish.

re
fre
and parchment-like. re
sf
f
ks
ks
(2) Abrasions and About the edges of About the edges of
k
ecchymoses: ligature mark not the ligature mark are

oo
oo
oo
common. common.
eb
eb
eb
(3) Bruising : Of the neck muscles Of the neck muscles

less common. more common.
m
(4) Neck : Stretched and Not stretched or

elongated. elongated.
om
(5) Subcutaneous White, hard and Ecchymosed under the

co
co
tissues : glistening under the mark.

mark.
e.
e.
(6) Hyoid bone : Fracture may occur. Fracture is uncommon.

fre
fre
fre
(7) Thyroid cartilage: Fracture is less Fracture is more

ks
ks
ks
common. common.
Contd...
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 117 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
Contd...
re
fre
fre
(8) Larynx and Fracture rare. Fracture may be
sf
trachea: found.
ks
ks
k
(9) Emphysematous Not present on the Very common on the
oo
oo
oo
bullae : surface of the lungs. surface of the lungs.
eb
eb
eb
(10) Carotid arteries : Damage may be seen. Damage is rare.
(11) Face: Usually pale and Congested, livid and
m
m
petechiae are not marked with petechiae.
common.
om
m
(12) Signs of asphyxia : External signs less External signs well-
marked. marked.
co
co
(13) Tongue : Swelling and Swelling and
e.
e.
protrusion is less protrusion is more
fre
fre
fre
marked. marked.
(14) Saliva: Often runs out of Absent.
ks
ks
ks
mouth.
oo
oo
oo
(15) Bleeding : From the nose, mouth From the nose, mouth
eb
eb
eb
and ears not common. and ears common.
(16) Involuntary Of faeces and urine Of faeces and urine
m
discharage :
(17) Seminal fluid :
less common.
At glans is more
more common.
m
At glans is less
common. common.
om
om
m
co
Palmar strangulation: The palm of one hand is placed

c
horizontally across the mouth and nostrils without using the fingertips,
e.
e.
its pressure being reinforced by placing the other palm on the top of
re
fre
it at right angles, the heel of the upper palm pressing up on the front re
sf
f
ks
ks
of the neck. Diffuse bruising with fracture of thyroid may be seen.
k
oo
oo
oo
The face is congested with petechiae.

eb
eb
eb
In cases of hanging, the hyoid bone is forced directly back-wards,

due to which the divergence of greater horns is increased, which may
m
fracture with outward displacement of the pusterior small fragments.

Common methods of homicidal strangulation are : (1)
om
Ligature strangulation. (2) Throttling. (3) Bansdola. (4) Garrotting.

co
co
(5) Mugging.
Bansdola : (1) One strong bamboo or stick is placed across
e.
e.
front and another on back of neck and both ends are tied with
fre
fre
fre
rope due to which victim is squeezed to death. (2) Sometimes a

ks
ks
ks
stick is placed across front of neck and assailant stands with a foot
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 118 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
on each end of stick. (3) If a stick or foot is used, a bruise is seen in
re
fre
fre
the centre of neck across the windpipe, corresponding in width to
sf
ks
ks
the substance used. (4) If two sticks are used, a similar mark will be
k
seen on back of neck.

oo
oo
oo
Garrotting : (1) Victim is attacked from behind without
eb
eb
eb
warning. (2) Throat may be grasped or a ligature is thrown over
m
m
neck and quickly tightened by twisting it with a lever, which
causes sudden unconsciousness and collapse. (3) The assailant is then
able to tie the ligature with one or more turns. (4) A single assailant
om
m
can kill healthy adult in this way. (5) This method is usually used in
co
co
lonely places to kill travellers and to rob them.
e.
e.
Mugging : (1) The neck of victim is held in bend of elbow
fre
fre
fre
from behind. (2) Pressure is exerted either on front of larynx, or
at one or both sides of neck by forearm and upper arm. (3) P.M
ks
ks
ks
appearances are those of ligature strangulation with a broad object.
oo
oo
oo
(4) There may be bruising behind the larynx and in the strap muscles
eb
eb
eb
of neck. (5) In some cases, neck may be pressed by foot or knee.
m
m
Throttling (manual strangulation) : Asphyxial death
produced by compression of neck by human hands is called
throttling.
om
om
Autopsy : External : (1) The situation and extent of contusions

co
on neck depend upon : (a) relative positions of assailant and

c
e.
e.
victim, (b) manner of grasping neck, (c) degree of pressure

re
fre
exerted upon throat. (2) Bruises are produced by tips or pads re

sf
f
of fingers. (3) Shape is oval or round, but continued bleeding into
ks
ks
k
contused area usually increases the size. (a) A grip from right hand
oo
oo
oo
from front produces a thumb impression on right side of victim’s neck,

eb
eb
eb
usually under lower jaw or cornu of thyroid. Several finger marks

m
are seen on left side of neck obliquely downwards and outwards,

one below the other, but may be grouped together. (b) In a grip from
behind victim, pressure is applied all round the neck. (c) When both
om
hands are used thumb marks of one hand and finger marks of other
co
co
hand are usually found on either sides of throat. Sometimes, both

e.
e.
thumb marks are found on one side and several finger marks on
fre
fre
fre
opposite side. (d) A grip from both hands, one being applied to front
and other to back, produces bruises on front and back of the neck.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 119 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
(4) Bruises may be seen in a completely haphazard manner due to
re
fre
fre
shifting of grip, or struggle of victim. (5) Fresh bruises are soft and
sf
ks
ks
red, but after several hours they appear brown, dry and parchment-
k
like. (6) Pressure of nails produces crescentic abrasions. (7) If soft

oo
oo
oo
material is kept between hand and throat, or if pressure on the neck
eb
eb
eb
is maintained until after death of victim, bruising may be absent. (8)
m
m
Signs of asphyxia are similar to those of ligature strangulation.
Internal : (1) Bruises are found in the skin, fascia, on sheaths
of muscles and in substance of thyroid gland. Bruises are usually
om
m
separate and involve muscles. In some cases, bruising may be absent
co
co
externally, although deeper tissues may show extensive bruising. (2)
e.
e.
Sternomastoid may be torn. (3) Muscles surrounding larynx show
fre
fre
fre
well-marked bruising. (4) In some cases, intima of carotid is ruptured.
(5) Haemorrhages may be found in pharynx, tonsils, base of tongue
ks
ks
ks
and upper part of larynx. (6) Fracture of superior cornu of thyroid at
oo
oo
oo
its base is common, but fractures of body are rare. (7) Fracture of ala
eb
eb
eb
of thyroid cartilage occurs in midline obliquely or spirally, if pressure
m
m
is much greater. This injury is more common in blows to front of
neck, either by fist or edge of hand, punching, kicking, arm-locks
or fall on to a ridged object, such as gate or chair-back. (8) Body of
om
om
thyroid can break due to : (a) Karate blow to front of neck, (b) handle
co
bar of a bicycle in traffic accident, (c) edge of chair or any projecting

c
e.
e.
object. (9) Fractures of hyoid bone with inward driving of distal

re
fre
fragment occurs in 30 to 50% of cases. (10) Fracture of cricoid re

sf
f
cartilage is seen only in fatal cases. (11) The lungs are congested,
ks
ks
k
oedematous with subpleural haemorrhages. (12) Froth is present in

oo
oo
oo
bronchi. (13) Subarachnoid haemorrhage may be present.

eb
eb
eb
Rapid or instantaneous death can occur due to vagal inhibition

m
commonly in throttling, very often in hanging and less often in

ligature strangulation.
Hyoid bone fractures : (1) Inward compression fractures are
om
seen in throttling. (2) Fracture occurs at junction of outer one-third

co
co
and inner two-thirds. (3) Posterior fragment is displaced inwards.

e.
e.
(4) Periosteum is torn on outer side of bone only. (5) A fracture may
fre
fre
fre
also be seen at the joint between greater horn and body. (6) In some
cases, bilateral inward, fractures may occur.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 120 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
(2) Anteroposterior compression : (1) In cases of hanging, the
re
fre
fre
hyoid bone is forced directly backwards, due to which the divergence
sf
ks
ks
of greater horns is increased, which may fracture with outward
k
displacement of the posterior small fragments. (2) Periosteum is torn

oo
oo
oo
on inner side. (3) Fracture may occur either in greater horn or at its
eb
eb
eb
junction with body and it may be bilateral. (4) It may also be seen in
m
m
ligature strangulation, run over motor vehicle accidents and blows
on front of neck. (5) The fractured fragments are displaced outwards.
(3) Avulsion fractures (tug or traction fractures) : They occur
om
m
due to muscular overactivity without direct injury to hyoid bone.
co
co
Suffocation : It is that form of asphyxia which is
e.
e.
caused by deprivation of oxygen either due to lack of oxygen in
fre
fre
fre
environment or from obstruction of air-passages at level of nose
and mouth.
ks
ks
ks
Smothering : (1) It is caused by closing external
oo
oo
oo
respiratory orifices either by hand or other means, or by blocking
eb
eb
eb
cavities of nose and mouth by foreign substances such as cloth,
m
m
paper, etc. (2) Suicidal smothering by hand is impossible. It can be
caused by burying face in a mattress or by tying polythene bag over
the head. (3) Most deaths are accidental due to : (a) In epileptic or
om
om
intoxicated person by burying his face in a pillow, etc. (b) Falling

co
into a large quantity of semisolid or finely divided material, like mud,

c
e.
e.
ashes, grain, sand, etc. (c) Air- tight place, e.g locked boxes or trunks.
re
fre
(d) Inhalation of irrespirable gases, e.g. CO, CO2, hydrogen sulphide. re

sf
f
(e) Application of plastic bags for experiment or autoerotic exercise.
ks
ks
k
Homicidal smothering occurs due to closure of the mouth and nose

oo
oo
oo
by a hand or cloth, or pressing the face into a pillow.

eb
eb
eb
Autopsy : (1) Obstruction by pillow, cushion, etc. may not leave

m
any signs. (2) If nose and mouth are closed by hands, scratches or
lacerations and bruises may be present around mouth and nose. (3)
Asphyxial signs are severe.
om
Environmental Suffocation : (1) Death from hypoxic hypoxia

co
co
may result form breathing in a vitiated atmosphere (deficient in

e.
e.
oxygen). (2) CO, CO2, methane, sulphureted hydrogen and sulphur

fre
fre
fre
dioxide are commonly found in vitiated atmosphere. (3) Deaths

are always accidental. (4) It may occur in vicinity of limekilns
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 121 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
and wells or excavations in chalk rock. (5) In such cases, petechial
re
fre
fre
haemorrhages are absent. (6) Congestion and cyanosis may or may
sf
ks
ks
not be present.
k
Gagging : (1) This is a form of asphyxia which results from

oo
oo
oo
pushing a cloth or soft object into the mouth sufficiently deep
eb
eb
eb
to block pharynx, or from closure of mouth and nose by a cloth
m
m
or similar material, which is tied around the head. (2) Collections
of saliva, and excessive mucus with oedema fluid causes complete
obstruction. (3) It is almost always homicidal and the victim is usually
om
m
an infant. (4) Sudden death due to reflex vagal inhibition may occur.
co
co
(5) It is usually resorted to prevent the victim from shouting for help,
e.
e.
and death is usually not intended.
fre
fre
fre
Overlaying (compression suffocation) : It occurs due to
compression of chest in an infant, e.g. during sleep mother or other
ks
ks
ks
person under influence of alcohol rolling on and crushing infants.
oo
oo
oo
Choking : (1) It is a form of asphyxia caused by obstruction
eb
eb
eb
within air-passages. It is almost always accidental. (2) Choking from
m
m
objects being lodged in the throat is commonly seen in the very young,
elderly, psychiatric patients, acutely intoxicated or physically weak,
particularly where the ability to swallow or masticate is severely
om
om
impaired. (3) The foreign body becomes arrested at or just below the
co
vocal cords and may produce an inflammatory reaction with oedema.

c
e.
e.
Causes : (1) Inhalation of food during meal. (2) Regurgitation

re
fre
of clotted milk in infants. (3) Vomited matter may be inhaled by re

sf
f
intoxicated, epileptic, while under anaesthesia, etc. (4) Impaction
ks
ks
k
of a solid body, such as bolus of food, seeds, piece of meat, etc. (5)
oo
oo
oo
Inhalation of gauze packs inserted during operation. (6) Inhalation

eb
eb
eb
of rubber balloons by children during play. (7) Inhalation of objects

m
like marbles, coins, etc. kept in mouth. (8) Impaction of large foreign
body, bolus of food, or denture in oesophagus compressing trachea.
Cafe coronary : (1) A healthy but grossly intoxicated
om
person (restaurant patron) taking a meal turns blue, coughs violently,

co
co
collapses and dies. (2) Death appears to be due to heart attack. (3)
e.
e.
At autopsy, large piece of poorly chewed food (bolus or piece of

fre
fre
fre
meat) may be found obstructing larynx. (4) Clinical signs of choking

are absent due to absence of gag reflex caused by alcohol. (5) The
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 122 04-03-2015 12:12:34 PM

e
e
m
m
om
m
co
co
e.
e.
foreign body which caused the occlusion of air-passages will be
re
fre
fre
found in mouth, throat, larynx or trachea. (6) When food or vomited
sf
ks
ks
material has been inhaled, particles of food material may be observed
k
embedded in thick mucus in trachea and bronchus.

oo
oo
oo
Traumatic Asphyxia : It results from respiratory
eb
eb
eb
arrest due to mechanical fixation of chest, which prevents normal
m
m
movements of chest wall. Fatal cases are only due to accident.
Causes : (1) Gross compression of chest and abdomen as in
stampedes. Victim may fall on ground and crushed under feet. (2)
om
m
Falls of earth or stone during tunnelling or in coal mine, etc, or
co
co
building collapse. (3) Run over by a vehicle or crushed by machine.
e.
e.
(4) Indirect compression due to thighs and knees being pressed against
fre
fre
fre
chest, so-called jack-knife position.
Autopsy : (1) Intense cyanosis of deep-purple or red colour of
ks
ks
ks
head, neck and upper chest, above level of compression is prominent
oo
oo
oo
feature. (2) Below this level skin is pale or slightly cyanosed. (3) Areas
eb
eb
eb
of pallor in areas of pressure, such as collars, buttons, folds in clothes
m
m
etc. (4) Multiple injuries. (5) If patient survives, purple colour will
disappear in 10 to 14 days. (6) Internal organs congested.
Burking : It is a combination of homicidal smothering
om
om
and traumatic asphyxia. A person under influence of alcohol was

co
thrown to ground and Burke used to kneel or sit on chest and close
c
e.
e.
nose and mouth with his hands and Hare used to pull him round the
re
fre
room by feet. They killed 16 persons in Edinburgh and sold bodies re

sf
f
to anatomy department.
ks
ks
k
Drowning : It is a type of asphyxia due to aspiration of

oo
oo
oo
fluid into air-passages caused by submersion in water or other

eb
eb
eb
fluid. Death can occur if only nose and mouth are submerged.
m
Types : (1) Wet drowning (primary drowning) : Water is

inhaled into lungs ; death occurs due to cardiac arrest or ventricular
fibrillation. (2) Dry drowning : Water does not enter lungs. Death
om
occurs from immediate sustained laryngeal spasm due to inrush

co
co
of water into nasopharynx or larynx. This is seen in 10 to 20%

e.
e.
cases. (3) Secondary drowning (post-immersion syndrome; near

fre
fre
fre
drowning) : Death occurs in half to several hours after resuscitation

from combined effects of pulmonary oedema, infective or chemical
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 123 04-03-2015 12:12:35 PM

e
e
m
m
om
m
co
co
e.
e.
pneumonitis, elctrolyte disturbances, metabolic acidosis, severe
re
fre
fre
infections or cerebral anoxia. (4) Immersion syndrome (hydrocution
sf
ks
ks
or submersion inhibition) : Death results from cardiac arrest from
k
vagal inhibition due to : (a) cold water stimulating nerve endings of

oo
oo
oo
surface of body, (b) water striking epigastrium, (c) cold water entering
eb
eb
eb
ear drums, nasal passages, pharynx and larynx.
m
m
Pathophysiology : (1) Fresh water : (1) In drowning in fresh
water (0.6% Nacl), water passes rapidly from lungs to blood, leading
to haemolysis and dilution of blood, which may increase by 50%
om
m
within a minute. (2) 2.5 litres of water may be inhaled and absorbed
co
co
in 3 minutes. (3) Sodium, calcium, protein and haemoglobin are
e.
e.
reduced; serum potassium increases. (4) Pulmonary oedema occurs
fre
fre
fre
(5) Oedema fluid contains serum proteins. (6) Cardiac arrhythmias
occur. (7) Haemoglobinaemia and haemoglobinuria occur.
ks
ks
ks
(2) Sea water (over 3% NaCl) : (1) Water is drawn from blood
oo
oo
oo
into lung tissues, and produces severe pulmonary oedema and
eb
eb
eb
hypernatraemia. (2) This causes haemoconcentration. (3) Salts from
m
m
water in the lungs pass into blood stream. (4) Slow death occurs from
asphyxia.
Causes of death : (1) Asphyxia. (2) Ventricular fibrillation. (3)
om
om
Laryngeal spasm. (4) Vagal inhibition. (5) Exhaustion. (6) Injuries.

co
Fatal Period : 4 to 8 minutes.

c
e.
e.
Autopsy : External : (1) P.M hypostasis is light-pink due to

re
fre
oxygenation, but in some cases may be dusky and cyanotic. It is re

sf
f
seen on face, upper part of front of chest, hands, lower arms, feet and
ks
ks
k
calves. (2) R.M appears early. (3) Signs of asphyxia. (4) Petechiae
oo
oo
oo
are rare in skin. (5) Fine, white, lathery froth or foam is seen at
eb
eb
eb
mouth and nostrils (characteristic external finding). Froth consists

m
of protein and water. Froth is also seen in death due to strangulation,

acute pulmonary oedema, electrical shock, epileptic fit, opium
poisoning and putrefaction, but in all these cases quantity is less
om
and bubbles are large. (6) Cutis anserina (goose skin, goose flesh)
co
co
in which skin has granular and puckered appearance may be seen

e.
e.
due to spasm of erector pilae muscles if the water is very cold. It is

fre
fre
fre
rarely seen in India. It can occur if a dead body is thrown into cold
water soon after death. It is also produced by R.M of erector muscles.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 124 04-03-2015 12:12:35 PM

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m
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om
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co
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e.
e.
(7) If cadaveric spasm develops, weeds, grass, twigs, leaves, etc. may
re
fre
fre
be firmly grasped in the hand. This strongly suggests that the person
sf
ks
ks
was alive when he drowned. Damaged nails and abraded fingers has
k
same significance. (8) washerwoman’s hands: Soddening of skin

oo
oo
oo
is first seen on fingertips in 2 to 4 hours, which spreads to palm and
eb
eb
eb
backs of fingers, and back of hand in that order in 24 hours. Wrinkling
m
m
of skin begins shortly after immersion, bleaching of epidermis in 4
to 8 hours, and bleached, wrinkled and sodden appearance is seen in
24 hours. Similar changes are seen in feet.
om
m
Internal : (1) Lungs are voluminous, cover pericardial sac
co
co
and bulge out of chest when sternum is removed (ballooning).
e.
e.
On section, oedematous condition due to large amount of watery,
fre
fre
fre
frothy, bloodstained fluid (emphysema aquosum) is seen in 80%
cases, which is presumptive evidence of death from drowning. (2)
ks
ks
ks
If the victim is unconscious at the time of drowning, mere flooding
oo
oo
oo
of lungs with water, but without formation of froth occurs which
eb
eb
eb
is known as oedema aquosum. (3) Lungs are usually moderately
m
m
congested but may be pale. (4) Lungs feel doughy and pit on pressure.
Alveloar walls may rupture and produce haemorrhages, which when
present subpleurally are called Paltauf’s haemorrhages. They are
om
om
shining, pale bluish-red and may be small, or 3 to 5 cm. in diameter.

co
They are present in 50% cases in lower lobes of lungs, and on

c
e.
e.
anterior surfaces and interlobar surfaces. (5) Red and grey patches
re
fre
may be seen on surface, due to Paltauf’s haemorrhages and patchy re

sf
f
interstitial emphysema. (6) Petechial haemorrhages on surfaces of
ks
ks
k
lungs are very rare or may be absent. (7) In fresh water drowning,
oo
oo
oo
lungs are ballooned but light, pale-pink, emphysematous, shape is

eb
eb
eb
retained and does not collapse after removal from body; on sectioning
m
crepitus is heard, and there may be little froth and no fluid. (8) In
sea water drowning, lungs are ballooned and heavy, weight up to
two kg, purplish or bluish, sodden and jelly-like, tend to flatten out
om
after removal from body; large amount of liquid and froth is present,
co
co
and on section crepitus is not heard. If the body remains in water for
e.
e.
several hours, differences in appearance between fresh and sea water

fre
fre
fre
drowning are not clear. (9) In many cases of drowning, relatively dry
lungs (dry-lung drowning) are seen, due to absorption of water from
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 125 04-03-2015 12:12:35 PM

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m
m
om
m
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e.
e.
air-spaces into pulmonary circulation, but lungs are distended. This
re
fre
fre
may occur if circulation continues for short time after removal of
sf
victim from water or if resuscitation is carried out. (10) Hydrostatic
ks
ks
k
lung, resembling drowning lung is seen if body remains in water at a

oo
oo
oo
depth of two metres for 20 hours. (11) Air- passages up to secondary
eb
eb
eb
bronchi and beyond are filled with froth. (12) If there is delay in
m
m
P.M, froth in lungs and air-passages and overdistension of lungs is
not seen in most cases. (13) Fluid in air-passages may contain fine
silt, sand, weeds, diatoms and various forms of algae, which is very
om
m
characteristic. (14) Rarely, the person vomits during unconscious
co
co
gasping phase of drowning, and stomach contents may be found in
e.
e.
air-passages. (15) Stomach contains water in 70% of cases. (16)
fre
fre
fre
Small intestine may contain water in 20% cases, which is positive
evidence as it depends on peristaltic movement. (17) Haemorrhages
ks
ks
ks
are found in middle ear in 50% cases. Haemorrhages in temporal bone
oo
oo
oo
or in mastoid air cells is seen in large number of cases. Temporal bone
eb
eb
eb
haemorrhages are also seen in deaths due to hanging, head injury and
m
m
CO poisoning. (18) Water may be found in middle ears. (19) Internal
organs are congested.
Sign of drowning : (1) In death due to laryngeal spasm asphyxial
om
om
signs are present, but no water in lungs. Laryngeal spasm disappears

co
after death due to primary relaxation. (2) In death due to vagal

c
e.
e.
inhibition, signs of drowning will not be present. (3) In syncope, or

re
fre
when person is in a state of helplessness from drink or other causes, re

sf
f
when person receives an injury during fall into water, signs will be
ks
ks
k
slight. (4) In dry drowning P.M appearances are those of asphyxia.

oo
oo
oo
Diatoms : (1) They are microscopic unicellular algae which

eb
eb
eb
are impregnated with silica and contain chlorophyll and diatomin.

m
(2) They resist heat and acid. (3) 15,000 species are present. (4) Size
varies from two microns to one mm. (5) They occur in fresh and salt
water, cultivated soils and on moist rocks. (6) Diatoms contained in
om
drowning fluid pass from ruptured alveolar walls into lymph channels
co
co
and pulmonary veins and enter left heart, and are found in lungs,
e.
e.
brain, bone marrow, liver, muscle, etc. The bone marrow is highly
fre
fre
fre
suitable and reliable. (7) Five grams of bone marrow, liver or kidney
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 126 04-03-2015 12:12:35 PM

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m
m
om
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co
co
e.
e.
is put in a test tube and covered with five times of its volume of
re
fre
fre
concentrated nitric acid and left for one day to allow digestion. This
sf
ks
ks
process chars, blackens and destroys organic matter but not diatoms
k
which have silica shells. (8) The tube is centrifuged, supernatant acid
oo
oo
oo
poured off and replaced with distilled water and centrifuged. This
eb
eb
eb
process is repeated two or three times, and deposit examined under
m
m
phase contrast or dark ground illumination. (9) Two litres of water is
obtained from accident site and examined for diatoms. (10) findings
similar diatoms in water and body tissues is in favour of drowning.
om
m
(11) Finding of diatoms is not absolutely diagnostic but is of greatest
co
co
value in putrefaction.
e.
e.
Tests : (1) Gettler Test is of no value. (2) The specific gravity
fre
fre
fre
of plasma from left side of heart is less than that of right side in
drowning. The reverse is seen in non-drowning cases. (3) Serum
ks
ks
ks
strontium is raised in drowning. (4) With decomposition water
oo
oo
oo
transudes into pleural cavities. (5) In advanced decomposition signs
eb
eb
eb
are completely absent.
m
Trait m
Difference in lungs between fresh water and sea water drowning
Fresh water drowning Sea water drowning
(1) Size and weight: Ballooned but light. Ballooned and heavy;
om
om
weight up to 2 kg.
co
c
(2) Colour : Pale pink. Purplish or bluish.

e.
e.
(3) Consistency : Emphysematous. Soft and jelly-like.

re
fre
(4) Shape after Retained; do not Not retained; tend to re

sf
f
ks
ks
removal: collapse. flatten out.
k
(5) Sectioning: Crepitus is heard. No crepitus. Copious.

oo
oo
oo
Little froth and no fluid and froth.

eb
eb
eb
fluid.
m
Duration of Submersion : The body floats in about 12 to 18

hours in summer, and 18 to 36 hours in winter in India. The body
usually floats with spine uppermost, though obese persons may float
om
face up. In advance putrefaction, the body usually floats belly up.
co
co
SEXUAL ASPHYXIAS : (1) Pressure on carotid vessels or partial

e.
e.
obstruction of air-passages impairs consciousness and may lead to

fre
fre
fre
hallucinations of an erotic nature. (2) These cases are associated with

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 127 04-03-2015 12:12:35 PM

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e.
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abnormal sexual behaviour, usually masochism and transvestism. (3)
re
fre
fre
victims are always male and usually young. (4) The scene is usually
sf
ks
ks
victim’s own house.
k
Methods : (1) Hanging is most frequent form. (a) The neck is

oo
oo
oo
protected by padding. (b) Such persons are usually found naked, or
eb
eb
eb
may be wearing women’s dress, wigs or make-up may be worn. (c)
m
m
Frequently they tie their arms, legs, waist and genitalia with a rope
(bondage). (d) Erotic or pornographic literature, nude photographs
are spread over. (e) Mirror may be arranged to watch event or
om
m
camera to make a photographic record. (2) Electrical stimulation
co
co
by applying electrodes to genitals or on abdominal wall with a low
e.
e.
voltage. (3) Head is covered with plastic or impervious bag, which
fre
fre
fre
is secured around neck by an elastic band. It is sometimes combined
with “glue-sniffing”. (4) Inhalation of stupefying substances, e.g.
ks
ks
ks
carbontetrachloride, or general anaesthetic.
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-12.indd 128 04-03-2015 12:12:35 PM

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co
co
e. 13
e.
re
fre
fre
sf
ks
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C h a p t e r
k
oo
oo
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eb
eb
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m
m
IMpotence and sterility
om
m
co
co
e.
e.
Impotence is the inability of a person to perform sexual
fre
fre
fre
intercourse. Sterility is the inability of male to beget children,
ks
ks
ks
and in female inability to conceive children. A person can be sterile
oo
oo
oo
without being impotent or he can be impotent without being sterile,
eb
eb
eb
or both may co-exist. Frigidity is the inability to start or maintain
sexual arousal pattern in female.
m
m
Examination: Obtain complete history of previous illness,
especially nervous and mental, and sexual history. A complete
om
om
medical examination should be carried out. Private parts are tested

co
for sensation.
c
Opinion: If male external genitalia are normal, it cannot be said

e.
e.
that the person is impotent. In such case opinion should be given

re
fre
in negative form, stating that from examination of male, he re

sf
f
ks
ks
finds nothing to suggest that the person is incapable of sexual
k
oo
oo
oo
intercourse.
eb
eb
eb
Causes of impotence in male: (1) Age: (a) Power of erection

may be present much earlier than puberty. (2) Poor physical
m
development of sex organs is common cause of impotence. (3) In

precocious development as in gonadal or adrenal tumours, sex organs
om
are developed at an early age. (4) In advanced age ability to perform

co
co
coitus may diminish. (5) Sperms are not found before puberty.
(2) Defects of development and acquired abnormalities: (1)
e.
e.
Impotency occurs due to absence or non-development of penis. (2)

fre
fre
fre
Double penis and penis adherent to scrotum may cause difficulty in

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-13.indd 129 04-03-2015 12:14:21 PM

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om
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co
co
e.
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coitus. (3) If testes are removed before puberty impotence occurs,
re
fre
fre
but if lost after puberty, potency is retained. (4) Sterility is common
sf
ks
ks
in cryptorchids.
k
(3) Local diseases: (1) Temporary impotence may be caused by

oo
oo
oo
acute disease of penis, e.g. gonorrhoea, sores on glans. (2) Disease
eb
eb
eb
of testicles, epididymis or penis, such as cancer, sarcoma, syphilis,
m
m
trauma, etc. may cause sterility, impotence or both. (3) Exposure to
X-rays causes temporary sterility.
(4) General diseases: During acute illness impotence is common.
om
m
(2) General diseases causing debility cause temporary impotence.
co
co
(3) Endocrine diseases may produce impotence. (4) Hemiplegia,
e.
e.
paraplegia, disseminated sclerosis, fracture vertebrae with cord injury
fre
fre
fre
may cause impotence. (5) Tumours or injury of cauda eqiuna, and
spina bifida produce impotence. (6) Excessive and continued use of
ks
ks
ks
some drugs, e.g. alcohol, opium, cannabis, tobacco, cocaine, etc. may
oo
oo
oo
cause impotence while the habit lasts. (7) Occupational exposure to
eb
eb
eb
lead and orchitis may cause sterility.
m
m
(5) Psychic causes: (1) Emotional disturbances, fear of impotence
or fear of inability to complete act may cause temporary impotence.
(2) Disgust of sexual act or dislike of partner may cause impotence. (3)
om
om
Quoad is a person who may be impotent with a particular woman,

co
but not with others. (4) Majority of cases of impotence have organic
c
e.
e.
causes. (5) Vasculogenic impotence is one of the most frequent causes

re
fre
of erectile failure (about 40%). It may be due to poor arterial inflow into re
sf
f
penis or excessive leakage of blood from the penis or both. (6) Other
ks
ks
k
causes are diabetes mellitus (20%), psychogenic (12%), neurogenic

oo
oo
oo
(7%), malignancy, testosterone deficiency, trauma, etc. (20%).

eb
eb
eb
Causes in female: (1) Age has no effect on potency. (2) A woman

m
is usually fertile from puberty to menopause.

(2) Defects of development and acquired abnormalities:
(1) Occlusion of vagina, adhesion of labia, intersexuality cause
om
impotence. (2) Conical cervix and absence of cervix, uterus, ovaries

co
co
or tubes produce sterility.

e.
e.
(3) Local diseases: (1) Hyperaesthesia of vagina, prolapse of

fre
fre
fre
uterus or bladder and vulval and vaginal tumours produce temporary

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-13.indd 130 04-03-2015 12:14:21 PM

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m
m
om
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co
co
Impotence and Sterility 131
e.
e.
impotence. (2) Gonorrhoea involving cervix, uterus, ovaries or tubes,
re
fre
fre
diseases of ovaries and tubes, disorders of menstruation, rectovaginal
sf
ks
ks
fistula, leucorrhoea may cause sterility.
k
(4) General diseases: (1) As woman is passive agent, general

oo
oo
oo
diseases do not cause impotence. (2) Occupational exposure to lead
eb
eb
eb
and exposure to X-rays cause sterility.
m
m
(5) Psychic causes: (1) Vaginismus is a spasmodic contraction
of vagina due to hyperaesthesia causing active impotence. (2) It is
classical example of psychosomatic illness. (3) It may affect perineal
om
m
muscles exclusively or may be felt as constriction of levator ani
co
co
right up to vaginal fornices. (4) There is definite cramp-like spasm
e.
e.
of adductor muscles. These muscle groups contract spastically. (5)
fre
fre
fre
Hysterical hyperaesthesia co-exists with this condition, which
starts at vaginal introitus, but in extreme cases it may be present
ks
ks
ks
all over the vulva. (6) The spastic contraction of vaginal outlet is
oo
oo
oo
completely involuntary reflex, caused by imagined, anticipated or
eb
eb
eb
real attempts at vaginal penetration. (7) In a fully developed state,
m
m
vaginal outlet is severely constricted and penetration by penis is
impossible. (8) It can occur with equal severity in the woman who
has borne children or in a virgin. (9) The aetiological factors are:
om
om
(1) Male sexual dysfunction. (2) Specific episodes of prior sexual

co
trauma. (3) Secondary to dyspareunia. (4) Rarely, personal dislike

c
e.
e.
or general feeling of disgust at idea of coitus.

re
fre
Artificial insemination: It is artificial introduction re

sf
f
of semen into vagina, cervix or uterus to produce pregnancy.
ks
ks
k
Types: (1) Homologous (semen of woman’s husband is used

oo
oo
oo
(A.I.H.). (2) donor (semen of any person other than husband is used
eb
eb
eb
(A.I.D.). (3) Pooled (semen of husband + semen of some other person

m
(A.I.H.D).
One ml. of semen is deposited by means of a syringe in or near
cervix on several successive days, about the time of ovulation.
om
Success rate is 70 to 75% within 3 to 4 months.

co
co
Indications: (1) Husband impotent. (2) Epispadiasis or

e.
e.
hypospadiasis. (3) Husband sterile. (4) Rh incompatibility between

fre
fre
fre
husband and wife. (5) Husband suffering from hereditary diseases.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-13.indd 131 04-03-2015 12:14:21 PM

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e
m
m
om
m
co
co
e.
e.
Precautions: (1) Consent of donor and his wife. (2) Identity of
re
fre
fre
donor kept secret. (3) Donor should not know to whom semen is
sf
ks
ks
donated and its result. (4) Donor should be mentally and physically
k
healthy. (5) Donor must not be relative of either spouse. (6) Race
oo
oo
oo
and characteristics of donor should resemble husband of woman. (7)
eb
eb
eb
Consent of woman to be inseminated and her husband in writing. (8)
m
m
Pooled semen to be used. (9) Witness must be present.
Legal problems: (1) Parties not guilty of adultery. (2) Child
becomes illegitimate. (3) Not a ground for nullity of marriage or
om
m
divorce. (4) Risk of incest between children born of A.I. and children
co
co
of donor.
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-13.indd 132 04-03-2015 12:14:21 PM

e
e
m
m
om
m
co
co
e. 14
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Virginity, pregnancy and delivery
om
m
co
co
e.
e.
Virginity : Virgin (virgo intacta) is a female who has
fre
fre
fre
not experienced sexual intercourse. Defloration means loss of
ks
ks
ks
virginity.
oo
oo
oo
Genitals: (1) In a virgin, labia majora are thick, firm, elastic and
eb
eb
eb
rounded, lie in apposition and close vaginal orifice. (2) the labia
minora are within labia majora. (3) Clitoris is small and vestibule
m
m
narrow. (4) The posterior commissure and fourchette are intact. (5)
Vagina is narrow and tight, mucosa is rugose, reddish, sensitive and
om
om
walls are approximated. (6) The hymen is a fold of mucous membrane

co
about one mm. thick, situated at vaginal outlet. The average adult
c
hymen consists of folds of membrane. Hymen is intact. (7) The

e.
e.
types of hymen are : (a) Semilunar or crescentic. (b) Annular. (c)

re
fre
Infantile. (d) Cribriform. (e) Vertical. (f) Septate. (g) Imperforate. re

sf
f
ks
ks
(8) The margins of hymen are sometimes fimbriated, which may
k
oo
oo
oo
be mistaken for artificial tears. (9) Natural notches are usually (a)
eb
eb
eb
symmetrical, (b) occur anteriorly, (c) do not extend to vaginal wall,

(d) covered with mucous membrane. (10) Tears caused by sexual
m
intercourse or by foreign body are (a) usually situated posteriorly at

one or both sides, or in midline, (b) usually extend to vaginal wall,
om
(c) not covered with mucous membrane.

co
co
Causes of rupture of hymen : (1) Accident, e.g. fall on

projecting substance. In these cases tearing of perineum occurs. (2)
e.
e.
Masturbation. (3) Surgical operation. (4) Foreign body, e.g. sola

fre
fre
fre
pith. (5) Ulceration from diphtheria, fungus, etc. (6) Scratching due
ks
ks
ks
to irritation. (7) Sanitary tampons.

oo
oo
oo
eb
eb
eb
m
Ch-14.indd 133 04-03-2015 12:14:40 PM

e
e
m
m
om
m
co
co
e.
e.
M.L. aspects : (1) Diagnosis of virginity is difficult. (2) Important
re
fre
fre
signs are (a) Intact hymen. (b) Normal fourchette and posterior
sf
ks
ks
commissure. (c) Narrow vagina with rugose walls. These signs taken
k
together may be regarded as evidence of virginity. (3) The presence

oo
oo
oo
of unruptured hymen is a presumption, but is not an absolute
eb
eb
eb
proof of virginity. (4) The hymen is usually ruptured at the time of
m
m
first coitus, and at first has a torn appearance. (5) Hymen may not be
ruptured even after repeated acts of coitus if it is loose, folded and
elastic, or thick, tough and fleshy, which permit displacement, change
om
m
of shape and stretching without rupture.
co
co
Pregnancy : It results when ovum is fertilised by a sperm
e.
e.
resulting in an embryo and foetus. It occurs usually between 14 to 45
fre
fre
fre
years. It has to be determined : (1) when woman pleads pregnancy to
avoid attendance in Court, (2) to avoid execution, when sentenced to
ks
ks
ks
death, (3) to claim succession to property, if husband dies, (4) to assess
oo
oo
oo
damages in seduction, (5) blackmails a man pleading pregnancy to
eb
eb
eb
compel marriage, (6) libel or slander of unmarried woman or widow,
m
m
that she is pregnant, (7) to secure greater compensation when her
husband dies due to negligence of some person, (8) in case of alleged
concealment of birth and infanticide.
om
om
Diagnosis : (I) Presumptive signs : (1) Amenorrhoea is

co
earliest and most important. (2) Breast changes are characteristic in

c
e.
e.
primigravidas. (a) Breasts increase in size and become nodular after

re
fre
second month. (b) Superficial veins become more distinct, nipples re

sf
f
more pigmented and more erectile. (c) Montgomery’s tubercles are
ks
ks
k
formed. (d) Colostrum is secreted in third month. (3) Morning

oo
oo
oo
sickness appears about end of first month and disappears 6 to 8 weeks

eb
eb
eb
later. (4) Quickening : From 16 to 20 weeks woman feels slight

m
fluttering movements in her abdomen due to foetal movements. (5)

Pigmentation of skin : Linea nigra is a dark line extending from pubis
to umbilicus. (6) Jacquemier’s sign : Mucosa of vagina changes from
om
pink to violet deepening to blue due to venous obstruction after fourth

co
co
week. (7) Frequent micturition during early weeks, and few weeks
e.
e.
before term. (8) Easy fatigue. (9) Salivation, preverted appetite.

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 134 04-03-2015 12:14:40 PM

e
e
m
m
om
m
co
co
Virginity, Pregnancy and Delivery 135
e.
e.
Difference between virginity and defloration.
re
fre
fre
Trait Virginity Defloration
sf
ks
ks
(1) Hymen: It is intact; the It may be torn or
k
edges are distinct intact; in the latter

oo
oo
oo
and regular with a case it is loose, elastic,
eb
eb
eb
narrow opening hardly with a wide opening
allowing a small finger allowing passage of
m
m
to pass. two or more fingers.
(2) Labia majora : They are apposed They are not apposed
to each other, fully to each other, not
om
m
developed and prominent and at the
co
co
completely close the lower end vaginal
e.
e.
vaginal orifice. orifice may be seen.
fre
fre
fre
(3) Labia minora : They are in contact They are not in contact
and are covered by and are exposed and
ks
ks
ks
labia majora. separated from labia
oo
oo
oo
majora.
(4) Fourchette : Intact. Torn or intact.
eb
eb
eb
(5) Fossa navicularis: Intact. Disappears.
m
(6) The vagina : It is narrow, the rugae After repeated

more folded, and the m
intercourse it usually
vault more conical. grows in length, and
om
om
the rugae are less

co
obvious.
c
e.
e.
(II) Probable signs : (1) Enlargement of abdomen occurs

re
fre
gradually after 12 weeks. (2) Uterus fills pelvis by end of third month; re
sf
f
at fifth month midway between symphysis and umbilicus; end of
ks
ks
k
six months at umbilicus; midway between umbilicus and xiphoid at

oo
oo
oo
seventh month; at xiphoid by end of eighth month. (3) By 7 months,

eb
eb
eb
umbilicus becomes level with skin. (4) Red-coloured subcutaneous

m
scars become visible over front of abdomen. (2) Hegar’s sign: It is

positive about sixth week. If one hand is placed on abdomen and two
fingers of other hand in vagina, firm hard cervix is felt, and above it
om
elastic body of uterus, and between the two isthmus is felt as a soft
co
co
compressible area. This is the most valuable physical sign of early

e.
e.
pregnancy. (3) Cervix : From second month, cervix progressively

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 135 04-03-2015 12:14:40 PM

e
e
m
m
om
m
co
co
e.
e.
softens from below upwards which is well marked by four months.
re
fre
fre
This is known as “Goodell’s sign”. (4) Intermittent uterine
sf
contractions are easily felt after fourth month; each contraction lasts
ks
ks
k
for one minute and relaxation for 2 to 3 minutes. (5) Ballottement

oo
oo
oo
: It is positive during fourth and fifth months. If sudden motion is
eb
eb
eb
imparted to abdominal wall, the rebound of foetus can be felt in a
m
m
few seconds. (6) Uterine souffle is a soft blowing murmur, which
is synchronous with pulse of mother. It is heard by auscultation just
above inguinal ligament at end of fourth month. (7) Biological tests
om
m
are based on reaction of test animals to chorionic gonadotropins
co
co
contained in blood or urine. (8) Immunological tests are based
e.
e.
on presence of chorionic gonadotropin and chorionic somato-
fre
fre
fre
mamnotropin. (1) Inhibition (indirect) latex slide test. (2) Direct latex
slide test. (3) Radioimmunoassay. (4) ELiSA test.
ks
ks
ks
(III) Positive signs: (1) Foetal parts can be identified by 36
oo
oo
oo
weeks, and foetal movements can be felt by 24 weeks. (2) Foetal
eb
eb
eb
heart sounds are heard between 18 to 20 weeks. The rate is about 160
m
m
at fifth and 120 at ninth month. Heart sounds are not heard: (a) when
foetus is dead, (b) when liquor amni is excessive, (c) abdominal wall
is very fat, (d) before 18 weeks of pregnancy. (3) X-ray exam : (1)
om
om
Foetal parts are detected at about 15 to 16 weeks. (2) The shadows

co
of skull, vertebral column, ribs and limbs can be seen. (3) Signs of
c
e.
e.
foetal death are: (a) Spalding’s sign. (b) Collapse of spinal column.
re
fre
(c) Presence of gas in heart and great vessels. (4) Sonography : re

sf
f
Gestational ring is seen by 6 weeks; distinct echoes from the embryo
ks
ks
k
within gestational ring by 7 weeks; foetal heart beat by 10 weeks and

oo
oo
oo
foetal head and thorax by 14 weeks.

eb
eb
eb
Pseudocyesis (spurious pregnancy): (1) It is usually seen in

m
patients nearing menopause or in younger women who intensely

desire children. (2) Most women suffer from some form of psychic
or hormonal disorders. (3) Such patients may present all subjective
om
symptoms of pregnancy and increase in size of abdomen due to

co
co
deposition of fat, or tympanites. (4) The woman may imagine foetal

e.
e.
movements. (5) In some cases, pregnancy had gone to full term and
fre
fre
fre
frank labour pains occurred, which stopped abruptly when patients

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 136 04-03-2015 12:14:40 PM

e
e
m
m
om
m
co
co
e.
e.
were told they were not pregnant. (6) Clinical and X-ray examination
re
fre
fre
will solve the problem. (7) In rare cases, pregnancy may go as far as
sf
ks
ks
full term, without the woman knowing it.
k
Average period of pregnancy is 280 days from first day of last

oo
oo
oo
menstural period, so that actual period is about 270 days. Children
eb
eb
eb
born after 210 days are viable, i.e. are born alive and able to survive.
m
m
Posthumous child is one born after death of its father, the
mother being conceived by the said father. Legal issues involved
are legitimacy, inheritance of property, and compensation case for
om
m
slander against mother.
co
co
Superfecundation : (1) It means fertilisation of two ova
e.
e.
discharged from ovary at the same period by two separate
fre
fre
fre
acts of coitus committed at short intervals. (2) The incidence of
twin pregnancy is about one-and-half percent, of which 70% are
ks
ks
ks
binovular twins, resulting from separate fertilisation of two ova. (3)
oo
oo
oo
Development of twins in uterus is parallel but not equal, depending
eb
eb
eb
on relative blood supplies. (4) Both ova do not always develop to
m
m
maturity. (5) One foetus may be aborted early or die. (6) The dead
foetus may be flattened by pressure and is referred to as foetus
compressus or foetus papyraceus. (7) The spermatozoa causing
om
om
fertilisation may be from different men. (8) The rare cases where two
co
ova are fertilised by a white and black person, or persons with entirely
c
e.
e.
different blood groups are the only certain examples of this condition.
re
fre
Superfoetation : (1) This means fertilisation of a second re

sf
f
ovum in a woman who is already pregnant. (2) Later, two
ks
ks
k
foetuses are born either at same time showing different stages

oo
oo
oo
of development, or two fully developed foetuses are born with

eb
eb
eb
interval of one to three months. (3) Cases where a second fully

m
developed child was born a considerable time after the first have been
explained on the assumption of twin pregnancy. (4) It is not only
possibility but a reality. (5) Its occurrence in a bipartite or double
om
uterus is certainly possible.

co
co
Legitimacy : A child is legitimate if born during continuance of

e.
e.
legal marriage, or within 280 days after dissolution of marriage by

fre
fre
fre
divorce or death. A child is illegitimate or bastard if alleged father is

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 137 04-03-2015 12:14:40 PM

e
e
m
m
om
m
co
co
e.
e.
: (1) under age of puberty, (2) physically incapable to beget children,
re
fre
fre
(3) did not have access to his wife during time the child was begotten,
sf
ks
ks
(4) blood groups of child and alleged father are not compatible.
k
Affiliation cases : (1) A woman may allege a particular man

oo
oo
oo
to be father of her illegitimate child. (2) A first class magistrate can
eb
eb
eb
sanction a monthly allowance of any sum for maintenance of the
m
m
child depending on the circumstances of the case, if the paternity
is fixed. (3) In such cases blood group tests are useful, and DNA
fingerprinting is conclusive.
om
m
Supposititious children : (1) It means fictitious
co
co
children. (2) A woman may pretend pregnancy and delivery and later
e.
e.
produce a child as her own, or she may substitute a male child for
fre
fre
fre
female child born of her, or for abortion. (3) In such cases, the woman
should be examined for signs of pregnancy and delivery, and the age
ks
ks
ks
of child determined. (4) This is done for extorting money or for the
oo
oo
oo
purpose of claiming property. (5) The medical evidence is useful only
eb
eb
eb
when the age of the supposititious child does not correspond to the
m
m
date of pretended delivery. (6) DNA fingerprinting will be conclusive.
Atavism: (1) The child does not resemble its parents,
but resembles its grand parents. (2) This is due to inheritance of
om
om
characteristics from remote instead of from immediate ancestors,

co
due to chance recombination of genes. (3) Any mental or physical

c
e.
e.
characteristic or tendency or disease peculiar to a remote ancestor

re
fre
may be inherited. re
sf
f
delivery : It means expulsion or extraction of child at birth.
ks
ks
k
Signs of recent delivery in living : (1) Woman is pale, exhausted,

oo
oo
oo
ill-looking with slight fever. (2) Breasts are full, enlarged, tender
eb
eb
eb
and contain colostrum or milk. (3) Abdominal walls are pendulous,

m
relaxed, wrinkled and show striae gravidarum, especially in flanks,

which appear as irregular, pink, subcutaneous scars. (4) Upper part
of uterus lies about 3 cm. below umbilicus soon after delivery. It
om
goes down by 1.5 cm. per day. On sixth day it is between umbilicus
co
co
and pubis, and returns to normal condition in nine weeks. (5) Labia
e.
e.
are tender, swollen, bruised. (6) Vagina is smoothwalled, relaxed,

fre
fre
fre
capacious. (7) Perineum may be lacerated. (8) Cervix is soft, canal

dilated, edges torn and lacerated. Internal os begins to close in 24
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 138 04-03-2015 12:14:41 PM

e
e
m
m
om
m
co
co
e.
e.
hours. External os is soft, admits two fingers; one finger is admitted at
re
fre
fre
end of week and is closed in two weeks. (9) Lochia : It is a discharge
sf
ks
ks
from uterus which lasts for 2 to 3 weeks. During first 4 to 5 days, it
k
is bright red and contains large clots (lochia rubra); next four days
oo
oo
oo
serous and pale (lochia serosa). After ninth day it is yellowish-grey
eb
eb
eb
or turbid (lochia alba). (10) Intermittent uterine contractions are
m
m
present for 4 to 5 days.
Recent delivery in dead : (1) All local signs are present as in
living. (2) Placental site appears as irregular, nodular, elevated area,
om
m
15 cm. in diameter; 4 cm. at end of second week, and 1 to 2 cm. at
co
co
end of six weeks. Corpus luteum is found in one of the ovaries.
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-14.indd 139 04-03-2015 12:14:41 PM

e
e
m
m
om
m
co
co
e. 15
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Sexual Offences
om
m
co
co
e.
e.
Rape
fre
fre
fre
S. 375, I.P.C.: A man is said to commit “rape” if he:
ks
ks
ks
(a) penetrates his penis, to any extent, into the vagina, mouth,
oo
oo
oo
urethra or anus of a woman or makes her to do so with him or any
eb
eb
eb
other person; or
(b) inserts, to any extent, any object or a part of the body, not
m
m
being the penis, into the vagina, the urethra or anus of a woman or
makes her to do so with him or any other person; or
om
om
(c) manipulates any part of the body of a woman so as to cause

co
penetration into the vagina, urethra, anus or any part of body of such
c
woman or makes her to do so with him or any other person; or

e.
e.
(d) applies his mouth to the vagina, anus, urethra of a woman

re
fre
or makes her to do so with him or any other person, under the

re
sf
f
ks
ks
k
circumstances falling under any of the following seven descriptions:

oo
oo
oo
(1) Against her will,

eb
eb
eb
(2) Without her consent.

(3) With the consent, when her consent has been obtained by
m
putting her or any person in whom she is interested, in fear of death

or of hurt.
om
(4) With her consent, when the man knows that he is not her
co
co
husband and that her consent is given because she believes that he is
another man to whom she is or believes herself to be lawfully married.
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-15.indd 140 04-03-2015 12:15:05 PM

e
e
m
m
om
m
co
co
Sexual Offences 141
e.
e.
(5) With her consent when, at the time of giving such consent, by
re
fre
fre
reason of unsoundness of mind or intoxication or the administration by
sf
ks
ks
him personally or through another of any stupefying or unwholesome
k
substance, she is unable to understand the nature and consequences

oo
oo
oo
of that to which she gives consent.
eb
eb
eb
(6) With or without her consent, when she is under 18 years of age.
m
m
(7) When she is unable to communicate consent.
Sexual intercourse by a man with his own wife above 15 years
is not rape.
om
m
Punishment: Rigorous imprisonment of not less than seven years,
co
co
but may extend to life and also fine.
e.
e.
S.354-A, I.P.C.: Sexual harassment: (1) Physical contact and
fre
fre
fre
advances involving sexual overtures, (2) a demand or request
for sexual flavours, (3) making sexually coloured remarks, (4)
ks
ks
ks
forcibly showing pornography, (5) any other unwelcome physical,
oo
oo
oo
verbal or nonverbal conduct of sexual nature (for offences of 1 &
eb
eb
eb
2 imprisonment up to 5 years, or with fine or both; for 3, 4 and 5
m
m
imprisonment of one year or with fine or with both).
S.354-B, I.P.C.: Assault or use of criminal force to woman
with intent to disrobe in public and even in private if force is used
om
om
(imprisonment of not less than 3 years, may extend to 7 years and

co
fine).
c
e.
e.
S.354-C, I.P.C.: Voyeurism: Imprisonment of not less than one

re
fre
year, may extend to 3 years and fine; for second and subsequent re
sf
f
offences imprisonment of 3 to 7 years).
ks
ks
k
S.354-D, I.P.C.: Stalking: Whoever follows a person and contacts

oo
oo
oo
or attempts to contact such person to foster personal interaction

eb
eb
eb
repeatedly, despite a clear indication of disinterest by such person,

m
or whoever monitors the use by a person of the internet, e-mail or

any other form of electronic communication, or watches or spies on a
person in a manner that results in a fear of violence or serious alarm
om
or distress in the mind or such person, or interferes with the mental

co
co
peace of such person, commits the offence of stalking (imprisonment

e.
e.
of not less than one year, may extend to 5 years, and fine).
fre
fre
fre
S.370, I.P.C.: Trafficking of person: Whoever for the purpose

of exploitation (a) recruits, (b) transports, (c) harbours, (d) transfers,
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-15.indd 141 04-03-2015 12:15:05 PM

e
e
m
m
om
m
co
co
e.
e.
(e) receives a person, by (1) using threats, (2) using force or coercion,
re
fre
fre
(3) by abduction, (4) by fraud or deception, (5) by abuse of power,
sf
ks
ks
(6) by inducement, including giving payments or benefits, commits
k
the offence of trafficking (imprisonment for 7 to 10 years).

oo
oo
oo
S. 509, I.P.C.: Whoever intending to insult the modesty of any
eb
eb
eb
woman, utters any word, makes any sound or gesture, or exhibits any
m
m
object, intending that such word or sound shall be heard, or that such
gesture or object shall be seen by such woman, or intrudes upon the
privacy of such woman, shall be punished with simple imprisonment
om
m
up to 3 years and fine.
co
co
Statutory rape : It is normal physiologic intercourse with a girl
e.
e.
below the age of 18 years even with her consent.
fre
fre
fre
Custodial rape : Rape committed on woman in the custody of
(1) police officer, (2) public servant, (3) management or staff of jail,
ks
ks
ks
(4) management or staff of hospital. Imprisonment not less than ten
oo
oo
oo
years or for life.
eb
eb
eb
Rape on pregnant woman, or on a child below 12 years, or gang
m
m
rape is punishable with imprisonment for ten years or for life.
Valid consent : (1) A female of 18 years and above can give valid
consent, which must be free, voluntry, while she is of sound mind and
om
om
not intoxicated. (2) Consent should be obtained prior to the act. (3)
co
Even a prostitute cannot be forced to have intercourse against her will.

c
e.
e.
Consent is invalid when obtained by (1) fraud (impersonation of

re
fre
husband or misrepresentation of facts), (2) putting her or any person re

sf
f
in whom she is interested in fear of death or hurt, (3) intoxicated or
ks
ks
k
insane, or unconscious person, (4) below 18 years of age.

oo
oo
oo
What constitutes rape? (1) Signs of resistance (struggle) are the

eb
eb
eb
chief evidence of absence of consent. (2) The slightest penetration

m
of penis within vulva (labia minora), with or without emission

of semen or rupture of hymen constitutes rape. (3) Rape can be
committed even when there is inability to produce erection of
om
penis (impotent person). (4) Rape can only be committed by a man;

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woman cannot rape a man, although she may be guilty of indecent

e.
e.
assault upon him. (5) In India, there is no age limit under which a
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boy is considered physically incapable of committing rape. (6) No

age of female is safe from rape.
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Ch-15.indd 142 04-03-2015 12:15:06 PM

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Sexual Offences 143
e.
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Exam. of victim : Objects of examination are : (1) To search for
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physical signs, that will corroborate history given by victim. (2) To
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collect physical evidence. (3) To treat victim for injuries and against
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venereal diseases or pregnancy.

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History : The history given by victim is recorded. (1) preliminary
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affairs, (2) date, time and place of offence, (3) exact relative
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positions of parties, (4) details of struggle or resistance, (5) any pain
experienced, (6) ejaculation occurred or not, (7) appearance of any
discharge, (8) bleeding from vagina, (9) calls for help, (10) events
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after assault, (11) whether consciousness was lost at any time. (12)
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time of first complaint. The degree of agreement of various statements
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e.
will be strong proof of their truth or contrary.
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Consent : (1) The victim should be examined only if there is a
requisition from police or Court. (2) She cannot be examined without
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her consent. (3) Consent of guardian is necessary if she is insane or
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under 12 years.
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Clothes are examined for blood and seminal stains, mud or grass
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stains, etc., soiling, tears and loss of buttons, etc. Foreign hair, fibres,
etc., must be preserved.
General exam : Marks of violence may be found : (1) about
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mouth and throat, (2) about wrists and arms, (3) about inner sides
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of thighs and knees, (4) on back, (5) on breasts (bites). Damaged

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e.
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fingernails should be noted, and debris under nails should be removed

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and examined for epidermal cells, blood, fibres, etc. re

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Rape on virgin : (1) Rupture of hymen occurs with first
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intercourse, which is the main evidence of rape. The character and

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extent of injury depends upon : (a) nature of hymen, (b) disproportion

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between male and female parts, (c) extent of penetration, (d) amount
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of force used. (2) Tearing usually occurs posteriorly at the sides,

between 4 and 8 O' clock position, or in midline. Several hymenal
lacerations indicate first sexual intercourse. (3) Margins of torn hymen
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are sharp and red which bleed on touch. (4) After 3 to 4 days, edges
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are congested and swollen, which heal in one week, but do not unite.
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(5) Rupture can be caused by fingers or foreign bodies, as such

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evidence of local injury is not proof of penetration. (6) In absence

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Ch-15.indd 143 04-03-2015 12:15:06 PM

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e.
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of hymenal tearing, usually there is abrasion and bruising of hymen
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and vaginal orifice. (7) For close examination of hymen (a) a glass rod
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with a small spherical head should be passed through hymenal orifice
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and passed round posterior surface of hymen, due to which edges are
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slightly everted, (b) finger is passed into rectum above perineal body,
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and posterior vaginal wall is pushed forwards and downwards, due to
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which hymen is clearly seen. (8) Fingernail scratches may be present
on labia. (9) Labia may be red and inflamed with slight oedema
of vaginal introitus. (10) Bruising and laceration of external genitals
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may be present with redness, swelling and inflammation. (11) Posterior
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commissure often ruptures. (12) Fourchette often tears and fossa
e.
e.
navicularis disappears. (13) Bruising of vagina is frequently seen on
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anterior vaginal wall in lower third, and on posterior wall in upper third.
(14) Laceration of vaginal wall or vault is rare, but occurs posteriorly
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if there is considerable disproportion between penis and vagina. (15)
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If there are no fresh injuries, vaginal exam. should be carried out.
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Digital exam may show : (a) areas of pain and tenderness in vagina,
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(b) some laxity of vaginal orifice (indicating previous penetration),
(c) elongation of posterior fornix (indicating previous sexual
intercourse), (d) number of fingers that can be introduced through
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hymenal orifice. (16) In most young women one finger may be inserted
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into vagina although hymen is intact. (17) Vaginal exam. helps to assess
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elasticity of hymen, and to determine degree of penetration which could

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be possible without its rupture. (18) If the vaginal opening is enough re

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to admit two fingers easily, the possibility of sexual intercourse having
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taken place may be inferred.

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Rape on deflorate women : (1) In deflorate women hymen is

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completely destroyed, vaginal orifice dilated, mucous membrane

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wrinkled and thickened. In such women, complete penetration

can occur without any evidence except semen. (2) In married
women marks of violence to genitalia are less likely, but may be
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seen if intercourse is violent. (3) In case of resistance vagina may

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show laceration or bruising, and swelling and inflammation of

e.
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vulva. (4) Tearing or perforation of vagina may occur when it is thin

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or fragile. (5) Presence of violence in other parts of body is chief

evidence of rape.
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Ch-15.indd 144 04-03-2015 12:15:06 PM

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Sexual Offences 145
e.
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Rape on children : (1) Signs of general violence are not seen.
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(2) Usually penis is placed either within vulva or between thighs, as
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such hymen is intact, and there may be little redness and tenderness of
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vulva. (3) If violence is used and penis penetrates deeper, hymenal

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tear extends into or through the perineal body and often involves
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wall of anorectal canal. (4) Full vaginal penetration produces
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bruising of vaginal wall and tears of anterior and posterior vaginal
walls. (5) Anterior tears can involve bladder. (6) Vaginal vault may
rupture and there may be vaginal herniation of abdominal viscera.
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Corroborative signs : (1) Presence of sperms in vagina is proof of
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sexual intercourse. (2) If assailant is suffering from venereal disease,
e.
e.
he may transmit it to victim. (3) In gonorrhoea, an inflammation with
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muco-purulent discharge will be seen in 2 to 4 days. (4) In syphilis
an indurated ulcer on external genitals may appear in three weeks.
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(5) Signs of struggle.
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Time of rape can be determined from : (1) Wounds on victim. (2)
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Sperms in vagina. (3) Venereal disease in victim.
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Rape is not a medical diagnosis, it is only a legal definition.
Medical proof of intercourse is not legal proof of rape. The doctor
should never make a diagnosis of rape.
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Opinion : There are signs of recent vaginal penetration/recent

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sexual intercourse/general physical injury and /or intoxication and

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e.
e.
that the signs are consistent with the history given by the victim.
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Dangers of rape : (1) Death may occur from : (a) shock due to re
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fright, emotion, or blunt force, (b) haemorrhage from injuries, (c)
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suffocation if mouth and nose are closed by hands or throttling. (2)

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Mental derangements. (3) Disruption of victim’s physical, social and

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sexual life.
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False charges : They can be disproved by (1) medical evidence,

(2) inconsistencies in statements of victim, (3) uncertainty as to
consent, (4) lack of corroboration.
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Exam. of accused : (1) Consent. (2) No delay. (3) Identification

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marks. (4) Time, date, place of exam, etc. (5) Age, development of
e.
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genitals and physical development. (6) General history taken, but

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specific history omitted. (7) Mental state and general behaviour.

(8) Influence of alcohol and drugs. (9) Exam. clothes for (a) tears
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Ch-15.indd 145 04-03-2015 12:15:06 PM

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e.
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and loss of buttons, (b) hair, fibres and foreign matter, (c) cosmetic
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contact traces, (d) blood stains, (e) seminal stains, (f) mud and other
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stains, grass, etc. (10) Nail scrapings. (11) Matting of pubic hair. (12)
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Female hair on body and clothes. (13) Presence of V.D. (14) Marks
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of struggle. (15) Genitals : (a) Development of genital organs. (b)
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Note any scratches, abrasions or bruises caused by the victim. Tears
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or bruising of fraenulum of prepuce in uncircumcised and abrasion
of glans penis (usually rape on a child) in both circumcised and
uncircumcised. (c) Penis is washed with saline, and material stained
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with Papanicolaou’s stain. Vaginal and cervical cells and Barr bodies
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suggest recent intercourse. (d) Glans is cleaned with a filter paper,
e.
e.
which is exposed to vapours of Lugol’s iodine. The paper becomes
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brown if vaginal epithelial cells are present, because of glycogen. (e)
In uncircumcised person absence of smegma (secretion of sebaceous
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glands) may indicate that intercourse might have been performed, but
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presence of smegma negatives possibility of complete penetration.
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Smegma usually requires 24 hours to collect.
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M.L. Aspects : (1) Usually, it is not possible for man to have
sexual intercourse with a healthy adult female in full possession
of her senses against her will. (2) Rape may be committed without
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knowledge of woman while she is under influence of narcotics,

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anaesthetic, coma and possibly in hypnotic trance. (3) It is impossible

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to have complete sexual intercourse with a woman during her

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natural sleep without her knowledge. (4) Rape by impersonation of re

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husband is possible when woman is sleeping. (5) Rape by fraud or
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misrepresentation are rare.

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Incest : (1) Incest is sexual intercourse by a man with a

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woman, who is closely related to him by blood, e.g. daughter,

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grand daughter, sister, step sister, aunt or mother, etc. (2) Instances
between brother and sister, and father and daughter are common. (3)
These cases usually have psychological features. (4) Incest occurs
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(a) between mental defectives, (b) under influence of alcohol, (c)

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cerebral disease, e.g. G.P.I., cerebral degeneration, etc., (d) where a

e.
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brother and sister separated in childhood and meet later as strangers.

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(4) In India, it is not a punishable offence.

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Ch-15.indd 146 04-03-2015 12:15:06 PM

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Sexual Offences 147
e.
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Unnatural offences : Voluntary sexual intercourse
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against order of nature with any man, woman, or animal is
sf
unnatural sexual offence (S.377, I.P.C.). Punishment is imprisonment
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for up to 10 years or life. Homosexuality means persistent emotional

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and physical attraction to members of the same sex.
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SODOMY : (1) Sodomy is the anal intercourse between two
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males or between a male and female. It is also called buggery. It is
called gerontophilia when passive agent is an adult and paederasty,
when passive agent is young boy, who is known as catamite. (3) A
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pedophile is an adult who repeatedly engages in sexual activities
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with children below the age of puberty. (4) It is sometimes called
e.
e.
Greek love. (5) Any degree of penetration or any attempt at
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penetration are punishable. (6) When passive agent consents, both
are punishable, but when it is done without consent only active agent
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is punishable. (7) False charges may be made for blackmail.
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Eunuch: In India, male prostitutes called ‘eunuchs’, act as
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passive agents in sodomy. They grow long hair, dress like women,
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wear ornaments and adopt most of habits of women. Among them
there are two groups who live separately : (1) Hijrahs, are those
who have been castrated before puberty. When the wound heals,
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external genitals resemble superficially those of female. They develop

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feminine characters due to the resulting hormonal imbalance. (2)

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e.
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Zenana are those in whom genitals are intact.

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Passive agent : Obtain consent and history of circumstances and re

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nature of act. (1) Anal muscle is dilated, irritable and tender. (2) Loss
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of elasticity and tone of anal muscle. (3) Haematoma as a diffuse

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swelling of anal margin or localised. (4) Linear abrasions extending

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from anal margin into anus. (5) There may be triangular bruised tear
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at posterior margin. (6) Anal fissures. (7) Tearing of sphincter ani

is rare. (8) Anal prolapse. (9) Blood stains and faecal matter around
anus. (10) Lubricant matter, seminal fluid or venereal infection
om
found at anus. (11) The presence of combination of semen, faeces,

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soft paraffin, and pubic hair on clothes is almost diagnostic of

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sodomy. (12) Only proof of sodomy is presence of semen in anus.

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(13) Opinion as to cause of dilation should be guarded; it should be

stated that opinion is consistent with entry of penis.
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Habitual passive agent : (1) Shaving of anal hair. (2) Skin about
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anus smooth, thickened. (3) Depression of buttocks towards anus.
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(4) Loss of tone of anal muscle. (5) Dilatation and laxity of anus. (6)
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Anal fissures, scars, etc. (7) Absence of fine wrinkles in anal mucosa.
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(8) Presence of V.D.
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Active agent : (1) Peculiar smell of anal glands transferred to
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penis, and traces of faecal matter and lubricant on penis. (2) Abrasions
on prepuce, glans penis, or tearing of fraenum. (3) Penis may be
elongated and constricted at some distance from glans. (4) Blood and
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seminal stains. (5) Presence of V.D. (6) Marks of violence on body.
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Buccal coitus (coitus per os or sin of Gomorrah) : (1) The
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e.
penis is introduced into mouth, usually of a young child. (2) Rarely
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faint teeth marks and abrasions may be seen on penis. (3) Death may
result from aspiration of semen or impaction of penis in hypopharynx.
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(4) Semen may be found in respiratory tract or stomach. (5) Buccal
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swabs may show sperms up to nine hours. (6) It is punishable offence.
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TRIBADISM (Lesbianism): (1) It is female homosexuality. (2)
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Sexual gratification of woman is obtained by another woman by
simple lip kissing, generalised body contact, deep kissing, manual
manipulation of breasts and genitalia, genital apposition, etc. (3) In
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some cases enlarged clitoris is used as an organ of passion, or some

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artificial penis or phallus may be used. (4) Many lesbians are

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e.
masculine in type, possibly because of endocrine disturbances. (5)

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It is usually indulged in by women who are mental degenerates re

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or those who suffer from nymphomania (excessive sexual desire).
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(6) they are morbidly jealous of one another, and when rejected may
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commit homicide, suicide or both. (7) It is not an offence in India.

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Bestiality : (1) Bestiality is sexual intercourse by a

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human being with a lower animal, usually kept on farm or pets

in households. (2) Calves and sheep are often involved. (3) Chicken,
ducks and geese are also involved. (4) Other animals are cows, mares,
om
she-asses and bitche. (5) Vaginal intercourse is common, but anus

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may be used. (6) Dogs or cats are common animals for females. (7)
e.
e.
Usually the animal manipulates the genitalia with its mouth and actual
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coitus is very rare.

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Ch-15.indd 148 04-03-2015 12:15:06 PM

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Sexual Offences 149
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In accused findings may be : (1) Animal faeces, vaginal secretion
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or hair may be present on penis. (2) Tearing of fraenum. (3) Animal
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hairs on person or clothes. (4) Stains of dung or animal blood on
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clothes. (5) Injuries due to kicks, teeth or claws of animals.

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Animal : (1) Human sperms in vagina. (2) Abrasions and
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lacerations on external genitals. (3) Gonorrhoeal discharges.
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Sexual perversions (deviation) : (1) They are
persistently indulged sexual acts, in which complete satisfaction
is sought and obtained without sexual intercourse. (2) Paraphilia
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is abnormal and unorthodox sex play by using unusual objects or
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parts of the body. (3) Uranism is general term for perversion of
e.
e.
sexual instinct.
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Sadism (active algolagnia): (1) Sexual gratification is
obtained or increased from acts of physical cruelty or causing
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ks
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pain upon one’s partner, which is common in men. (2) To obtain
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oo
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sexual pleasure, sadist may bite, beat, whip, produce cuts, etc. or
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eb
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ill-treat or torture his sexual partner in many other cruel ways. (3)
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Extremely sadistic attacks may be made in which the victim’s nipples
may be bitten off, articles such as bottles, candles or sticks are inserted
into the vagina, cigarettes or lighters may be used to burn the skin,
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and blows which may rupture internal organs or cause fractures of

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bones. (4) Many are sociopathic, some schizoid and others inadequate
c
e.
e.
personalities.
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Lust murder : In extreme cases of sadism, murder re

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serves as stimulus for sexual act and becomes equal of coitus,
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the act being accompanied by erection, ejaculation and orgasm. It is

oo
oo
oo
characterised by : (1) Periodic outbreaks. (2) Cutting or stabbing of

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eb
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breasts, genitalia or lower abdomen with sucking, licking or mouthing

m
of wounds and biting of skin. (3) Sometimes, sexual intercourse with

dying or injured victim. (4) Normal behaviour until next outburst.
Mental disease is very common.
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Necrophagia : This is extreme degree of sadism in which

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the person after mutilating the body sucks or licks wounds, bites
e.
e.
skin, drinks blood and eats flesh of his victim to derive sexual
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pleasure.
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Ch-15.indd 149 04-03-2015 12:15:06 PM

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Masochism (passive algolagnia): (1) This is opposite of
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sadism. Sexual gratification is obtained or increased by suffering
sf
of pain. (2) Masochists get pleasure by being beaten, tortured, abused,
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ks
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humiliated, degraded or dominated by their sexual partner, and they

oo
oo
oo
tend to place themselves repeatedly in self-defeating situations. (3)
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Such painful stimuli may entirely replace ordinary sex stimuli.
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(4) It is usually found in males, but is also seen in females. (5)
Sadism and masochism are usually found as combination, with
one type dominant over other. (6) The combining of these practices
om
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is called bondage. (7) They are found in all age groups and in all
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socio-economic levels.
e.
e.
necrophilia : (1) In this, there is desire for sexual
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fre
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intercourse with dead bodies. (2) It is said to have sado-
masochistic foundation and that decomposition, foul smell and
ks
ks
ks
coldness act as stimulants. (3) There is also no danger of rejection
oo
oo
oo
or resistance. (4) It is usually committed on a newly buried corpse
eb
eb
eb
or body awaiting burial. (5) The corpse may be mutilated following
m
m
intercourse. (6) Necrophilia and necrophagia are punishable with
imprisonment up to one year.
FETICHISM: (1) The person experiences sexual excitement
om
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leading to orgasm, from parts of body of a woman or some

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article belonging to her, that normally has no sexual influence on

c
e.
e.
mind, e.g. underclothing, brassiere, petticoat, stocking, shoes, etc.

re
fre
which acts as substitute for female love object. (2) The fetish may re
sf
f
be only incidentally associated with human body, e.g. a flower. (3)
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ks
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In some cases a picture of fetish object provides sufficient stimulus.

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oo
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(4) Sometimes the act of stealing the article or touching it provides

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adequate sexual satisfaction. (5) It is almost exclusively seen in males.

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(6) They rarely commit violence or murder.

transvestism (Eonism) : (1) It is usually found in males
who obtain sexual pleasure by wearing female dress. (2) Whole
om
personality is dominated by the desire to be identified with the

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opposite sex. (3) His dress, manners, occupational interests and

e.
e.
associations are all designed to increase his feelings of being a

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woman. (4) There are varying degrees. (5) Sexuality with him is
relatively unimportant. (6) Only small percentage are homosexuals.
ks
ks
ks
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Ch-15.indd 150 04-03-2015 12:15:06 PM

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Sexual Offences 151
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(7) There is no hormonal disturbances or genital abnormality. (8)
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Psychologically, it may depend upon an individual’s erotic attraction
sf
ks
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for opposite sex. (9) Many cases are associated with sado-masochism.
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sexual oralism is the obtaining of sexual pleasure from

oo
oo
oo
application of mouth to sexual organs. It is a common perversion
eb
eb
eb
both heterosexual and homosexual. Fellatio is the oral stimulation
m
m
or manipulation of penis, either by male or female. Cunnilingus
is oral stimulation of female genitalia.
Masturbation (onanism; ipsation): (1) is the deliberate
om
m
self-stimulation, which affects sexual arousal. (2) In males,
co
co
techniques are largely manual, by moving penis against a bed or other
e.
e.
object. Hollow articles like bottles, test tubes, etc. may be used, or
fre
fre
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articles made of rubber or elastic which simulate female genitalia
are used. (3) (a) In females, finger is gently and rhythmically moved
ks
ks
ks
over clitoris or labia minora, or steady pressure is applied over these
oo
oo
oo
parts with several fingers or whole hand. (b) Genitalia may be rubbed
eb
eb
eb
against a pillow or bed. (c) Sometimes fingers, wooden rods, glass
m
m
tubes, metallic bars, etc. or artificial masculine genital parts made of
rubber or plastic may be inserted into vagina. (4) It is an offence only
when practiced openly e.g. in telephone booths, lavatories, etc.
om
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Exhibitionism : (1) It is wilful and intentional exposure of

co
genitalia in a public place in presence of others, to obtain sexual

c
e.
e.
pleasure. (2) It may or may not be accompanied by masturbatory acts.

re
fre
(3) It is done mostly by males, often to children or persons of opposite re

sf
f
sex. (4) The act is impulsive and spontaneous. (5) Occassionally,
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ks
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women may expose in public. (6) Most of them are psychopathic or

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oo
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suffer from compulsion neuroses. (7) It is an obscene act under S.

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294, I.P.C. with imprisonment up to 3 months or fine.

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voyeurism (scoptophilia): (1) It is the counterpart of

exhibitionism. (2) The voyeur (Peeping Tom) must see people
undress to be sexually satisfied. (3) the perversion is in the sexual
om
dependence upon “looking”, “seeing”. (4) There is morbid desire to

co
co
look at sexual organs or other usually clothed parts of body of one of

e.
e.
the opposite sex, or to watch sexual intercourse as a source of sexual

fre
fre
fre
gratification. (6) It occurs in severe sociopathic personality disorder.

(7) Usually, such persons do not commit a major sex crime. (8) It is
ks
ks
ks
rare in females.
oo
oo
oo
eb
eb
eb
m
Ch-15.indd 151 04-03-2015 12:15:06 PM

e
e
m
m
om
m
co
co
e.
e.
Troilism is an extreme degree of voyeurism. It is sexual practice
re
fre
fre
involving 3 persons, 2 of one sex and one of the opposite sex. A
sf
ks
ks
perverted husband gets sexual satisfaction by inducing his wife to
k
sexual intercourse with another man and by watching the same.

oo
oo
oo
frotteurism : (1) It is contact with another person to
eb
eb
eb
obtain sexual gratification. (2) Sexual satisfaction is obtained by
m
m
rubbing against persons in crowds. (3) It is uncommon and rarely
occurs alone.
Undinism : Sexual pleasure is obtained by witnessing the act
om
m
of urination by some one of same or opposite sex.
co
co
Pyromania : Sexual satisfaction is obtained by seeing flames
e.
e.
and destruction of buildings.
fre
fre
fre
Indecent assault : (1) It is any offence committed on a
female, with the intention or knowledge to outrage her modesty.
ks
ks
ks
(2) Usually, the act involves sexual parts of either or is sexually
oo
oo
oo
flavoured. (3) A man may kiss a woman, press breasts, touch or
eb
eb
eb
expose genitalia, or put a finger in vagina, play with vulva, etc. (4)
m
m
Stripping naked a woman for medical exam. is regarded as assault. (5)
He may attempt at exhibitionism or masturbation. Indecent offences
between two males include (a) friction of penis on gluteal folds, (b)
om
om
handling of male parts, (c) mutual masturbation. (6) Such assaults are
co
punishable under S.354, I.P.C. with imprisonment up to two years.

c
e.
e.
Seminal fluid : Dry stains have a greyish-white or yellow-

re
fre
grey colour. They stiffen cloth. When examined under filtered U.V. re
sf
f
light, a bluish-white fluorescence is seen, which is not specific.
ks
ks
k
Florence test : (1) The stain is extracted by one% hydrochloric acid.

oo
oo
oo
(2) A drop is put on a glass slide and allowed to dry. (3) A coverslip
eb
eb
eb
is put over this and a drop of Florence solution (potassium iodide) is

m
allowed to run under coverslip. (4) If semen is present, dark-brown

crystals of choline iodide appear immediately. (5) They are rhombic,
resembling haemin but are larger, arranged in clusters, rosettes,
om
crosses, etc. (6) Choline originates from seminal vesicles. (7) It is

co
co
not specific. (8) Negative reaction excludes semen.

e.
e.
Barberio’s test : A saturated aqueous or alcoholic solution of

fre
fre
fre
picric acid when added to spermatic fluid, produces yellow needle -

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-15.indd 152 04-03-2015 12:15:06 PM

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co
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Sexual Offences 153
e.
e.
shaped rhomboid crystals of spermine picrate. Reaction depends on
re
fre
fre
presence of prostatic secretion.
sf
Acid phosphatase test : (1) Seminal fluid contains much higher
ks
ks
k
percentage of acid phosphatase than any other body fluid. (2) In

oo
oo
oo
humans it is greater than animals. (3) Undiluted semen has acid
eb
eb
eb
phosphatase activity of 340 to 360 Bodansky units per ml. (4) Its
m
m
concentration gradually falls in vaginal secretions, but it can be
recognised up to 36 hours after its deposition. (5) Concentration in
excess of 100 Bodansky units with or without motile sperms indicate
om
m
that ejaculation occurred within 2 hours of examination. (6) In humans
co
co
acid phosphatase content is greater than in animals. (7) Dried stains
e.
e.
give positive results for weeks or months. (8) The test is conclusive
fre
fre
fre
in absence of demonstrable sperms or in aspermia.
Creatine phosphokinase : Sperms contain high concentration
ks
ks
ks
of creatine phosphokinase, which is more than double than found in
oo
oo
oo
any other body fluid. The enzyme is stable and can be demonstrated
eb
eb
eb
even in six months old stains.
m
m
Prostate specific antigen (P 30) is a protein, which is found in
vaginal fluid up to 27 hours after sexual intercourse.
Microscopic exam : (1) In a slide stained with methylene blue
om
om
and eosin, posterior 1/2 to 1/3 of head is stained deep-red or pink, and
co
anterior 1/2 to 2/3 appears unstained or faintly stained with basic dye.
c
e.
e.
(2) The tail is stained pink. (3) Sperms disintegrate in seminal stains
re
fre
within a few months. (4) Head resists decomposition for some time. re
sf
f
(5) Old stains of several years may give positive results. (6) Human
ks
ks
k
spermatozoa vary from 50 to 55 microns in length and consist of

oo
oo
oo
head, neck and tail. (7) Head is oval, flattened, 5 microns in length.
eb
eb
eb
(8) The neck is very short; tail is long and tapered.

m
Absolute proof of semen is finding of at least one unbroken

spermatozoon, or electrophoretic LHD isoenzyme detection of sperm.
In absence of spermatozoa, a stain which gives fluorescence in U.V.
om
light, positive precipitin test, a high level of acid phosphatase and a

co
co
high creatine phosphokinase can be considered to be due to semen.

e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-15.indd 153 04-03-2015 12:15:06 PM

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e. 16
e.
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C h a p t e r
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eb
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m
m
Abortion
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m
co
co
e.
e.
Legally, abortion (miscarriage) means premature expulsion
fre
fre
fre
of foetus from mother’s womb at any time of pregnancy, before
ks
ks
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term of pregnancy is completed.
oo
oo
oo
Natural abortion occurs commonly in second or third month in
eb
eb
eb
10 to 15% of all pregnancies. Justifiable or therapeutic abortion is
one which is done in good faith to save the life of woman.
m
m
Criminal abortion is the induced destruction and expulsion
of foetus from womb of mother unlawfully, i.e. when there is no
om
om
therapeutic indication. It is usually induced before third month.

co
Medical Termination of Pregnancy Act (M.T.P.) 1971: Under

c
the Act, pregnancy can be terminated: (1) therapeutic: When

e.
e.
continuation of pregnancy endangers life of woman, or may cause

re
fre
severe injury to her mental or physical health. (2) Eugenic: When re

sf
f
ks
ks
there is risk of child being born with serious physical or mental
k
oo
oo
oo
abnormality. (3) Humanitarian: Pregnancy caused by rape. (4)

eb
eb
eb
Social: (a) Pregnancy resulting from failure of contraceptive methods

in a married woman, which is likely to cause serious injury to her
m
mental health, (b) when social or economic environment can injure

mother’s health.
om
Rules: (1) A qualified r.M.P. who has assisted in performance of

co
co
25 cases of M.T.P. can terminate pregnancy. (2) Private hospitals have

to obtain licence from chief medical officer of district. (3) Consent
e.
e.
of woman, or of her guardian is required in case of minor or an

fre
fre
fre
insane person. (4) Consent of husband is not necessary. (5) Abortion

ks
ks
ks
oo
oo
oo
eb
eb
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Ch-16.indd 154 04-03-2015 12:15:20 PM

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Abortion 155
e.
e.
cannot be performed on request of husband, if woman is not willing.
re
fre
fre
(6) Woman need not produce proof of age; her statement that she is
sf
ks
ks
above 18 years is accepted. (7) It is enough for the woman to state
k
that she was raped. (8) Professional secrecy has to be maintained. (9)
oo
oo
oo
M.T.P. should be done in Govt. hospital or a licensed private hospital.
eb
eb
eb
(10) If period of pregnancy is below 12 weeks, it can be terminated
m
m
by a single doctor. (11) If it is below 20 weeks, two doctors must
concur, that there is an indication; later any one doctor can terminate
pregnancy. (12) In emergency, M.T.P. can be done by a single doctor,
om
m
even without required training, even after 20 weeks, in a private
co
co
hospital, which is not recognised.
e.
e.
Methods of procuring criminal abortion : (I) Abortifacient
fre
fre
fre
drugs : (1) Drugs acting directly on uterus : (A) (1) Ecoblics :
Ergot is commonly used but fails during earlier months. (2) Quinine
ks
ks
ks
has direct action on uterus, but its action is uncertain. (3) Lead causes
oo
oo
oo
tonic contractions of uterus and has direct toxic effect on ovum.
eb
eb
eb
Death of foetus, and symptoms of lead poisoning may occur before
m
m
abortion. (4) Pituitary extract has specific oxytocic effect on uterine
muscle, but its action is significant only near term. (5) Synthetic
oestrogens act only in large doses. (B) Emmenagogues : They
om
om
increase menstrual flow and act when given in large and repeated
co
doses. They are savin, borax, apiol, oestrogens.

c
e.
e.
(2) Irritants of genito-urinary tract: They produce reflex uterine

re
fre
contractions, e.g. oil of pennyroyal, oil of turpentine, cantharides, etc. re

sf
f
(3) Irritants of G.I. tract : Purgatives, rhubarb, senna, etc. are
ks
ks
k
used. Tartar emetic is also used.

oo
oo
oo
(4) Systemic poisons, such as lead, copper, mercury, etc., and

eb
eb
eb
organic irritants.
m
(II) General violence : It acts directly on uterus, or indirectly

by producing congestion of pelvic organs, or haemorrhages between
uterus and membranes. (1) Severe pressure on abdomen by kneading,
om
blows, kicks, etc. and massage of uterus. (2) Violent exercise, e.g.
co
co
horse riding, cycling, jumping from a height, etc. (3) Cupping : A

e.
e.
mug is turned mouth downwards over a lighted wick and placed on

fre
fre
fre
hypogastrium, and mug is pulled, which causes partial separation of

ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-16.indd 155 04-03-2015 12:15:20 PM

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e.
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placenta. (4) Very hot and cold hip baths alternately. (5) A general
re
fre
fre
shakeup in advance pregnancy.
sf
(III) Local violence : (1) Syringing : (1) Enema syringe with a
ks
ks
k
hand-bulb is used to inject fluid into uterus. (2) The suction valve is
oo
oo
oo
placed in a bowl of fluid and pressure applied on bulb. (3) A mixture
eb
eb
eb
of fluid and air is forced into uterine cavity, which detaches parts
m
m
of amniotic sac and placenta, followed by haemorrhage, uterine
contraction and abortion. (4) Irritating substances may be added to
the fluid. (5) Death may occur from vagal inhibition or air embolism.
om
m
(2) Rupturing of membranes by introduction of probe, stick,
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co
pencil, umbrella rib, wire, glass rod, screw driver, etc. (2) Abortion
e.
e.
occurs from few hours to 2 to 3 days, due to escape of liquor amnii.
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fre
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(3) Instruments can break or perforate vaginal or uterine wall.
(3) Dilatation of cervix : (1) Foreign bodies left in cervical
ks
ks
ks
canal, such as pessaries, laminaria or sea tangle tent, or obturator,
oo
oo
oo
irritate uterine mucosa, and produce congestion and contraction. (2)
eb
eb
eb
A compressed sponge may be introduced into cervix. (3) Slippery
m
m
elm bark occurs in soft, flat pieces about 3 mm. in thickness. The
pieces are inserted into cervical canal, which absorb moisture and
dilate cervical canal within few minutes.
om
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(4) Abortion stick : (1) This is a thin wood or bamboo stick, 12

co
to 18 cm., long. (2) It is wrapped at one end with cotton wool or cloth
c
e.
e.
and soaked with juice of marking nut, calotropis, abrus or a paste

re
fre
of arsenious oxide or red lead and introduced into vagina or os by re

sf
f
professional abortionists, and retained there till uterine contractions
ks
ks
k
begin.
oo
oo
oo
(5) Air insufflation: Air is introduced into vagina and uterus by

eb
eb
eb
pumps, syringes, and oral-genital contact.

m
(6) Electricity : Negative pole is placed over cervix and positive

over sacrum or lumbar vertebrae and current passed.
(7) Curettage : Dilatation and curettage under general anaesthesia.
om
(8) Pastes containing iodine or thymol or mercury are injected

co
co
from a collapsible tube with a uterine applicator, which detach parts

e.
e.
of placenta from uterine wall.

fre
fre
fre
Therapeutic methods : (1) Low rupture of membranes. (2)

Utus paste injection. (3) Dilatation of cervix and oxytocic infusion.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-16.indd 156 04-03-2015 12:15:20 PM

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Abortion 157
e.
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Distinction between natural and criminal abortion.
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Trait Natural abortion Criminal abortion
sf
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(1) Cause: Predisposing diseases. Pregnancy in
k
unmarried women or
oo
oo
oo
widows.
eb
eb
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(2) Marks of violence: Not present on the May be present on
m
m
abdomen. abdomen.
(3) Genital organs: Injuries are not Injuries, such as
present. contusions, lacerations,
om
m
perforations, etc., may
be seen in uterus or its
co
co
contents and vagina.
e.
e.
(4) Foreign bodies: Not present in genital May be present in
fre
fre
fre
tract. genital tract.
ks
ks
ks
(5) Toxic effect of Absent. Erosions and
drugs: inflammation of vagina
oo
oo
oo
and cervix. The G.I. or
eb
eb
eb
urinary tract may show
signs of irritation.
m
(6) Infection:
(7) Foetus:
Rare.
Wounds absent.
Frequent.
m
Rarely wounds may be
present.
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co
c
e.
e.
(4) Dilatation and curettage. (5) prostaglandins, PGE2, and PGF2,

re
fre
given i.v., orally or by intravaginal application. (6) Amniotic fluid re

sf
f
ks
ks
replacement. (7) Abdominal hysterotomy. (8) Vacuum aspiration :
k
(1) This is done during first three months. (2) Cervix is dilated and
oo
oo
oo
cannula is introduced into the uterine cavity. (3) Between 8 to 12

eb
eb
eb
weeks 9 mm. cannula is sufficient. (4) A negative pressure of 0.4

m
to 0.6 kg/sq. cm. is created in uterine cavity by means of a vacuum

pump for evacuation of contents. (5) The contents are broken up by
aspiration and collected in a bottle connected to the cannula.
om
Doctor’s duties in criminal abortion : (1) Professional secrecy

co
co
should be maintained. (2) Ask patient to make a statement about

e.
e.
induction of criminal abortion. If she refuses, he should not pursue

fre
fre
fre
the matter. (3) Treat her to the best of his ability. (4) Must consult
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ks
ks
a professional colleague. (5) If she is serious, he must arrange to

oo
oo
oo
eb
eb
eb
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Ch-16.indd 157 04-03-2015 12:15:20 PM

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record dying declaration. (6) If she dies, police should be informed,
re
fre
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and death certificate should not be issued.
sf
Causes of death : (I) Immediate : (1) Vagal inhibition. (2)
ks
ks
k
haemorrhage. (3) Air embolism. (4) Fat embolism. (II) Delayed (48
oo
oo
oo
to 72 hours) : (1) Septicaemia. (2) Pyaemia. (3) General peritonitis. (4)
eb
eb
eb
Confined local infection and toxaemia. (5) Tetanus. (III) Remote: (1)
m
m
Jaundice and renal failure. (2) bacterial endocarditis. (3) Pulmonary
embolism.
om
m
co
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e.
e.
fre
fre
fre
ks
ks
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oo
oo
oo
eb
eb
eb
m
m
om
om
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co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
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co
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e.
e.
fre
fre
fre
ks
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oo
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eb
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Ch-16.indd 158 04-03-2015 12:15:20 PM

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co
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e. 17
e.
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sf
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C h a p t e r
k
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eb
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m
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Infant Deaths
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co
co
e.
e.
(1) Infanticide means unlawful killing of a child under age
fre
fre
fre
of one year. (2) Only mother can be charged with this offence in
ks
ks
ks
England. (3) In India, this is not applicable, and is considered as
oo
oo
oo
murder. (4) Infanticide does not include death of foetus during labour,
eb
eb
eb
when it is destroyed by craniotomy or decapitation. (5) Foeticide is
the killing of foetus prior to birth.
m
m
Stillbirth: (1) A stillborn child is one which is born after
28 weeks of pregnancy, and which did not breathe or show any
om
om
other signs of life, after being completely born. (2) The child
co
was alive in uterus, but dies during birth. (3) Stillbirths occur
c
frequently among illegitimate, immature, male children in primiparae.

e.
e.
(4) Incidence is about 5%. (5) It is born in a sterile condition, and

re
fre
as such putrefaction starts on surface and extends inwards. (6) Signs re

sf
f
ks
ks
of prolonged labour, i.e. oedema and bleeding into scalp, caput
k
oo
oo
oo
succedaneum and severe moulding of head indicate stillbirth.

eb
eb
eb
Deadbirth: A deadborn child is one which had died in

uterus and shows one of the following signs.
m
(1) Rigor mortis at delivery.

(2) Maceration: (1) It is a process of aseptic autolysis, and is
om
the usual change. (2) This occurs when dead child remains in uterus
co
co
for 3 to 4 days surrounded with liquor amnii but exclusion of air. (3)
If air enters putrefaction occurs. (4) Maceration is not seen if child
e.
e.
is born within 24 hours after death. (5) Skin slippage is seen in 12

fre
fre
fre
hours after death. (6) Body is soft, flaccid and flattens out. (7) Odour
ks
ks
ks
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Ch-17.indd 159 04-03-2015 12:15:39 PM

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e.
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is sweetish, disagreeable. (8) Skin is red or purple. (9) Large blebs
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fre
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containing serous or serosanguineous fluid are present. (10) Tissues
sf
ks
ks
are oedematous. (11) Abdomen distended. (12) Bones are flexible
k
and readily detached from soft parts. (13) Skull bones are separated
oo
oo
oo
and brain is greyish-white and pulpy. (14) All viscera become soft,
eb
eb
eb
oedematous and lose their morphology except lungs and uterus. (15)
m
m
The umbilical cord is red, smooth, thickened and soft. (16) Gas in
aorta (in 12 hours) of foetus indicates foetal death. (17) Collapse
of the vertebral column occurs.
om
m
Spalding’s sign : (1) Loss of alignment and overriding of bones
co
co
of cranial vault occurs due to shrinkage of cerebrum after death of
e.
e.
foetus. (2) The sign will develop earlier with a vertex presentation
fre
fre
fre
than with a breech. (3) It may be detected within a few days of death
of foetus, but often takes 2 to 3 weeks.
ks
ks
ks
(3) Mummification : It occurs when foetus dies from (a) deficient
oo
oo
oo
supply of blood, (b) when liquor amnii is scanty, (3) when no air
eb
eb
eb
enters uterus.
m
m
Viability of infant : Viability means physical ability of foetus
to lead a separate existence after birth apart from its mother, by
virtue of certain degree of development. A child is viable after 210
om
om
days of intrauterine life, and in some cases after 180.

co
Livebirth means child showed signs of life when only part of

c
e.
e.
child was out of mother, though the child may not have breathed or
re
fre
completely born. Killing of such a child is murder. re

sf
f
Signs of livebirth : In civil cases, hearing a cry, seeing movements
ks
ks
k
of body or limbs, muscle contraction, etc., are accepted as proof of

oo
oo
oo
livebirth. In criminal cases, signs of live birth have to be demonstrated

eb
eb
eb
by P.M. exam. of child.

m
(I) Shape of chest : Before respiration chest is flat; after

respiration it expands and becomes arched or drum-shaped.
(II) Position of diaphragm : Abdomen should be opened before
om
thorax. Before respiration highest point of diaphragm is about the

co
co
level of fourth or fifth rib, and after respiration at sixth or seventh rib.
e.
e.
(III) Lungs : (1) Volume : Unrespired lungs appear smaller and

fre
fre
fre
collapsed; after respiration they fill pleural cavities. (2) Margins:

Before respiration are sharp which become rounded after breathing.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-17.indd 160 04-03-2015 12:15:39 PM

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Infant Deaths 161
e.
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Bullae along the margins indicate struggle to breathe. (3) Consistency:
re
fre
fre
Before respiration lungs are dense, firm and non-crepitant like liver.
sf
After respiration they are soft, spongy, elastic and crepitant. (4) Colour
ks
ks
k
and expansion of air sacs : (a) Before respiration, uniformly reddish-

oo
oo
oo
brown, bluish or deep-violet, and surface of lobules is marked with
eb
eb
eb
shallow furrows. On section little frothless blood exudes on pressure.
m
m
(b) After respiration, air-cells become distended with air; vesicles
become raised above surface, giving it a fine mosaic appearance.
The colour becomes light red, and whole lung has mottled or marbled
om
m
appearance. (5) Amount of blood into the lungs after respiration
co
co
is about twice than before respiration. (6) Weight : (a) Static or
e.
e.
Fodere’s test : Average weight of both lungs before respiration is 30
fre
fre
fre
to 40 g. and after respiration from 60 to 66 g. (b) Ploucquet’s test :
After respiration weight of lungs is almost doubled from 1/70 of body
ks
ks
ks
weight before respiration to 1/35 after respiration.
oo
oo
oo
Hydrostatic test : (1) The specific gravity of lungs before
eb
eb
eb
respiration varies from 1040 to 1050 and after respiration about 940.
m
m
(2) Lungs are separated after tying bronchi. (3) Each lung is placed
in water. (4) If these float, each lung is cut into 12 to 20 pieces and
placed in water. (5) If these pieces float, they are each squeezed in
om
om
between thumb and index finger under water, to see if any bubbles
co
of air escape, and if they still presist to float. (6) Pieces are wrapped
c
e.
e.
in cloth and squeezed by putting a weight to remove tidal air. (7)

re
fre
The pieces are again put in water, and if they continue to float due to re
sf
f
presence of residual air, it indicates that respiration has taken place.
ks
ks
k
(8) If some pieces float, while others sink, it shows feeble respiration.
oo
oo
oo
The expanded lungs may sink from : (1) Disease. (2) Atelectasis.
eb
eb
eb
The unexpanded lungs may float from : (1) Putrefactive gases. (2)
m
Artificial inflation.
Hydrostatic test is not necessary when : (1) Foetus is born
before 180 days of pregnancy. (2) Foetus is a monster. (3) Foetus is
om
macerated or mummified. (4) Umbilical cord has separated and scar

co
co
formed. (5) Stomach contains milk.

e.
e.
A child may breathe (1) while in the womb, after rupture

fre
fre
fre
of membranes (vagitus uterinus), (2) while its head is in vagina

(vagitus vaginalis), (e) while head is protruding from the outlet. A
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 161 04-03-2015 12:15:39 PM

e
e
m
m
om
m
co
co
e.
e.
child which had breathed in a womb or vagina may die from natural
re
fre
fre
causes, before it is completely born. Therefore, proof of breathing
sf
is not proof of livebirth.
ks
ks
k
Microscopic exam, helps to know extent of respiration and the

oo
oo
oo
presence of pulmonary disease or abnormality. Lining of alveoli by
eb
eb
eb
flattened epithelium does not indicate that respiration has taken place.
m
m
The struggle to breathe may result in (1) Incomplete lung expansion,
(2) suboxia and cyanosis, (3) subpleural petechial haemorrhages, (4)
oedema of mediastinum, and often of lungs.
om
m
(IV) Stomach and intestines : (1) The stomach and intestines
co
co
are removed after tying double ligatures at each end. (2) If respiration
e.
e.
has taken place, they float in water. This is known as Breslau’s
fre
fre
fre
second life test, or stomach-bowel test. This is not of much value.
(3) When dissected under water, stomach shows mucus, saliva
ks
ks
ks
and air-bubbles if respiration has taken place, and only mucus if
oo
oo
oo
breathing has not occurred. (4) Blood, meconium or liquor amnii
eb
eb
eb
in the stomach indicate that child was alive at or shortly before birth.
m
m
(V) Middle ear : Before birth, middle ear contains gelatinous
embryonic connective tissue. After respiration air replaces gelatinous
substance (Wredin’s test). This is not reliable.
om
om
Other signs: (1) Blood : Nucleated red cells disappear in

co
24 hours. Foetal haemoglobin is about 80% before birth, rapidly

c
e.
e.
decreases to 8% at third month.

re
fre
Difference in lungs before and after respiration re

sf
f
ks
ks
Trait Before respiration After respiration
k
oo
oo
oo
(1) Weight: 1/70 of body weight. 1/35 of body weight.

(2) Volume: Normal or small. Larger, and cover the heart.
eb
eb
eb
(3) Consistency: Dense, firm, non- Soft, spongy, elastic,

m
crepitant. erepitant.
(4) Margins: Sharp. Rounded.
(5) Colour: Uniformly reddish- Mottled or marbled
om
brown or bluish-red. apperance.

co
co
(6) Air vesicles: Not inflated. Inflated.

e.
e.
(7) Section: Little frothless blood Abundant frothy blood.

fre
fre
fre
exudes on pressure. exudes on section.

ks
ks
ks
(8) Floatation: Whole and parts sink Expanded areas or whole

in water. float in water.
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 162 04-03-2015 12:15:40 PM

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Infant Deaths 163
e.
e.
(2) Meconium : It is green, sticky substance consisting of
re
fre
fre
thickened bile and mucus. It is completely excreted from large
sf
ks
ks
bowel in 24 to 48 hours after birth, but in breech presentation and in
k
severe anoxia, it may be excreted completely before birth. Stains are

oo
oo
oo
brownish-green, stiffen cloth and reaction is acid.
eb
eb
eb
(3) Caput succedaneum : (1) This is an area of soft swelling
m
m
that forms in scalp over presenting part of head. (2) In vertex
presentation the elevated rounded area corresponds to portion of scalp
surface that is exposed within the opening of dilated cervix during
om
m
labour. (3) The affected part of scalp is swollen to 3 to 4 times due
co
co
to oedema and congestion. (4) It gradually decreases within a week,
e.
e.
often dissappearing during one to two days.
fre
fre
fre
(4) Cephalhaematoma : (1) This is a localised accumulation
of blood, between periosteum and bone surface. (2) It is limited
ks
ks
ks
to periosteal sheath of a single bone, commonly right parietal
oo
oo
oo
bone and never crosses a suture line. (3) It is seen in less than
eb
eb
eb
one precent cases; size varies from one to 5 cm. (4) The haematoma
m
m
swelling often tends to increase during the first day or two after birth
as more and more blood accumulates, but gradually shrinks in about
two weeks as the blood is absorbed.
om
om
(5) Skin : (1) At first bright-red; darker on second or third day,

co
then brick-red, yellow and normal in about a week. (2) Vernix

c
e.
e.
caseosa (white cheesy substance produced by sebaceous glands)

re
fre
covers skin mostly in axilla, inguinal region, folds of neck, buttocks re

sf
f
and persists for one to two days. (3) It is removed by washing. (4)
ks
ks
k
Skin of abdomen sheds in flakes during first three days.

oo
oo
oo
(6) Umbilical cord : (1) Blood clots in cut end two hours after
eb
eb
eb
birth, and vessels begin to be obliterated in 24 hours. (2) Cord attached

m
to child shrinks and dries in 12 to 24 hours, and an inflammatory ring

forms at its base in 36 to 48 hours. (3) It contracts and mummifies
on second or third day. (4) It falls off on fifth or sixth day and leaves
om
an ulcer, which leaves a scar in 10 to 12 days.

co
co
(7) Circulation : Umbilical arteries are closed by third day. Umbilical

e.
e.
veins and ductus venosus are closed on fourth day. Ductus arteriosus
fre
fre
fre
closes by tenth day, and foramen ovale by second or third month.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 163 04-03-2015 12:15:40 PM

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m
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om
m
co
co
e.
e.
During birth, death may occur due to : (1) Prolonged labour.
re
fre
fre
(2) Prolapse of cord or pressure on cord producing asphyxia. (3)
sf
ks
ks
Twisting of the cord round the neck causing strangulation, or knot on
k
cord. (4) Injuries to mother, e.g. heavy blows, kicks on abdomen, fall
oo
oo
oo
from a height. (5) Death of mother. Child can be saved if delivered
eb
eb
eb
within 5 to 10 minutes of mother’s death.
m
m
Death may occur after birth from suffocation, when membranes
cover head during birth (can survive for 20 to 30 minutes), or
submerged in discharges.
om
m
Precipitate labour : (1) Labour terminating in a very
co
co
short time is called precipitate labour. (2) Delivery occurs suddenly
e.
e.
and rapidly without mother’s knowledge. (3) Foetus is normal or
fre
fre
fre
premature. (4) It is possible in multiparae with large roomy pelvis,
but is extremely rare in primiparae. (5) Sometimes, a woman may not
ks
ks
ks
be able to distinguish the sense of fullness produced by the descent
oo
oo
oo
of a child, from the feeling of bulky evacuation. (6) Child may die
eb
eb
eb
from: (a) suffocation by falling into lavatory pan, (b) head injury and
m
m
fracture of skull with subdural haemorrhage often bilateral, by a fall
on a hard floor. (c) haemorrhage from torn end of cord. The average
length of cord is 50 cm. (7) The cord is torn most commonly at foetal
om
om
end than the placental end, but is not torn in its middle. (8) torn edges
co
are ragged. (9) Caput succedaneum and moulding of head are absent.
c
e.
e.
(10) Usually fissured fractures occur limited to parietal bones, but

re
fre
may extend to frontal and squamous parts of temporal bone. re

sf
f
M.L.I.: (1) Mother or relatives may be accused of infanticide. (2)
ks
ks
k
In a case of infanticide, death may be attributed to precipitate labour.

oo
oo
oo
Criminal causes: (A) Acts of commission: (1) Suffocation. (2)

eb
eb
eb
Strangulation. (3) Drowning. (4) Burning. (5) Blunt head injury.

m
(6) Fracture and dislocation of cervical vertebrae. (7) Wounds. (8)

Poisoning. (B) Acts of omission or neglect. (1) Failure to provide
proper assistance during labour. (2) Failure to clear air passages. (3)
om
Failure to tie cord. (4) Failure to protect child from heat or cold. (5)
co
co
Failure to supply proper food.

e.
e.
Battered baby syndrome (non-accidental injury of

fre
fre
fre
childhood): (1) It is also known as child abuse syndrome. Caffey’s

syndrome and maltreatment syndrome in children. (2) It is very rare
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 164 04-03-2015 12:15:40 PM

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Infant Deaths 165
e.
e.
in India. (3) A battered child is one who has received repetitive
re
fre
fre
physical injuries due to non-accidental violence, produced by a
sf
parent or guardian. (4) There may also be non-accidental deprivation
ks
ks
k
of nutrition, care and affection. (5) The classical features are : (a)
oo
oo
oo
obvious disagreement between nature of injuries and explanation
eb
eb
eb
offered by parents, (b) delay between injury and medical attention,
m
m
(c) repetition of injuries at different dates. (6) Age of child is usually
less than three years; slightly more in males; one child of a family,
usually eldest or youngest and often unwanted; parents are young
om
m
between 20 to 30, belong to lower social class and lower education;
co
co
history of family disharmony, emotional or financial problems; suffer
e.
e.
from guilt amnesia; mother low I.Q. often pregnant; parents unco-
fre
fre
fre
operative; episodic infliction of injuries. Subdural haemorrhage is
common due to shaking of infant (infantile whiplash syndrome).
ks
ks
ks
Injuries: (1) Soft tissue injuries such as bruises, abrasions and
oo
oo
oo
lacerations of different ages are common. (2) Bite marks, burns of
eb
eb
eb
various parts, subdural haemorrhage, damage to internal organs,
m
m
epiphysial separation or periosteal shearing and haemorrhage,
metaphyseal fragmentation, long bone fractures, fracture ribs, etc. are
seen. (3) The most characteristic lesion is laceration of mucosa inside
om
om
the upper lip, often near centre line where the frenulum may be torn.
co
munchausen’s syndrome: It is feigning illness or injury

c
e.
e.
and going from hospital to hospital for unnecessary investigations

re
fre
and treatment. These patients appear to be compulsively driven to re

sf
f
make their complaints. The person is aware that he is acting an illness,
ks
ks
k
but he cannot stop the act.

oo
oo
oo
Munchausen’s syndrome by proxy: In this the actions of one

eb
eb
eb
person (usually mother) who inflicts harm against another person

m
(usually an infant or a small child) in an attempt to gain sympathy

and attention for both her own and child’s suffering. It is a peculiar
and dangerous type of child abuse. The mother is involved in more
om
than 90% cases.

co
co
Methods of production of illnesses: (1) The mother pricks

e.
e.
her finger and adds blood to the urine of the child. (2) The mother
fre
fre
fre
gives insulin to the child and takes to hospital with hypoglycaemia.

(3) Vomiting: allegation or by ipecac. (4) Diarrhoea: laxatives or
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 165 04-03-2015 12:15:40 PM

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e.
e.
salt poisoning: (5) Rash : scratching or intoxication, etc., (6) Fever:
re
fre
fre
Alleged.
sf
Sudden infant death syndrome (sids): (1) Sids
ks
ks
k
or cot or crib deaths are sudden and unexpected death of healthy

oo
oo
oo
infant, whose death remains unexplained after a complete
eb
eb
eb
autopsy. (2) Incidence is 0.2 to 0.4% of livebirths. (3) Age two
m
m
weeks to two years, but majority of cases occur between 6 weeks
to 6 months. (4) Occurrence is world wide. (5) Male to female ratio
3 : 2. (6) There is increased risk in twins, who are permature and of
om
m
low birth weight. (7) When put to bed, child is healthy or has minor
co
co
upper respiratory infection or minor G.I. disturbances. (8) They are
e.
e.
major cause of death in infants in first 6 months of life. (9) P.M.
fre
fre
fre
findings are negative. (10) Death always occurs during sleep at all
times of night with moderate increase in early morning hours. (11)
ks
ks
ks
Death may result from a number of causes. (12) Some infants have
oo
oo
oo
prolonged “sleep apnoea”, which makes them susceptible to hypoxia,
eb
eb
eb
which leads to bradycardia and cardiac arrest. (13) Other hypotheses
m
m
are: respiratory infection, laryngeal spasm, sensitivity to cows milk,
parathyroid deficiency, antibody deficiency, metabolic disorders,
bacterial or viral infection.
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-17.indd 166 04-03-2015 12:15:40 PM

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e. 18
e.
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fre
fre
sf
ks
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C h a p t e r
k
oo
oo
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eb
eb
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m
m
Blood Stains
om
m
co
co
e.
e.
Blood stains are examined in State Forensic Science Laboratory.
fre
fre
fre
Stained article is dried at room temperature. Extra heat should not be
ks
ks
ks
used. If stains are not dried, putrefaction sets in.
oo
oo
oo
Solvents for blood stains are : (1) 10% solution of potassium
eb
eb
eb
cyanide, (2) 10% solution of glycerine, (3) weak solution of ammonia.
Rust stains, synthetic dye stains, certain mineral and vegetable
m
stains resemble blood stains.

m
(1) Fresh stains are bright-red, which become reddish-brown in
om
om
24 hours, brown within few days, and black after long time. (2) Fresh
co
stains are moist and sticky, and stiffen cloth on drying. (3) A drop of
c
blood dries in 1 to 2 hours. (4) the fresher the blood, more easily it
e.
e.
dissolves in water. (5) Fluorescence decreases as the stain becomes

re
fre
older. (6) Sex can be determined from presence of sex chromatin. (7) re
sf
f
ks
ks
Blood effused during life can be removed in scales on drying, due
k
oo
oo
oo
to presence of fibrin. (8) Blood flowed after death tends to break up

eb
eb
eb
into powder on drying.

Chemical exam: Chemical tests depend on presence in blood
m
of enzyme peroxidase. (1) Benzidine test : Cut out a small piece of

stained material or tease out fibres from the stained fabric and place
om
it on porcelain tile. Add a drop of saturated solution of benzidine in

co
co
glacial acetic acid, and then a drop of 10 volumes hydrogen peroxide.

If the blood is present, dark blue colour is produced immediately.
e.
e.
This is the best preliminary test for blood, and it detects blood when
fre
fre
fre
present in a dilution of one part of blood in three lakhs. If positive

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-18.indd 167 04-03-2015 12:16:02 PM

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e.
reaction is obtained, it is not proof of presence of blood, but a negative
re
fre
fre
reaction excludes blood. (2) Phenolphthalein (Kastle-Meyer) test:
sf
ks
ks
Stain is extracted with distilled water. To an extract, 10 to 20 drops
k
of phenolphthalein reagent is added, and then a drop or two of 10

oo
oo
oo
volumes of hydrogen peroxide. If blood is present a pink or purple
eb
eb
eb
colour develops immediately. It is extremely delicate and detects
m
m
blood in a dilution of one part in five millions, but is not specific.
Red cells: (1) Intact red cells are seen only when stains are
fresh, or when clot is available. (2) Red cells are circular, biconcave,
om
m
non-nucleated discs in all mammals except camels. (3) In camels, they
co
co
are oval, biconvex, but non-nucleated. (4) In birds, fishes, amphibia,
e.
e.
and reptiles they are oval, biconvex and nucleated.
fre
fre
fre
Haemin crystal (Teichmann’s) test: (1) A small crystal of
sodium chloride and 2 to 3 drops of glacial acetic acid are placed
ks
ks
ks
on small piece of suspected stain on a glass slide. (2) A coverslip is
oo
oo
oo
applied and acid is evaporated by heating over a small flame. (3) It
eb
eb
eb
is cooled and examined under microscope. (4) Faintly-yellowish to
m
m
brownish-black rhombic crystals of haemin or haematin chloride,
arranged single or in clusters are seen if blood is present.
Haemochromogen crystal (Takayama) test: (1) Put a small
om
om
piece of suspected material on a glass slide, add 2 to 3 drops of

co
Takayama reagent and cover with a coverslip. (2) Pink, feathery

c
e.
e.
crystals of haemochromogen or reduced alkaline haematin arranged

re
fre
in clusters, sheaves, etc. appear in one to 6 minutes. (3) It is delicate, re

sf
f
more reliable even with old stains.
ks
ks
k
Spectroscopic examination : It is most delicate and reliable test

oo
oo
oo
for both recent and old stains. Less than 0.1 mg. of blood is sufficient.
eb
eb
eb
The stain is extracted with water, diluted and put into a glass test
m
tube, which is then put between spectroscope and source of light.

The solution absorbs some of the rays from the spectrum, producing
characteristic dark absorption bands, which vary with type of blood
om
pigment present.
co
co
Precipitin test : (1) It determines whether blood is from human

e.
e.
being or lower animal. (2) When human serum is injected in an

fre
fre
fre
animal, the animal becomes immunised against human proteins and

antibodies develop in its blood. (3) If human serum is then brought
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-18.indd 168 04-03-2015 12:16:02 PM

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Blood Stains 169
e.
e.
into contact with this animal serum, the antibodies in the animal
re
fre
fre
serum react with proteins in human serum, and a visible precipitate is
sf
ks
ks
formed. (4) A suitable antiserum should react immediately or within
k
a minute on 1 : 1000 dilution.

oo
oo
oo
Technique : (1) Blood is extracted which should be clear,
eb
eb
eb
and diluted 1:100 with normal saline. (2) Two drops of undiluted
m
m
antiserum are added to 0.75 ml. of dilute stain extract in a small
tapering test tube. (3) Antiserum slowly settles down to bottom,
and at junction of two fluids a white ring appears in case of positive
om
m
reaction, which should begin in ten minutes and should be read in
co
co
half hour. (4) It is a specific protein test. (5) The origin of skin, flesh,
e.
e.
bone, saliva, milk, and semen is determined by this test.
fre
fre
fre
Gel diffusion and double diffusion in agar gel are also used to
detect human blood.
ks
ks
ks
M.L. aspects of blood groups: (1) A blood group antigen cannot
oo
oo
oo
appear in a child unless present in one or other parents. (2) If an
eb
eb
eb
individual is homozygous for a blood group factor, it must appear in
m
m
the blood of all his children. (3) If a child is homozygous for a factor,
the gene for the same must have been inherited by it from each of its
parents. (4) Blood group characters are specific to individual and are
om
om
unchanged throughout life.

co
Group specific substances : (1) The antigens of ABO system

c
e.
e.
are also present in body tissues in a lipoidal form. (2) In about 80%,
re
fre
they appear in a water-soluble form and are present in all body fluids re
sf
f
except C.S.F. (3) Persons who possess water-soluble form are known
ks
ks
k
as “secretors”. (4) Secretors posses H antigen on their red cells. (5)

oo
oo
oo
M and N antigens are present in body tissues in water-soluble form.

eb
eb
eb
(6) Rh antigens are found in body fluids, except amniotic fluid.

m
Blood groups can be determined from soft tissues, hair, nails,

dental tissue and bone.
HLA consists of protein substances on surface of wide variety
om
of tissues and organs, tumours, white cells and platelets. (2) They
co
co
are present on placenta at term and in foetal tissues at six weeks. (3)
e.
e.
They are found on lymphocytes and granulocytes.

fre
fre
fre
M.L. aspects: (I) Disputed paternity: The blood groups used

to determine paternity are: (1) Red cell antigens: ABO, MNS, Rh,
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-18.indd 169 04-03-2015 12:16:02 PM

e
e
m
m
om
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co
e.
e.
Kell, Lutheran, Duffy and Kidd. (2) White cell antigens: HLA-A,
re
fre
fre
B, C, D and DR. (3) Serum protein polymorphism: Haptoglobins,
sf
ks
ks
GC groups, Ag groups, Gm, Inv, Km system, serum lipoproteins,
k
abnormal haemoglobins. (4) Red cell enzyme polymorphism.

oo
oo
oo
These tests may exclude a certain person as the possible father of
eb
eb
eb
child, but they cannot definitely establish paternity.
m
m
(2) Disputed maternity can be settled.
(3) Crimes: (1) Bloodstains may be found on clothing and person
of suspect. (2) If the characteristics of victim’s blood are similar with
om
m
those of the suspect, an association is established between suspect
co
co
and victim. (a) Blood stains may be found at scene of house-breaking,
e.
e.
murder, accident, etc. (b) Under fingernails of assailant in throttling.
fre
fre
fre
(c) Under fingernails of victim in case of struggle. (d) On vehicles
in traffic accidents.
ks
ks
ks
(4) Body fluids: Blood group agglutinogens are present in body
oo
oo
oo
secretions, which may be corroborative evidence of accused.
eb
eb
eb
(5) Identity : If a person has rare blood group, it helps in identity.
m
m
(6) Cause of death : In incompatible blood transfusion, cause of
death can be determined. Poisons can be detected in blood.
DNA fingerprinting : (1) About 5% of DNA is used for
om
om
genetic coding, the rest being redundant or silent segments (stutters;

co
hypervariable regions; minisatellites). (2) Of these redundant segment,

c
e.
e.
there may be 200 to 14,000 repeats of each identical sequence on

re
fre
each DNA strand, which are called repetitive DNA. (3) The length, re
sf
f
constitution and number of repetitive sequences are different for each
ks
ks
k
person, but are unique for an individual, and are stably inherited in
oo
oo
oo
a Mandelian fashion. (4) This method is as unique as fingerprints

eb
eb
eb
to an individual. (5) DNA can be extracted from blood, semen,

m
tooth pulp, bonemarrow, hair roots, muscle, skin, etc. (6) It is cut
into fragments at specific base sequences by a restriction enzyme,
and repeated several times. (7) Next, double stranded DNA are
om
denatured into single strand. (8) DNA fragments are then separated
co
co
by gel electrophoresis that spreads fragments into bands. (9) These

e.
e.
are transferred to nitrocellulose sheets by Southern blotting technique.

fre
fre
fre
(10) The membrane is then exposed to DNA probe (radioactive

phosphorus 32), which binds to core sequences. (11) X-ray film is put
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-18.indd 170 04-03-2015 12:16:02 PM

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Blood Stains 171
e.
e.
in direct contact with probe-labelled membrane to detect radioactive
re
fre
fre
patterns, which appear as series of 30 to 40 parallel bands or bars.
sf
ks
ks
(12) This is compared with other samples. (13) The chances of two
k
persons sharing same sequence is one in thirty thousand billions.

oo
oo
oo
M.L. Imp: (1) DNA fingerprinting can match blood on weapon
eb
eb
eb
against that of victim. (2) Hair roots on weapon can be matched with
m
m
blood of victim and accused. (3) Seminal fluid from the victim can be
matched with blood of accused. (4) It can exonerate a person falsely
implicated in a crime. (5) Paternity is established positively. (6) It
om
m
can trace pedigrees. (7) Identity of unknown person can be made by
co
co
matching prints with suspected parents or close relatives.
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-18.indd 171 04-03-2015 12:16:02 PM

e
e
m
m
om
m
co
co
e. 19
e.
re
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fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
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m
m
Forensic Psychiatry
om
m
co
co
e.
e.
Psychiatry deals with study, diagnosis, and treatment of mental
fre
fre
fre
illness. Forensic psychiatry deals with application of psychiatry in
ks
ks
ks
administration of justice. Insanity is disease of mind or personality,
oo
oo
oo
in which there is derangement of mental or emotional processes,
eb
eb
eb
intelligence is weakened and perverted. The law has not defined
insanity.
m
m
Aphasia: Loss of ability to express meaning by use of speech
or writing (motor), or to understand spoken or written language
om
om
(sensory aphasia).
co
Delirium: (1) It is a disturbance of consciousness in which

c
orientation in impaired, critical faculty is blunted, and thought

e.
e.
content is irrelevant or inconsistent. (2) In the early stage the

re
fre
patient is restless, uneasy and sleepless. He then completely loses re

sf
f
ks
ks
self-control, becomes excited and talks furiously. (4) Delusions and
k
oo
oo
oo
sometimes hallucinations are present. (5) It usually occurs in high

eb
eb
eb
fevers and sometimes due to overwork, mental stress, metabolic

diseases, cerebral tumours or drug intoxication. (6) A person may
m
become impulsive and violent and may commit suicide. (7) Such
person is not responsible for his criminal acts.
om
Delusion: (1) It is false belief in something which is not a fact,

co
co
and which persists even after its falsity has been clearly demonstrated.
(2) A normal person can correct delusion by his reasoning power,
e.
e.
by his past experience and by being convinced by others. (3) It is

fre
fre
fre
a disorder of thought which is under control of emotional but not

ks
ks
ks
rational forces.
oo
oo
oo
eb
eb
eb
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Ch-19.indd 172 04-03-2015 12:32:17 PM

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co
co
Forensic Psychiatry 173
e.
e.
Types: (1) Grandeur or exaltation: Person imagines himself
re
fre
fre
very rich while he is pauper. (2) Persecution: imagines that
sf
ks
ks
attempts are being made to poison him. Delusions of grandeur and
k
persecution are common and often present together. (3) Reference:

oo
oo
oo
The person believes that people, things, events, etc. refer to him in a
eb
eb
eb
special way, or items in radio or newspaper are refering to him. (4)
m
m
Influence: Imagines that his thoughts, feelings and actions are being
influenced and controlled by radio, hypnotism, telepathy, etc (5)
Infidelity: Imagines his wife to be unfaithful, while she is chaste. (6)
om
m
Self-reproach: The person blames himself for the past failures and
co
co
misdeeds which are often of no importance. (7) Nihilistic: He declares
e.
e.
that he does not exist or that there is no world. (8) Hypochondriacal:
fre
fre
fre
The person believes that there is something wrong with his body,
though he is healthy. Other types are of self-reproach, jealousy,
ks
ks
ks
religion, etc.
oo
oo
oo
Delusion is not an isolated disorder, but is an indication of deep-
eb
eb
eb
seated widespread disorder. He is not fully responsible for his
m
m
antisocial acts.
Erotomania: (1) It is a delusion in which a person believes
that someone is deeply in love with him/her. (2) He develops an
om
om
obsession for a particular person and starts believing that other person
co
is reciprocating. (3) The other person is usually of higher status,

c
e.
e.
famous or superior at work. (4) The erotomanic tries to get close with
re
fre
the person through telephone calls, letters, gifts, visits, etc. (5) The re
sf
f
person is otherwise normal.
ks
ks
k
Hallucination: It is a false sense perception without any

oo
oo
oo
external object or stimulus to produce it. It is purely imaginary.

eb
eb
eb
Types: (1) Visual: A person imagines of being attacked by a lion

m
when it does not exist. (2) Auditory: hears voices and imagines that a
person is talking to him when no one is present. (3) Olfactory: smells
pleasant or unpleasant odour when none is present. (4) Gustatory:
om
feels sweet, sour or bitter taste, though no food is present. (5) Tactile:
co
co
imagines rats and mice crawling on his bed, when there are none. (6)
e.
e.
Psychomotor: feeling of movement of some part of body in absence

fre
fre
fre
of such movement.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 173 04-03-2015 12:32:17 PM

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e
m
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om
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co
co
e.
e.
(1) Hallucinations occur in fevers, intoxications and insanity. (2)
re
fre
fre
Visual and auditory are most common. (3) A person suffering from
sf
ks
ks
unpleasant hallucinations may commit suicide or homicide.
k
Illusion: is a false interpretation by senses of external object

oo
oo
oo
or stimulus which has a real existence, e.g. seeing a dog and
eb
eb
eb
mistaking it for lion, hears notes of birds and imagines them to be
m
m
human voices, or imagines a string hanging in his room to be snake,
etc. (2) A sane person is capable of correcting false impressions but
insane person continues to believe in the illussion even though real
om
m
facts are pointed out.
co
co
Impulse: (1) Is a sudden and irresistable force compelling a
e.
e.
person to conscious performance of some action without motive
fre
fre
fre
or forethought. (2) A sane person can control impulse. (3) An insane
person having no judgement, no reasoning power and no capacity
ks
ks
ks
to understand facts, may do things on impulse. (4) They are usually
oo
oo
oo
seen in imbecility, dementia, acute mania and epilepsy.
eb
eb
eb
Types: (1) Kleptomania: irresistible desire to steal articles of
m
m
little value. (2) Pyromania: to set fire to things. (3) Dipsomania:
to alcholic drinks at periodic intervals. (4) Mutilomania: mutilate
animals. (5) Sexual. (6) Suicidal and homicidal.
om
om
Obsession: (1) In this a single idea, thought or emotion

co
is constantly entertained by a person which he recognises as

c
e.
e.
irrational, but persists in spite of all efforts to drive it from his

re
fre
mind. (2) It is a disorder of content of thought. (3) It is a borderline re

sf
f
between sanity and insanity. (4) They usually occur in neurotic
ks
ks
k
people. (5) These ideas are usually associated with some sort of dread
oo
oo
oo
and fear. (6) A wife may believe her husband to be unfaithful inspite
eb
eb
eb
of proof to the contrary. (7) A person may go to bed at night after

m
securely bolting the door of his room, but soon gets up to see he had
done so. A sane person may do it once or twice, but an insane person
does not sleep, and spends whole night in frequently seeing whether
om
door is bolted or not.

co
co
Phobia is an excessive or irrational fear of a particular object or

e.
e.
situation.
fre
fre
fre
Lucid interval: (1) It is a period during which all

symptoms of insanity disappear completely. (2) The person is able
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 174 04-03-2015 12:32:17 PM

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e
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om
m
co
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e.
e.
to judge his acts soundly, and he becomes legally liable for his acts.
re
fre
fre
(3) In mania and melancholia lucid intervals are common. (4) It occurs
sf
ks
ks
frequently, and preceding and following symptoms are those of insanity.
k
Psychopath: (1) Is a person who is neither insane nor

oo
oo
oo
mentally defective, but fails to conform to normal standards of
eb
eb
eb
behaviour. (2) They have abnormal personality, persistently behave
m
m
in an antisocial or disruptive manner, and are unable to appreciate
normal implications of their actions. (3) The person retains a child-
like selfishness. (4) They can plan and implement their antisocial
om
m
acts in an effective way. (5) the basic defect is moral, rather than
co
co
psychological or neurological.
e.
e.
Psychoses: They are characterised by a withdrawal from
fre
fre
fre
reality, a living in a world of fantasy. (2) It is a disease entity with
physical basis which is determined genetically, and is a major disease.
ks
ks
ks
(3) Empathy, contact with reality and insight are absent.
oo
oo
oo
Neuroses: (1) The patient suffers from emotional or
eb
eb
eb
intellectual disorders, but he does not lose touch with reality. (2)
m
m
they occur mostly in the form of anxiety, depression, or hysteria. (3)
They are reaction to stressful circumstances due to adverse childhood
experiences. (4) Empathy, contact with reality and insight are present.
om
om
(5) It is a minor disease.

co
Mental subnormality (amentia): It is characterised by incomplete

c
e.
e.
maturation of attention, perception, cognition, and social adaptability

re
fre
due to arrested mental development. (1) Idiots are persons so re

sf
f
defective in mind from birth or from early age that they are
ks
ks
k
unable to guard themselves from ordinary physical dangers.

oo
oo
oo
Mentality is that of a child of 3 years. I.Q. 0 to 20. (2) Imbeciles:

eb
eb
eb
They are incapable of managing themselves or their affairs, and are

m
incapable of being taught. I.Q. 20 to 50. Mentality 3 to 7 years. (3)

feeble-minded (Moron): Mental age 6 to 11. I.Q. 20 to 50.
Dementia is a condition in which there is degeneration of
om
mental faculties after they have been fully developed.

co
co
Post-epileptic insanity : (1) Stupor following epileptic fit is

e.
e.
replaced by automatic acts of which patient has no recollection. (2)

fre
fre
fre
He is confused and terrified by visual and auditory hallucinations

and delusions of persecution, and commit crimes like thefts, burning
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 175 04-03-2015 12:32:17 PM

e
e
m
m
om
m
co
co
e.
e.
of property, sexual assaults and murders. (3) These crimes are
re
fre
fre
involuntary, automatic and unpremeditated. (4) He never attempts
sf
ks
ks
to conceal them at the time of committing, but may try to conceal
k
them on regaining consciousness. (5) Automatic act tends to be of

oo
oo
oo
the same type in each attack.
eb
eb
eb
Schizophrenia : It is a condition of split personality,
m
m
in which the patient loses his contact with his environment. It
is primarily a disorder of thinking (cognition). It is characterised
by : (1) splitting of different psychic functions. (2) Disorders of
om
m
thought. (3) Disorders of effect. (4) Delusions. (5) Hallucinations.
co
co
(6) Personality deterioration.
e.
e.
Types : (1) Simple. (2) Hebephrenia. (3) Catatonia. (4) Paranoia.
fre
fre
fre
(5) Shcizo-effective, and (6) Pseudo-neurotic.
Affective type : These are of hereditary origin affecting young
ks
ks
ks
adults and form a major group of all psychiatric illnessses.
oo
oo
oo
Manic-depressive psychosis : (1) Manic phase is a condition of
eb
eb
eb
exaltation of emotions and intellect. (A) Acute mania is characterised
m
m
by euphoria, or irritable mood, excitement, loss of self-control, flight
of ideas, and great muscular activity. Mood is elated, attention is
fleeting and there is high degree of distortion. (B) Hypomania is a
om
om
mild form.
co
(2) Depressive phase (melancholia) : It is an intense feeling

c
e.
e.
of depression or misery without any cause. The sadness of mood is

re
fre
reflected in posture, movements and facial expressions. He retires re

sf
f
from his usual social activities, avoids friends. Suicide is well
ks
ks
k
planned and is of great danger to the patient. Homicidal and suicidal

oo
oo
oo
tendencies co-exist.
eb
eb
eb
Diagnosis of insanity : (1) The person should be kept under

m
observation, which should not exceed ten days, but with permission
of Magistrate, he may be detained for further periods of ten days up
to a maximum of 30 days. (2) Violent or criminal persons should be
om
kept in a prison. (3) The person should be watched during different

co
co
times of day, when he is alone, in company and while he is working,

e.
e.
eating, reading or writing and when he is not aware of the fact of

fre
fre
fre
being observed.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 176 04-03-2015 12:32:17 PM

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om
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co
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e.
e.
Difference between real and feigned insanity
re
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fre
Trait Real insanity Feigned insanity
sf
ks
ks
(1) Onset: Gradual. Sudden.
k
oo
oo
oo
(2) Motive: Absent, e.g., no history Present, e.g.,
of commission of crime. commission of crime.
eb
eb
eb
(3) Predisposing Usually present, e.g., Absent.
m
m
factors: history of insanity in
parents or of sudden
monetary loss, grief, etc.
om
m
(4) Signs and Uniform and present Present only when
co
co
symptoms: whether the patient is conscious of being
being observed or not. observed; variable and
e.
e.
always exaggerated.
fre
fre
fre
(5) Facial: expression: Peculiar, e.g., vacant No peculiarity,
ks
ks
ks
look or fixed look of frequently changing,
excitement. exaggerated and
oo
oo
oo
voluntary.
eb
eb
eb
(6) Insomnia: Present. Cannot persist.
(7) Exertion: Patient can stand Cannot stand exertion
m
exertion of fatigue,
hunger and sleep, for m
for more than a few
days and breaks down.
several days.
om
om
(8) Habits: Dirty and filthy. Not dirty and filthy.

co
c
(9) Frequent exam : Does not mind. Resents for fear of

e.
e.
detection.
re
fre
Certification : Three examinations on different days and different re

sf
f
ks
ks
hours are usually recommended, because a person may behave
k
oo
oo
oo
peculiarly at a single examination, either due to effect of drugs or

due to delirium caused by fever.
eb
eb
eb
Mental Health Act, 1987: Mentally ill person is defined “a

m
person who is in need of treatment by reason of any mental disorder

other than mental retardation”.
Restraint of insane : (1) Immediate restraint: this is
om
done in case of: (1) insane person who is dangerous to himself or to

co
co
others, (2) persons suffering from delirium, (3) delirium tremens. It

e.
e.
is done under personal care of attendants, e.g. by safely locking up

fre
fre
fre
in a room, as long as danger exists.

ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-19.indd 177 04-03-2015 12:32:17 PM

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co
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e.
e.
(II) Admission in psychiatric hospital: (1) Admission on
re
fre
fre
voluntary basis: Any major person, who considers himself to
sf
ks
ks
be mentally ill person, may request medical officer-in-charge of
k
psychiatric hospital or nursing home, for admission and treatment.

oo
oo
oo
(2) In case of minor, guardian may make such request. (3) He may
eb
eb
eb
be admitted if officer-in-charge is satisfied that he requires treatment.
m
m
(2) Admission under special circumstances: (1) If mentally ill
person cannot express his willingness to be admitted in a hospital, a
relative or friend can make application in prescribed form, and attach
om
m
two medical certificates, one of which shall be by a Government
co
co
medical officer. (2) If medical certificates are not submitted, officer-
e.
e.
in-charge can get the mentally ill person examined by two doctors
fre
fre
fre
working in the hospital. (3) Such person can be admitted for 90 days.
(3) Reception order on application : (A) Officer-in-charge
ks
ks
ks
of psychiatric hospital can make an application to Magistrate in
oo
oo
oo
case of mentally ill person who is undergoing treatment under a
eb
eb
eb
temporary treatment order, if he is satisfied that (a) treatment has
m
m
to be continued for more than six months, or (b) in the interest of
health and personal saftey of mentally ill person or for protection
of others. (B) (1) The spouse of mentally ill person or any relative
om
om
can make an application in prescribed form to the Magistrate. (2)

co
The applicant must be major, must have personally seen patient

c
e.
e.
within 14 days of date of application, and should mention manner of

re
fre
relationship. (3) The application should be verified and signed by the re

sf
f
applicant. (4) Two medical certificates issued by two doctors, who
ks
ks
k
have separately examined patient within ten days of presentation of

oo
oo
oo
application should be submitted. (5) Each doctor should certify that

eb
eb
eb
the person is suffering from mental disorder of such a nature and

m
degree as to be detained in a psychiatric hospital, in the interest of

health and personal saftey of that person, or for protection of others.
(6) The Magistrate will examine the contents of application, and if
om
he is satisfied, he may pass a Reception Order immediately, or he

co
co
may fix a date for consideration of petition. (7) The petition must be
e.
e.
considered in private, in the presence of petitioner, alleged mentally

fre
fre
fre
ill person and his representative. (8) If Magistrate is satisfied, he

passes a Reception Order, which is valid for 30 days.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 178 04-03-2015 12:32:18 PM

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co
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e.
e.
(4) Reception Order on production of mentally ill person
re
fre
fre
before Magistrate: (A) (1) An officer-in-charge of a police station
sf
can arrest a wandering or dangerous mentally ill person and
ks
ks
k
produce him before Magistrate. (2) A wandering mentally ill person

oo
oo
oo
is one who wanders aimlessly, and a dangerous mentally ill person is
eb
eb
eb
one who because of his violent behaviour is dangerous to himself or
m
m
others. (3) The Magistrate may send him for medical examination, and
if he is satisfied he may pass a Reception Order. (B) (1) An officer-
incharge of a police station or any person can report to a Magistrate,
om
m
if he believes that any person is mentally ill, and not kept under
co
co
proper care and control, or that he is cruelly treated or neglected.
e.
e.
(2) In such case, Magistrate may order to produce mentally ill person
fre
fre
fre
and summon guardian and order for proper care and treatment. (3)
If there is no one legally bound to maintain mentally ill person,
ks
ks
ks
Magistrate may pass an order for admission in a psychiatric hospital.
oo
oo
oo
(5) Admission after judicial inquisition: (1) If a person
eb
eb
eb
possessing property is alleged to be mentally ill, the District Court
m
m
may order inquiry upon application made by any relative. (2) The
Court, if it is satisfied may order to admit such person in psychiatric
hospital.
om
om
(6) Admission of an escaped mentally ill person: A mentally

co
ill person escaping from a psychiatric hospital, can be retaken by any

c
e.
e.
police officer, or any officer or servant of psychiatric hospital, and

re
fre
readmitted into such hospital. re

sf
f
Discharge of mentally ill person: (1) Voluntary patient should
ks
ks
k
be discharged within 24 hours of receipt of request for discharge

oo
oo
oo
made by patient or guardian. (2) A person admitted on an application

eb
eb
eb
by a relative or friend can apply to Magistrate, who will enquire and

m
allow discharge. (3) Officer-in-charge of psychiatric hospital can

discharge on recommendation of two medical officers. (4) A person
detained under Reception Order made on application or the person
om
on whose application admission order was made, applies in writing.

co
co
(5) If a person detained on Reception Order is subsequently found by

e.
e.
any judicial inquisition to be of sound mind, he is to be discharged.

fre
fre
fre
Civil Responsibility: (1) Management of property

and affairs : (1) If any relative gives an application to the court and
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 179 04-03-2015 12:32:18 PM

e
e
m
m
om
m
co
co
e.
e.
submits a medical certificate stating “that mental illness is of such
re
fre
fre
a degree as to make him incapable of managing his property and
sf
ks
ks
affairs”, the court will conduct an enquiry, and appoint a manager
k
to look after the property. (2) The court may order sale or disposal
oo
oo
oo
of property, for payment of his debts and expenses. (3) Later if it is
eb
eb
eb
reported that mental illness has ceased, Court orders an enquiry, and
m
m
if it is satisfied, it will order all proceedings in mental illness to cease.
(2) Contracts : (1) Contract is invalid if one of the parties was
mentally ill at the time of making contract. (2) If mental illness
om
m
develolps subsequent to contract, it will be valid, unless performance
co
co
of services becomes impossible. (3) A mentally ill person is
e.
e.
responsible for payment of simple necessities of life, but he is not
fre
fre
fre
responsible if order is grossly excessive or unreasonable. (4) Contracts
made during lucid interval are valid.
ks
ks
ks
(3) Marraige contract: A marriage is invalid if at the time of
oo
oo
oo
marriage, either party (i) is incapable of giving valid consent due to
eb
eb
eb
mental illness, (ii) has been suffering from recurrent attacks of mental
m
m
illness or epilepsy.
(4) Evidence : An mentally ill person is not competent to give
evidence, if he cannot understand the necessity of telling truth due to
om
om
mental illness. He will be competent during lucid interval.

co
(5) Consent : Consent to sexual intercourse, hurt, etc. is not

c
e.
e.
valid, if mentally ill person is unable to understand the nature and

re
fre
consequences of that act. re

sf
f
(6) Testamentary capacity: (1) It is the mental ability
ks
ks
k
of a person to make a valid will. (2) Requirements of valid will are:

oo
oo
oo
(a) written and properly signed and witnessed document must exist,
eb
eb
eb
(b) person should be major, (c) of sound disposing mind, (d) at time
m
of making will, force, undue influence, or dishonest representation

of facts should not have been applied by others. (3) Holograph
will is one written by a testator in his own handwriting. (4) The
om
testator is said to be of sound mind if he is capable of disposing of

co
co
his property with understanding and reason. (5) The most important
e.
e.
thing to determine is whether at the time of making will, the testator

fre
fre
fre
understood the business in which he was engaged, and how he wanted

to dispose of his property. (6) The doctor should take history and
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 180 04-03-2015 12:32:18 PM

e
e
m
m
om
m
co
co
e.
e.
make complete examination before certifying. (7) A valid will can
re
fre
fre
be made by: (a) a person affected by an insane delusion, if delusion
sf
ks
ks
is not related to disposal of property or persons affected by will, (b)
k
during lucid interval, (c) person of extreme age, feeble health with
oo
oo
oo
defective memory, (d) a person suffering from aphasia, agraphia, and
eb
eb
eb
alexia, or who is blind, if he can make clear by gestures that he wishes
m
m
to make a will. (8) A will is invalid: (a) when made by persons in
extremis, (b) will executed by a dying person during delirium, (c)
when drunkenness has caused a temporary loss of reasoning powers.
om
m
criminal responsibility: (1) A person may plead
co
co
mental illness to avoid trial, conviction and capital punishment. (2)
e.
e.
If mental illness is found, accused person is found “not guilty”, and
fre
fre
fre
is ordered to be kept in a psychiatric hospital. (3) The law presumes
that: (a) every person is sane, (b) for every criminal act, there must
ks
ks
ks
be criminal intent or mind, mens rea (criminal mind) motivating it.
oo
oo
oo
Tests: (1) Mc Naughten rule (right or wrong test; legal test):
eb
eb
eb
Daniel Mc Naughten was schizophrenic, who had delusional belief
m
m
that he was being persecuted by Sir Robert Peel (prime minister of
England). By mistake he shot and killed Edward Drummond, the
prime minister’s private secretary. Mc Naughten was acquitted as
om
om
medical evidence showed him to be of unsound mind. The public

co
reaction was unfavourable. The House of Lords appointed a full

c
e.
e.
bench of 14 Judges, to determine criminal responsibility of mentally

re
fre
ill person. The rule is “An accused person is not criminally re

sf
f
responsible, if it is proved that at the time of committing crime, he
ks
ks
k
was suffering from such a defect of reason from disease of mind,

oo
oo
oo
that he did not know nature and quality of act he was doing, or
eb
eb
eb
that what he was doing was wrong”.

m
Under S.84, I.P.C. this legal test has been accepted in India.
Examples : If due to insane delusion: (1) a person thinks that
another man is attempting to kill him, and in self-defence he kills
om
that person, he is not responsible, (2) a person thinks another to be a

co
co
wild animal and kills him, he is not responsible, (3) a person thinks
e.
e.
that another person had caused a serious injury to his character and
fre
fre
fre
fortune and kills him, he becomes responsible, because under the law
no one can kill a person in revenge.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 181 04-03-2015 12:32:18 PM

e
e
m
m
om
m
co
co
e.
e.
(2) Durham rule. (3) Curren’s rule. (4) Irresistible impulse
re
fre
fre
test. (5) American law institute test (A.L.I.).
sf
Insanity and murder: (1) In criminal cases where insanity is
ks
ks
k
pleaded as a defence, the defence has to prove it. (2) The doctor should
oo
oo
oo
obtain detail history from accused person, and carry out physical
eb
eb
eb
exam. and investigations. (3) There is no motive, no pre-arrangement
m
m
and pre-planning, no accomplices, he does not try to destroy evidence,
and after the crime, he may notify police. (4) The psychiatrist’s task
becomes difficult with increase in interval between alleged crime and
om
m
his examination. (5) All mental disorders do not free a person from
co
co
criminal responsibility for his acts. (6) If disorders impair cognitive
e.
e.
faculties of accused, i.e. faculty of understanding the nature of his
fre
fre
fre
act and its consequences, he is not held responsible. (7) If insanity
affects only emotions and will, but not cognitive faculties, the person
ks
ks
ks
is held responsible for his acts. Only persons who are completely
oo
oo
oo
incompetent, demented or wild, are considered as lacking ability to
eb
eb
eb
have a guilty intention.
m
m
Automatism : (1) It is conduct of a person whose consciousness
is impaired to such an extent that he is not fully aware of his
actions. (2) There may be no consciousness at all of the actions,
om
om
or the awareness may be below level of normal consciousness. (3)

co
Main factors producing automatism are : (1) Epilepsy (mentally ill

c
e.
e.
automatism). (2) Concussion or cerebral disease. (3) Hypoglycaemia.

re
fre
(4) Somnambulism (non-mentally ill automatism). re

sf
f
Somnambulism: (1) It means, walking during sleep. A person
ks
ks
k
leaves his bed and walks in the house or out of house without any
oo
oo
oo
awareness of his actions, but rarely injures himself. (2) He is not

eb
eb
eb
asleep but in a state of dissociated consciousness, in a hallucinatory

m
state, unrelated to his immediate environment. (3) Such persons

are usually well-adjusted in life, socially well-behaved, and not
aggressive. (4) The crime is not wilfil or premeditated. (5) The mental
om
faculties are partially active. (6) He may commit sucide, fall in a well,
co
co
meet with an accident or commit crime. (7) There is no recollection

e.
e.
of the event, but in some cases the events of one fit are remembered
fre
fre
fre
in a subsequent fit and carried out similarly. (8) Such person is not
criminally responsible.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 182 04-03-2015 12:32:18 PM

e
e
m
m
om
m
co
co
e.
e.
If a crime is committed due to impulse, the person is criminally
re
fre
fre
responsible. A person committing a crime under hypnotism or
sf
mesmerism is responsible for his acts.
ks
ks
k
Drunkenness: (1) An act done by a person who is incapable of

oo
oo
oo
knowing nature of act due to intoxication is not an offence, if the
eb
eb
eb
thing which intoxicated him was administered to him without his
m
m
knowledge and against his will. (2) An intoxicated person (voluntary
drunkenness) is criminally responsible if he has the intention or
knowledge of committing a crime.
om
m
A person is not responsible for his criminal acts done during post-
co
co
traumatic automatism, twilight state, delirium and oneiroid states.
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-19.indd 183 04-03-2015 12:32:18 PM

e
e
m
m
om
m
co
co
e. 20
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Artefacts
om
m
co
co
e.
e.
Artefact is any change caused or feature introduced in
fre
fre
fre
body after death, that is likely to lead to misinterpretation of
ks
ks
ks
medicolegally significant antemortem findings.
oo
oo
oo
(1) Agonal : Regurgitation and aspiration of gastric contents;
eb
eb
eb
oesophagogastromalacia.
(2) Resuscitation : Injection marks, defibrillator mark, external
m
m
massage of chest causing rib fractures, and lacerations of internal
organs.
om
om
(3) Handling of body : Fracture of ribs, contusion of occipital

co
region.
c
(4) Rigor mortis : Partial breaking due to handling; heart

e.
e.
simulating hypertrophy.
re
fre
(5) P.M. lividity : Some poisons change colour; hypostasis of re

sf
f
ks
ks
internal organs may resemble disease, such as coronary occlusion,
k
oo
oo
oo
pneumonia, intestinal strangulation.

(6) Burns : Heat ruptures, heat haematoma, fat droplets in
eb
eb
eb
pulmonary vessels, pseudo-strangulation mark due to tight collar.

m
(7) Animal and insect bites.

(8) Decomposition : (a) Pseudobruising, (b) simulate obesity, (c)
om
P.M. purge, (d) groove in neck due to buttoned shirt, (e) congested
co
co
appearance of internal organs, (f) P.M. digestion of stomach, (g) blebs

mistaken for burns, (h) air in right heart mistaken for air embolism,
e.
e.
(i) separation of sutures of skull in a child, (j) fissures or splits in skin

fre
fre
fre
simulate AM lacerations, (k) holes produced from maggots resemble

ks
ks
ks
bullet holes.
oo
oo
oo
eb
eb
eb
m
Ch-20.indd 184 04-03-2015 12:33:02 PM

e
e
m
m
om
m
co
co
Artefacts 185
e.
e.
(9) Air in blood vessels due to pulling of dura in sagittal line.
re
fre
fre
(10) Skull fractures due to use of chisel and hammer while
sf
ks
ks
removing skull cap.
k
(11) Visceral damage due to rough handling of brain and liver.

oo
oo
oo
(12) Extravasation of blood due to cutting of vessels during
eb
eb
eb
autopsy.
m
m
(13) Fracture hyoid bone due to block removal of viscera.
(14) Toxicological due to contamination of viscera with stomach
contents during autopsy; faulty storage or use of preservatives.
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-20.indd 185 04-03-2015 12:33:02 PM

e
e
m
m
om
m
co
co
e. 21
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Forensic Science Laboratory
om
m
co
co
e.
e.
Forensic science is the study and application of scientific
fre
fre
fre
examination and evaluation of evidences for legal purposes.
ks
ks
ks
Physical evidence includes any and all objects, living or
oo
oo
oo
inanimate, solid, liquid or gas, and the relationship between all objects
eb
eb
eb
as they relate to the problem in question, e.g. crime. Knife, burglar
tool, signature, firearms, bullets, blood and seminal stains, poisons,
m
m
fingerprints, hair, fibres, glass, paint, oil, dust, microscopic fragments
of all types, bacteria, etc. and even odour are all physical evidence.
om
om
Physical evidence is often (1) the decisive factor in determining guilt

co
or innocence, (2) it can be a material aid in locating the criminal.

c
Locard’s Exchange principle : When any two objects come into

e.
e.
contact, there is always a transfer of material form each object on the

re
fre
other. Traces from scene may be carried away on clothes or tools of re

sf
f
ks
ks
criminal, and at the same time, traces from all or any of these may
k
oo
oo
oo
be left at the scene. Wherever a criminal goes, whatever he touches,

eb
eb
eb
and whatever he leaves will serve as silent evidence against him, e.g.
fingerprints, hair, fibres from clothes, broken glass, paints, blood or
m
seminal stains. It is actual evidence and its presence is absolute proof

of crime. Physical evidence cannot be wrong and completely absent.
om
(1) Lie detection : Polygraph : (1) It is an instrument used

co
co
to detect lies. (2) Polygraph makes a continuous record of B.P.,

pulse, respiration and electrodermal reaction changes in response to
e.
e.
stimuli in the form of questions. (3) It is based on theory that when

fre
fre
fre
person tells a lie in answer to a question and there is fear that lie will
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-21.indd 186 04-03-2015 12:33:19 PM

e
e
m
m
om
m
co
co
Forensic Science Laboratory 187
e.
e.
be detected, the fear results in stimulation of sympathetic nervous
re
fre
fre
system, which results in certain physiological changes, some of which
sf
ks
ks
may be easily recorded. (4) Ten questions are framed with mutual
k
consent of person to be examined and the examiner. (5) Relevant

oo
oo
oo
and irrelevant questions are mixed up which demand “Yes” or “No”
eb
eb
eb
answer. (6) A question is asked every 20 to 25 seconds, and polygraph
m
m
chart recorded in 3 to 4 minutes. (7) The test is repeated twice or
thrice. (8) Truth or lie can be correctly recorded in 80 to 90% cases.
(9) Offenders, suspects, complainants, witnesses and informants are
om
m
examined.
co
co
(2) Brain Mapping (Brain Fingerprinting) : (1) It is based on
e.
e.
the theory that the suspect’s reaction to the details of an event
fre
fre
fre
or activity will reflect, if the suspect had prior knowledge of the
event or activity. (2) The equipment called “electrocap” is fixed on
ks
ks
ks
the suspect’s head for recording EEG. (3) The suspected person is
oo
oo
oo
questioned about the crime and shown visuals of crime scene, such
eb
eb
eb
as victim, weapon, time, place and how he committed the crime
m
m
along with irrelevant photographs, etc. (4) Another computer keeps
track of neuro-impulses. (5) The intensity of brain waves shoots up
whenever a question or visual stimuli matches the information stored
om
om
in the brain, if suspect has really committed the crime. (6) It depends
co
upon cognitive brain responses, but not on emotional responses. (7)

c
e.
e.
It is said to be 100% accurate.

re
fre
(3) Narco-analysis (Truth serum drugs): The principle is re

sf
f
that at a point very close to unconsciousness, the person will be
ks
ks
k
mentally incapable of resistance to questioning and incapable

oo
oo
oo
of inventing falsehoods that he had used to conceal guilt. The

eb
eb
eb
methods used are: (1) Half mg. of scopolamine hydrobromide s.c.,

m
followed by one-fourth mg. every 20 minutes for an average of 3

to 6 injections, until person reaches proper stage for questioning.
(2) Sodium amytal or sodium pentothal 2.5 to 5% solution. i.v. at a
om
rate not to exceed one ml/m. until proper stage is reached. In a state
co
co
of relaxation, the suspect is susceptible to suggestion and reveals

e.
e.
repressed feeling or memories.

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-21.indd 187 04-03-2015 12:33:19 PM

e
e
m
m
om
m
Toxicology
co
co
e. 22
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
General Considerations
om
m
co
co
e.
e.
A poison is a substance (solid, liquid or gaseous) which if
fre
fre
fre
introduced in the living body, or brought into contact with any
ks
ks
ks
part thereof will produce ill-health or death, by its systemic or local
oo
oo
oo
effects or both. Toxicology is the science dealing with properties,
eb
eb
eb
actions, toxicity, fatal dose, detection, estimation, and treatment
of poisons. “Forensic toxicology” deals with medical and legal
m
aspects of harmful effects of chemicals on human beings.

m
Acts: (1) Poisons Act, 1919. (2) Drugs and Cosmetics Act, 1940.
om
om
(3) Drugs and Cosmetics rules, 1945. These rules have classified
co
drugs into Schedules. (4) Drugs Control Act, 1950. (5) Drugs and
c
Magic Remedies Act, 1954. (6) Narcotic Drugs and Psychotropic

e.
e.
Substances Act, 1985: A psychotropic drug is one that alters

re
fre
mental function by its action. A narcotic drug means cocoa leaf, re

sf
f
ks
ks
cannabis, poppy straw, etc. This lists 77 psychotropic substances,
k
oo
oo
oo
e.g. amphetamine, tranquilisers, barbiturates, etc.

Ideal homicidal poison: (1) It should be cheap, easily available,
eb
eb
eb
colourless, odourless and tasteless, capable of being administered

m
either in food, drink or in medicine without producing any visible

change, highly toxic, signs and symptoms should resemble natural
om
disease, there should not be any antidote and no P.M. changes, should
co
co
not be detected by chemical tests and must be rapidly destroyed in

the body. (2) Fluorine and thallium satisfy several of above criteria.
e.
e.
(3) Arsenic and aconite are commonly used as homicidal poisons.

fre
fre
fre
Stupefying: Datura, cannabis, chloral hydrate.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 188 04-03-2015 12:33:36 PM

e
e
m
m
om
m
co
co
General Considerations 189
e.
e.
Abortifacients: Calotropis, oleanders, aconite, ergot, lead,
re
fre
fre
arsenic, mercury, croton, semecarpus, cantharides, etc.
sf
A love philter is a drug which is supposed to increase the
ks
ks
k
love between giver and taker. All aphrodisiacs such as cantharides,

oo
oo
oo
arsenic, alcohol, opium, cocaine and cannabis are supposed to act as
eb
eb
eb
love philters.
m
m
Ideal suicidal poison: (1) Cheap, easily available, toxic,
tasteless or pleasant taste, easily taken in food or drink and cause
painless death. (2) Opium and barbiturates satisfy several criteria.
om
m
(3) Organophosphorus compounds are commonly used.
co
co
Cattle poisons: Abrus, calotropis, oleanders, organophosphates,
e.
e.
arsenic, zinc phosphide, strychnine, aconite, etc.
fre
fre
fre
Arrow poisons: Abrus, croton oil, aconite, strychnine, curare,
calotropis, snake venom, etc.
ks
ks
ks
Classification: Poisons may be classified according to chief
oo
oo
oo
symptoms which they produce: (1) Corrosives: (1) Strong acids:
eb
eb
eb
(a) Mineral or inorganic acids: Sulphuric, nitric, hydrochloric. (b)
m
m
Organic acids: Carbolic, oxalic, acetic, salicyclic. (2) Strong alkalis:
Hydrates and carbonates of sodium, potassium and ammonia. (3)
Metallic salts: Zinc chloride, ferric chloride, copper sulphate, silver
om
om
nitrate, potassium cyanide, chromates, bichromates.

co
(II) Irritants: (1) Agricultural. (2) Inorganic: (a) Non-metallic:

c
e.
e.
Phosphorus, iodine, chlorine. (b) Metallic: Arsenic, antimony,

re
fre
copper, lead, mercury, silver, zinc. (c) mechanical: Powdered glass, re

sf
f
diamond dust, hair. (3) Organic: (a) Vegetable: abrus, castor, croton,
ks
ks
k
calotropis, aloes. (b) Animal: Snake and insect bites, cantharides,

oo
oo
oo
ptomaines.
eb
eb
eb
(III) Systemic: (1) Cerebral: (a) CNS depressants: Alcohols,

m
general anaesthetics, opioid analgesics, hypnotics, sedatives. (b) CNS

stimulants: Cyclic antidepressants, amphetamine, methyl phenedate.
(c) Deliriant: datura, belladonna, hyocyamus, cannabis. (2) Spinal:
om
Nux vomica, gelsemium. (3) Peripheral: Conium, currare. (4)

co
co
Cardiovascular: Aconite, quinine, oleanders, tobacco, hydrocyanic

e.
e.
acid. (5) Asphyxiants: CO, CO2, hydrogen sulphide.

fre
fre
fre
(IV) Miscellaneous: Food poisoning, botulism.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 189 04-03-2015 12:33:36 PM

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e
m
m
om
m
co
co
e.
e.
Routes of Administration: In order of rapidity of action: (1)
re
fre
fre
Inhaled in gaseous or vaporous form. (2) Injection into blood vessels.
sf
ks
ks
(3) Intramuscular injection. (4) Application to a wound. (5) Serous
k
surface. (6) Bronchotracheal mucous membrane. (7) Introduction

oo
oo
oo
into stomach. (8) Natural orifices, e.g., rectum, vagina, urethra, etc.
eb
eb
eb
(9) Skin. Organophosphates, nicotine, insecticides, some organic
m
m
solvents and lewisite gas can penetrate the skin and produce death.
Other substances which are absorbed through the skin are: phenol,
endrin, HCN, cantharidin, mercury, vitamin D and k, etc.
om
m
Action of poisons: (1) Local: (a) Chemical destruction by
co
co
corrosives. (2) Congestion and inflammation by irritants.(3) Effects
e.
e.
on motor and sensory nerves, e.g., tingling of skin and tongue by
fre
fre
fre
aconite, dilation of pupils by datura.
(2) Remote: Poison absorbed into the system through the blood,
ks
ks
ks
and then exerts a specific action on certain organs and tissues, e.g.,
oo
oo
oo
cantharides acting on kidneys produces convulsions.
eb
eb
eb
(3) Combined: Drugs like carbolic acid, oxalic acid, phosphorus,
m
m
etc., have local and remote actions.
Types: (1) Fulminant Poisoning: is produced by massive dose.
Death occurs rapidly, sometimes without producing symptoms. (2)
om
om
Acute poisoning is caused by an excessive single dose or several

co
smaller doses taken over short interval of time. (3) subacute

c
e.
e.
poisoning shows features of both acute and chronic poisoning.

re
fre
(4) Chronic poisoning is caused by smaller doses over a period re

sf
f
of time, resulting in gradual worsening. The poisons which are
ks
ks
k
commonly used for the purpose of chronic poisoning are arsenic,

oo
oo
oo
phosphorus, antimony and opium. (5) Self-poisoning (attempted

eb
eb
eb
suicide, parasuicide or pseudocide) is a conscious, often impulsive

m
manipulative act, undertaken to rectify any intolerable situation. Most

persons are psychologically disturbed.
Diagnosis of poisoning in the living: Suspicion of poisoning
om
arises when symptoms appear (1) suddenly in a healthy person, (2)

co
co
immediately or within a short period after food and drink, (3) are
e.
e.
uniform in character, and rapidly increase in severity, (4) when several

fre
fre
fre
persons eat or drink at the same time from the same source of poison,
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 190 04-03-2015 12:33:36 PM

e
e
m
m
om
m
co
co
e.
e.
all suffer from similar symptoms at or about the same time, (5) the
re
fre
fre
detection of poison in food taken, in the vomit or in the excreta is
sf
ks
ks
strong proof of poisoning.
k
Collect: (1) Stomach wash. (2) Ten ml. blood. (3) Urine 30 ml.
oo
oo
oo
Diagnosis of chronic poisoning: (1) The symptoms are
eb
eb
eb
exaggerated after eating of suspected food, fluid, or medicine. (2)
m
m
Malaise, cachexia, depression and gradual deterioration of general
condition of the patient. (3) Repeated attacks of diarrhoea, vomiting,
etc. (4) When the patient is removed from his usual surroundings,
om
m
the symptoms disappear. (5) Traces of poison may be found in urine,
co
co
stool or vomit.
e.
e.
Poison Information centres: National Poisons Information
fre
fre
fre
Centre has been established in AIIMS, New Dlhi and National
Institute of Occupation Health at Ahmedabad. They provide toxicity
ks
ks
ks
assessment and treatment recommendations over the telephone
oo
oo
oo
throughout the day for all kinds of poisons.
eb
eb
eb
Diagnosis in the dead: (1) Autopsy: External: (1) The surface
m
m
of the body and clothes may show stains or marks of vomit, faeces
or the poison itself. The colour changes in the corroded skin and
mucous membrane are: (1) sulphuric acid and hydrochloric acid: grey,
om
om
becoming black from blood, (2) nitric acid: brown, (3) hydrofluoric
co
acid: reddish-brown, (4) carbolic acid: greyish-white, (5) oxalic acid:

c
e.
e.
grey, blackened by blood, (6) cresols: brown leathery, (7) caustic

re
fre
alkalis: greyish-white, (8) mercuric chloride: bluish-white, (9) zinc re

sf
f
chloride: whitish, (10) chromic acid and potassium chromate: orange,
ks
ks
k
leathery. (2) Colour of P.M. staining. (3) Smell about mouth and
oo
oo
oo
nose: (a) Garlic-like: Phosphorus, arsine gas, arsenic (breath and

eb
eb
eb
perspiration), thallium, selenium, parathion, malathion, (b) Sweet

m
or fruity: Ethanol, chloroform, nitrites. (c) Acrid: paraldehyde,

chloral hydrate. (d) Rotten eggs: Hydrogen sulphide, mercaptans,
disulfiram. (e) Musty or fishy: Zinc phosphide. Other substances
om
are cyanides, phenol, opium, ether, camphor, etc. (4) The natural
co
co
orifices, e.g. mouth, nostrils, rectum, and vagina may show the
e.
e.
presence of poisonous material or the signs of its having been used.

fre
fre
fre
(5) Injection marks.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 191 04-03-2015 12:33:36 PM

e
e
m
m
om
m
co
co
e.
e.
Internal: (1) Smell: The skull should be opened first to detect
re
fre
fre
unusual odours in the brain tissues. This is useful in cyanide, alcohol,
sf
ks
ks
phenol, cresol, ether, chloroform and camphor poisoning.
k
(2) Mouth and throat for any evidence of inflammation, erosion

oo
oo
oo
or staining.
eb
eb
eb
(3) Oesophagus: Corrosive alkalis produce marked softening
m
m
and desquamation of the mucous membrane.
(4) Upper respiratory tract: Oedema of glottis, and congestion
and desquamation of the mucous membrane of the trachea and bronchi
om
m
may be seen in corrosive acid or alkali poisoning when it enters the
co
co
respiratory tract.
e.
e.
(5) Stomach: (a) Hyperaemia of the mucous membrane is caused
fre
fre
fre
by an irritant poison. It is usually patchy and of a deep crimson colour.
The ridges are more involved. The mucosa is covered with a sticky
ks
ks
ks
secretion and shows small haemorrhagic foci. (b) Softening of mucous
oo
oo
oo
membrane of stomach is caused by corrosive or irritant poisons,
eb
eb
eb
chiefly alkaline corrosives. (c) Ulcers: Ulceration due to corrosive
m
m
or irritant poisons is seen as an erosion, with thin, friable margins.
The surrounding mucosa is softened due to inflammation, and there
is diffuse hyperaemia. (d) Perforation: Perforation is occasionally
om
om
observed when the strong mineral acids have been taken, especially
co
sulphuric acid. The stomach is blackened and extensively destroyed,

c
e.
e.
the opening is irregular, the edges sloughing, and the adjecent tissues
re
fre
esaily torn. The acid escapes into the abdomen and causes peritonitis. re
sf
f
(6) The duodenum and Intestines: The only characteristic
ks
ks
k
change is colitis, which occurs in mercury poisoning.

oo
oo
oo
(7) Liver: Arsphenamine, chloroform, trinitrotoluene, carbon

eb
eb
eb
tetrachloride and senecio may produce liver necrosis. Arsenic,

m
carbon tetrachloride, amanita phalloides, yellow phosphorus, iodine

and rarely ferrous sulphate produce a fatty liver. Jaundice may arise
in poisoning by phosphorus, senecio and potassium chlorate, due to
om
acute heamolytic anaemia.

co
co
(8) Kidneys: Parenchymatous degenrative changes are commonly

e.
e.
found in irritant metal and cantharidin poisoning. Extensive necrosis

fre
fre
fre
of proximal convoluted tubules may be found from poisoning by

mercuric chloride, phenol, lysol and carbon tetrachloride.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 192 04-03-2015 12:33:36 PM

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e
m
m
om
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co
co
e.
e.
(9) Heart: Subendocardial haemorrhages in the left ventricle
re
fre
fre
occur in most cases of acute arsenic poisoning.
sf
Failure to Detect Poison: The possible explanations of negative
ks
ks
k
findings are: (1) The poison may have been eliminated by vomiting
oo
oo
oo
and diarrhoea, e.g. in irritant poisons. (2) The whole of the poison
eb
eb
eb
has disappeared from the lungs by evaporation or oxidation. (3)
m
m
The poison after absorption may be detoxified, conjugated, and
eliminated from the system. (4) Some vegetable alkaloidal poisons
cannot be detected by chemical analysis. (5) Some drugs are rapidly
om
m
metabolised, making extraction difficult. (6) Biological toxins and
co
co
venoms which may be protein in nature cannot be separated from
e.
e.
body tissues. (7) Some organic poisons especially alkaloids and
fre
fre
fre
glucosides may by oxidation during life or due to faulty preservation
or a long interval, or from decomposition of the body may deteriorate
ks
ks
ks
and cannot be detected chemically. (8) Many drugs may be present
oo
oo
oo
in very small quantity. (9) Insufficient material for analysis.
eb
eb
eb
(III) Experiments on Animals: Cat and dog are affected by
m
m
poisons almost in the same way as man. They may be fed with
suspected food, or with the poison after it is separated from the viscera
and the symptoms noted.
om
om
(IV) Circumstantial Evidence: Such evidence may consist of

co
motive, the evidence of witnesses about the recent purchase of the

c
e.
e.
poison, his behaviour before and after the commission of the offence,
re
fre
and the recovery of poison from the possession of the accused. re

sf
f
Drug Automatism: According to this hypothesis, the patient
ks
ks
k
develops a state of toxic delirium or amnesia after ingesting one or

oo
oo
oo
several doses of a drug (usually depressant drugs, barbiturates and

eb
eb
eb
alcohol), and in the delirious or automatism state, takes additional

m
doses of the drug without realising it.

Duties of medical practitioner in case of suspected poisoning:
The duties are (I) Medical: Care and treatment of the patient. (II)
om
Legal: Assist the police to determine the manner of death. (1) Note
co
co
preliminary particulars of the patient, i.e. age, sex, address, date and
e.
e.
time, identification marks, etc. (2) In case of suspected homicidal

fre
fre
fre
poisoning, the doctor must cnfirm his suspicion. For this he must
(a) collect vomit and urine and submit for analysis. (b) Observe and
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 193 04-03-2015 12:33:36 PM

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e
m
m
om
m
co
co
e.
e.
record the symptoms in relation to food. (c) Consult in confidence
re
fre
fre
senior doctor. (d) Either remove the patient to hospital, or appoint
sf
ks
ks
nurses of his confidence. (e) Keep detailed records of symptoms and
k
signs observed and treatment given from time to time. (3) If a private
oo
oo
oo
practitioner is convinced that the patient is suffering from homicidal
eb
eb
eb
poisoning, he is bound under S.39, Cr.P.C. to inform the police officer.
m
m
(4) If he is sure that the patient is suffering from suicidal poisoning,
he is not bound to inform police. (5) If the doctor is summoned by
investigating police officer, he is bound to give all information. (5)
om
m
A Government medical officer has to report to police all cases of
co
co
suspected poisoning, whether suicidal, homicidal or accidental treated
e.
e.
in the hospital. (6) If the condition of the patient is serious, he must
fre
fre
fre
arrange to record the dying declaration. (7) If patient dies, he should
not issue death certificate but he should inform the police.
ks
ks
ks
Treatment of poisoning: (I) Immediate resuscitative
oo
oo
oo
measures should be adopted to stabilise respiration, circulation and
eb
eb
eb
to correct CNS depression (ABCD of resuscitation). (II) Removal
m
m
of unabsorbed poison from body. (i) Inhaled poisons: The patient
must be removed into fresh air, artificial respiration and oxygen
given. The air-passages should be kept free from mucus by postural
om
om
drainage or by aspiration.
co
(ii) Injected poisons: If a poison has been injected subcutaneously

c
e.
e.
from a bite or an injection, a tight ligature should be applied

re
fre
immediately above the wound. The wound should be excised, and re

sf
f
the poison neutralised by suitable chemical substance.
ks
ks
k
(iii) Contact poisons: If the poison is applied to the skin or

oo
oo
oo
wound or is inserted into the vagina, rectum, or urinary bladder, it

eb
eb
eb
should be removed by washing with water or should be neutralised

m
by specific substance.
(iv) Ingested poisons: (1) Gastric lavage is useful within three
hours after ingestion of a poison. (2) It is done using a stomach tube
om
(Ewald or Boas tube), or ordinary soft, non-collapsible rubber tube

co
co
of one cm diameter and 1.5 metres length, with a funnel attached at

e.
e.
one end and a mark about 50 cm. from the other end, which should
fre
fre
fre
be rounded with lateral openings. (3) dentures must be removed and

a mouth gag used in patients whose mouth cannot be kept open while
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-22.indd 194 04-03-2015 12:33:36 PM

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co
e.
e.
passing the tube. (4) Patient should be lying on his left side or prone
re
fre
fre
with head hanging over the edge of the bed, and face down supported
sf
ks
ks
by an assistant, so that the mouth is at a lower level than pharynx.
k
(5) The end is lubricated with olive or sweet oil, or glycerine and
oo
oo
oo
is passed into the stomach by depressing the tongue with the finger
eb
eb
eb
and slowly passing it downwards till the fifty cm. mark is reached.
m
m
(6) About 250 ml. of warm water (35°C) should be passed through
the funnel held high up above the patient’s head. (7) When funnel is
empty, compress the tube below it between the finger and thumb, and
om
m
lower it below the level of the stomach; its contents will be emptied by
co
co
siphon action on releasing pressure on the rubber tubing. (8) Preserve
e.
e.
this for chemical analysis. (9) Gastric lavage may be done with water;
fre
fre
fre
1:5000 potassium permanganate; five percent sodium bicarbonate,
four percent tannic acid; one percent sodium thiosulphate; one percent
ks
ks
ks
sodium or potassuim iodide; one to three percent calcium lactate;
oo
oo
oo
saturated lime water or starch solution. (10) Next, use about half litre
eb
eb
eb
of suitable solution and repeat till clear and odourless fluid comes out.
m
m
(11) A small quantity of fluid containing the antitode is left behind in
the stomach, so that it may neutralise whatever small quantity of the
poison is left behind in the stomach. (12) Ryle’s tube or number 10
om
om
to 12 French catheter can be used for infants and children and about
co
25 cm. is necessary to reach stomach.

c
e.
e.
Contraindications: (1) The only absolute contraindication

re
fre
is corrosive poisoning (except carbolic acid) due to danger of re

sf
f
perforation. In the following conditions stomach wash can be done
ks
ks
k
by taking proper precautions. (1) Convulsant poisons, after controlling

oo
oo
oo
the convulsions. (2) Comatose patients. The airways should be sealed

eb
eb
eb
by cuffed intubation and lavage done. (3) Volatile poisons which may
m
be inhaled. (4) Upper alimentary disease, e.g. oesophageal varices.

(5) In patients with marked hypothermia and haemorrhagic diathesis.
Emetics: (1) Ipecac powder 1 to 2 g. or 30 ml. ipecac syrup for
om
adults, 15 ml (1 to 2 years); 10 ml. (9 to 12 months); 5ml (6 to 9

co
co
months); followed by several glasses of water produces vomiting in

e.
e.
90 to 95% of patients within 20 to 30 minutes. (2) The dose is repeated

fre
fre
fre
if vomiting does not occur in half hour. (3) This is the only and best
method of producing vomiting. (4) Stimulation of back of throat with
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-22.indd 195 04-03-2015 12:33:36 PM

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m
om
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co
e.
e.
finger, leaf, twig or a wooden tongue depressor is usually ineffective
re
fre
fre
and may be dangerous. (5) Household emetics, i.e. mustard powder
sf
ks
ks
and common salt are not effective and can lead to complications. (6)
k
Copper sulphate, tartar emetic, zinc sulphate and apomorphine are

oo
oo
oo
absolete.
eb
eb
eb
Contraindications: (1) Same as for stomach wash, and (1) severe
m
m
heart and lung diseases. (3) Advanced pregnancy.
(III) Antidotes: Antidotes are substances which counteract
or neutralise the effects of poisons. (a) Mechanical or physical
om
m
antidotes: They neutralise poisons by mechanical action or prevent
co
co
their absorption. (1) Activated charcoal is fine, black, adourless
e.
e.
powder. It can be used by mixing with water to form a soap-like
fre
fre
fre
slurry. Four to eight g. acts mechanically by adsorbing and retaining
within its pores organic and also to a less degree, mineral poisons
ks
ks
ks
and thus delays the absorption from the stomach. (2) Demulcents
oo
oo
oo
are substances which form a protective coating on the gastric
eb
eb
eb
mucous membrane, e.g. milk, starch, egg-white, mineral oil, milk
m
m
of magnesia, aluminium hydroxide gel, etc. Fats and oils should
not be used for oil-soluble poisons, such as kerosene, phosphorus,
organophosphorus compounds, DDT, phenol, turpentine, aniline,
om
om
acetone, carbontetrachloride, etc. (3) Bulky food acts as mechanical

co
antidote to glass powder by imprisoning its particles within its meshes.

c
e.
e.
Multidose activated charcoal: It facilitates the passage of

re
fre
substances from plasma into the intestinal lumen (by creating a re

sf
f
concentration gradient between blood and bowel fluid), where the
ks
ks
k
concentration of toxin has been significantly lowered by intraluminal

oo
oo
oo
charcoal adsorption, and significantly decreases half-life of several

eb
eb
eb
drugs. Initial loading dose is 1 to 2 g/kg. Repeat doses of 0.5 to one g/

m
kg are given at 4 to 6 hour intervals. It can also be given by continuous

infusion of 0.25 to 0.5 g/kg/ hour through a nasogastric tube.
(b) Chemical Antidotes: They counteract action of poison by
om
forming harmless or insoluble compounds or by oxidising poison when

co
co
brought into contact with them. (1) Dialysed iron is used to neutralise
e.
e.
arsenic. (2) Albumen precipitates mercuric chloride. (3) Common

fre
fre
fre
salt decomposes silver nitrate by direct chemical action, forming

insoluble silver chloride. (4) Alkalis for acids and acids for alkalis are
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-22.indd 196 04-03-2015 12:33:36 PM

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e.
e.
not advisable. (5) Potassium permanganate has oxidising properties.
re
fre
fre
1:5000 solution is used in poisoning for opium, strychnine, cyanides,
sf
ks
ks
barbiturates, atropine, phosphorus. When it reacts with the poison in
k
the stomach it loses its pink colour. (6) A solution of tincture iodine or
oo
oo
oo
Lugol’s iodine, fifteen drops to half a glass of warm water precipitates
eb
eb
eb
most alkaloids, lead, mercury, silver, quinine and strychnine. (7)
m
m
One teaspoonful of tannic acid in water precipitates apomorphine,
cinchona, strychnine, nicotine, cocaine, aconite, pilocarpine, lead,
silver, aluminium, cobalt, copper, mercury, nickle and zinc.
om
m
Universal antidote consists of (1) activated charcoal (or burnt
co
co
toast) two parts. (2) magnesium oxide one part, (3) tannic acid (or
e.
e.
strong tea) one part. It is not recommended.
fre
fre
fre
(c) Physiological or pharmacological Antidotes: (1) These act
on the tissues of the body and produce symptoms exactly opposite
ks
ks
ks
to those caused by the poisons. (2) They are used after poison is
oo
oo
oo
absorbed into circulation. (3) Atropine and physostigmine are two
eb
eb
eb
real physiological antidotes, as both of them affect nerve endings
m
m
and produce opposite effects on the heart rate, state of the pupils,
and glandular secretory activity. (4) Others are: barbiturates and
picrotoxin or amphetamine; strychnine and barbiturates; cyanides
om
om
and amyl nitrite.

co
Chelating agents: they inactivate a metallic ion with formation

c
e.
e.
of an inner ring structure in the molecule, the metallic ion becoming

re
fre
a member in the ring. re

sf
f
(A) B.A.L. (British anti-lewisite; dimercaprol): (1) It is used in
ks
ks
k
arsenic, lead, copper, mercury,, bismuth, gold and other heavy metals.
oo
oo
oo
(2) Many heavy metals have great affinity for sulphydryl (-SH)
eb
eb
eb
radicles and combine with them in tissues, and deprive the body of
m
the use of respiratory enzymes of tissue cells. (3) Dimercaprol has

two unsaturated sulphydry1 groups which combine with metal, and
thus prevent union of metal with the -SH group of the respiratory
om
enzyme systems. (4) In severe poisoning a dose of three to four mg/

co
co
kg is given. (5) Three ml. of 10% B.A.L. and 20% benzyl benzoate
e.
e.
in arachis oil is injected deep intramuscularly fourth hourly for the

fre
fre
fre
first two days, and then twice daily for ten days or till recovery. (6)
It is not used when liver is damaged.
ks
ks
ks
oo
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eb
eb
eb
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Ch-22.indd 197 04-03-2015 12:33:36 PM

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e.
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(B) E.D.T.A. (ethylenediamine tetra-acetic acid; calcium
re
fre
fre
disodium versenate): (1) It is effective in lead, mercury, copper,
sf
ks
ks
cobalt, iron, nickle, cadmium poisoning. (2) The usual dose is 25 to
k
35 mg/kg. body weight in 250 to 500 ml. of 5% glucose or normal

oo
oo
oo
saline i.v. over a one to two hour period twice daily for five days, and
eb
eb
eb
may be repeated after two to three days. (3) It is superior to B.A.L.
m
m
for the treatment of poisoning by arsenic and mercury.
(C) Penicillamine (cuprimine): (1) It is given in a dose of 30
mg/kg. body weight orally for seven days. (2) One to three g. can be
om
m
given in slow normal saline drip daily for two to four days. (3) It is
co
co
the chelating agent of maximum efficiency for heavy metals.
e.
e.
(D) DMSA (succimer): (1) It is used in lead, mercury and
fre
fre
fre
arsenic poisoning. (2) it is superior to EDTA in the treatment of lead
poisoning. (3) It is given in a dose of 10 mg/kg. orally every 8 hours
ks
ks
ks
for 5 days, followed by same dose every 12 hours for 14 days. (4) A
oo
oo
oo
combination of succimer and EDTA is more effective.
eb
eb
eb
(E) DMPS is used in mercury, lead and arsenic poisoning. Dose
m
m
5 mg/kg. i.v. in 6 divided doses, followed by 100 mg. orally twice a
day for 10 days.
(F) Desferrioxamine 8 to 12 g. orally for poisoning by iron.
om
om
(IV) Elimination of poison by Excretion: (1) Renal Excretion:

co
Salicylates and phenobarbitone can be easily excreted in alkaline

c
e.
e.
urine. Amphetamine, quinine and quinidine can be easily excreted

re
fre
in acid urine. (2) Purgatives. (3) Diaphoretics: In most cases re

sf
f
application of heat (blankets, hot water) will cause adequate
ks
ks
k
perspiration. A very abundant diaphoretic action will be produced

oo
oo
oo
by five mg. of pilocorpine nitrates s.c.

eb
eb
eb
(4) Peritoneal dialysis: (1) Alcohols, long-acting barbiturates,

m
chloral hydrate, salicylate, bromides, inorganic mercury, theophylline,

and sodium chlorate are effectively removed by peritoneal dialysis.
(2) It is only 10 to 25% as effective as haemodialysis. (3) Exchange
om
transfusion especially in children is useful in barbiturate, CO and

co
co
salicylate poisoning.
e.
e.
(5) Haemodialysis: (1) It is very useful for removing ethanol,

fre
fre
fre
methanol, ethylene glycol, chloral hydrate, trivalent arsenic,

ks
ks
ks
oo
oo
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eb
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Ch-22.indd 198 04-03-2015 12:33:36 PM

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acetaminophen, phenobarbital, bromides, salicylates, fluoride, sodium
re
fre
fre
chlorate, digitalis, methaqualone, and thiocyanates. (2) haemodialysis
sf
ks
ks
should be done (a) when normal route of excretion of a compound is
k
impaired, (b) when blood concentration of lethal substance is in toxic

oo
oo
oo
range, (c) patient is progressively deteriorating. (3) Haemodialysis
eb
eb
eb
is superior to charcoal haemoperfusion in poisoning by salicylates,
m
m
methanol, ethylene glycol.
(6) Charcoal haemoperfusion: Many drugs are actively adsorbed
by coated charcoal. They include barbiturates, salicylates, paraquat,
om
m
phenytoin, theophylline, chloral hydrate, digitalis, glutethimide,
co
co
pentobarbital, carbamozepine and paracetamol.
e.
e.
fre
fre
fre
ks
ks
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oo
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oo
eb
eb
eb
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co
c
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e.
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re
sf
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ks
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oo
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eb
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co
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e.
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Ch-22.indd 199 04-03-2015 12:33:36 PM

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co
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e. 23
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C h a p t e r
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Agricultural poisons
om
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co
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e.
e.
Organophosphorus poisons: They are derived from
fre
fre
fre
phosphoric acid and form two series of compounds. (A) Alkyl
ks
ks
ks
phosphates: (1) HETP. (2) TEPP (tetron). (3) OMPA. (4) Dimefox.
oo
oo
oo
(5) Isopestox. (6) Malathion (kill bug; bugsoline). (7) Sulfotepp.
eb
eb
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(8) Demeton. (9) Tichlorfon. (B) Aryl phosphates: (1) Parathion
(Follidol, kill phos; ekato). (2) Paraoxon. (3) Methly- parathion
m
m
(metacide). (4) Chlorothion. (5) Diazinon (Tik 20; diazion).
Absorption: It is absorbed by inhalation, through the skin,
om
om
mucous membranes and the G.I. tract.

co
Action: (1) Organophosphorus compounds are powerful

c
inhibitors of carboxylic esterase enzymes, including

e.
e.
acetylcholinesterase. (2) They bind firmly to the esterase enzyme,

re
fre
inactivating it by phosphorylation, at the myoneural junctions and re

sf
f
ks
ks
synapses of the ganglions. (3) Organic phosphates inhibit AChE
k
oo
oo
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in all parts of the body due to which acetylcholine accumulates

eb
eb
eb
at the parasympathetic, sympathetic and somatic sites and transfer

of nerve impulses across synapses at the autonomic ganglia at
m
the nerve-muscle junction is prevented. (4) They are also called

cholinesterase inhibitors. This produces a syndrome of overactivity
om
due to unhydrolysed acetylcholine. (5) Symptoms appear in both

co
co
sympathetic and parasympathetic nervous system.

Symptoms: With massive ingestion or inhalation, symptoms may
e.
e.
begin within five minutes, or may be delayed for half to one hour and
fre
fre
fre
are at maximum in two to eight hours.

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ks
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eb
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Ch-23.indd 200 04-03-2015 12:33:53 PM

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Agricultural Poisons 201
e.
e.
(I) Muscarinic manifestations: These symptoms can be easily
re
fre
fre
remembered by the acronym SLUDGE: Salivation, lachrymation,
sf
urination, defaecation, G.I. distress, and emesis. Bronchial tree:
ks
ks
k
Bronchoconstriction, increased bronchial secretions, dyspnoea,

oo
oo
oo
cyanosis, pulmonary oedema. G.I.: Anorexia, nausea, vomiting,
eb
eb
eb
cramps, diarrhoea, faecal incontinence, tenesmus. Sweat glands:
m
m
Increased sweating. Salivary glands: Increased salivation. Lacrimal
glands: Increased lacrimation. C.V.S: Bradycardia, hypotension.
Pupils: Miosis, occasionally unequal or dilated. Ciliary body:
om
m
Blurred vision. Bladder: Urinary incontinence.
co
co
(II) Nicotinic manifestations: (1) Striated muscle: muscular
e.
e.
fasciculations, cramps, weakness, areflexia, muscle paralyses. (2)
fre
fre
fre
Sympathetic ganglia: Hypertension, tachycardia, pallor, mydriasis.
(III) CNS manifestations: Restlessness, emotional lability,
ks
ks
ks
headache, tremors, drowsiness, confusion, slurred speech, ataxia,
oo
oo
oo
generalised weakness, coma, convulsions, depression of respiratory
eb
eb
eb
and cardiovascular centres.
m
m
Porphyrinaemia, resulting in chromolachryorrhoea (shedding of
red tears) due to accumulation of porphyrin in the lachrymal glands
is seen rarely.
om
om
Fatal Dose: Tepp, HETP, OMPA, Parathion: 80mg. i.m. or 175

co
mg. orally. Malathion and diazinon: one g. orally.

c
e.
e.
Fatal period: Usually within 24 hours.

re
fre
Cause of Death: Death is caused by paralysis of respiratory re

sf
f
muscles, respiratory arrest due to failure of respiratory centre, or
ks
ks
k
intense bronchoconstriction.
oo
oo
oo
Diagnosis: Give two mg. of atropine. In a normal person

eb
eb
eb
this causes marked atropinisation, but in a case of poisoning by

m
organophosphorus compound, symptoms are relieved without

atropinizing. Estimations of cholinesterase are confirmatory.
Treatment: (1) The patient is removed from the source of
om
exposure, the contaminated clothing removed, and the exposed

co
co
areas are washed with soap and water or some alkaline solution. (2)
e.
e.
Administer oxygen and aspirate secretions. (3) When cyanosis is

fre
fre
fre
present, maximal oxygenation should be achieved before atropine

is given. (4) Stomach should be washed with 1:5,000 potassium
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-23.indd 201 04-03-2015 12:33:53 PM

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m
m
om
m
co
co
e.
e.
permanganate solution. (5) Atropine sulphate arrests the muscarine
re
fre
fre
and CNS effects. Two to four mg. is given i.v. (paediatric dose 0.05
sf
ks
ks
mg/kg.) as a test dose. This dose may be doubled every five to ten
k
min. until muscarinic symptoms are relieved. Atropine should be

oo
oo
oo
continued until the tracheobronchial tree is cleared of the secretions
eb
eb
eb
and most secretions are dried. The average patient requires 40 mg.
m
m
per day but as much as 1000 mg/day has been used. It can be given
in continuous infusion. (6) Specific cholinesterase reactivators like
diacetyl monoxime (DAM), or 2-pyridine aldoxime methiodide
om
m
(pralidoxime iodide, 2-PAM), and pralidoxime chloride
co
co
(protopan, 2-PAM chloride) act by competing for the phosphate
e.
e.
moiety of organophosphorus compound and release it from the
fre
fre
fre
cholinesterase enzyme. Its action is marked at nicotinic sites. It also
lessens muscarine and CNS symptoms. The adult dose is one to
ks
ks
ks
two g.i.v. as a five percent solution given over half-an-hour. This
oo
oo
oo
dose should be repeated at 6 to 12 hour intervals for 24 to 48 hours.
eb
eb
eb
Maximum dose should not exceed 12 gm. in a 24 hours period. (7)
m
m
Pralidoxime and atropine work synergistically, and should be used
together. (8) Obidoxime chloride 250 mg. i.v. or i.m. is more potent,
but its toxicity is slightly greater. (9) Symptomatic.
om
om
Prophylaxis: The precautions to be taken are: (1) protective

co
clothing. (2) The face and the hands should be thoroughly washed
c
e.
e.
after spraying with soap and water. (3) Not more than two hours
re
fre
spraying a day should be done by a worker. (4) The workers should re

sf
f
not smoke, chew or drink in the spraying area.
ks
ks
k
P.M. appearances: (1) Signs of asphyxia are found. (2) The face
oo
oo
oo
is congested and there is cyanosis of the lips, fingers and toes. (3)
eb
eb
eb
Blood stained froth is seen at the mouth and nose. (4) The stomach
m
contents may smell of kerosene. (5) The mucosa of the stomach is

congested with submucous petechial haemorrhages. (6) Respiratory
passages are congested and contain frothy, haemorrhagic exudate. (7)
om
The lungs show gross congestion, excessive oedema and subpleural

co
co
petechiae. (8) The internal organs, brain and meninges are congested;
e.
e.
petechial haemorrhages are present. (9) The cholinesterase in

fre
fre
fre
erythrocytes and at myoneural junctions is below normal.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-23.indd 202 04-03-2015 12:33:53 PM

e
e
m
m
om
m
co
co
e.
e.
Carbamates: (1) They are marketed in the form of dust or
re
fre
fre
solutions, such as aldicarb (Temik), aminocarb (Matacil), aprocarb
sf
ks
ks
(Baygon), carbaryl (Sevin), carbofuran (Furaxdan). (2) Absorption
k
occurs through all routes. (3) They will spontaneously hydrolyse

oo
oo
oo
from the cholinesterase enzymatic site within 48 hours and as such
eb
eb
eb
toxicity is limited. (4) All other clinical manifestations are similar to
m
m
organophosphates.
Treatment: Atropine is the specific antidote. Pralidoxime may
diminish the severity of symptoms and help prevent some morbidity.
om
m
Paraquat
co
co
It is a dipyridylium compound and used as herbicide and weed-
e.
e.
killer. It is produced commercially as a brownish concentrated liquid
fre
fre
fre
of the dichloride salt in 10 to 30% strength, under the trade name,
ks
ks
ks
‘Gramoxone’ and as brown granules called “Weedol” at about 5%
strength. Deaths by inhalation while spraying are very rare.
oo
oo
oo
Absorption and excretion: Absorption through inhalation, skin
eb
eb
eb
or eye contact is minimal. Five to ten percent of the dose is absorbed,
m
m
and the rest is excreted in the faeces. It is distributed to all the organs.
More than 90% of the absorbed paraquat is excreted unchanged in
the urine within the first twentyfour hours.
om
om
Fatal Dose: Three to five gm.

co
Fatal Period: 2 to 7 days.

c
e.
e.
Signs and symptoms: local: Irritation and inflammation of skin,

re
fre
nails, cornea, conjunctivae and nasal mucosa. G.I.T.: Oropharyngeal re

sf
f
ks
ks
ulceration and corrosion, nausea, vomiting, haematemesis, diarrhoea,
k
painful mucosal ulceration, dysphagia, aphonia, perforation of

oo
oo
oo
oesophagus, mediastinitis and pneumothorax. Renal: Oliguria or non-

eb
eb
eb
oliguric renal failure due to acute tubular necrosis. Lungs: Cough,

m
haemoptysis, dyspnea due to pulmonary oedema, haemorrhage

or fibrosis. Liver: Centrilobular hepatic necrosis and cholestasis.
C.V.S.: Hypovolaemia, shock, arrhythmias. C.N.S.: Late coma,
om
convulsions, cerebral oedema.

co
co
Cause of death: Death occurs from multiorgan failure or

e.
e.
corrosive effects in the G.I. tract. Death from oesophageal perforation

fre
fre
fre
and mediastinitis can occur within two to three days of ingestion.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-23.indd 203 04-03-2015 12:33:53 PM

e
e
m
m
om
m
co
co
e.
e.
In ingestions of less than three gm death occurs from five days to
re
fre
fre
several weeks.
sf
Treatment: (1) Gastric lavage. (2) One litre of 15 to 30% aqueous
ks
ks
k
suspension of Fuller’s earth or 7% bentonite are given to adsorb

oo
oo
oo
paraquat, followed by 200 ml of 20% mannitol. (3) If the above
eb
eb
eb
adsorbents are not available, activated charcoal can be given. (4)
m
m
Haemodialysis and haemoperfusion is useful if done within 12 hours
of ingestion. (5) Remove all clothing and wash the patient thoroughly
with soap and water.
om
m
Postmortem appearances: There may be ulceration around the
co
co
lips and mouth. The stomach may show erosions. The kidneys may
e.
e.
show cortical pallor and diffuse tubular damage. Progressive lung
fre
fre
fre
damage may cause death within two weeks. Diffuse pulmonary
oedema and haemorrhages occur. Within a few days repair begins.
ks
ks
ks
If patient continues to survive, the alveoli begin to fibrose. The lungs
oo
oo
oo
may be mistaken for a diffuse pneumonia. There may be a fibrinous
eb
eb
eb
pleurisy.
m
m
Endrin: (1) Endrin is a polycyclic, polychlorinated hydrocarbon.
(2) Its taste is bitter. (3) It is also called “plant penicillin”, because
of its broad spectrum of activity against various insect pests. (4) It
om
om
is mixed with petroleum hydrocarbon such as aromax, which smells

co
like kerosene.
c
e.
e.
Symptoms: These begin within one to six hours. They are

re
fre
salivation, nausea, vomiting, abdominal pain, hoarseness of voice, re

sf
f
coughing, froth at the mouth and nose, dyspnoea, headache, giddiness,
ks
ks
k
restlessness, hyperirritability, dilated pupils, incoordination, ataxia,

oo
oo
oo
mental confusion, tremors, tonic and clonic convulsions, coma and

eb
eb
eb
death due to respiratory failure.

m
F.D.: Five to six g. F.P.: One to several hours.

P.M.Appearances: The mouth and stomach contents smell of
kerosene. Signs of asphyxia are present.
om
Treatment: There is no specific antidote.

co
co
Zinc Phosphide: It is a steel-grey crystalline powder with

e.
e.
a garlicky odour. It reacts with the acid in the stomach and liberates
fre
fre
fre
phosphine. The symptoms are: vomiting, diarrhoea, cyanosis, fever,

respiratory distress and death.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-23.indd 204 04-03-2015 12:33:53 PM

e
e
m
m
om
m
co
co
e.
e.
F.D.: Five g. F.P. One day.
re
fre
fre
P.M. Appearances: Garlicky odour in stomach contents. Blood
sf
ks
ks
is cherry-red. Lungs are congested and oedematous. Liver shows fatty
k
degeneration and necrosis.

oo
oo
oo
Aluminium Phosphide (ALP) is a solid fumigant
eb
eb
eb
pesticide, insecticide and rodenticide. On coming in contact with
m
m
moisture ALP liberates phosphine. It has garlicky odour.
Absorption and Excretion: Phosphine is rapidly absorbed from
the G.I. tract and from the lungs after inhalation. Phosphine is oxidised
om
m
slowly to oxyacids and excreted in the urine as hypophosphite and
co
co
through the lungs.
e.
e.
Action: Phosphine inhibits cytochrome oxidase.
fre
fre
fre
F.D.: One tablet. F.P.: one hour to 4 days. Majority die within
24 hours.
ks
ks
ks
Symptoms: Moderate and severe poisoning produces: G.I.T.:
oo
oo
oo
nausea, vomiting, diarrhoea, retrosternal pain. C.V.S.: Hypotension,
eb
eb
eb
shock, arrhythmias, myocarditis, pericarditis, acute congestive
m
m
heart failure. R.S.: cough, dyspnoea, cyanosis, pulmonary oedema,
respiratory failure. Hepatic: Jaundice, hepatitis, hepatomegaly.
Renal failure. C.N.S.: Headache, dizziness, altered mental state,
om
om
restlessness, convulsions, acute hypoxic encephalopathy, coma.

co
P.M. Appearances: Garlic-like odour is present at the mouth

c
e.
e.
and nostrils and in the gastric contents. Blood stained forth is found
re
fre
at the mouth and nostrils. The lungs, liver, spleen, kidneys and brain re
sf
f
are congested.
ks
ks
k
Treatment: (1) Gastric lavage with potassium permanganate. (2)

oo
oo
oo
Activated charcoal. (3) There is no specific antidote.

eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-23.indd 205 04-03-2015 12:33:53 PM

e
e
m
m
om
m
co
co
e. 24
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Corrosive Poisons
om
m
co
co
e.
e.
They act by extracting water from the tissues, and coagulate
fre
fre
fre
cellular proteins, and convert haemoglobin into haematin.
ks
ks
ks
Sulphuric Acid (oil of vitriol).
oo
oo
oo
Symptoms: (1) The lips are usually swollen and excoriated, and
eb
eb
eb
brown or black streaks may be found from angles of the mouth to
the sides of the chin. (2) There is corrosion of mucous membranes
m
m
of mouth, throat and oesophagus, immediate burning pain and
dysphagia. (3) Eructation, nausea and vomiting occur. (4) The vomit
om
om
is brown or black, mucoid, strongly acid and may contain shreds of

co
the charred wall of the stomach. (5) Thirst is intense. (6) Teeth are
c
chalky-white. (7) Tongue becomes swollen, sodden and black. (8) The
e.
e.
abdomen becomes distended and very tender. (9) The voice becomes
re
fre
hoarse, and the pupils usually dilated. (10) If person recovers, late re
sf
f
ks
ks
oesophageal, gastric and pyloric strictures and stenoses may develop.
k
oo
oo
oo
Fatal dose: 5 to 10 ml. F.P. 12 to 24 hours.

eb
eb
eb
Cause of Death: (1) Circulatory collapse. (2) Spasm or oedema

of glottis. (3) Collapse due to perforation of stomach. (4) Toxaemia.
m
Treatment: (1) The acid should be immediately diluted

and neutralised in situ by giving one-fourth litre of water or
om
milk, mixed with four tablespoonfuls of calcium or magnesium

co
co
oxide, aluminium hydroxide gel or calcined magnesia. (2) Alkaline

carbonates and bicarbonates, which liberate CO2 should not be used,
e.
e.
as they cause gastric distention and sometimes rupture. (3) Give

fre
fre
fre
demulcents. (4) Prednisolone sixty mg./day may be given in divided

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-24.indd 206 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
Corrosive Poisons 207
e.
e.
doses to prevent oesophageal stricture and for shock. (5) Later, three
re
fre
fre
to four cm. diameter mercury-filled bougie should be passed daily
sf
ks
ks
if stricture develops. (6) Tracheostomy. (7) Give nothing by mouth.
k
(8) Nutrient substances are given by i.v. route for about a week. (9)
oo
oo
oo
Then try liquids, soft food and finally a regular diet. (10) Skin burns
eb
eb
eb
are washed with water, and a paste of magnesium oxide is applied.
m
m
P.M. Appearances: (1) Corrosion of mucous membranes of lips,
mouth and throat and of the skin over the chin, angles of the mouth
and hands is seen. (2) The necrotic areas are at first greyish-white, but
om
m
soon become brown or black and leathery. (3) The upper digestive
co
co
tract is inflamed and swollen by oedema and severe interstitial
e.
e.
haemorrhage, even when corrosion is absent. The greater part of
fre
fre
fre
stomach may be converted into soft, spongy, black mass. (4) the
mucosal ridges are more damaged than the intervening furrows. (5)
ks
ks
ks
In the damaged area, the mucosa or even the whole thickness of the
oo
oo
oo
stomach wall has a brown or black colour. (6) Perforation may occur,
eb
eb
eb
and chemical peritonitis and corrosion of organs is seen. (7) Corrosion
m
m
or severe inflammation of the larynx and trachea may be present.
Vitriolage (vitriol throwing): throwing of sulphuric
acid on another individual is known as vitriolage. (2) Jealous or
om
om
disgruntled persons may throw a corrosive to disfigure and harm their

co
enemies. (3) Blindness may occur if the eyes are involved. (4) Death
c
e.
e.
may result from shock or toxaemia, if extensive area is involved. (5)

re
fre
The burns are painless, and penetrating. (6) Repair is slow and the re
sf
f
scar tissue causes contracture. (7) Sometimes, corrosive alkali or juice
ks
ks
k
of marking nut or calotropis is used to disfigure the face.

oo
oo
oo
Treatment: (1) The affected part is washed with plenty of water

eb
eb
eb
and soap and a thick paste of magnesium oxide or carbonate is

m
applied. (2) The eyes are washed with water and irrigated with dilute
sodium bicarbonate solution. (3) Later, a few drops of olive oil or
castor oil is put into eyes.
om
Nitric Acid (aqua fortis, red spirit of nitre). In concentrated

co
co
from, it combines with organic matter and produces an yellow

e.
e.
discolouration of tissues, due to the production of picric acid

fre
fre
fre
(xanthoproteic reaction).
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-24.indd 207 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
e.
e.
Symptoms are those of poisoning by sulphuric acid. (2) It causes
re
fre
fre
yellow discolouration of the tissues, including the crown of the teeth
sf
ks
ks
and yellow stains on the clothing.
k
F.D.: 10 to 15 ml. F.P.: 12 to 24 hours.

oo
oo
oo
P.M. Appearances are same as sulphuric acid except tissues are
eb
eb
eb
stained yellow.
m
m
Hydrochloric Acid (muriatic acid):
Symptoms: It does not usually corrode or seriously damage the
skin, but readily destroys mucous membrane which is at first grey or
om
m
grey-white, and later becomes brown or black.
co
co
F.D.: 15 to 20 ml. F.P.: 12 to 24 hours.
e.
e.
Oxalic acid: It is used as a bleach to remove stains, and for
fre
fre
fre
removing writing and signature illegally.
Action: Local: (1) Crystals and concentrated solution of oxalates
ks
ks
ks
are corrosive. (2) They rarely damage the skin, but readily corrode
oo
oo
oo
the mucous membrane of the digestive tract. (3) They do not lose
eb
eb
eb
their poisonous properties when diluted.
m
m
Systemic: (a) Shock: Large doses cause rapid death from shock.
(b) Hypocalcaemia: Those who survive for a few hours develop
hypocalcaemia. (c) Renal damage: Tubular nephrosis or necrosis
om
om
and death from uraemia in 2 to 14 days.

co
F.D.: 15 to 20 g. F.P.: One to two hours

c
e.
e.
Symptoms: (a) Fulminating poisoning: (1) Large concentrated

re
fre
doses of 5 g. or more produce immediate symptoms and death within re

sf
f
minutes. (2) There is burning, sour, bitter taste in the mouth with a
ks
ks
k
sense of constriction around the throat and burning pain from the
oo
oo
oo
mouth to the stomach. (3) Pain is very severe all over the abdomen.
eb
eb
eb
(4) Nausea and eructations are followed by vomiting which may be

m
persistent. (5) Vomit has a coffee-ground appearance. (6) Diarrhoea

will occur if life is prolonged.
(b) Acute Poisoning: (1) When the patient survives for a few
om
hours, the symptoms are those of hypocalcaemia, and less by digestive

co
co
upset. (2) There may be numbness and tingling of the fingertips and
e.
e.
legs. (3) Signs of cardiovascular collapse appear.

fre
fre
fre
(c) Delayed Poisoning: The symptoms are of uraemia. There

may be metabolic acidosis and ventricular fibrillation.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-24.indd 208 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
e.
e.
Treatment: (1) The stomach is washed using calcium lactate or
re
fre
fre
gluconate. (2) The antidote is any preparation of calcium which
sf
ks
ks
converts the poison into insoluble calcium oxalate, e.g. lime water,
k
calcium lactate, calcium gluconate, calcium chloride, a suspension

oo
oo
oo
of chalk in water or milk. (3) Calcium gluconate 10%, 10 ml. i.v. at
eb
eb
eb
frequent intervals. (4) Parathyroid extract hundred units i.m. in severe
m
m
cases. (5) Symptomatic.
P.M. Appearances: (1) Used in strong solution, the mucous
membrane of the tongue, mouth, pharynx and oesophagus will be
om
m
whitened as if bleached, and has a scalded appearance. (2) The inner
co
co
surface of the oesophagus is corrugated. (3) The mucous membrane
e.
e.
of the stomach is reddened or punctate from erosions or almost black.
fre
fre
fre
It may be softened in patches. (4) Many dark-brown or black streaks
run along the length of the stomach over the mucous membrane,
ks
ks
ks
often with intercommunicating branches. (5) The stomach contents
oo
oo
oo
are gelatinous and brownish. (6) The kidneys are swollen by oedema,
eb
eb
eb
congested, and the tubules are filled with oxalate crystals.
m
m
Absorption: It is absorbed from the alimentary tract, respiratory
tract, rectum, vagina, serous cavities, wounds and through skin.
Elimination: Phenol is converted into hydroquinone and
om
om
pyrocatechol in the body before being excreted in the urine. A trace

co
is excreted by the lungs, salivary glands, skin and stomach.

c
e.
e.
Carbolic acid
re
fre
F.D.: 10 to 15 g. F.P.: 3 to 4 hours. re

sf
f
ks
ks
Symptoms: Poisoning by carbolic acid is known as carbolism.
k
Local: (1) Skin: (1) It causes burning and numbness and a white
oo
oo
oo
opaque eschar which is painless and falls off in a few days. (2) G.I.T.
eb
eb
eb
(a) Hot burning pain extends from the mouth to the stomach, followed
m
by tingling and later anaesthesia. (b) Deglutition and speech become

painful and difficult. (c) The lips, mouth and tongue are corroded,
which soon become white and hardened. (3) R.S.: Pulmonary and
om
laryngeal oedema develop due to irritation.

co
co
Systemic Effects: (1) Phenol is depressant of nervous system,

e.
e.
especially the respiratory centre. (2) Headache, giddiness, tinnitus,

fre
fre
fre
muscular spasm and later collapse, unconsciousness and coma occur.

ks
ks
ks
(3) Pupils are contracted, breathing is stertorous, pulse is rapid, feeble

oo
oo
oo
eb
eb
eb
m
Ch-24.indd 209 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
e.
e.
and irregular, face covered with cold sweat, and thre is cyanosis. (4)
re
fre
fre
There is a strong odour of phenol in breath.
sf
Urine: (1) It is scanty and contains albumin and free haemoglobin;
ks
ks
k
suppression may follow. (2) It may be colourless or slightly green at

oo
oo
oo
first, but turns green or even black on exposure to air. (3) In the body,
eb
eb
eb
phenol is partly oxidised to hydroquinone and pyrocatechol, which
m
m
with unchanged phenol are excreted in the urine, partly free and partly
in unstable combination with sulphuric and glucoronic acids. (4) The
further oxidation of hydroquinone and pyrocatechol in the urine
om
m
is the cause of green colouration. This is known as carboluria.
co
co
The hydroquinone and pyrocatechol may cause pigmentation
e.
e.
in cornea and various cartilages, a condition called oochronosis.
fre
fre
fre
Treatment: (1) The stomach should be washed with luke
warm water containing charcoal, olive oil, castor oil, magnesium or
ks
ks
ks
saccharated lime with which phenol combines and forms harmless
oo
oo
oo
products. (2) When lavage is completed, 30 g. of magnesium sulphate
eb
eb
eb
or a quantity of medicinal liquid paraffin should be left in the
m
m
stomach. (3) Activated charcoal in usual dose. (4) Saline containing
7 g. of sodium bicarbonate per litre is given i.v. to dilute carbolic
acid in blood and to encourage excretion by producing diuresis. (5)
om
om
Demulcents. (6) If phenol falls on the body, the area is washed with
co
soap and water. (7) Olive oil, or methylated spirit or ethyl alcohol
c
e.
e.
act as solvents.
re
fre
P.M. Appearances: External: (1) Corrosion of the skin has a re

sf
f
greyish or brown colour. (2) The tongue is usually white and swollen,
ks
ks
k
and there is a smell of phenol about the mouth. (3) The mucous
oo
oo
oo
membrane of the lips, mouth and throat is corrugated, sodden,

eb
eb
eb
whitened or ash-gey with small submucous haemorrhages.

m
Internal: (1) The mucosa of the oesophagus is tough, white or

grey, corrugated and arranged in longitudinal folds. (2) The stomach
mucosal folds are swollen and covered by opaque, coagulated grey
om
or brown thickened mucous membrane. The intervening furrows are

co
co
less damaged, dark-red and not opaque. The mucous membrane is

e.
e.
thickened and looks leathery. (3) The liver and spleen usually show
fre
fre
fre
a whitish, hardened patch where the stomach has been in contact

with them due to transudation of phenol. (4) The kidneys show
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-24.indd 210 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
e.
e.
haemorrhagic nephritis in cases of delayed death. (5) The brain
re
fre
fre
is congested and may be oedematous. (6) The blood is dark and
sf
ks
ks
semifluid or only partially coagulated.
k
Caustic Alkalis: Action: Strong alkalis absorb water from

oo
oo
oo
the tissues and precipitate proteins. Alkalis produce liquefaction
eb
eb
eb
necrosis and saponification of fats.
m
m
Symptoms: (1) When strong alkali is ingested, abrasions, blisters
and brownish discolouration are seen on the lips and skin around the
mouth. (2) The mucosa of digestive tract is swollen and a grey slough
om
m
readily detached, lies over the inflamed tissues. (3) Oesophageal
co
co
stricture formation is a major long-term complication. (4) Ammoniacal
e.
e.
vapour when inhaled, causes congestion and watering of the eyes,
fre
fre
fre
violent sneezing, coughing, choking and suffocation.
F.D.: Potassium or sodium hydorxide five g.; Potassium and
ks
ks
ks
sodium carbonate and ammonia 30 g.; F.P.: Usually 24 hours.
oo
oo
oo
Treatment: (1) Neutralise poison by giving vegetable acids, e.g.,
eb
eb
eb
acetic, citric, or tartaric acid mixed with large quantity of water. (2)
m
m
Demulcents.
P.M. Appearances: (1) The marks about the mouth become
dark in colour and parchment-like after death. (2) Alkalis produce a
om
om
soft, oedematous, translucent, soap-like, swollen eschar, red-brown

co
from absorption of altered blood pigment. (3) The sloughs are

c
e.
e.
mucilaginous. (4) Charring is not seen. (5) Alkalis most severely

re
fre
affect the squamous epithelium of the oesophagus, although re

sf
f
stomach is involved in 20% cases. (6) Mucosa may be brownish due
ks
ks
k
to formation of alkali haematin. (7) Acids produce more damage

oo
oo
oo
to the stomach than the oesophagus.

eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-24.indd 211 04-03-2015 12:34:17 PM

e
e
m
m
om
m
co
co
e. 25
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Metallic Poisons
om
m
co
co
e.
e.
Arsenic: Action: It combines with the sulphydryl enzymes
fre
fre
fre
and interferes with cell metabolism. Locally it causes irritation of the
ks
ks
ks
mucous membranes and remotely depression of the nervous system.
oo
oo
oo
Symptoms: (1) The fulminant type: Large dose when rapidly
eb
eb
eb
absorbed causes death in one to 3 hours from shock and peripheral
vascular failure.
m
m
(2) The gastroenteric type: (1) It resembles bacterial food
poisoning. (2) Symptoms usually appear half to one hour after
om
om
ingestion. (3) There is sweetish metallic taste. (4) G.I.T.: Constriction

co
in the throat and difficulty in swallowing; burning and colicky pain

c
in oesophagus, stomach and bowel occur. Intense thirst and severe

e.
e.
vomiting which may be projectile are the constant symptoms. The

re
fre
stools are expelled frequently and involuntarily and are dark-coloured, re

sf
f
ks
ks
stinking and bloody, but later become colourless, odourless and
k
oo
oo
oo
watery resembling rice-water stools of cholera. (5) Hepatic: Fatty

infiltration. (6) Renal: Oliguria, uraemia. Urine contains albumen,
eb
eb
eb
red cells and casts. (7) C.V.S.: Acute circulatory collapse with
m
vasodilation, increased vascular permeability, ventricular tachycardia,

ventricular fibrillation. (8) C.N.S.: Headache, vertigo, hyperthermia,
om
tremors, convulsions, coma, general paralysis. (9) Skin: Delayed loss

co
co
of hair, skin eruptions.

(3) Narcotic type: G.I. symptoms are slight. There is giddiness,
e.
e.
formication and tenderness of the muscles, delirium, coma, and death.

fre
fre
fre
F.D.: 100 to 200 mg. F.P.: One to two days.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 212 04-03-2015 12:34:34 PM

e
e
m
m
om
m
co
co
Metallic Poisons 213
e.
e.
Treatment: (1) Emetics. (2) The stomach should be emptied and
re
fre
fre
then repeatedly washed with large amount of warm water and milk.
sf
(3) Freshly precipitated hydrated ferric oxide (arsenic antidote)
ks
ks
k
is given in tablespoonful dose at short intervals for two to three days.

oo
oo
oo
This forms a sparingly soluble ferric arsenite. (4) Tablespoonful dose of
eb
eb
eb
dialysed iron may be used as substitute. (5) If none of these is available
m
m
calcined magnesia mixed with an equal quantity of activated
charcoal may be given. (6) The stomach should be washed out at
intervals to remove iron compounds, and adherent arsenic. (7) Butter
om
m
and greasy substances prevent absorption. (8) B.A.L. 3 to 5 mg/kg.
co
co
i.m. every 4 hours for 2 days and then twice daily for 7 to 10 days. (9)
e.
e.
Calcium disodium versenate is superior to B.A.L. in some respects.
fre
fre
fre
(5) Penicillamine 100 mg/kg. daily in 4 divided doses for 5 days.
ks
ks
ks
Differences between arsenic poisoning and cholera
oo
oo
oo
Trait Arsenic poisoning Cholera
(1) Pain in throat: Before vomiting After vomiting.
eb
eb
eb
(2) Purging: Follows vomiting. Precedes vomiting.
m
(3) Stools: Rice-water in the Rice water and

m
early stages, and later passed in continuous
bloody. involuntary jet.
om
om
(4) Tenesmus: Present. Absent.

co
c
(5) Vomited matter: Contains mucus, bile Watery without mucus,

e.
e.
and blood. bile and blood.

re
fre
(6) Voice: Not affected. Rough and whistling. re

sf
f
ks
ks
(7) Conjunctivae: Inflamed. Not inflamed.
k
(8) Excreta: Arsenic present. Cholera vibrio present.

oo
oo
oo
P.M. Appearances: (1) The eyeballs are sunken and the skin
eb
eb
eb
is cyanosed. The body may be shrunken due to dehydration. (2)

m
The lesions are mainly found in stomach. The mucosa is swollen,

oedematous and red either generally or in patches, especially in
the pyloric region. There may be lines of redness running along the
om
walls or curved lines of submucous haemorrhages. Usually groups

co
co
of petechiae are seen scattered over the mucosa, and sometimes

e.
e.
large submucosal and subperitoneal haemorrhages. (3) the stomach

fre
fre
fre
mucosa resembles red velvet. (4) Small acute ulcerations or large

ks
ks
ks
erosions may be found, especially at the pyloric end. (5) A mass of

oo
oo
oo
eb
eb
eb
m
Ch-25.indd 213 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
sticky mucus covers the mucosa. (6) The liver, spleen and kidneys are
re
fre
fre
congested, enlarged and show cloudy swelling and ocassionally fatty
sf
ks
ks
change. (7) The lungs are congested with subpleural ecchymoses.
k
(8) Nephritis, particularly of golmerular type is frequent. (9)

oo
oo
oo
Haemorrhages may be found in the abdominal organs, mesenteries,
eb
eb
eb
and occassionally in the larynx, trachea and lungs. (10) There may be
m
m
oedema of brain with patchy necrosis or haemorrhagic encephalitis.
(11) The meninges are congested. (12) Subendocardial petechial
haemorrhages of the left ventricle are common in arsenic poisoning
om
m
and may be found even when the stomach does not show signs of
co
co
irritation.
e.
e.
Chronic poisoning: C.N.S.: Polyneuritis, optic neuritis,
fre
fre
fre
anaesthesias, paraesthesias. Skin: Pigmentation consists of a finely
mottled brown change mostly on the temples, eyelids and neck
ks
ks
ks
(raindrop type of pigmentation) which persists for many months.
oo
oo
oo
There may be a rash. In prolonged contact, hyperkeratosis of the
eb
eb
eb
palms and soles with irregular thickening of the nails and development
m
m
of bands of opacity in the fingernails called Aldrich-Mees lines is
seen. G.I.Tract: Cirrhosis of the liver, nausea, vomiting, abdominal
cramps, diarrhoea, salivation. C.V. System and kidney: Chronic
om
om
nephritis, cardiac failure, dependent oedema. General: Anaemia

co
and weight loss.

c
e.
e.
Absorption: It is absorbed from the alimentary tract and from

re
fre
the skin when applied in suitable vehicle. re

sf
f
Distribution: (1) In the early stage, it is found in greatest quantity
ks
ks
k
in the liver followed by kidneys and spleen. (2) Arsenic is excreted

oo
oo
oo
into the stomach and intestines after absorption even when given
eb
eb
eb
by routes other than mouth. (3) In cases in which life is prolonged,

m
it is found in the muscles for days, in the bones for weeks, and in
keratin tissues, hair, nails and skin for months.
Elimination: It is eliminated mainly by the kidneys, but also in
om
the faeces, bile, sweat, milk and other secretions.

co
co
Tolerance: Some people take arsenic daily as a tonic or as an

e.
e.
aphrodisiac and they acquire tolerance up to 0.3 g. or more in one

fre
fre
fre
dose. Such people are known as arsenophagists.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 214 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
Poisoning: Homicide: The disadvantages are: (1) it delays
re
fre
fre
putrefaction, (2) can be detected in completely decomposed bodies,
sf
ks
ks
(3) can be found in bones, hair and nails for a long time, (4) can be
k
detected in charred bones or ashes. Sometimes, it is given mixed with

oo
oo
oo
tobacco cigars for homicide or to rob.
eb
eb
eb
P.M.Imbibition of Arsenic: In exhumations the possibility of
m
m
imbibition of arsenic from the stomach into neighbouring viscera and
also contamination from the surrounding earth should be remembered.
Arsenic found in the soil is usually an insoluble salt. Keratin tissues
om
m
absorb arsenic by contamination from outside.
co
co
Mercury: It forms two series of compounds: (1) Mercuric,
e.
e.
which are solube and intensely poisonous, and (2) mercurous,
fre
fre
fre
which are much less solube and less active. Metallic mercury is not
poisonous if swallowed.
ks
ks
ks
Symptoms: (1) Acrid metallic taste and a feeling of constriction
oo
oo
oo
in the throat, hoarse voice, difficulty in breathing. (2) The mouth,
eb
eb
eb
tongue and fauces become corroded, swollen and show a greyish-
m
m
white coating. (3) Nausea, retching, vomiting and diarrhoea with
blood stained stools and tenesmus. (4) Circulatory collapse occurs
soon. (5) If a person survives, second phase begins in one to three
om
om
days; glossitis, and ulcerative gingivitis appear within 24 to 36 hours.

co
(6) Severe infection, loosening of teeth and necrosis of the jaw may
c
e.
e.
occur. (7) In two to three days, renal tubules show necrosis and
re
fre
produce transient polyuria, albuminuria, cylindruria, uraemia and re

sf
f
acidosis. (8) Recovery may occur within 10 to 14 days. (9) After
ks
ks
k
many days membranous colitis develops and produces dysentery,

oo
oo
oo
tenesmus, ulceration of colonic mucosa and haemorrhage.

eb
eb
eb
F.D.: One to 2 g. F.P.: Three to 5 days.

m
Treatment: (1) Give egg-whites, milk or activated charcoal

to precipitate mercury. (2) Gastric lavage with 5% solution of
sodium formaldehyde sulphoxylate. This reduces mercuric chloride
om
to metallic mercury. (3) B.A.L. is the chelator of choice. (4)

co
co
penicillamine. (5) sodium or magnesium sulphate. (6) demulcents.

e.
e.
(7) High colonic lavage with 1:1000 solution of sulphoxylate twice

fre
fre
fre
daily.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 215 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
P.M. Appearances: (1) The mucosa of the G.I. tract shows
re
fre
fre
inflammation, congestion, coagulation and corrosion. (2) If the person
sf
ks
ks
survives for few days, the large intestine shows necrosis, due to the
k
re-excretion of mercury into the large bowel. (3) Acute tubular and
oo
oo
oo
glomerular degenration or haemorrhagic glomerular nephritis is seen.
eb
eb
eb
(4) The liver shows cloudy swelling or fatty change.
m
m
Chronic Poisoning: (1) The symptoms are salivation,
inflammation of gums and occasionally a blue line at their junction
with teeth, sore mouth and throat, loosening of teeth, gastrointestinal
om
m
disturbances, fine tremors of the tongue, hands, arms and later of
co
co
legs, anaemia, anorexia, loss of weight and chronic inflammation
e.
e.
of kidneys. (2) Tremors occur first in the hands, then progress to
fre
fre
fre
lips and tongue and finally involve arms and legs. The tremor is
moderately coarse with jerky movements. The advanced condition
ks
ks
ks
is called hatter’s shakes or glass blower’s shakes, because they are
oo
oo
oo
common in persons working in glass blowing and hat industries. (3)
eb
eb
eb
There may be mental disturbances. (4) Mercurial erethism is seen
m
m
in persons working with mercury in mirror manufacturing firms. This
term is used to refer to the psychological effects of mercury toxicity
which include anxiety, depression, shyness, timidity, irritability,
om
om
loss of confidence, mental depression, delusions and hallucinations,

co
or suicidal melancholia, or manic depressive psychosis, emotional

c
e.
e.
instability, loss of memory and insomnia. (5) Mercurialentis is a

re
fre
peculiar eye change due to exposure to deposit of mercury through re

sf
f
the cornea on the anterior lens capsule. Slit-lamp examination
ks
ks
k
demonstrates a malt-brown reflex from the anterior lens capsule. It

oo
oo
oo
is bilateral and has no effect on visual acuity.

eb
eb
eb
Acrodynia or pink disease is thought to be hypersensitivity

m
reaction especially in children. This can be caused by chronic mercury

exposure in any form. There is irritation of hands and feet usually
followed by desquamation, loss of hair, hyperkeratosis and excessive
om
sweating.
co
co
Lead: Action: At the cellular level, lead interacts with

e.
e.
sulphydryl groups and interferes with the action of enzymes necessary

fre
fre
fre
for haem synthesis and for haemoglobin and cytochrome production.

F.D.: 20 g. lead acetate; 40 g. lead carbonate. F.P.: one to 2 days.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 216 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
Chronic Poisoning (plumbism): Causes: (1) Inhalation of lead
re
fre
fre
dust and fumes. (2) Continuous absorption of minute amounts from
sf
ks
ks
drinking water stored in lead cisterns, from tinned food contaminated
k
with lead from the solder and from constant use of hair dyes and
oo
oo
oo
cosmetics containing lead. (3) Absorption through raw or intact skin.
eb
eb
eb
(4) Use of ghee stored in brass or copper vessels lined inside with
m
m
tin in which oleate of lead is formed and also by taking food cooked
in tinned vessels. (5) Absorption of vermilion applied to the scalp.
Chronic poisoning results from a daily intake of one to two mg. of
om
m
lead.
co
co
Symptoms: (1) Facial Pallor: The facial pallor particularly
e.
e.
about the mouth is one of the earliest and most consistent sign. (2)
fre
fre
fre
Anaemia: (a) There may be polycythaemia with polychromatophilia
in early stages, but later there is anaemia which is associated with
ks
ks
ks
polychromasia, punctate basophilia, reticulocytosis, poikilocytosis,
oo
oo
oo
anisocytosis, nucleated red cells and an increase in mononuclear
eb
eb
eb
cells, whereas polymorphonuclear cells and platelets are decreased.
m
m
(b) Punctate basophilia or basophilic stippling means the presence
of many dark-blue coloured, pinhead sized spots in the cytoplasm of
red blood cells, due to toxic action of lead on porphyrin metabolism.
om
om
Reticulocytes and basophilic stippled cells result from the inhibition

co
of 5-pyrimidine nucleotidase, an mpaired ability to rid the cells of

c
e.
e.
RNA degradation products, and the aggregation of ribosomes. (3)

re
fre
Lead line: (a) A stippled blue line, called Burtonian line, is seen re
sf
f
on the gums in 50 to 70% of cases. (b) it appears due to subepithelial
ks
ks
k
deposit of granules at the junction with teeth, only near dirty or carious
oo
oo
oo
teeth, within a week of exposure, usually on upper jaw. (c) It is due

eb
eb
eb
to formation of lead sulphide by the action of hydrogen sulphide

m
formed by decomposed food in the mouth. (d) A similar blue line

may be seen in cases of poisoning by mercury, copper, bismuth,
iron and silver. (4) Colic and constipation: (a) It is usually later
om
symptom. (b) Colic of intestines, ureters, uterus and blood vessels

co
co
occur in 85% of cases. (c) The colic occurs at night and the pain
e.
e.
may be very severe. (d) Individual attacks last only a few minutes,
fre
fre
fre
but may recur for several days or weeks. (e) Constipation is usual.
(5) Lead palsy: (a) it usually occurs late and is seen in less than
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 217 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
10% of cases. (b) There may be tremors, numbness, hyperaesthesia,
re
fre
fre
and cramps before the actual muscle weakness. (c) It is commoner
sf
ks
ks
in adults than in children and men are particularly affected. (d) The
k
muscle groups affected are those most prone to fatigue. (e) Usually,
oo
oo
oo
the extensor muscles of the wrist (wrist drop) are affected but rarely
eb
eb
eb
muscles of eye or intrinsic muscles of hand or foot are affected. (f)
m
m
The paralysis is associated with degeneration of the nerve and atrophy
of the muscles. (g) Recovery may be complete but is usually slow.
(6) Encephalopathy: (a) Lead encephalopathy in some form is said
om
m
to be present in almost every case of plumbism. (b) It is common
co
co
in children. (c) The symptoms are vomiting, headache, insomnia,
e.
e.
visual disturbances, irritability, restlessness, delirium, hallucinations,
fre
fre
fre
convulsions, coma and death. (7) C.V.S. and kidneys: Lead causes
vascular constriction leading to hypertension and permanent arteriolar
ks
ks
ks
degeneration. Chronic arteriosclerotic nephritis and interstitial
oo
oo
oo
nephritis occur. (8) Reproductive system: Menstrual derangements,
eb
eb
eb
such as amenorrhoea, dysmenorrhoea, menorrhagia, sterility of both
m
m
sexes and abortion (between 3 to 6 months) are frequent. (9) Other
systems: They are dyspepsia, emaciation, irritability, headache,
vertigo, loss of hair and drowsiness.
om
om
Diagnosis: (1) History. (2) Clinical features. (3) Erythrocyte

co
protoporphyrin (EP), commonly assayed as zinc protoporphyrin

c
e.
e.
(ZPP) are usually below 35 µg/dL. (4) X-ray evidence of increase

re
fre
radio-opaque bands or lines at the metaphyses of long bones is seen re

sf
f
in children. (5) Basophilic stippling.
ks
ks
k
Treatment: (1) Sodium bicarbonate 20 to 30 g. a day divided

oo
oo
oo
in 4 or 5 portions. (2) Magnesium or sodium sulphate 8 to 12 g. will

eb
eb
eb
change unabsorbed lead salts to the highly insoluble lead sulphate and
m
hasten its passage in the stools. (3) Calcium disodium versenate acts
as an ion exchanger. (4) BAL four mg/kg of body weight every four
hours. (5) Pencillamine 0.3 to 0.5 g. orally one to five times daily is
om
very effective in excretion of circulating lead but is not as effective as

co
co
EDTA. (6) DMSA (Succimer) is superior to EDTA. (7) A diet poor

e.
e.
in calcium, and ammonium chloride one g. ten times daily is given.

fre
fre
fre
By this lead deposited in the bones is mobilised into the blood and
excreted. High doses of parathormone have similar effects.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 218 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
Distribution: (1) Lead is normally present in almost all tissues.
re
fre
fre
(2) It is a typical cumulative poison. (3) The bones contain large
sf
ks
ks
amounts and also hair and nails. (4) Lead is excreted largely in the
k
faeces and to a small extent in urine.

oo
oo
oo
Copper: Copper as a metal is not poisonous. Copper
eb
eb
eb
compounds are powerful inhibitors of enzymes. (1) Copper sulphate
m
m
(blue vitriol) occurs in large, blue crystals. (2) Copper subacetate
(verdigris), occurs in bluish-green masses or powder.
Symptoms: (1) Symptoms appear in 15 to 30 minutes. (2) There
om
m
is metallic taste, increased salivation, burning pain in the stomach
co
co
with colicky abdominal pain, thirst, nausea, eructations and repeated
e.
e.
vomiting. (3) The vomited matter is blue or green. (4) There is
fre
fre
fre
diarrhoea with much straining; motions are liquid and brown but
not bloody. (5) Oilguria, haematuria, albuminuria and uraemia may
ks
ks
ks
occur. (6) In some cases paralysis of limbs is followed by drowsiness,
oo
oo
oo
insensibility, coma and death.
eb
eb
eb
F.D.: Copper sulphate 30 g; copper subacetate 15 g.
m
m
F.P.: One to three days.
Treatment: (1) Stomach wash with one percent solution of
potassium ferrocyanide forms an insoluble cupric ferrocyanide.
om
om
(2) N-penicillamine is very effective. (3) E.D.T.A. (4) B.A.L. (5)

co
Demulcent drinks.
c
e.
e.
P.M.Appearances: (1) The skin may be yellow. (2) Greenish-

re
fre
blue froth at mouth and nostrils. (3) The gastric mucosa and stomach re
sf
f
contents are greenish or bluish. (4) The gastric mucosa may be
ks
ks
k
congested, swollen, inflamed, and occasionally eroded. (5) the liver

oo
oo
oo
may be soft and fatty.

eb
eb
eb
Poisoning: (1) Accidental, esp. in children. (2) Abortifacient.

m
(3) Cattle poison. (4) Food contaminated with verdigris formed in

copper cooking vessels.
Metal Fume Fever: (1) It is caused by inhalation of fumes
om
of zinc, copper, magnesium, nickle, mercury, lead and other

co
co
heavy metals. (2) The syndrome resembles a flu-like illness which

e.
e.
starts 6 to 8 hours after exposure to fumes with fever, chills, cough,

fre
fre
fre
dyspnoea, cyanosis, myalgia, salivation, sweating and tachycardia.

(3) Symptoms subside in about 36 hours after stoppage of exposure.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 219 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e.
e.
Methaemoglobinaemia is caused by amyl nitrite, nitroglycerin,
re
fre
fre
nitrous gases, chloroquine, primaquine, silver nitrate, aniline,
sf
ks
ks
benzocaine, sulphonamides, naphthalene, phenacetin, pyridium,
k
trinitrotoluene, bromates, chlorates, pyrogallol.

oo
oo
oo
Treatment: Treatment is necessary if the methaemoglobin level
eb
eb
eb
is more than 30%. Methylene blue is specific antidote.
m
m
Nitrates: Action: Relaxation of smooth muscle, especially
of small blood vessels and conversion of haemoglobin to
methaemoglobin.
om
m
F.D.: Sodium nitrate one to two g.; nitroglycerine 200 mg.
co
co
F.P.: few hours to few days.
e.
e.
Symptoms: Low B.P., headache, vertigo, palpitations, visual
fre
fre
fre
distrubances; skin is flushed and perspiring, vomiting, colick, bloody
diarrhoea; slow pulse; paralysis, coma convulsions; death due to
ks
ks
ks
circulatory collapse.
oo
oo
oo
Treatment: (1) Stomach wash. (2) Methylene blue one
eb
eb
eb
percent solution, one two mg/kg. i.v., or fifty mg/kg. orally converts
m
m
methaemoglobin to heamoglobin. (3) Transfusion with whole blood.
(4) Oxygen and artificial respiration.
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-25.indd 220 04-03-2015 12:34:35 PM

e
e
m
m
om
m
co
co
e. 26
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Inorganic Irritant Poisons
om
m
co
co
e.
e.
Phosphorus: White phosphorus occurs as white or yellow,
fre
fre
fre
translucent waxy cylinders. Smell and taste is garlicky, luminous in
ks
ks
ks
dark, oxidises and emits white fumes, ignites at 340C., and as such kept
oo
oo
oo
under water, and is highly toxic. Red phosphorus is reddish-brown,
eb
eb
eb
amorphous, solid mass. It is tasteless, odourless, non-luminous, non-
oxidised, non-inflammable and non-toxic.
m
Action: It is protoplasmic poison which affects cellular

oxidation.
m
om
om
(1) Fulminating poisoning is seen when a dose exceeding one

co
g. is taken. These patients usually die within 12 hours due to shock.

c
(2) Acute Poisoning: (A) First stage: Burning pain in throat and
e.
e.
abdomen, with intense thirst, nausea, vomiting, diarrhoea. Breath

re
fre
and excreta have gralic-like odour. Luminescent vomit and faeces re

sf
f
ks
ks
are diagnostic. Skin contact produces painful penetrating second and
k
oo
oo
oo
third degree burns.

eb
eb
eb
(B) Second stage is symptom-free lasting for two or three days.

(C) Third Stage: (1) Symptoms of systemic toxicity occur from
m
absorbed poison. (2) There is nausea, prolonged vomiting, diarrhoea,

haematemesis, liver tenderness and enlargement, jaundice, pruritus.
om
(3) Haemorrhages occur into skin, mucous membrane and viscera,

co
co
due to injury to blood vessels and inhibition of blood clotting. (4)

Renal damage results in oliguria, haematuria, casts, albuminuria and
e.
e.
sometimes anuria. (5) Convulsions, delirium and coma. (6) Death

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-26.indd 221 04-03-2015 12:18:44 PM

e
e
m
m
om
m
co
co
e.
e.
may result from shock, hepatic failure, CNS damage, haematemesis
re
fre
fre
or renal insufficiency.
sf
F.D.: 60 to 120 mg. F.P.: 2 to 8 days.
ks
ks
k
Treatment: (1) Gastric lavage using 1:5000 solution of

oo
oo
oo
potassium permanganate oxidises phosphorus into phosphoric
eb
eb
eb
acid and phosphates, which are harmless. (2) Activated charcoal
m
m
adsorbs the poison. (3) Vitamin K 20 mg. i.v. in repeated doses. (4)
Wash out the bowel and repeat at intervals for several days. (5) Oil
and fats should be avoided. (6) If renal failure is severe, peritoneal
om
m
or haemodialysis may be required.
co
co
P.M. Appearances: (1) In acute poisoning, the body usually
e.
e.
shows signs of jaundice.(2) The gastric and intestinal contents may
fre
fre
fre
smell of garlic and be luminous. (3) The mucous membranes of the
stomach and intestine are yellowish or greysih-white in colour, and
ks
ks
ks
are softened, thickend, inflamed and corroded or destroyed in patches.
oo
oo
oo
(4) Multiple smaller or larger haemorrhages are seen in the skin,
eb
eb
eb
subcutaneous tissues, muscles, and serosal and mucosal membranes.
m
m
(5) The liver becomes swollen, yellow, soft, fatty and is easily
ruptured. (6) In persons who survive for a week or longer, the
appearances of acute yellow atrophy are present. (7) The kidneys
om
om
are large, greasy, yellow and show haemorrhages on the surface. (8)
co
The heart is flabby, pale and shows fatty drgeneration. (9) Fat emboli
c
e.
e.
may be found in the pulmonary arterioles and capillaries.

re
fre
Chronic Poisoning: The frequent inhalation of fumes over re

sf
f
a period of years causes necrosis of the lower jaw in the region
ks
ks
k
of a decayed tooth. At first there is toothache, which is followed

oo
oo
oo
by swelling of jaw, loosening of the teeth, necrosis of gums, and

eb
eb
eb
sequestration of bone in the mandible. This condition is known as

m
phossy jaw, in which osteomyelitis and necrosis of the jaw occurs,

with multiple sinuses discharging foul-smelling pus.
Poisoning: (1) Accidental poisoning in children may occur due
om
to chewing of fireworks or eating rat paste. (2) Occasionally used

co
co
for homicide mixed with alcohol, coffee, etc. (a) Taken by mouth or
e.
e.
introduced into the vagina to produce abortion. (4) For arson, white
fre
fre
fre
phosphorus covered with dung or wet cloth is thrown on huts. When

the covering becomes dry, the roof catches fire.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-26.indd 222 04-03-2015 12:18:44 PM

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e. 27
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Organic Irritant Poisons
om
m
co
co
e.
e.
RICINUS COMMUNIS: (1) Entire plant is poisonous,
fre
fre
fre
containing toxalbumen ricin. (2) The seeds are rich in purgative oil.
ks
ks
ks
(3) The ‘press cake’ contains ricin and is poisonous whereas castor
oo
oo
oo
oil is not poisonous. (4) The unbroken seeds are non-poisonous when
eb
eb
eb
swallowed and also when cooked.
Toxalbumen or phytotoxin is a toxic protein, which resembles
m
m
bacterial toxin in action and causes agglutination of red cells with
some haemolysis and is antigenic. Phytotoxin is a toxin produced
om
om
by a plant. Ricin, crotin and abrin are phytotoxins. Animal

co
toxalbumens are snake and scorpion venoms.

c
Symptoms: Symptoms include salivation, nausea, vomiting,

e.
e.
bloody diarrhoea, abdominal pain, thirst, cramps in calves and

re
fre
abdominal muscles, drowsiness, delirium, convulsions, shallow re

sf
f
ks
ks
breathing, uraemia and jaundice, dehydration, collapse and death.
k
oo
oo
oo
Ricin is excreted by intestinal epithelium.

eb
eb
eb
F.D.: 5 to 10 seeds; ricin six mg. F.P.: Two to several days.

P.M. Appearances: Ricin produces haemorrhagic inflammation
m
of the G.I. tract even when given subcutaneously. Haemorrhages

occur in internal organs.
om
Croton Tiglium (jamalgota or naepala): (1) Seeds contain

co
co
crotin, a toxalbumen which is not expressed with oil. Crotonoside,

is also present. (2) The oil contains a powerful vesicating resin. (3)
e.
e.
Applied to skin, oil produces burning, redness and vesication. (4) It

fre
fre
fre
is used as abortifacient and arrow poison.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-27.indd 223 04-03-2015 12:19:05 PM

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co
e.
e.
F.D.: 4 to 5 seeds; one to two ml. of oil.
re
fre
fre
F.P.: Six hours to three days.
sf
Abrus Precatorius: (1) The seeds are egg-shaped,
ks
ks
k
brightscarlet colour with a large spot at one end, 8 mm. long and 6
oo
oo
oo
mm. broad, and weigh 105 mg. on an average. (2) The seeds contain
eb
eb
eb
active principle abrin, a toxalbumin, which is similar to viperine
m
m
snake venom; also abrine, abralin and haemoglutin. (3) All parts of
the plant are poisonous.
Symptoms: (1) When an extract of seeds is injected under the skin
om
m
of the animal, inflammation, oedema, oozing of haemorrhagic fluid
co
co
from the site of puncture and sometimes necrosis occurs surrounding
e.
e.
the site of injection. (2) The animal does not take food and drops after
fre
fre
fre
3 to 4 days, becomes cold and drowsy or comatose and dies. (3) The
symptoms resemble those of viperine snake bite.
ks
ks
ks
F.D.: 90 to 120 mg. by injection. F.P.: 3 to 5 days.
oo
oo
oo
Poisoning: (1) The seeds are used for killing cattle and rarely
eb
eb
eb
for homicide. (2) The seeds are decorticated and alone or mixed with
m
m
datura, opium and onion are made into paste with spirit and water, and
small sharp-pointed needles or “suis” are prepared which are then dried
in the sun. (3) The needles are 15 mm. long and weigh 90 to 120 mg. (4)
om
om
Two needles are inserted by their base into holes in a wooden handle.
co
(5) A blow is struck to the animal with great force which drives the
c
e.
e.
needle into the flesh. (6) For homicide, the needle is kept in between
re
fre
two fingers, and the person slapped. (2) Abortifacient and arrow poison. re
sf
f
ERGOT: Ergot is dried sclerotinum of the fungus claviceps
ks
ks
k
purpurea, which grows on cereals like rye, barley, wheat, oats, etc. It
oo
oo
oo
gradually replaces the grain forming a curved, dark-purple or black

eb
eb
eb
compact mass. It contains about thirty alkaloids, but ergotoxine,

m
ergotamine and ergometrine are important.

Chronic poisoning (ergotism): There is tingling and numbness
of the skin, vasomotor disturbances leading to dry gangrene of fingers,
om
toes, ears, nose, etc. and sensation of insects creeping under skin.
co
co
F.D.: 2 to 10 g. F.P.: One to several days.

e.
e.
Capsicum Annum: They have a pungent odour and taste and

fre
fre
fre
are used as condiment. They are not fatal. The active principles are
capsaicin and capsicin.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-27.indd 224 04-03-2015 12:19:06 PM

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m
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om
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co
co
Organic Irritant Poisons 225
e.
e.
Criminal use: (1) Powder is thrown into the eyes to facilitate
re
fre
fre
robbery. (2) Torture.
sf
Semecarpus anacardium (Marking nuts; bhilawa): It
ks
ks
k
contains an irritant juice which is brownish, oily and acrid but turns
oo
oo
oo
black on exposure to air. The active principles are semecarpol and
eb
eb
eb
bhilawanol.
m
m
Symptoms: (1) Applied externally, the juice causes irritation
and a painful blister which contains acrid serum which produces
eczematous eruptions of surrounding skin with which it comes into
om
m
contact and there is itching. The lesion resembles a bruise. (2) Taken
co
co
by mouth, it produces blisters on throat and severe G.I. irritation,
e.
e.
dyspnoea, tachycardia, cyanosis, delirium.
fre
fre
fre
F.D.: 5 to 10 g. 6 to 8 seeds. F.P.: 12 to 24 hours.
Calotropis: Calotropis gigantea (akdo, madar) has purple
ks
ks
ks
flowers and calotropis procera has white flowers. The active principles
oo
oo
oo
are uscharin, calotoxin, calactin and calotropin. The leaves and stalk
eb
eb
eb
when incised yield thick milky juice.
m
m
Symptoms: Applied to the skin, it causes redness and vesication.
When taken by mouth, the juice produces burning pain in throat and
stomach, salivation, stomatitis, vomiting, diarrhoea, convulsions and
om
om
death.
co
F.D.: Uncertain. F.P.: 12 hours.

c
e.
e.
Poisoning: (1) To produce artificial bruise. (2) Cattle poison.

re
fre
(3) Criminal abortion. (4) Arrow poison. (5) The root of calotropis re
sf
f
procera is highly poisonous to cobras, and other poisonous snakes,
ks
ks
k
which cannot stand even its smell.

oo
oo
oo
Cantharides (spanish fly): The active principle is cantharidin,

eb
eb
eb
which is readily absorbed from all surfaces including the skin.

m
Symptoms: (1) Applied to the skin, redness and burning pain

are produced followed by vesication. (2) Taken internally, burning
sensation in the mouth and throat, pain in the stomach, vomiting,
om
severe thirst, difficulty in swallowing and speech. (3) Later dull pain
co
co
in the loins, the urine is scanty and bloodstained. (4) Priapism may
e.
e.
occur; there is often tenesmus.

fre
fre
fre
F.D.: 15 to 50 mg. of cantharidin; 2 to 3 g. powdered cantharides.

F.P.: 24 to 36 hours.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-27.indd 225 04-03-2015 12:19:06 PM

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P.M. Appearances: (1) The kidneys are acutely inflamed and
re
fre
fre
there is haemorrhage in the renal pelvis and bladder. (2) The bladder
sf
ks
ks
mucosa in inflamed and ecchymoses may be present. (3) The surface
k
of the heart and endocardium shows haemorrhages.

oo
oo
oo
Poisoning: (1) Aphrodisiac. (2) Criminal abortion.
eb
eb
eb
Snakes: In India, there are more than 200 species of land
m
m
snakes. Only five of them are dangerously poisonous to man; king
cobra, cobra, common krait, Russell’s viper and saw-scaled viper.
The most common poisonous snake is common krait.
om
m
Fangs: (1) All the snakes have two fangs. (2) These are curved
co
co
teeth situated on the maxillary bones and lie along the jaws. (3)
e.
e.
When the snake is about to bite, they become erect and point directly
fre
fre
fre
forward. (4) They are bigger than the other teeth and are grooved or
canalised in poisonous snakes.
ks
ks
ks
Snake Venom: (1) Venom is the saliva of the snake. (2) Cobra
oo
oo
oo
venom is faint transparent, yellow and is slightly viscous. (3)
eb
eb
eb
Russell’s viper venom is white or yellow. (4) Snake venoms are
m
m
complex mixtures, chiefly proteins, many of which have enzymatic
activities, such as proteolytic enzymes, phosphatidase, neurotoxins,
hyaluronidase, ophioxidase, lecithinase, proteases, etc. (5) The
om
om
colubrine venom is mainly neurotoxic and has a primary toxicity

co
for the respiratoy and cardiac centres. It can produce marked

c
e.
e.
cardiac or vascular changes, or have a direct effect on the blood. (6)

re
fre
The viperine venom is mainly haemolytic and causes intravascular re

sf
f
haemolysis and depression of the coagulation mechanism. It can
ks
ks
k
also produce changes in the nervous system or in vascular dynamics.

oo
oo
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(7) As a rule one of the modes of action far exceeds the other. The
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eb
eb
sea snake venom is myotoxic.

m
Symptoms: (1) Ophitoxaemia is poisoning by snake venom.

(2) The most common symptom following snake bite (poisonous or
non-poisonous) is fright. (3) Due to fright, the victim may become
om
semiconscious with cold clammy skin, feeble pulse and rapid breathing.
co
co
(4) Sometimes, it produces psychological shock and even death.

e.
e.
Cobra: (1) Within six to eight minutes, a small reddish wheal

fre
fre
fre
develops at the site of bite. (2) The bitten area is tender with slight
radiating burning pain. (3) Swelling may be minimal or even absent.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-27.indd 226 04-03-2015 12:19:06 PM

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e.
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(4) Symptoms may appear after about half hour. (5) The patient
re
fre
fre
feels sleepy, slightly intoxicated, weakness of legs, and is unable to
sf
ks
ks
stand or move. (6) Weakness of muscles increase, and develops into
k
paralysis of the lower limbs. The paralysis then spreads to the trunk,
oo
oo
oo
and affects the head which droops. (7) This is followed by paralysis
eb
eb
eb
and swelling of the tongue and the larynx, due to which there is
m
m
difficulty in speech and swallowing. (8) There may be extra-ocular
muscle weakness, ptosis and strabismus. (9) After about two hours,
the paralysis is complete. (10) Respirations become slower and the
om
m
heart rate increases. (11) Though the patient is conscious, he is not
co
co
able to speak. (12) Coma sets in and finally the respirations stop with
e.
e.
or without convulsions.
fre
fre
fre
Krait: Symptoms resemble those of cobra bite, but there is no
swelling or burning pain at the site of the bite and the convulsions
ks
ks
ks
are milder, while the feeling of drowsiness and intoxication is more
oo
oo
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intense.
eb
eb
eb
Russle’s Viper and Echis Carinate: (1) More than 50% of
m
m
the victims have minimal or no poisoning, as little or no venom is
injected. (2) About 25% will develop serious generalised poisoning
but death occurs rarely. (3) When venom is injected, the spot develops
om
om
a severe pain within eight minutes. (4) The area around the bite is red
co
and painful. (5) The onset of swelling starts within fifteen minutes
c
e.
e.
and there is often bloodstained discharge from the wound. (6) When
re
fre
the venom injected is less, pain and swelling restricted to below re

sf
f
the elbow or knee and nausea disappear within one to two days. (7)
ks
ks
k
In moderate poisoning, there is a marked feeling of intense pain,

oo
oo
oo
vomiting, giddiness, sweating, abdominal pain, dilation of the pupils,

eb
eb
eb
and in about one to two hours, there is marked collapse and often
m
complete loss of consciousness. (8) Tingling and numbness over the

tongue and mouth or scalp and paraesthesia around the wound occur.
(9) These symptoms usually subside within few hours. (10) There is
om
local extravasation of blood and swelling spreads as far as the trunk in

co
co
one to two days. (11) In severe cases, the main feature is the persisting
e.
e.
shock. (12) A haemorrhagic syndrome with blood-stained sputum,

fre
fre
fre
haemorrhages from the gums, rectum, the site of bite, etc. occur due
to increased coagulation time. (13) Intravascular haemolysis may lead
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-27.indd 227 04-03-2015 12:19:06 PM

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e.
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to haemoglobinuria and renal failure. (14) Petechial haemorrhages
re
fre
fre
are common. (15) The prothrombin time is markedly increased, blood
sf
ks
ks
becomes defibrinated and will not clot. (16) Towards the end, there
k
is an extensive suppuration and sloughing. (17) Paralysis does not

oo
oo
oo
occur. (18) Death is usually due to shock and haemorrhage.
eb
eb
eb
Sea Snakes: (1) Bites cause little or no local reaction. (2) After
m
m
half to one hour, the patient develops pain, stiffness and weakness
of the skeletal muscles. (3) Marked polymyositis with a limb-girdle
distribution. (4) Later, flaccid paralysis develops, beginning with
om
m
ptosis. (5) Marked weakness of muscles persists for several months.
co
co
(6) Myoglobinuria with renal failure may occur. (7) Death may occur
e.
e.
due to cardiac arrest or paralysis of respiratory muscles.
fre
fre
fre
F.D.: Cobra: 12 mg; Russel viper: 15 mg; echis: 8 mg; krait: 6
mg; of dried venom. The average yield in one bite in terms of dry
ks
ks
ks
weight of lyophilised venom is : cobra 170 to 325 mg; Russell’s viper
oo
oo
oo
130 to 250 mg; krait 20 mg; and echis 20 to 35 mg.
eb
eb
eb
Diagnosis: (1) Snake specific venom antigens can be detected
m
m
in urine. (2) Radio immunoassay (RIA) detects venom. (3) Enzyme
immunoassay. (4) ELISA. (5) Injection of extract from the skin into frog.
F.P.: Cobra half to six hours; viper one to four days.
om
om
First Aid: (1) Assure the patient. (2) Immediately apply a broad
co
firm bandage around the limb and on the bitten area. In bites on
c
e.
e.
the trunk, head or neck apply firm pressure over the bitten area. (3)
re
fre
Immobilise the limb. (4) Make parallel incisions one cm. long and re
sf
f
half cm. deep over each fang mark. drainage of blood and lymph from
ks
ks
k
the cuts shoud be done by mechanical suction. (5) Do not cauterise

oo
oo
oo
the wound. (6) Clean wound with saline.

eb
eb
eb
Treatment: (1) Polyvalent anti-snake venom is prepared

m
by hyper-immunising horses against venom of cobra, common

krait, Russell’s viper and saw-scaled viper, and is available in the
form of lyophilised powder in an ampoule. (2) It is useful when
om
given within four hours and is of doutful value after 24 hours. (2)
co
co
Its half-life is 90 hours. (3) Dose: (a) Minimal symptoms: Local

e.
e.
swelling but no systemic reactions: 5 vials. (b) Moderate: Swelling

fre
fre
fre
progressing beyond site of bite with systemic reaction: 10 vials. (c)

Severe: Marked local reaction, severe symptoms: 10 to 15 vials.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-27.indd 228 04-03-2015 12:19:06 PM

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(4) The powder is diluted in 500 ml. of distilled water or saline
re
fre
fre
and infused in a period of one hour. (5) In neurotoxic poisoning
sf
ks
ks
a second dose of ten vials should be given after one hour. (6) In
k
haemotoxic poisoning the dose is repeated after six hours. (7) If

oo
oo
oo
anti-snake venom is not available, 40 ml. of antivenene is given i.v.
eb
eb
eb
and repeated as required. It is effective for cobra and Russell’s viper
m
m
bites. (8) 1.5 mg. neostigmine, if neuroparalysis occurs. (9) Tetanus
antitoxin. (10) Heparin for clotting abnormalities. (11) Sedatives.
(12) Haemodialysis or peritoneal dialysis.
om
m
P.M. Appearances: (1) Poisonous snakes leave two or
co
co
ocassionally one fang mark. (2) Non-poisonous snakes leave a
e.
e.
semicircular set of tooth marks. (3) The punctures are one and
fre
fre
fre
one-fourth cm. deep in colubrine and two-and-half cm. deep in
viperine bites. (4) Sometimes the bite marks may not be visible. (5)
ks
ks
ks
Haemorrhages into the bowel, pupuric spots on pericardium and
oo
oo
oo
haemorrhages in the lungs and in many tissues may be seen. (6)
eb
eb
eb
Internal organs are congested. (7) Washing from the bite may contain
m
m
cholinesterase or thromboplastin.
Absorption and Excretion: Snake venom is poisonous only
when injected, and is harmless when taken by the mouth. It is excreted
om
om
by kidneys, milk and probably by salivary glands and the mucous

co
membranes.
c
e.
e.
Poisoning: (1) Poisoning is always accidental. (2) Occasionally,

re
fre
a murder is commited by throwing a poisonous snake on the bed of re

sf
f
sleeping person. (3) Cattle are sometimes poisoned by snake venom.
ks
ks
k
Scorpions: The venom is clear, colourless toxalbumen and

oo
oo
oo
can be either heamolytic or neurotoxic. Its toxicity is more than that

eb
eb
eb
of snakes, but only a small quantity is injected. The mortality, except

m
in children is negligible.
Symptoms: If the scorpion has heamolytic venom, the reaction
is mainly local and simulates the viper snake bite, but the scorpion
om
sting will have only one hole in the centre of the reddened area. The
co
co
symptoms produced by a neurotoxic venom is similar to cobra bite.

e.
e.
Treatment: (1) A torniquet should be applied above the location

fre
fre
fre
of sting. (2) A local anaesthetic is injected at the site to lessen pain.

(3) A specific antivenin is available for most species.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-27.indd 229 04-03-2015 12:19:06 PM

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e. 28
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sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
CNs Depressants
om
m
co
co
e.
e.
Alcohol
fre
fre
fre
Absolute alcohol contains 99.95% alcohol; rectified spirit
ks
ks
ks
contains 90% alcohol. Arrack is liquor distilled from palm, rice,
oo
oo
oo
sugar or jaggery, etc.
eb
eb
eb
Absorption: (1) About 20% is absorbed from the stomach and
80% from small intestine. (2) Alcohol can be detected in the blood
m
m
within 2 or 3 minutes of swallowing. (3) The maximum concentration
in blood is reached within 45 to 90 minutes after ingestion.
om
om
Metabolism: (1) About 90% of alcohol absorbed is oxidised

co
in the liver, and the remaining 10% is excreted by the kidneys and
c
the lungs. (2) In the liver, alcohol is oxidised to acetaldehyde by

e.
e.
alcohol dehydrogenase (ADH) and its coenzyme, nicotinamide

re
fre
adeninedinucleotide (NAD). (3) It disappears from the blood at

re
sf
f
ks
ks
k
a fairly uniform rate of about 10 to 15 ml. per hour. This is the

oo
oo
oo
equivalent of about 15 mg. % from the blood per hour. (4) Chronic
eb
eb
eb
alcoholics are able to metabolise alcohol at a faster rate of 40 to 50

mg. / 100 ml. / hour. (5) during oxidation alcohol is not stored in
m
the tissues. (6) It is poorly soluble in body fat and as such females
of the same body weight will have a higher (25% higher) blood
om
alcohol concentration for the same amount of drink. (7) Venous blood
co
co
alcohol in the absorption phase is about ten percent lower than arterial
blood. (8) One hour after drinking, venous blood contains the same
e.
e.
concentration of alcohol as arterial blood.

fre
fre
fre
ks
ks
ks
oo
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eb
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Ch-28.indd 230 04-03-2015 12:19:47 PM

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CNs Depressants 231
e.
e.
Symptoms: (1) Stage of Excitement: There is increased
re
fre
fre
confidence and a lack of self-control, which is constant feature.
sf
ks
ks
(2) The person may disclose secrets. (3) Normal good manners are
k
forgotten. (4) When jerking movement is in the direction of the gaze

oo
oo
oo
and independent of the position of the head, it is known as alcohol
eb
eb
eb
gaze nystagmus, and appears at blood levels of 40 to 100 mg%
m
m
(average. 80 mg. %). (5) Mental concentration is poor and judgement
is impaired. (6) These effects are usually seen between 50 to 150
mg./100 ml. of blood alcohol.
om
m
(2) Stage of incoordination (150 to 250 mg/100ml.): (1) The
co
co
sense perceptions and skilled movements are affected. (2) He
e.
e.
may become carefree, cheerful, ill-tempered, irritable, excitable,
fre
fre
fre
quarrelsome, sleepy, and so on. (3) The breath smells of alcohol. (4)
The face is flushed and the pulse is increased. (5) The temperature
ks
ks
ks
becomes subnormal.
oo
oo
oo
(3) Stage of coma: (1) Speech becomes thick and slurring,
eb
eb
eb
coordination is markedly affected, causing the patient to become
m
m
giddy, stagger and possibly to fall. (2) The person passes into a state
of coma with stertorous breathing. (3) The pupils are contracted,
but stimulation of the person, e.g. pinching or slapping causes them
om
om
to dilate with slow return (Mc Ewan sign). (4) Death occurs from
co
asphyxia due to respiratory paralysis.

c
e.
e.
F.D.: 150 to 200 ml. of absolute alcohol consumed in one hour.

re
fre
F.P.: 12 to 24 hours. re
sf
f
Treatment: (1) Heamodialysis or peritoneal dialysis is very
ks
ks
k
useful.
oo
oo
oo
Alcohol addicts are people who cannot stop drinking for long, or
eb
eb
eb
who experience withdrawal symptoms if they do. Chronic alcoholics

m
are those who have reached a state of irreversible somatic or brain

changes caused due to alcohol.
Treatment of chronic alcoholics: (1) Antabuse (disulfiram) is
om
given in a daily dose of three-fourth g. for two days followed by half

co
co
g. for three to five days. The dosage is gradually reduced. (2) Citrated
e.
e.
calcium carbimide (temposil) 50 mg. once a day. (3) Chlorpromazine

fre
fre
fre
20 to 25 mg. every four to six hours.

ks
ks
ks
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eb
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Ch-28.indd 231 04-03-2015 12:19:47 PM

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co
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e.
e.
(4) The conditioned Reflex Treatment: (1) With backdrop of
re
fre
fre
bottles of various alcoholic beverages, the patient is given various
sf
ks
ks
types of liquor, together with drugs that will cause immediate acute
k
nausea and vomiting. After five to eight daily treatments, symptoms

oo
oo
oo
are brought on simply by the sight of a bottle, and the patient begins
eb
eb
eb
mentally to associate his painful sickness with alcohol. (2) Hypnosis
m
m
and pschotherapy are also useful.
Drunkenness: Drunkenness is a condition produced in
a person, who has taken alcohol in a quantity sufficient to cause
om
m
him to lose control of his faculties to such an extent, that he is
co
co
unable to execute safely the occupation in which he is engaged
e.
e.
at the particular time.
fre
fre
fre
A model scheme of Medical Examination: (1) Exclusion
of injuries and pathological states: Exclude: (a) Severe head
ks
ks
ks
injuries. (b) Metabolic disorders, e.g. hypoglycaemia, diabetic
oo
oo
oo
precoma, uraemia, hyperthyroidism. (c) Neurological conditions,
eb
eb
eb
e.g. disseminated sclerosis, intracranial tumours, Parkinson’s disease,
m
m
epilepsy. (d) Drugs: Insulin, barbiturates, antihistamines, morphine,
atropine. (e) Psychological disorders, e.g., hypomania, general
paresis. (f) High fever. (g) Exposure to CO.
om
om
(2) History: The history of the relevant events should be obtained.

co
(3) General behaviour: (a) General manners and behaviour.

c
e.
e.
(b) State of dress: Presence of slobber on mouth or clothing;

re
fre
presence, character and colour of any vomit, soiling of clothes by re

sf
f
excretions. (c) Speech: Note the type, e.g., is it thick, slurred or
ks
ks
k
overprecise? Slight blurring of certain consonants is one of the earliest

oo
oo
oo
signs of incoordination of the muscles of the tongue and lips. Certain

eb
eb
eb
test phrases may be used to bring out this difficulty in speech, such
m
as ‘British Constitution’, ‘West Register Street, Truly Rural, etc. (d)

Self-control: Whether he is able to control himself.
(4) Memory and mental alertness: Ask suitable questions about his
om
movements during the preceding few hours, and the details of his accident
co
co
if any. A few very simple sums of addition or subtraction may be asked.

e.
e.
(5) Handwriting: Ask to copy a few lines from a newspaper or

fre
fre
fre
book. A note should be made of: (a) The time taken, (b) repetition or
omission of words, letters or lines, (c) ability to read his own writing.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 232 04-03-2015 12:19:47 PM

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CNs Depressants 233
e.
e.
(6) Pulse: The pulse is rapid and is usually full and bounding.
re
fre
fre
(7) Temperature: The surface temperature is usually raised.
sf
(8) Skin: Skin is warm, dry and flushed.
ks
ks
k
(9) Mouth: (a) Note whether the tongue is dry, furred or bitten,
oo
oo
oo
(b) The smell of the breath should be recorded.
eb
eb
eb
(10) Eyes: (a) General appearances: The eyelids are swollen,
m
m
red, congested. (b) Visual acuity: Any gross defect should be noted.
(c) Intrinsic muscles: (i) Pupils: Usually dilated in early stage, but
may be contracted in later stages or coma. (ii) Reaction to light:
om
m
they may become unequal, equalising again in response to light,
co
co
and dilate again slowly even if the light continues to be directed in
e.
e.
the eyes. (d) Extrinsic muscles: (i) Convergence: Test the degree
fre
fre
fre
of ability to follow a finger in all normal directions and to converge
the eyes normally on a near object. (ii) Strabismus: Note whether it
ks
ks
ks
is present. (iii) Nystagmus: the presence of fine lateral nystagmus
oo
oo
oo
may indicate alcoholic intoxication.
eb
eb
eb
(11) Ears: Examine for gross impairment of hearing.
m
m
(12) Gait: Ask to walk across the room and note: (a) Manner of
walking: Is it straight, irregular, overprecise, unsteady, reeling, or
with feet wide apart? (b) Reaction time to a direction to turn: Does
om
om
he turn at once or continue for one or two steps before obeying? (c)
co
Manner of turning: Does he keep his balance, lean forward, or swing

c
e.
e.
to one side? Does he correct any mistake in a normal or exaggerated

re
fre
way? It is undesirable to ask him to walk along a straight line. re

sf
f
(13) Stance: Note whether he can stand with his eyes closed and
ks
ks
k
heels together without swaying.

oo
oo
oo
(14) Muscular coordination: Ask him to perform: (a) Placing

eb
eb
eb
finger to nose. (b) Placing finger to finger. (c) Unbuttoning and

m
rebuttoning coat.
(15) Reflexes: Knee and ankle reflexes should be tested which
are delayed or sluggish. Plantar reflex may be extensor or flexor.
om
(16) Laboratory Investigations: Blood is the most suitable and

co
co
the most direct evidence of the concentration of alcohol in the brain.

e.
e.
Collection of Blood: (1) The skin is cleaned with a solution of

fre
fre
fre
1:1000 mercuric chloride or washed with soap and water. (2) Do not
use spirit. (3) Blood samples should be preserved by the addition of
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 233 04-03-2015 12:19:47 PM

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e
m
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co
co
e.
e.
100 mg of sodium fluoride and 30 mg. of potassium oxalate for ten
re
fre
fre
ml. (4) A screw-capped glass bottle of “universal” size is suitable.
sf
Widmark formula is a=prc, where a, is weight of alcohol (in g.)
ks
ks
k
in the body; p, is the body weight (in kg.); c, is the concentration of

oo
oo
oo
alcohol in the blood (in mg. per kg.); and r is a constant (0.6 for men
eb
eb
eb
and 0.5 for women). For urine analysis, the formula is a=3/4 prq. q
m
m
is the alcohol concentration (in mg. per kg.)
Breath: (1) 60 to 100 ml. of breath is received into a dry
balloon and analysed by drunkotester, drunkometer, intoximeter,
om
m
or breathalyser. (2) 2100 ml. of alveolar air contains the same
co
co
amount of alcohol as one ml. of blood. (3) The person is asked to
e.
e.
blow into plastic balloon through a glass tube, containing a crystalline
fre
fre
fre
bichromate-sulphuric acid mixture. (4) If the blood alcohol is 80
mg% or more, the crystals will become green. (5) Recently developed
ks
ks
ks
breath analysers rely on infrared absorption of energy by ethyl alcohol
oo
oo
oo
vapour in breath samples. (6) They are a direct method which instantly
eb
eb
eb
measures breath alcohol quantitatively.
m
m
Diagnosis of Drunkenness: The usual signs of drunkenness
are: strong odour of alcohol in breath, loss of self-control and loss
of clearness of intellect, unsteady gait, vacant look, congested eyes,
om
om
sluggish and dilated pupils, dry lips, increased pulse rate, unsteady
co
and thick voice, talks at random and lack of perception of passage

c
e.
e.
of time.
re
fre
Medical Terminology: “Under influence” means that due to re

sf
f
drinking alcohol, a person has lost some of the clearness of the mind
ks
ks
k
and self-control that he normally possesses.

oo
oo
oo
Below 10 mg%: Sober.

eb
eb
eb
20 to 70 mg% : Drinking.
m
80 to 100 mg% : Under the influence.

150 to 300 mg% : Drunk or intoxicated.
400 mg% and above : Coma, and death.
om
In India the law has made it an offence for a person to drive

co
co
a motor vehicle above 30 mg%.

e.
e.
Saturday night paralysis occurs in the stage of coma due to

fre
fre
fre
pressure on nerve (radial) as when an arm hangs over a chair.

ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 234 04-03-2015 12:19:47 PM

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CNs Depressants 235
e.
e.
Alcohol and Traffic Accidents: There is progressive loss of
re
fre
fre
driving ability as blood alcohol concentration rises. 30 to 50 mg%. of
sf
ks
ks
blood alcohol affects the driving ability of many persons. All persons
k
with a blood alcohol level of 140 mg% are intoxicated to the point
oo
oo
oo
where they cannot deal with unusual, emergency or non-customary
eb
eb
eb
problems.
m
m
Delirium tremens: (1) It occurs in chronic alcoholics due to (a)
temporary excess, (b) sudden withdrawal, (c) shock after receiving
an injury, such as fracture of a bone, (d) from an acute infection, such
om
m
as pneumonia, influenza, erysipelas, etc. (2) it begins 72 to 96 hours
co
co
after last drink. (3) There is an acute attack of insanity in which the
e.
e.
main symptoms are coarse muscular tremors of face, tongue and
fre
fre
fre
hands, insomnia, restlessness, loss of memory, uncontrollable fear
and tendency to commit suicide, homicide or violent assault. (4)
ks
ks
ks
There is disorientation as to time and place and a peculiar kind of
oo
oo
oo
delirium of horrors, due to hallucinations of sight and hearing. (5)
eb
eb
eb
Patient imagines that insects are crawling under skin or snakes are
m
m
crawling on his bed. (6) It is considered unsoundness of mind and
not intoxication.
Mythyl Alcohol: Pure methyl alcohol (wood alcohol)
om
om
is colourless, volatile liquid, with an odour similar to ethyl alcohol,

co
and has burning taste.

c
e.
e.
Symptoms: (1) Methyl alcohol produces symptoms of

re
fre
drunkenness in the same way as ethyl alcohol, but inebriation is not re

sf
f
prominent, and the effects are more prolonged. (2) Toxicity can result
ks
ks
k
following absorption through skin or respiratory tract. (3) Symptoms

oo
oo
oo
may appear within an hour or after an interval of several hours. (4)

eb
eb
eb
They consist of nausea, vomiting, and pain or severe cramps in the

m
abdomen, headache, dizziness, vertigo. (5) There is marked muscular

weakness, depressed cardiac action and hypothermia. (6) There may
be dyspnoea and cyanosis. (7) The odour is usually present in the
om
breath. (8) The effect on CNS is more intense and persistent than
co
co
with ethyl alcohol. (9) There may be delirium and coma which may
e.
e.
last for two or three days. (10) there is a toxic effect on the liver
fre
fre
fre
and kidneys and on highly specialised nerve elements. (11) Urine is

ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 235 04-03-2015 12:19:47 PM

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e
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e.
e.
strongly acid and may contain acetone and a trace of albumin. (12)
re
fre
fre
Severe non-diabetic acidosis in unconscious persons is suggestive
sf
of methyl alcohol poisoning. (13) The pupils are dilated and fixed.
ks
ks
k
Visual disturbances like photophobia and blurred vision, (snowfield

oo
oo
oo
vision), seeing spots, central and peripheral scotomata, decreased
eb
eb
eb
light perception, concentric diminution of visual fields for colour
m
m
and form, followed by fairly sudden failure of vision or complete
blindness occur due to optic neuritis and atrophy from the effect of
formic acid on the optic nerve. (14) Convulsions are usual and death
om
m
occurs from respiratory failure.
co
co
F.D.: Sixty to 200 ml. F.P.: 24 to 36 hours.
e.
e.
Absorption: (1) It is rapidly absorbed through the stomach
fre
fre
fre
and intestines, and also through the lungs and the skin. (2) Its
rate of oxidation and elimination is one-fifth that of ethanol. (3)
ks
ks
ks
Formaldehyde (33 times more toxic than methanol) and formic
oo
oo
oo
acid are formed during the oxidation of methyl alcohol, which are
eb
eb
eb
responsible for metabolic acidosis and retinal toxicity. (4) About 80%
m
m
is excreted unchanged from the lungs and about 3 to 5% is excreted
in urine.
Treatment: (1) Gastric lavage using 5% bicarbonate solution.
om
om
(2) Activated charcoal reduces the mortality significantly. (3) Ethyl

co
alcohol 50% is given in dosage of one ml/kg. body weight every two
c
e.
e.
hours for five days. The i.v. route is preferred to avoid gastritis. A 5
re
fre
to 10% concentration should be given slowly. (4) Alternatively 60 re

sf
f
ml of ethyl alcohol in 200 ml. fruit juice can be given orally over a
ks
ks
k
period of 30 minutes. Give 50 ml of 50% ethyl alcohol every hour

oo
oo
oo
for maintenance. (5) Folic acid 50 to 75 mg. every 4 hours. (6) Keep
eb
eb
eb
airway clear. (7) Haemodialysis is the treatment of choice in severe

m
poisoning. It reduces the half-life of methanol from 40 hours to about

one hour. (8) Symptomatic.
P.M. Appearances: (1) Cyanosis is marked and there is an
om
absence of postmortem clotting of the blood. (2) The pyridine may

co
co
give the skin a purple colour. (3) the mucous membrane of the
e.
e.
stomach and the duodenum is congested and inflamed with small

fre
fre
fre
haemorrhages. (4) The lungs are congested and oedematous. (5) The
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 236 04-03-2015 12:19:47 PM

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CNs Depressants 237
e.
e.
brain is oedematous and shows focal haemorrhages. (6) The mucosa
re
fre
fre
of the bladder is often congested. (7) The liver shows fatty change
sf
ks
ks
and sometimes early necrosis, and there is tubular degeneration of
k
the kidneys.
oo
oo
oo
Opium: (1) Opium (afim) is the dried juice of the poppy
eb
eb
eb
(Papaver somniferum) which is cultivated in India and other Eastern
m
m
countries, only under a license. (2) The unripe capsule is incised and
the white juice which exudes is collected and allowed to evaporate
to obtain opium. (3) Ripe and dry poppy capsules contain a trace of
om
m
opium and are used for their sedative and narcotic action. (4) Poppy
co
co
seeds (khaskhas) are white, harmless, demulcent and nutritive and are
e.
e.
used as food. (5) The oil from the seeds is used for cooking purposes.
fre
fre
fre
(6) Opium occurs in rounded, irregularly formed or flattened masses
and has strong characteristic odour and bitter taste. (7) Crude opium
ks
ks
ks
occurs in rounded, irregularly formed or flattened masses and has
oo
oo
oo
strong characteristic odour and bitter taste. (7) Crude opium contains
eb
eb
eb
about 25 alkaloids. These form two chemically different groups: (a)
m
m
the phenanthrenes: morphine (ten percent), codeine (half percent),
and thebaine (0.3%)., which are narcotic, and the isoquinoline group:
papaverine (one%), and narcotine (six percent), which have mild
om
om
analgesic but no narcotic properties. Thebaine acts as convulsant.

co
The narcotic symptoms of opium poisoning are practically those of

c
e.
e.
morphine poisoning.
re
fre
Action: Opiates exert their effects because of their chemical re

sf
f
similarity to natural substances called endorphins. The opiate
ks
ks
k
drugs activate receptor sites normally occupied by the natural opiates

oo
oo
oo
or endorphins.
eb
eb
eb
F.D.: Opium two g; morphine 0.2 g.; coedine half g.

m
F.P.: 6 to 12 hours.
Symptoms: (1) Stage of Excitement: There is a sense of well-
being, increased mental activity, freedom from anxiety, talkativeness,
om
restlessness, or even hallucinations, flushing of face and greatly

co
co
excited or maniacal condition.

e.
e.
(2) Stage of Stupor: (1) The symptoms are headache, nausea,

fre
fre
fre
vomiting, incapacity for exertion, a sense of weight in the limbs,

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-28.indd 237 04-03-2015 12:19:47 PM

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e
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om
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e.
e.
giddiness, drowsiness and stupor. (2) The pupils are contracted, face
re
fre
fre
and lips are cyanosed and an itching sensation is felt all over the skin.
sf
ks
ks
(3) Pulse and respiration are normal.
k
(3) Stage of Coma: (1) The patient passes into deep coma. (2)
oo
oo
oo
The muscles become relaxed and all reflexes are abolished. (3) The
eb
eb
eb
pupils are contracted to pinpoint size and do not react to light, but
m
m
in late stage and before death, they may be found dilated. (4) All the
body secretions are suspended except sweat. (5) Prespiration is very
much increased. (6) Temperature is subnormal. (7) Blood pressure
om
m
is low, breathing is slow and stertorous and may be reduced to three
co
co
to four per minute. (8) The odour of opium may be present in breath.
e.
e.
(9) Pulse slow, irregular and imperceptible, respiration becomes
fre
fre
fre
Cheyne-Stokes in type, and death occurs from asphyxia.
Treatment: (1) Wash the stomach frequently, with a solution of
ks
ks
ks
1:5000 potassium permanganate. Gastric lavage should be done even
oo
oo
oo
after hypodermic injection of the drug, for the alkaloid is re-excreted
eb
eb
eb
into the stomach after absorption. (2) The intestines should be cleared
m
m
out by enema twice daily for two days to prevent reabsorption. (3)
Atropine is not recommended.(4) Naloxone hydrochloride is a
specific opioid antagonist. It competes with opioids at receptor
om
om
sites. It can reverse not only the respiratory, depressant, analgesic

co
and euphoric effects of opioids, but also dysphoric, delusional

c
e.
e.
and hallucinatory properties of the synthetic opioids. Two mg.,

re
fre
is given and repeated every half to one hour up to a total dose of re

sf
f
ten to twenty mg., i.v. It can also be given i.m. or sublingualy. (5)
ks
ks
k
Nalmefene has longer duration of effect than naloxone. 0.1 mg. is

oo
oo
oo
given i.v. followed by one mg. in 2 to 5 minutes. (6) When coma is

eb
eb
eb
deep, artificial respiration and oxygen is given by inhalation. Coma

m
cocktail: (7) In comatose patients where the identity of poison is not

known, 100 ml. 50% glucose, 100 mg. thiamine and 2 mg. naloxone
should be given i.v.
om
P.M. Appearances are those of asphyxia.

co
co
Absorption : It is absorbed from mucous membranes, raw

e.
e.
surfaces, hypodermic injection and when smoked in cirgarettes. It

fre
fre
fre
is eliminated mainly as morphine in urine and faeces, and also by

stomach, intestines, saliva, bile and milk.
ks
ks
ks
oo
oo
oo
eb
eb
eb
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Ch-28.indd 238 04-03-2015 12:19:47 PM

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CNs Depressants 239
e.
e.
Poisoning: (1) Sucide. (2) To steady the nerves for doing some
re
fre
fre
bold act requiring special courage.
sf
Chronic Poisoning: (Morphinism; morphinomania): Opium
ks
ks
k
addicts can tolerate 3 to 6 g. per day. The habitual use first causes
oo
oo
oo
a pleasurable feeling of relief and well-being, but as larger doses
eb
eb
eb
are taken, there is disinterest and recurring periods of depression
m
m
follow. Loss of memory, mental fatigue and gradual intellectual and
moral deterioration occur. Constipation, contracted pupils, anorexia,
emaciation and weakness and impotence are frequent.
om
m
Barbiturates: They have depressant action on the
co
co
central nervous system. Large doses directly depress the medullary
e.
e.
respiratory centre and cause irreversible brain damage, and yet
fre
fre
fre
the patient survives for a sufficiently long period so that they are
completely metabolised or excreted before death occurs.
ks
ks
ks
Symptoms: (1) Usually the first symptom is drowsiness. (2) A
oo
oo
oo
short period of confusion, excitement, delirium, and hallucinations is
eb
eb
eb
common. (3) Ataxia, vertigo, slurred speech, headache, paraesthesias,
m
m
and subjective visual disturbances occur. (4) A stupor progressing
through deepening coma, with inhibition or loss of superficial and
deep reflexes occur. (5) The Babinski toe sign may become positive.
om
om
(6) Respirations may be rapid and shallow or slow and laboured, but
co
the minute volume is always reduced. (7) There is a fall in cardiac

c
e.
e.
output and an increase in capillary permeability leading to an increase

re
fre
in extracellular fluid. (8) Mild but progressive cardiovascular collapse re

sf
f
occurs. (9) The pupils are usually slightly contracted, but react to
ks
ks
k
light; they may dilate during terminal asphyxia. (10) The urine
oo
oo
oo
may be scanty or suppressed and may contain sugar, albumen and

eb
eb
eb
haematoporphyrin. (11) Incontinence of urine and faeces may occur.

m
(12) The body temperature is usually reduced. (13) Respirations

become irregular, sometimes Cheyne-stokes in character and finally
stop. (14) The finding of blisters on the skin, often on areas of
om
erythema, strongly suggests barbiturate poisoning. Blisters contain

co
co
clear serous fluid. Blisters are commonly found in the sites where
e.
e.
pressure has been exerted between two skin surfaces, such as the
fre
fre
fre
interdigital clefts and inner aspects of the knees. (15) Death occurs
from respiratory failure or ventricular fibrillation.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-28.indd 239 04-03-2015 12:19:47 PM

e
e
m
m
om
m
co
co
e.
e.
F.D.: Short-acting: One to two g.; Medium-acting: Two to three
re
fre
fre
g.; Long-acting: 3 to 5 g.: F.P.: One to two days.
sf
Treatment: (1) Gastric lavage. (2) There is no specific antidote.
ks
ks
k
Analeptics: (a) Amphetamine. (b) Cardiazol. (3) Scandinavian

oo
oo
oo
method, uses antishock measures, maintenance of airway, and
eb
eb
eb
adequate respiratory support. CNS stimulants have been totally
m
m
eliminated. Fluid replacement therapy should be used and not
vasopressors. If shock persists dopamine should be given. (4)
Haemodialysis and exchange transfusion are sometimes life-
om
m
saving. (5) Forced alkaline diuresis is most useful in poisoning
co
co
by barbiturates which are not protein-bound like phenobarbitone,
e.
e.
allobarbitone and barbitone.
fre
fre
fre
P.M. Appearances are mainly of asphyxia.
Methaquolone: Some persons are extermely sensitive
ks
ks
ks
to this drug and may become unconscious even after one tablet.
oo
oo
oo
The patient may feel dizzy, sweat and a syndrome similar to
eb
eb
eb
hypoglycaemia is produced. Addiction may occur and some degree
m
m
of tolerance is seen after prolonged use.
Chloral Hydrate: It depresses the CNS. It is absorbed
rapidly from the stomach and small intestine and also from the rectum.
om
om
Signs and Symptoms resemble those of barbiturates. Death

co
usually occurs from paralysis of the respiratory centre.

c
e.
e.
F.D.: 5 to 10 gm. F.P.: Eight to twelve hours.

re
fre
Poisoning: (1) It is given in food or drink to render a person re

sf
f
suddenly helpless for the purpose of robbery or rape. Its action is
ks
ks
k
so rapid that it has been given the name of “knockout drops”. A

oo
oo
oo
combination of alcohol and chloral is commonly known as “Mickey

eb
eb
eb
Finn”. (2) It is often added to liquor to increase its potency.

m
Bromides: The bromides displace chlorides from plasma and

cells, and may cause fatal depression of the nervous system. Excessive
comsumption may lead to clinical picture resembling intoxication.
om
F.D.: 30 to 45 g. F.P.: 6 to 18 hours.

co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-28.indd 240 04-03-2015 12:19:47 PM

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e
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om
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co
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e. 29
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Miscellaneous Poisons
om
m
co
co
e.
e.
Hydrocarbons: Most of the hydrocarbons are derivatives
fre
fre
fre
of petroleum distillates. The toxic substances like gasoline, kerosene,
ks
ks
ks
naphtha, mineral spirit, light gas oil, and mineral sea oil are poorly
oo
oo
oo
absorbed from the G.I. tract.
eb
eb
eb
Signs and Symptoms: (1) Acute or chronic contact with
hydrocarbons causes chronic eczematoid dermatitis, with redness,
m
m
itching and inflammation. (2) Cutaneous exposure to gasoline and
other hydrocarbons can cause second degree burns, and systemic
om
om
manifestations. (3) When ingested symptoms are: nausea, vomiting,

co
abdominal pain and diarrhoea with risk of aspiration pneumonitis. (4)

c
The breath, vomit and urine have the peculiar smell. (5) Aspiration
e.
e.
produces coughing, choking, gasping, bronchospasm, hypoxia and

re
fre
CNS depression. re
sf
f
ks
ks
F.D.: 15 to 50 ml. of kerosene. F.P.: Within one day.
k
oo
oo
oo
P.M.Appearances are those of asphyxia.

eb
eb
eb
Poisoning: Poisoning is usually accidental, especially among

children. In the siphoning of gasoline from a tank, the mobile liquid
m
can easily be aspirated in the lungs and cause death.

Symptoms: (1) Burning pain in the throat and mouth, anorexia,
om
apathy, lassitude, nausea, vomiting and thirst are the early symptoms.
co
co
(2) The respiration is at first fast and deep, and later laboured and
dyspnoeic. (3) Vertigo, ringing in the ears, deafness and impaired
e.
e.
vision are common. (4) In severe poisoning a primary respiratory

fre
fre
fre
alkalosis with marked hyperapnoea and loss of CO2 is caused. (5)

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-29.indd 241 04-03-2015 12:20:55 PM

e
e
m
m
om
m
co
co
e.
e.
Later, metabolic acidosis supervenes. (6) The urine is strongly acid.
re
fre
fre
(7) The skin is flushed and moist, pupils dilated, pulse is rapid and
sf
ks
ks
irregular. (8) There may be platelet dysfunction and prolonged clotting
k
time. (9) Death occurs from acidosis and uraemia with peripheral
oo
oo
oo
failure due to shock. (10) Idiosyncrasy is seen in 0.2% cases.
eb
eb
eb
Paracetamol (Acetaminophen): F.D.: 10 to 20 g.
m
m
F.P.: 2 to 4 hours.
Symptoms: (1) Anorexia, nausea, vomiting, diaphoresis,
hypotension, tachycardia and dyspnoea. (2) In two to three days,
om
m
there is pain in the right upper quadrant due to hepatic damage. (3)
co
co
In 3 to 5 days, jaundice and renal failure.
e.
e.
Treatment: (1) N-acetylcysteine (NAC) is a specific antidote.
fre
fre
fre
(2) Haemodialysis.
P.M.Appearances: They include acute centrilobular hepatic
ks
ks
ks
necrosis, acute tubular necrosis in the kidney, myocardial necrosis
oo
oo
oo
and cerebral oedema.
eb
eb
eb
m
m
om
om
m
co
c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-29.indd 242 04-03-2015 12:20:55 PM

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e
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om
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co
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e. 30
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Stimulants
om
m
co
co
e.
e.
Amphetamine: (1) The common preparations are:
fre
fre
fre
amphetamine (benzedrine), dexamphetamine sulphate (dexedrine),
ks
ks
ks
methylphenidate (ritalin), lithium carbonate and caffeine. (2) They
oo
oo
oo
give a feeling of confidence and mental alertness. (3) They produce a
eb
eb
eb
false sense of euphoria which may be followed by severe depression.
(4) The onset of fatigue is delayed and tasks are more easily
m
m
completed, but there is loss of judgement and accuracy. (5) Symptoms
begin to appear within an hour after ingestion. They are: increased
om
om
awareness and activity, lessening of fatigue, liveliness, talkativeness,

co
insomnia, tremors, anorexia, dry mouth, nausea, vomiting, sweating,

c
tachycardia, arrhythmias, palpitation, anxiety, headache, dilated

e.
e.
pupils, confusion, hallucinations, delirium, convulsions, coma and

re
fre
death. (6) Fatal dose is about 200 mg. and fatal period about five days. re
sf
f
ks
ks
(7) Dangers of misuse are: (1) Overactivity or aggressive behaviour.
k
oo
oo
oo
(2) paranoid psychosis. (3) Shock and collapse. (4) Risk of suicide
eb
eb
eb
during the withdrawal.

Caffeine: (1) Large doses can stimulate directly the
m
myocardium to produce tachycardia, arrhythmias and extrasystoles.

(2) It increase cardiac output and stroke volume. (3) It decreases
om
fatigue. (4) Adrenaline and noradrenaline secretion is increased. (5) It

co
co
can increase the basal metabolic rate by about ten percent. (6) It also
increases oxygen consumption. (7) It acts as diuretic. (8) Significant
e.
e.
amounts of caffeine are present in tea, cola beverages and chocolates.

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-30.indd 243 04-03-2015 12:21:10 PM

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om
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e. 31
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Deliriant Poisons
om
m
co
co
e.
e.
Datura Fastuosa: Datura alba is a white flowered plant, and
fre
fre
fre
datura niger, a deep-purple flowered plant. All parts of these plants are
ks
ks
ks
poisonous, especially the seeds and the fruit. They contain 0.2 to 1.4%
oo
oo
oo
of hyoscine (scopolamine), hyoscyamine and traces of atropine.
eb
eb
eb
Action: The alkaloids first stimulate the higher centres of brain,
then the motor centres and finally cause depression and paralysis.
m
m
Symptoms: (1) Contact with leaves or flowers causes dermatitis
in sensitive persons. (2) A bitter taste, dryness of mouth and throat,
om
om
with difficulty in talking, dysphagia, and vomiting are first noticed.

co
(3) The face becomes flushed, conjunctivae congested, pupils widely

c
dilated with diplopia. (4) Mental changes include restlessness and

e.
e.
agitation, and patient cannot recognise relatives or friends. (5) The

re
fre
patient becomes confused, giddy, staggers as if drunk. (6) The skin is re

sf
f
ks
ks
dry and hot, the pulse rapid 120 to 140 per minute, full and bounding,
k
oo
oo
oo
respirations are increased. (7) The temperature may be raised by 2 to

eb
eb
eb
30C . (8) Muscle tone and deep reflexes are increased. (9) A scarlatinal
rash or exfoliation of the skin may be seen over most of the body.
m
(9) Delirium is restless and purposeless; in its earlier stages it is

indicated by excitement, talkativeness and unintelligent speech. The
om
patient may be silent but usually he is noisy, tries to run away from
co
co
his bed, picks at the bed clothes, tries to pull imaginary threads from
the tips of his fingers, threads imaginary needles. (11) Hallucinations
e.
e.
of sight and hearing and delusions occur. (12) This excitement passes
fre
fre
fre
off in one to two hours and the patient passes into deep sleep or coma
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-31.indd 244 04-03-2015 12:34:53 PM

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Deliriant Poisons 245
e.
e.
which may end rarely in death from respiratory paralysis. (13) The
re
fre
fre
patient may remain in this condition for two to three days, but usually
sf
ks
ks
distinct improvement occurs in 24 hours.
k
8D’s : Dryness of mouth, dysphagia, dilated pupils, dry hot skin,

oo
oo
oo
drunken gait, delirium, drowsiness, death due to respiratory failure.
eb
eb
eb
F.D.: One g. (100 to 125 seeds); Atropine 120 mg.
m
m
F.P.: One day.
Treatment : (1) Physostigmine half mg. i.v or i.m. In many cases
a single dose is sufficient. (2) Pilocarpine nitrate 5 mg s.c
om
m
P.M appearances are those of asphxia
co
co
Poisoning : (1) Curshed or powdered seeds or an extract is
e.
e.
used by criminals for stupefying a victim prior to robbery, rape or
fre
fre
fre
kidnapping. It is usually given in food or drink, e.g chapatis, curry,
tea, liquor, etc. to travellers in railway stations, choultries, etc. (3)
ks
ks
ks
Sometimes, the seeds are mixed with incense wood, and the victim
oo
oo
oo
is exposed to the fumes which produce lethargy. The victim soon
eb
eb
eb
falls into a deep sleep and later wakes up to find his belongings lost.
m
m
(4) Abortifacient. (5) Aphrodisiac. (6) Added to liquor or toddy to
increase the intoxication. (7) Love philter.
Cannabis sativa or Indica : (1) It is also known as
om
om
Indian hemp, hashish or marihuana. (2) The plant grows all over
co
Inida, but its cultivation is restricted by law. (3) The active principle
c
e.
e.
tetrahydrocannabinols (THC) are contained in its resin. (4) All parts

re
fre
of the plant, male or female, contain the active material. It is a CNS re

sf
f
stimulant. It is used in the following forms.
ks
ks
k
(1) Bhang (Siddhi, sabji) : (a) It is prepared from the dried leaves
oo
oo
oo
and fruit shoots. (b) It is used as we use tea to prepare a decoction. (c)
eb
eb
eb
It is the mildest and contains 15% of active principle. (2) Majoon :

m
It is sweet prepared with bhang. (3) Ganja : (a) It is prepared from

the flower tops of the female plant. (b) It has a rusty-green colour and
a characteristic odour. (c) It is mixed and smoked with tobacco in a
om
pipe or hukka. (d) It contains 15 to 25% of the active principle. (e)

co
co
Ganja (pot or grass) also known as marihuana, is used for smoking

e.
e.
in cigarettes, which contain 0.3 to 0.6 g. cannbis and are known

fre
fre
fre
as reefer. (4) Charas or hashish: (a) It is the resin (dope or shit)

exuding from the leaves and stems of the plant, and it contains 25 to
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-31.indd 245 04-03-2015 12:34:53 PM

e
e
m
m
om
m
co
co
e.
e.
40% of the active principle. (b) It is darkgreen or brown in colour.
re
fre
fre
(c) It is mixed and smoked with tobacco in a pipe.
sf
Symptoms : (1) They appear soon after smoking and last for one to
ks
ks
k
two hours, and within half hour after swallowing and last for two to three
oo
oo
oo
hours. (2) Taken in small dose the effects are very slight, which usually
eb
eb
eb
include euphoria, passivity, heightening of subjective experiences, and
m
m
disorientation. (3) With moderate doses these effects are intensified
by impaired immediate memory function, disturbed, thought patterns,
lapses of attention, and subjective feeling of unfamiliarity.
om
m
Intoxication : (a) Psychiatric : (1) Feelings of detachment,
co
co
disinhibition, depersonalisation, euphoria, elation, relaxation, well-
e.
e.
being, dreaminess, sleepiness, self-confidence, jocularity, laughing,
fre
fre
fre
silliness, rapidly changing emotions. (2) Thought process: irrelevant,
decreased concentration and attention span, altered sense of identity,
ks
ks
ks
disorientation. (3) Sensory novelty and increased awareness of
oo
oo
oo
stimuli: vivid images, illusions and hallucinations. (4) Feeling of
eb
eb
eb
precordial distress and tightness in chest; fear of dying. (5) Altered
m
m
concepts of time and space, change in body image, altered sexual
feelings. (6) Impaired judgement, failure to meet responsibilities. (7)
Talkative, flighty, poor immediate memory.
om
om
(b) Physical : Increased appetite and thirst, nausea, heaviness

co
in the head, dizziness, dysesthesias, somnolence, paraesthesias,

c
e.
e.
restlessness, ataxia, tremors, dry mouth, tachycardia, urinary

re
fre
frequency, congested conjunctivae. re

sf
f
F.D.: Chars two g.: ganja eight g.: bhang ten g./kilo body weight
ks
ks
k
F.P.: Several days.

oo
oo
oo
Treatment: (1) Stomach wash, (2) Diazepam, (3) Antipsychotic

eb
eb
eb
drugs.
m
Chronic Poisoning : (1) The use of the drug in small quantities

even for long periods is not harmful. (2 ) Used in excess, it causes
degeneration of the CNS and insanity. (3) There is loss of appetite,
om
weakness, wasting, tremors, vacant look, red eyes, impotence and

co
co
moral and mental deterioration. (4) Rarely they become insane, and
e.
e.
may suffer from hallucinations and delusions of persecution. The

fre
fre
fre
person may run amok, i.e., he develops a psychic disturbance marked

by period of depression, followed by violent attempts to kill people
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-31.indd 246 04-03-2015 12:34:53 PM

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om
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co
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Deliriant Poisons 247
e.
e.
(impulse to kill). He first kills a person against whom he may have
re
fre
fre
real or imaginary enemity and then kills anyone that comes in his
sf
ks
ks
way until the homicidal tendency lasts. Then he may commit suicide
k
or may surrender himself.

oo
oo
oo
Poisoning : (1) To stupefy persons to facilitate robbery. (2)
eb
eb
eb
Taken by criminal before committing a criminal act, to strengthen
m
m
the nerves. (3) Aphrodisiac.
CoCAine : (1) It is obtained from the leaves of Erythroxylum
coca. (2) The usual routes of intake are by application to the nasal
om
m
mucous membrane (snorting) and by the i.v route (skin popping). It
co
co
is also smoked.
e.
e.
Symptoms : (1) Stage of Excitement : (1) Dryness in the mouth,
fre
fre
fre
dysphagia, feeling of well-being and loss of depression and fatigue.
(2) The patient may be excited, restless and talkative, but this passes
ks
ks
ks
into a calm, dull condition. (3) The pulse is rapid, blood pressure
oo
oo
oo
falls, respirations rapid and deep, pupils dilated, headache, pallor of
eb
eb
eb
the skin, cyanosis, sweating and the temperature is raised. (4) The
m
m
reflexes are exaggerated and there may be tremors or convulsions. (2)
Stage of Depression: (1) Within an hour or even less, respirations
become feeble, profuse perspiration, collapse, convulsions and death.
om
om
F.D.: One to one -and-half g. orally. F.P.: Few minutes to few hours.
co
Treatment: (1) Gastric lavage. (2) If applied to the nose or throat,

c
e.
e.
wash out the mucous membrane with water. (3) If injected, apply a
re
fre
ligature above the part. (4) Amyl nitrite is antidote and is given re
sf
f
by inhalation.
ks
ks
k
P.M appearances are those of asphyxia

oo
oo
oo
Cocaine habit : (1) It is also known as cocainism, cocainophagia

eb
eb
eb
or cocainomania. (2) It causes anorexia, salivation and emaciation. (3)

m
The face is pale, sunken, pupils dilated and the gaze ‘shifty’. (4) The
tongue and teeth are black. (5) The sniffing habit leads to ulceration
of the nasal septum. (6) Degeneration of CNS occurs, and the patient
om
may suffer from hallucinations. convulsions, delirium and insanity.

co
co
Magnan’s symptom or cocaine bugs is seen in chronic cocaine

e.
e.
habit, in which there is feeling as if grains of sand are lying under

fre
fre
fre
the skin, or some small insects are creeping on the skin, giving rise
to itching sensation (tactile hallucinations).
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-31.indd 247 04-03-2015 12:34:53 PM

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m
om
m
co
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e. 32
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Drug Dependence
om
m
co
co
e.
e.
(1) Drug addiction is a state of periodic or chronic
fre
fre
fre
intoxication, produced by the repeated consumption of a drug
ks
ks
ks
and is harmful to the individual and the society. The most important
oo
oo
oo
drugs of addiction are opium and its derivatives, pethidine, heroin,
eb
eb
eb
alcohol, barbiturates, cocaine, cannabis, LSD and amphetamine.
Other drugs are chloral hydrate and bromides. Heroin is the most
m
m
dangerous. (2) Drug habituation (habit) is a condition resulting
from the repeated consumption of a drug, in which there is a
om
om
psychological or emotional dependence on the drug. Caffeine and

co
nicotine are habit forming drugs. Drug dependence includes both

c
the terms ‘ addiction’ and habituation’. (3) Drug abuse (substance

e.
e.
abuse): Improper or excessive use of therapeutic drugs may be termed

re
fre
abuse, even in the absence of addiction. The use of medically not re

sf
f
ks
ks
useful or illegal drugs is usually called drug abuse, even when
k
oo
oo
oo
the use is moderate and leads to no harm. (4) Addiction consists of

eb
eb
eb
physical dependence and psychological dependence. (5) Physical

dependence is a biological phenomenon, which depends on the type,
m
dose and duration of drug use irrespective of personality factors. If

the drug is abruptly withdrawn, a withdrawal syndrome will occur
om
in a physically dependent person. (6) Psychological dependence is

co
co
a compulsive need for a drug in order to maintain a state of well-

being, and it can occur in the absence of physical dependence. (7)
e.
e.
Indiscriminate use of any of these drugs produces a gradual mental,

fre
fre
fre
physical and moral worsening of the individual and sometimes sexual

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-32.indd 248 04-03-2015 12:35:11 PM

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om
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co
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Drug Dependence 249
e.
e.
perversions or crime. (8) The majority of drug victims are neurotic
re
fre
fre
individuals who are mentally unbalanced. (9) Hereditary factors,
sf
ks
ks
abnormal mental conditions, frustrations in life, anxiety, chronic
k
tensions, physical inability to do a job, curiosity, etc, are some of

oo
oo
oo
the causes.
eb
eb
eb
Symptoms of Drug Dependency : Loss of appetite and weight,
m
m
clumsy movements, unsteady gait, tremors, reddening or puffiness of
eyes, unclear vision, slurring of speech, loss of interest, sleeplessness,
lethargy and passivity, acute anxiety, depression, profuse sweating,
om
m
mood changes, temper tantrums, depersonalisation and emotional
co
co
detachment, impaired memory and concentration, preference for
e.
e.
solitude, especially spending long hours in the toilet.
fre
fre
fre
Trait Drug addiction Drug habituation
ks
ks
ks
(1) Dependence: Psychological and physical. Psychological only.
oo
oo
oo
(2) Compulsion : Present. Desire but not
compulsion
eb
eb
eb
(3) Dose : Tendency to increase. No tendency to
m
m
increase.
(4) Withdrawal Characteristic symptoms. None or mild.
symptoms.
om
om
(5) Harm : Both to the individual and If any, primarily to the

co
society. individual.
c
e.
e.
Withdrawal symptoms : (1) They may begin within 6 to 8 hours

re
fre
following stoppage of the drug or they may be delayed for 24 to 48 re

sf
f
ks
ks
hours, depending upon the particular drug being used. (2) The length
k
of period of withdrawal symptoms also varies and can last up to ten

oo
oo
oo
days. (3) The intensity of the symptoms depends on the dose and type
eb
eb
eb
of the drug used, the duration of addiction, and the suddenness of

m
withdrawal of the drug. (4) Early symptoms are chilliness, sensation

of cold, uneasiness, yawning and rhinorrhoea. (5) Later, respirations
become laboured, and very rapid. (6) Goose skin, lachrimation, gross
om
tremors and dilated pupils are seen. (7) Anorexia is present in all the
co
co
stages. (8) The third stage is one of sleep lasting from 8 to 16 hours.
e.
e.
(9) Upon awakening all the previous symptoms become intense.

fre
fre
fre
(10) In addition, there is tachyapnoea, fever, hypertension, pain and

ks
ks
ks
cramps in the legs and abdomen, perspiration, vomiting and diarrhoea.

oo
oo
oo
eb
eb
eb
m
Ch-32.indd 249 04-03-2015 12:35:11 PM

e
e
m
m
om
m
co
co
e.
e.
Treatment : (1) The person should be removed to an institution,
re
fre
fre
so as to remove him from the association with which the addiction
sf
ks
ks
started. (2) Constant supervision to prevent addict from obtaining secret
k
supplies of the drug. (3) Detoxification : This consists of reduction

oo
oo
oo
in dosage of drug over a period of one to three weeks. (4) Sedatives,
eb
eb
eb
benzedrine, hyoscine. (5) Diverting the mind by engaging him
m
m
physically and mentally in some occupation. (6) Psycotherapy (group,
family or individual). (7) Improving general health. (8) Symptomatic.
(9) The treatment is successful only in 10 to 25 percent of cases.
om
m
Narcotic addicts may be murdered by a ‘hot shot’. This is a dose
co
co
of narcotic with poison, such as strychnine in it. In such cases, only
e.
e.
signs of anoxia and cerebral depression are present. Another method
fre
fre
fre
of accidental or homicidal death is by the use of purer drug than the
addict has been using.
ks
ks
ks
Heroin (brown sugar) : (1) Street heroin is known as “smack,
oo
oo
oo
junk, or dope”. (2) Heroin is the most dangerous among all drugs of
eb
eb
eb
addiction. (3) It can be smoked or injected or used as snuff. (4) It is
m
m
more analgesic and euphorogenic than opium. (5) Tolerance to heroin
occurs very rapidly (within days) and can be increased to more than
hundred times the initial dose. (6) The effects last for 3 to 6 hours.
om
om
(7) Fatal dose 50 mg.

co
PEthidine (Meperidine) : (1) It acts on cerebrum and

c
e.
e.
produces analgesia and sedation. (2) Two grams is fatal. (3) Death
re
fre
in 24 hours. re
sf
f
Symptoms : (1) Effects are similar to morphine. (2) It causes
ks
ks
k
more dizziness, greater elation, and impairnment of ability to work is

oo
oo
oo
more than with morphine. (3) Addicts may have twitchings, tremors,
eb
eb
eb
dry mouth. (4) Abstinence syndrome resembles that of morphine

m
withdrawal and symptoms appear in 3 to 4 hours and are maximum

in 8 to 12 hours and disappear in 4 to 5 days. (5) Treatment is same
as for opium.
om
Hallucinogenic Drugs : LSD, mescaline, dimethyl tryptamine

co
co
(DMT), psylocybin, psylocin, peyote and phencyclidine (PCP) are

e.
e.
important.
fre
fre
fre
Symptoms : (1) Both sympathetic and parasympathetic symptoms

are produced. (2) During hallucinations sensory perceptions are
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-32.indd 250 04-03-2015 12:35:11 PM

e
e
m
m
om
m
co
co
Drug Dependence 251
e.
e.
intensified, colours seem brighter and more clear, sounds seem
re
fre
fre
excessively loud with an exaggeration of detail. (3) The individual
sf
ks
ks
feels a sense of depersonalisation and separation from the environment.
k
(4) The person may perceive that he is observing an event as opposed

oo
oo
oo
to being involved in one. (5) The person’s body image may become
eb
eb
eb
distorted, so also the boundaries of objects in the environment. (6)
m
m
Alternatively, synesthesias or sensory misperceptions occur such as
hearing colour or seeing sounds.
LSD (Lysergic acid diethylamide) : (1) It is a colourless,
om
m
tasteless, odourless, semi-synthetic compound. (2) The dose required
co
co
to produce psychotropic effects (take a trip) is 100 to 200 micrograms.
e.
e.
(3) Tolerance develops rapidly. (4) It is commonly taken as : (a) liquid
fre
fre
fre
on sugar, (b) saturated sugar cube, (c) soaked into blotting paper, (d)
capsule, and (e) blue pills.
ks
ks
ks
Fatal Dose : About fourteen mg.
oo
oo
oo
(1) The after-effects may persist for days or weeks. (2) At the
eb
eb
eb
height of the effects of the drug on the mind, individual may commit
m
m
a crime of violence or personal injury. (3) The feeling of being able to
fly under the influence of LSD can lead users to jump out of windows.
(4) Biological half-life of LSD in man is three hours. (5) Tolerence
om
om
develops fast and also disappears quickly.

co
Flashback Phenomenon : This may occur days, weeks or even

c
e.
e.
months after the ingestion of a dose, and the person experiences a

re
fre
recurrence of the emotional and psychological aspects of the previous re

sf
f
‘LSD trip’. These delayed recurring symptoms may lead to eccentric
ks
ks
k
behaviour, suicide or even homicide.

oo
oo
oo
Solvent (volatile substance) Abuse : (1) It involves the

eb
eb
eb
deliberate inhaling of a variety of substances, such as toluene (glue-

m
sniffing), gasoline (petrol), xylene, benzene, methylene, ethylene

chloride, fluorocarbons, carbon tetrachloride, butane, propane, etc.,
for their psychotropic and hallucinogenic properties. (2) Huffing
om
refers to inhaling vapours from a cloth that is saturated with the

co
co
volatile substance and held over or near to the nose and mouth. (3)
e.
e.
Bagging refers to inhaling and exhaling into a bag that has been filled
fre
fre
fre
with a small amount of a volatile substance. (4) The effects vary

from a condition resembling alcoholic intoxication, and distortion
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-32.indd 251 04-03-2015 12:35:11 PM

e
e
m
m
om
m
co
co
e.
e.
of perception to actual hallucinations. (5) The person feels powerful
re
fre
fre
dreams, heightened sensation and detachment from reality. (6) The
sf
ks
ks
sufferer often behaves totally irrationally and may injure or even
k
kill himself. (7) Later, the abuser will often have complete amnesia
oo
oo
oo
for the period of intoxication. (8) Major cause of death is due to
eb
eb
eb
sudden cardiac arrest. (9) Other causes of death are hypoxia and
m
m
hypercapnoea, plastic bag asphyxia, aspiration of vomit and accidents.
Body packer and body stuffer syndromes : (1) The act of
swallowing containers, condoms, balloons, plastic bags of packages
om
m
filled with illegal drugs for the purpose of smuggling has been termed
co
co
“body-packing”. (2) On arrival at his destination, the courier takes
e.
e.
a laxative, retrieves the packets and passes them on to the “pusher”
fre
fre
fre
who distributes the drugs. (3) Sometimes, packets become unsealed
or burst in the small intestine, especially cocaine filled containers,
ks
ks
ks
allowing massive absorption and cause the courier’s death from
oo
oo
oo
poisoning. (4) Even if the packets do not rupture, osmotic seepage
eb
eb
eb
across the latex wrapping allows small amounts of drug to appear
m
m
in the circulation and urine. (5) Drugs may be concealed in the
ears, mouth, nose, vagina or rectum. (6) Most body packers may be
diagnosed by X-ray of the abdomen as the packages are often radio-
om
om
opaque. (7) Arrested perosn swallows illegal drugs for concealing the
co
evidence from authorities. This is termed “body stuffer”.

c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-32.indd 252 04-03-2015 12:35:11 PM

e
e
m
m
om
m
co
co
e. 33
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Spinal Poisons
om
m
co
co
e.
e.
Strychnos Nux Vomica : (1) Strychnine (kuchila) is an
fre
fre
fre
alkaloid obtained from the seeds of strychnos nux vomica and other
ks
ks
ks
species of strychnos, which are found in the jungles in India. (2) The
oo
oo
oo
seeds of nux vomica contained in the ripe fruit are poisonous.
eb
eb
eb
(3) The seeds contain strychnine and brucine up to one-and-half
percent each. (4) All parts of the tree are toxic. (5) Strychnine is 10
m
to 20 times more poisonous than brucine. (6) The bark, wood and
leaves contain brucine but no strychnine.
m
om
om
Absorption and Excretion : (1) All mucous membranes absorb

co
strychnine. (2) Much is taken up by the liver and muscles to be either

c
released again to blood stream or to be destroyed. (3) About 80% is

e.
e.
oxidised mainly in the liver. (4) It may be found in the cadaver up

re
fre
to four years. re
sf
f
ks
ks
Action : (1) It depresses the inhibitory post-synaptic potentials
k
oo
oo
oo
in the spinal cord and prevents the effects of glycine. (2)

eb
eb
eb
Widespread inhibition in the spinal cord results in ‘release’ excitation.

(3) The action is particularly noted in the anterior horn cells. (4)
m
It stimulates the cerebral cortex.

Symptoms : (1) If swallowed uncrushed, the seeds of nux
om
vomica have no poisonous action, as they are not dissolved in

co
co
the G.I tract, and are passed entire in faeces. (2) Bitter taste in the
mouth, sense of uneasiness and restlessness, feeling of suffocation
e.
e.
and great fear and difficulty in swallowing occur. (3) The convulsions
fre
fre
fre
are preceded by such prodromal symptoms as increased acuity of

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-33.indd 253 04-03-2015 12:22:04 PM

e
e
m
m
om
m
co
co
e.
e.
Trait Strychnine Tetanus
re
fre
fre
(1) History : No history of injury. History of injury present
sf
ks
ks
(2) Onset : Sudden. Gradual.
k
oo
oo
oo
(3) Convulsions : All muscles of the body All the muscles are not
are affected at a time. affected at a time.
eb
eb
eb
(4) Lower jaw : Does not start in, nor Usually starts in and
m
m
especially affect the especially affects lower
jaw. jaw.
(5) Muscular Between fits muscles Between fits muscles are
om
m
condition: are completely relaxed. slightly rigid.
co
co
(6) Fatal period : One to two hours. More than 24 hours.
e.
e.
fre
fre
fre
perception, increased rigidity of muscles, and muscular twitchings.
(4) Convulsions are at first clonic, but eventually become tonic. (5)
ks
ks
ks
Risus sardonicus results. (6) The convulsions are most marked in anti-
oo
oo
oo
gravity muscles, so that the body typically arches in hyperextension
eb
eb
eb
(opisthotonus). (7) In supine position the body is supported by the
heels and head in a bow-like from. (8) Sometimes, the spasm of the
m
abdominal muscles may bend the body forward (emprosthotonus), m

or to the side (pleurosthotonus). (9) Consciousness is not lost and
om
om
the mind remains clear till death. (10) The duration of convulsion
co
varies from half to two minutes. (11) In between the convulsions,

c
e.
e.
the muscles are completely relaxed and the patient looks well and
re
fre
the breathing is resumed. (12) After 5 to 15 minutes or on slightest

re
sf
f
impulse, another convulsion occurs. (13) Death usually occurs
ks
ks
k
after 4 to 5 convulsions. (14) Hypoxia causes medullary paralysis

oo
oo
oo
and death.
eb
eb
eb
Fd.: 15 to 50 mg : one crushed seed. F.P.: One to two hours.

Treatment : (1) The patient should be kept in the bed in a dark
m
room, free from noise and disturbance. (2) Convulsions may be

controlled initially with diazepam. (a) Between convulsions ether
om
may be administered to the point of unconsciousness. (3) Short-

co
co
acting barbiturates like pentobarbital sodium or sodim amytal are

e.
e.
antidotes to strychnine and should be given in a dose of 0.3 to 0.6

fre
fre
fre
g.i.v (4) Stomach wash with potassium permanganate. (5) Activated

charcoal to adsorb strychnine.
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-33.indd 254 04-03-2015 12:22:04 PM

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e
m
m
om
m
co
co
e. 34
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Cardiac Poisons
om
m
co
co
e.
e.
NeRIum odoRum : (White oleander) : All parts of th plant
fre
fre
fre
are poisonous, containing several cardiac glycosides, primarily
ks
ks
ks
oleandroside (oleandrin), and nerioside (nerin), which resemble
oo
oo
oo
digitalis in action.
eb
eb
eb
Symptoms : Difficulty in swallowing and articulation, abdominal
pain, vomiting, salivation, diarrhoea. Pulse is first slow and later rapid
m
m
and weak, respirations are increased, muscular twitchings, tetanic
spasms, lockjaw, drowsiness, coma, respiratory paralysis and death.
om
om
F.D.: Fifteen to 20 g. of the root. F.P.: 24 to 36 hours.

co
Poisoning : (1) Suicide (2) Abortifacient. (3) Cattle poison.

c
CerBera thevetia : (Yellow oleander) : All parts are

e.
e.
poisonous. The seeds contain cardiac glycoside thevetin, and

re
fre
thevetoxin, similar to digitalis in action; nerifolin, peruvocide, re

sf
f
ks
ks
ruvocide and cerberin.
k
oo
oo
oo
Symptoms: Burning pain in the mouth, dryness of throat,

eb
eb
eb
tingling and numbness of tongue, vomiting, diarrhoea, headache,

giddiness, loss of muscular power and fainting. Pulse is rapid, weak
m
and irregular, blood pressure is low. Heart block, collaps and death
from peripheral circulatory failure.
om
F.D.: Eight to ten seeds, 15 to 20 g. root; 5 to 10 leaves.

co
co
F.P.: 2 to 3 hours.
Cerbera odallam (pilikirbir) : The active principles are
e.
e.
cerberin, cerberoside, odollin, odollotoxin, thevetin and cerapain.

fre
fre
fre
F.D.: Kernal of one fruit F.P.: One to two days or more

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-34.indd 255 04-03-2015 12:22:18 PM

e
e
m
m
om
m
co
co
e.
e.
AconIte : All varieties and all parts of the plant are poisonous.
re
fre
fre
The root is most potent, contains aconitine, and ten or more other
sf
alkaloids, such as pseudoconitine, indaconitine, bikhaconitine,
ks
ks
k
picraconitine, aconine. Aconitine stimulates and then depresses

oo
oo
oo
CNS.
eb
eb
eb
Symptoms : There is a burning sensation from the mouth to the
m
m
stomach and tingling and numbness in the mouth, tongue and pharynx,
followed by salivation, nausea, vomiting and diarrhoea. (2) Later
the mouth is dry, thirst and dysphagia. (3) Tingling and numbness
om
m
are then felt all over the body. (4) The limbs become weak and the
co
co
patient is unable to walk or stand. (5) There may be twitching of the
e.
e.
muscles with darting pains, and cramps and convulsions may occur.
fre
fre
fre
(6) The pupils alternately contract and dilate (hippus), but remain
dilated in the later stages. The vision becomes dim and there may be
ks
ks
ks
diplopia. (7) The pulse is slow, feeble and irregular, blood pressure
oo
oo
oo
low, the breathing laboured. (8) Death occurs from paralysis of heart
eb
eb
eb
or respiratory centres or both.
m
m
F.D.: One to 2 g. root : 2 to 5 mg. of aconitine.
F.P.: One to 8 hours.
Poisoning: (1) Added to liquor to increase intoxication. (2)
om
om
It is given with betel leaf to disguise its tasts for homicide. (3)
co
Abortifacient. (4) Cattle poison. (5) Arrow poison.

c
e.
e.
re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-34.indd 256 04-03-2015 12:22:19 PM

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co
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e. 35
e.
re
fre
fre
sf
ks
ks
C h a p t e r
k
oo
oo
oo
eb
eb
eb
m
m
Asphyxiants
om
m
co
co
e.
e.
CarBon MonoxiDE : Action : (1) Co has 200 to 300 times
fre
fre
fre
greater affinity for haemoglobin than that of oxygen, and 40 times
ks
ks
ks
more to myoglobin. (2) It displaces oxygen from its combination
oo
oo
oo
with haemoglobin and forms a relatively stable compound known as
eb
eb
eb
carboxyhaemoglobin. (3) It acts as chemical asphyxiant and produces
death due to anaemic anoxia. (4) The blood under the skin and in
m
m
the tissues will be cherry-red in 15 to 20% cases. (5) It inhibits the
electron transport by blocking cytochrome oxidase.
om
om
Sources : The common sources of CO include : coal gas, smoke

co
from fire and the fumes from defective heating appliances, e.g.,
c
furnace stove, waterheater, burning oil lamps, fumes of coke kilns,

e.
e.
lime kilns, explosion in mines, detonation of explosives, and the

re
fre
exhaust fumes of internal combustion engines. re

sf
f
ks
ks
symptoms: (1) The effects of CO are simply those of suboxia.
k
oo
oo
oo
(2) Damage to the CNS may produce monoplegia or hemiplegia. (3)

eb
eb
eb
Impairment of higher intellectual functions, personality changes,

cerebellar damage, and severe Parkinsonism may occur and may be
m
delayed by several weeks after apparent recovery. (4) Bullae tend to

be separate and isolated lesions. These bullae are localised by external
om
pressure. They are caused due to skin hypoxia. They rerely involve
co
co
fingers and toes. (5) There is tendency of the dying victim to wild,
swinging, erratic movements inside the room distrubing clothing and
e.
e.
furniture, which gives an impression of violent struggle. (6) Death

fre
fre
fre
usually occurs when 80% of haemoglobin is saturated with Co.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-35.indd 257 04-03-2015 12:22:38 PM

e
e
m
m
om
m
co
co
e.
e.
(7) CO can pass from the maternal to the foetal blood, and can produce
re
fre
fre
intrauterine death, even though the mother survives.
sf
Delayed Deaths: Coma is accompanied by degenerative changes
ks
ks
k
in brain and capillaries. A wide variety of neurological symptoms

oo
oo
oo
ranging from blindness to decerebrate rigidity occur.
eb
eb
eb
The Effects of Different Air Concentrations of CO: (1) The
m
m
upper limit of safety is 0.01% CO in air. (2) If a person breathes CO
in low concentration for a considerable length of time, especially
during sleep, he will be poisoned just as effectively as though he
om
m
were exposed to high concentrations for a short period. (3) Exposure
co
co
to atmosphere containing 0.2% of gas will cause death in about four
e.
e.
hours, 0.4% in one hour, and 10% in half hour.
fre
fre
fre
Treatment : (1) Remove the patient to fresh air. Between 40
to 50 percent of CO is eliminated by the blood during first half an
ks
ks
ks
hour. (2) With higher degrees of gassing, artificial respiration must
oo
oo
oo
be started and pure oxygen given. (3) A whole blood transfusion is
eb
eb
eb
useful. (4) Complete rest for 48 hours.
m
CoHb%
0 to 10% No appreciable symptoms.
Symptoms
m
om
om
10 to 20% Breathlessness on moderate exertion, mild headache.

co
20 to 30% Headache, irritability, emotional instability, disturbed

c
judgement, defective memory and rapid fatigue.

e.
e.
30 to 40 % Severe headache, nausea, vomiting, dimness of vision,

re
fre
confusion, cherry-red discolouration of skin. re

sf
f
ks
ks
40 to 50 % Increasing confusion, sometimes hallucinations, severe
k
ataxia, rapid respirations and collapse with attempts at

oo
oo
oo
exertion. Symptoms resemble alcoholic intoxication.

eb
eb
eb
50 to 60% Syncope or coma with intermittent convulsions, rapid

respirations, tachycardia with weak pulse.
m
60 to 70% Increasing depth of coma with incontinence of urine and

faeces.
om
70 to 80% Deep coma with depressed or absent reflexes, a weak

thready pulse, shallow and irregular respirations.
co
co
Above 80% Rapid death from respiratory arrest.

e.
e.
Autopsy : (1) A cherry-red colouration of the skin, mucous

fre
fre
fre
membranes, areas of hypostasis, blood, tissues and internal organs,

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-35.indd 258 04-03-2015 12:22:38 PM

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e
m
m
om
m
co
co
Asphyxiants 259
e.
e.
seen in 15 to 20% cases. (2) The cherry-red discolouration changes
re
fre
fre
to dark-green, then to brown with the onset of decomposition. (3)
sf
ks
ks
Fine froth may be seen at mouth and nose. (4) Muscle necrosis and
k
skin blebs are common. (5) Pulmonary congestion and oedema.

oo
oo
oo
(6) The blood is fluid, hyperaemia is general and serous effusions
eb
eb
eb
are common. (7) Necrobiosis of the heart muscle and pleural
m
m
and pericardial anoxial haemorrhages are common. (8) Bilateral
symmetrical necrosis of the basal ganglia in the brain, especially the
putamen and globus pallidus and punctiform haemorrhages in the
om
m
white matter of the brain with widespread oedema are common. (9)
co
co
CO persists for many weeks after death, and may be detected
e.
e.
even after putrefaction or embalming and prolonged burial. (10)
fre
fre
fre
Co-blood has very little tendency to clot.
HydroGen sulphide : It is colourless gas with a smell
ks
ks
ks
of rotten eggs. It is often found in large quantities in sewers (sewer
oo
oo
oo
gas), cess pools, privy vaults and tannery vats.
eb
eb
eb
Symptoms : (1) In great dilution, there is feeling of dullness and
m
m
sleepiness, and death may occur during sleep without the victim
regaining consciousness. (2) In weak concentration there is cough,
giddiness, nausea and feeling of oppression. (3) The breathing is
om
om
laboured and heart irregular, cyanosis of the face, inflammation of

co
the conjunctivae, lachrymation and photophobia, muscular weakness

c
e.
e.
and prostration. (4) There may be delirium, convulsions or coma and

re
fre
death occurs from asphyxia. (5) If breathed in a concentrated form, re

sf
f
death occurs immediately from paralysis of respiratory centre.
ks
ks
k
(6) Its toxicity and rapidity of action are comparable to HCN. (7) The
oo
oo
oo
colour of blood and viscera is greenish-purple.

eb
eb
eb
Treatment : (1) Remove patient to fresh air. (2) Amyl

m
nitrite inhalation and sodium nitrite infusion will form sulphmet-

haemoglobin.
HydroCyanic Acid : It is also called prussic acid or
om
cyanogen; odour of bitter almonds. All persons cannot smell the gas.
co
co
Action : Cyanide inhibits the action of cytochrome oxidase

e.
e.
and carbonic anhydrase. It kills by creating histotoxic or cyotoxic

fre
fre
fre
anoxia, although the blood may contain a normal oxygen content.

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Ch-35.indd 259 04-03-2015 12:22:38 PM

e
e
m
m
om
m
co
co
e.
e.
Absorption: Cyanide gas is absorbed rapidly from the respiratory
re
fre
fre
system, and the acid and cyanide salts from the stomach. The acid
sf
ks
ks
is also absorbed through the skin. Alkaline cyanides when ingested
k
are converted by hydrochloric acid in the gastric juice into chlorides,

oo
oo
oo
and hydrocyanic acid is liberated.
eb
eb
eb
Symptoms : (1) This is most rapid of all poisons. (2) When
m
m
inhaled as a gas, its action is instantaneous. (3) If a large dose is
taken, symptoms usually occur at once, but in some cases symptoms
appear after about one minute. (4) CNS : Headache, vertigo, faintness,
om
m
perspiration, anxiety, excitement, confusion, drowsiness, prostration,
co
co
opisthotonus and trismus, hyperthermia, convulsions, paralysis,
e.
e.
stupor, coma. (5) G.I.T.: Bitter, acid burning taste, constriction or
fre
fre
fre
numbness of throat, salivation, nausea. (6) R.S.: Odour of bitter
almonds in breath. (7) Initially tachyaponea and dyspnoea. Later
ks
ks
ks
rapid slowing of respiratory rate with severe respiratory depression
oo
oo
oo
and cyanosis. (8) C.V.S.: Initially hypertension with reflex
eb
eb
eb
bradycardia, sinus arrhythmia. Later tachycardia with hypotension
m
m
and cardiovascular collapse. (9) Skin : Perspiration, bullae. Eyes
: Glassy and prominent, pupils dilated, unreactive. (10) Renal :
Acidosis. (11) Death occurs from respiratory failure.
om
om
(1) In poisoning by cyanides the symptoms may not occur for 10

co
to 20 minutes because of the delay in the decomposition of the salt by

c
e.
e.
gastric juice, and the liberation and absorption of hydrocyanic acid.

re
fre
(2) Cyanide salts have a corrosive effect on the mouth, throat and re
sf
f
stomach and cause epigastric pain and vomiting. (3) Other symptoms
ks
ks
k
are similar to hydrocyanic acid.

oo
oo
oo
F.D.: Fifty to sixty mg. of pure acid; 200 to 300 mg. of sodium
eb
eb
eb
or potassium cyanide.
m
F.P.: Two to ten minutes. Potassium or sodium cyanide half hour.

Treatment : (1) Break 0.2 ml. ampoule of amyl nitrite in a
handkerchief and hold over the patient’s nose for 15 to 30 seconds of
om
every minute. (2) 0.3 g. of sodium nitrite in 10 ml. of sterile water

co
co
is given i.v. slowly over a period of one to three minutes. Sodium

e.
e.
nitrite forms methaemoglobin. (3) Through the same needle infuse

fre
fre
fre
25 g. sodium thiosulphate in 50% solution i.v. over a period of

ten minutes. It converts cyanide to non-toxic thiocyanate. Repeat
ks
ks
ks
oo
oo
oo
eb
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Ch-35.indd 260 04-03-2015 12:22:38 PM

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Asphyxiants 261
e.
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the nitrite-thiosulphate injection after an hour if recovery has not
re
fre
fre
occurred. (4) Hydroxocobalamine 4 to 5 g. i.v as infusion is given.
sf
It forms non-toxic cyanocobalamine. (5) Dicobalt EDTA acts
ks
ks
k
by chelating cyanide. 600 mg. i.v. slowly followed by 300 mg. if

oo
oo
oo
recovery does not occur. Cobalt EDTA and aminophenols are more
eb
eb
eb
rapid in action, efficacious and less toxic than nitrites. (6) Gastric
m
m
lavage is then performed using activated charcoal, or 10% sodium
thiosulphate or potassium permanganate. (7) Ventilate with 100%
oxygen. (8) Methaemoglobin of more than 50% is an indication for
om
m
exchange transfusion.
co
co
P.M.Appearances : (1) Eyes are glistening and prominent with
e.
e.
dilated pupils. (2) The jaws are firmly closed and there is froth at the
fre
fre
fre
mouth. (3) The colour of the cheeks and postmortem staining may be
cherry-red or brick-red. (4) The blood is bright cherry-red in about
ks
ks
ks
half the cases. (5) All the vessels of the body including the veins
oo
oo
oo
contain oxygenated blood. (6) The odour of hydrocyanic acid may
eb
eb
eb
be noticed on opening the body. (7) There is congestion of viscera
m
m
and oedema of the lungs. (8) Potassium or sodium cyanide produce
slight corrosion of mouth.
JuDicial Execution : (1) In some contries, hydrocyanic
om
om
acid gas is used for legal execution. (2) The condemned person is
co
strapped in a chair and several cyanide “eggs” are dropped into a

c
e.
e.
pan of strong acid, which produces large quantities of the poison gas
re
fre
immediately. (3) Unconsciousness occurs very rapidly, although the re

sf
f
heart continues to beat for ten to twenty minutes.
ks
ks
k
War GaseS : The term “ war gases” includes any chemical

oo
oo
oo
(gaseous, liquid or solid), which are used to produce destruction

eb
eb
eb
mostly in times of war.

m
(1) Vesicant or Blistering gases : These are mainly mustard gas

and lewisite. Mustard gas causes irritation of the eyes, nose, throat,
and respiratory passages, nausea, vomiting and abdominal pain. It
om
passes through the clothes into the skin and produces intense itching,
co
co
redness, vesication, and ulceration, especially of the moist areas.

e.
e.
(2) Asphyxiants or Lung Irritants : These are chlorine,

fre
fre
fre
phosgene. Chloropicrin and diphosgene are liquids, which are used

in gas shells. Their action is mainly on pulmonary alveoli.
ks
ks
ks
oo
oo
oo
eb
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eb
m
Ch-35.indd 261 04-03-2015 12:22:38 PM

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e.
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(3) Lachrymators or Tear Gases : These are mainly
re
fre
fre
chloracetophenone (C.A.P) and ethyliodoacetate (K.S.K), and
sf
ks
ks
bromobenzyl cyanide (B.B.C). The vapours cause intense irritation
k
of the eyes with a copious flow of tears, spasm of the eyelids and
oo
oo
oo
temporary blindness.
eb
eb
eb
(4) Sternutators or nasal Irritants : These are solid, organic
m
m
compounds of arsenic. They are diphenylchlorarsine (D.A),
diphenylamine-chlorarsine (D.M), and diphenylcyanrsine (C.D).
The vapours cause intense pain and irritation in the nose and sinuses,
om
m
sneezing, headache, salivation, nausea, vomiting, tightness in the
co
co
chest and prostration.
e.
e.
The above are used to control riots. only two are being used now.
fre
fre
fre
(1) Orthochlorobenzylidene malanonitrite (CS) by police and the
military. (2) CN (Mace) available in devices used for self- protection.
ks
ks
ks
They are solids dispersed in an aerosol of either powder or liquid.
oo
oo
oo
Effects begin within seconds after exposure and usually lost in 10 to
eb
eb
eb
15 minutes. Improvement is usually rapid.
m
m
The nerve agents are esters of phosphoric acid (liquid) and are
identical in their biological activity to organophosphates. (2) The
major agents are G.A (tabun) GB (soman) and VX. (3) The vapours
om
om
are heavier than air so they tend to sink into valleys, trenches and
co
basements. (4) They are compounds related to phosphate esters in

c
e.
e.
action and toxicity. (5) These are colourless and odourless volatile
re
fre
liquids. (6) They are absorbed from the lungs, G.I.T, skin and re
sf
f
conjunctivae. (7) They inhibit acetylcholine esterase. (8) Exposure
ks
ks
k
to a large amount of vapour will cause loss of consciousness within

oo
oo
oo
seconds followed by convulsions. (9) Muscles become flaccid and

eb
eb
eb
breathing stops. (10) Treatment is similar to organophosphates.

m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
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Ch-35.indd 262 04-03-2015 12:22:38 PM

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e. 36
e.
re
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C h a p t e r
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m
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Food poisoning
om
m
co
co
e.
e.
The term food poisoning in its wider sense includes all illnesses
fre
fre
fre
which result from ingestion of foods containing non-bacterial
ks
ks
ks
products. But the term is usually restricted to acute gastroenteritis
oo
oo
oo
due to the bacterial infection of food or drink.
eb
eb
eb
Causes : (I) Poisoning due to bacteria and toxins. (II) Poisons
of vegetable origin (natural food poisons) : (1) Lathyrus sativus.
m
m
(2) Poisonous mushroooms. (3) Rye, oats, barley, etc. (4) Poisonous
berries, such as atropa belladonna. (5) Lolium temulentum. (6)
om
om
Paspalam scrobiculatum. (7) Argemone mexicana. (8) Cotton seeds.

co
(9) Groundnuts. (10) Vitia fava. (11) Cabbage. (12) Solanine. (13)
c
Soyabean. (14) Sweet clover. (III) Chemical : (1) Intentionally

e.
e.
added, such as flavouring agents in processed food, colouring agents,

re
fre
preservatives, extraction of fat by solvents like hydrocarbons. (2) re

sf
f
ks
ks
Accidentally added, such as pesticides and insecticides. (3) Products
k
oo
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of foods. (4) Radionucleides.

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eb
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Bacterial Food Poisoning : Bacterial food poisoning is divided

into two groups. (1) Infection type, which follows the multiplication
m
within body of pathogenic organisms, contained in the foods. (2) The

‘toxin’ type, which follows the ingestion of food in which poisonous
om
substances have been formed due to bacterial proliferation. In the

co
co
infection type, organisms belong mainly to the salmonella group,

e.g. S. enteritidis of Gaertner, S. typhimurium, S. cholerasuis and
e.
e.
less commonly the paratyphoid bacilli. Bacterial food poisoning

fre
fre
fre
results from the ingestion of contaminated food, uncooked food

ks
ks
ks
oo
oo
oo
eb
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eb
m
Ch-36.indd 263 04-03-2015 12:22:54 PM

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om
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e.
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or imperfectly cooked food. The toxic type is due to ingestion of
re
fre
fre
preformed toxin in prepared food, such as canned or preserved food.
sf
ks
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Exotoxin, e.g. enterotoxin of staphylococci and the botulinum toxin
k
produce intoxication. The materials usually affected are meat, milk,

oo
oo
oo
fish or egg. Less frequently, vegetables and cereals and very rerely
eb
eb
eb
fruit are affected.
m
m
Food poisoning is common in summer, because the temperature
favours multiplication of microorganisms. It may occur as isolated
cases or small outbreaks. The main diseases spread by infected food
om
m
are : (1) The enteric group. (2) Cholera. (3) Bacillary dysentery. (4)
co
co
Staphylococcal and other bacterial infection. (5) Amoebic dysentry
e.
e.
and other portozoal infections. (6) Acute infective hepatitis. (7)
fre
fre
fre
Brucellosis. (8) Various worm infestations. (9) Schistosomiasis. (10)
Traveller’s diarrhoea (due to pathogenic E.coli).
ks
ks
ks
Diagnosis : This is made from : (1) History. (2) Clinical features.
oo
oo
oo
(3) Isolation of the organism from the remnants of suspected food and
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eb
eb
from vomit, faeces, blood, etc., from sick person. (4) The injection
m
m
of the portion of the left off food into mice or guinea pigs should be
performed. If the animal gets sick, attempt should be made to isolate
organism from them.
om
om
Botulism : (1) Cl. botulinum does not grow in body, but produces
co
a potent neurotoxin. (2) It is normally present in the soil and by soil

c
e.
e.
contamination, food may become infected especially, fruits and

re
fre
vegetables. (3) The toxin is destroyed by heat at 800C. (4) Botulism re

sf
f
is an intoxication, not an infection. (5) C. botulinum multiplies in
ks
ks
k
the food, e.g, tinned meat, fish, fruits, etc., before it is consumed,
oo
oo
oo
and produces a powerful exotoxin. (6) The fatal dose for an adult is
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eb
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0.01 mg. or even less. (7) The toxin paralyses the nerve endings, by
m
blocking the nerve impulses at the myoneural junctions.

Symptoms : (1) Symptoms are : dry or sore mouth or throat,
dysphagia, difficulty with visual accommodation, dysphonia,
om
diplopia, descending bilaterally symmetrical motor paralysis,

co
co
constipation, respiratory insufficiency, and urinary retention. (2)

e.
e.
Death may occur within 24 hours from the onset of symptoms, but
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fre
fre
may be delayed for a week. (3) Mortality varies from 25 to 100%.

ks
ks
ks
oo
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Ch-36.indd 264 04-03-2015 12:22:54 PM

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Food Poisoning 265
e.
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Ptomaines : (1) These are alkaloidal bodies which are formed
re
fre
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as a result of bacterial decomposition of protein. (2) When they are
sf
formed in the dead tissues, they are known as cadaveric alkaloids.
ks
ks
k
(3) Alkaloids secreted by living cells during metabolism are called

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oo
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leucomaines, which are slightly toxic when injected to an animal,
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eb
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but have no action when ingested. (4) They are not bacterial poisons.
m
m
They are found only when the food becomes too disagreable to be
eaten. (5) The symptoms rersemble those of atropine. Ptomaines are
not the causative agents of food poisoning.
om
m
Lathyrus Sativus (Kesari dhal) : (1) Consumption of
co
co
L. Sativus seeds in quantities exceeding 30% of the total diet for
e.
e.
more than six months have been known to causes paralysis. (2)
fre
fre
fre
The active neurotoxic principle is B (N) oxalyl aminoalanine (BOAA).
L. sativus produces neurolathyrism, which is characterised by
ks
ks
ks
progressive spastic paraplegia with preservation of sphincters,
oo
oo
oo
sensation and mental activity. (4) There may be pain in the back or
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eb
eb
weakness of legs, and difficulty in sitting down and getting up. (5)
m
m
Later the patient is unable to walk without the aid of a stick; spastic
gait occurs. (6) Later complete paraplegia occurs.
Mushrooms : (1) Amanita phalloides and Amanita muscaria
om
om
are the common varieties of poisonous fungi. (2) A. muscaria contains

co
an alkaloid muscarine, the action of which resembles stimulation of

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e.
e.
parasympathetic post-ganglionic nerves. (3) A. Phalloides contains

re
fre
phalloidin, phallon, and B amanitin, which are cyclopeptides. (4) re

sf
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They are cytotoxic.
ks
ks
k
Symptoms : In some cases irritant symptoms may be present,

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oo
and in others neurotic or a combination of both.

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Fatal dose : 2 to 3 mushrooms . Fatal Period : 24 hours.

m
Treatment : (1) Atropine sulphate. (2) Antiphalloidien serum.

(3) Haemodialysis.
Argemone Mexicana : (1) The plant contains two
om
alkaloids berberine and protopine. (2) The oil contains two alkaloids,
co
co
sanguinarine and dihydrosanguinarine. (3) All parts of the plant are

e.
e.
poisonous. (4) The oil causes epidemic dropsy.

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Ch-36.indd 265 04-03-2015 12:22:54 PM

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Symptoms: (1) Marked oedema of the legs, sometimes
re
fre
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generalised anasarca. (2) In severe cases, myocardial damage and
sf
ks
ks
dilatation of the heart is seen. Liver may be enlarged and tender. (4)
k
Patient becomes breathless. (5) Tingling and hyperaesthesia of skin

oo
oo
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and tenderness of the calf muscles may be seen. (6) Bluish mottling
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eb
eb
of the skin is seen due to dilation of the peripheral vessels. (7) Death
m
m
occurs from severe damage to the heart.
Fish and marine Animals : (1) A primary toxicity is
caused by the presence in certain fishes of a neurotoxin. (2) 90% of
om
m
cases of fish poisoning are icthyosarcotoxic (involving toxin from
co
co
muscles, viscera, skin, gonads, and mucous surfaces). (3) Rarely,
e.
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toxicity involves the fish blood or skeleton, characterised by various
fre
fre
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gastrointestinal and neurological disturbances.
ks
ks
ks
oo
oo
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eb
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co
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re
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re
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Ch-36.indd 266 04-03-2015 12:22:54 PM

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Index
sf
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k
oo
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eb
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m
m
A Artificial Bromides, 240
Abortion, 154 insemination, 131 Brown sugar, 250
Abrasions, 64 Asphyxia, 48 Bruises, 66
om
m
Abrasion collar, 82 Assault, 99 Brush burn, 65
Atavism, 138 Buccal coitus, 148
co
co
Abrus precatorius, 224
Accident register, 99 Automatism, 182 Buggery, 147
e.
e.
Acid phosphatase, 53 Autopsy, medicolegal, 41 Bullets, 78
fre
fre
fre
Aconite, 256 Avulsion, 64 Burking, 123
Acrodynia, 216 B Burns, 104
ks
ks
ks
Adipocere, 61 C
Back spatter, 81
oo
oo
oo
Affiliation cases, 138
Age, in identification, 26 B.A.L., 197 Cadaveric spasm, 57
eb
eb
eb
criminal Bagging, 251 Cafe coronary, 122
Bansdola, 118 Caffey’s syndrome, 164
m
m
responsibility, 33
foetus, 33 Barberio’s test, 152 Calotropis, 225
m.l. importance, 33 Barbiturate, 239 Capsicum annum, 224
Alcohol, ethyl, 231 Basophilic stippling, 212 Cannabis indica, 245
om
om
Aldrich-Mees lines, 214 Battered baby, 164 Cantharides, 225

co
Algor mortis, 53 Bestiality, 148 Caput succedaneum, 163

c
Bhang, 245 Carbamates, 201

e.
e.
Alkalis, caustic, 210

Aluminium Bite marks, 39 Carbine, 77
re
fre
phosphide, 205 Blast lung, 85 Carbolic acid, 209 re

sf
f
Blood stains, 167 Carboluria, 210
ks
ks
Amensia, in head injury, 88
k
Amphetamine, 243 Body packer Carbon monoxide, 257

oo
oo
oo
Anoxia, 48 syndrome, 252 Cartridges, 77

Bomb explosion Casper dictum, 61
eb
eb
eb
Anthropometry, 35
Antidotes, 196 wounds, 85 Catamite, 147
m
Aphasia, 172 Bones, examination, 43 Cephalhaematoma, 163

Arborescent markings, 109 Bore of firearm, 76 Cephalic index, 23
Arcus senilis, 32 Botulism, 264 Cerbera odallam, 255
om
Argemone mexicana, 265 Boxing injuries, 94 Cerbera thevetia, 255

co
co
Arrow poisons, 189 Brain death, 47 Chain of custody, 5

Arsenic, 212 Brain mapping, 187 Charas, 245
e.
e.
Artefacts, 184 Breslau’s second life Chelating agent, 197

fre
fre
fre
Artificial bruise, 68 test, 162 Chemical antidotes, 196

ks
ks
ks
oo
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oo
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m
Index.indd 267 04-03-2015 4:09:53 PM

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co
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e.
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Chloral hydrate, 240 Cutis anserina, 124 E
re
fre
fre
Choking, 122 Cut-throat wounds, 71 EDTA, 198
sf
of firearms, 77 Cyanides, poisoning, 208 Effacement of identity, 42
ks
ks
Chop wounds, 74
k
D Electric burns, 108
oo
oo
oo
Chromolachryorrhoea, Electric mark, 108
201 Dactylography, 35
eb
eb
eb
Dangerous injury, 98 Electrocution, judicial, 109
Civil negligence, 14
Datura, 244 Embalming, 62
m
m
Civil responsibility and
Dead born child, 159 Embolism, air, 101
insanity, 179
Death, brain, 47 fat, 101
Cobra, poisoning by, 226
modes of, 47 Emetics, 195
Cocaine, 247
om
m
molecular, 47 Emphysema
Cocaine bugs, 247
co
co
Cognisable offence, 2 somatic, 47 aquosum, 125
sudden, 50 Endrin, 204
e.
e.
Cold stiffening, 57
time of, 63 Entomology, 63
fre
fre
fre
Coma, 48
Common witness, 5 Decomposition, 59 Eonism, 150
ks
ks
ks
Concealed puncture Defence wounds, 75 Epileptic psychosis, 175
wounds, 75 Defloration, 133 Epiphyses, union with
oo
oo
oo
Concussion of brain, 88 Delirium, 172 shafts, 30
eb
eb
eb
Conduct money, 2 Delirium tremens, 235 Erasure of name, 11
Consent, 19 Delivery, 138 Ergot, 224
m
m
Consumer Protection Delusions, 172 Erotomania, 173
Act, 21 Dementia, 175 Eunuch, 147
Contrecoup, injury, 88 Diatoms, 126 Euthanasia, 19
om
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Contributory Dichotomy, 11 Examination-in-chief, 6

co
negligence, 17 Dipsomania, 174 Exhibitionism, 151

c
Contusions, 66 DMSA, 198

e.
e.
Exhumation, 46
Contusion collar, 82 DNA fingerprinting, 170 Exit wound of bullet, 83
re
fre
Cooling of body, 53 Disciplinary control, 11 Expert witness, 6 re

sf
f
ks
ks
Copper, 219 Dowry death, 96 Extradural
k
Corona, 81 Drowning, 123 haemorrhage, 89

oo
oo
oo
Corpus delicti, 24 Drug, addiction, 248 Eye, m.l. importance, 52

eb
eb
eb
Cot death, 166 Drug habituation, 248

Courts of law, 1 Drunkenness, 232 F
m
Covering, 11 Dry drowning, 123 Fabricated wounds, 76

Criminal, negligence, 15 Duties, of patient, 13 Fall, from height, 92
Criminal responsibility in abortion, 157 Feigned insanity, 177
om
in insanity, 181 of physician, 12 Fellatio, 151

co
co
in ralation to age, 33 in suspected Fetichism, 150

Cross-examination, 7 poison, 193 Filigree burns, 109
e.
e.
Croton, poisoning by, 223 in witness box, 8 Firearms, 76

fre
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Crush syndrome, 100 Dying declaration, 4 Fish-tailing, 75

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oo
oo
oo
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Index.indd 268 04-03-2015 4:09:53 PM

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Index 269
e.
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Flashback Hermaphroditism, 24 Inquest, Magistrate, 1
re
fre
fre
phenomenon, 251 Heroin, 250 police, 1
sf
Flash burns, 105 Hesitation cuts, 73 Instantaneous rigor, 57
ks
ks
Florence test, 152 Hippus, 256 Intersexuality, 24
k
oo
oo
oo
Fodere’s test, 161 Hijrah, 147 Intracerebral
Foetus, development Holograph will, 180 haemorrhage, 90
eb
eb
eb
of, 33 Homicide, culpable, 95 J
m
m
Food poisoning, 263 Homicidal poison,
Forensic psychiatry, 172 ideal, 188 Joule burn, 108
Forensic science Hostile witness, 6 Judicial execution, 261
laboratory, 186 Jury, 1
om
m
Hurt, 98
Frost bite, 103 Hydrochloric acid, 208 K
co
co
Friction burn, 65 Hydrocyanic acid, 259 Kastle-Meyer test, 168
e.
e.
Frigidity, 129 Hydrocyanic acid, 208 Kerosene, 241
fre
fre
fre
Frotteurism, 152 Hydrogen sulphide, 259 Kleptomania, 174
G Hydrostatic test, 161 Klinefelter’s
ks
ks
ks
Gagging, 121 Huffing, 251 syndrome, 24
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oo
oo
Ganja, 245 Hymen, 133 Knockout drops, 240
Hyoid bone,
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eb
eb
Garrotting, 118 L
Gas rigidity, 60 fracture of, 120
m
m
Gastric lavage, 194 Lacerated wounds, 69
I
Gauge of firearm, 76 Lathyrism, 265
Identification, 23 Lead, 216
Gerantophilia, 147 Identity, destruction, 42
om
om
Glass-blower's shakes, 216 Leading question, 7

Idiot, 175 Legal procedure, 1
co
Graze, 65 Illusions, 174

c
Grievous injury, 98 Legitimacy, 137

e.
e.
Immersion syndrome, 123 Lesbianism, 148

Gun powder, 78
Impotence and
re
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Gustafson’s method, 29
sterility, 129
Lie detector, 186
re
sf
Ligature mark, 114

f
ks
ks
H Impulses, 174 Lightning, death from, 109
k
Haemin crystal test, 168 Incest, 146

oo
oo
oo
Live birth, 160

Haemochromogen Injury, 64 Locard’s princple of
eb
eb
eb
crystal test, 168 Inscised wounds, 70 exchange, 186

Haemodialysis, 198 Inscised-like wounds, 69 loco parentis, 21
m
Hair, 37 Indecent assault, 152 Love philter, 189

Hallucination, 173 Index, 267 LSD, 251
Hallucinogenic drugs, 250 Indian Medical Council, 9 Lucid interval, 174
om
Hanging, 113 Informed consent, 19 Lust murder, 149

co
co
judicial, 115 Infanticide, 159 Lynching, 115

e.
e.
Hatter’s shakes, 216 Infantile whiplash

Heat haematoma, 106 syndrome, 165 M
fre
fre
fre
Heat hyperpyrexia, 103 Injury, 64 Maceration of foetus, 159

ks
ks
ks
Heat stiffening, 57 Inhibition of heart, 50 Mc Ewan sign, 231

oo
oo
oo
eb
eb
eb
m
Index.indd 269 04-03-2015 4:09:53 PM

e
e
m
m
om
m
co
co
e.
e.
Mc Naughten rules, 181 N Pelvis, sex, 24
re
fre
fre
Magnan’s symptom, 247 Narco-analysis, 187 Penicillamine, 198
sf
Malingering, 21 Necrophagia, 149 Peritoneal dialysis, 198
ks
ks
Malpraxis, 14 Perjury, 6
k
Necrophilia, 150
oo
oo
oo
Mania, 176 Neonatal cold injury, 103 Pethidine, 250
Manual strangulation, 119 Nerium odorum, 255 Phenol, 209
eb
eb
eb
Masquerades, m.l., 7 Neuroses, 175 Phenolphthalein test, 168
m
m
Masochism, 150 Negative autopsy, 49 Phobia, 174
Mastrubation, 151 Negligence, criminal, 15 Phosphorus, 221
Meconium, 163 medical, 14 Physical antidotes, 196
Medical certificates, 3 Physical evidence, 186
om
m
Nitric acid, 207
Medical education, 9 Physiological antidotes,
co
co
Nitrites, 220
Medical ethics, 9 Novus actus 197
e.
e.
Medical etiquette, 9 interveniens, 15 Phytotoxin, 223
fre
fre
fre
Medical evidence, 3 Nystagmus, alcohol Phossy jaw, 222
Medical indemnity gaze, 233 Pistols, wounds from, 81
ks
ks
ks
insurance, 19 Ploucquet's test, 161
Medical maloccurrence, 15 O Point blank shot, 81
oo
oo
oo
Medical records, 21 Obscure autopsy, 50 Poisons Act, 189
eb
eb
eb
Medical register, 9, 10 Obsession, 174 classification of, 189
M.T.P. Act, 154 Oochronosis, 210 diagnosis, 190
m
Medico-legal reports, 4
M.L. masquerades, 7
Opium, 237
Ophitoxaemia, 226 m
failure to detect, 193
treatment, 194
Melancholia, 176 Oral evidence, 4 Polygraph, 186
om
om
Mental Health Act, 177 Organophosphates, 200 Poroscopy, 35

co
Mental subnormality, 175 Ossific centres of P.M. caloricity, 53

c
Mercury, 215 changes, 52

e.
e.
skeleton, 30
Mercurialentis, 216 Osteometric board. 45 estimation of
re
fre
Metal fume fever, 219 Overlaying, 122 interval, 63 re

sf
f
ks
ks
Methaemoglobinaemia, Oxalic acid, 208 hypostasis, 54
k
220 Posthumous child, 137

oo
oo
oo
Methaquolone, 240 P Precipitate labour, 164

eb
eb
eb
Methyl alcohol, 235 Paederasty, 147 Precipitin test, 168

Mugging, 119 Palmar strangulation, 118 Pregnancy, 134
m
Multidose charcoal, 196 Paltauf’s Primary flaccidity, 55

Mummification, 62 haemorrhages, 125 Primers, 78
Munchausen’s Paracetamol, 242 Privileged
om
syndrome, 165 Paradox guns, 77 communications, 13

co
co
Murder, 96 Paraquat, 203 Products liability, 18

Mushrooms, 265 Parathion, 200 Professional death
e.
e.
Musket, 77 Paternalism, 20 sentence, 11

fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Index.indd 270 04-03-2015 4:09:53 PM

e
e
m
m
om
m
co
co
Index 271
e.
e.
Professional Scoptophilia, 151 Stature, 34
re
fre
fre
miscounduct, 11 Self-inflicted wounds, 76 Statutory rape, 142
sf
Professional Semecarpus Steering wheel impact
ks
ks
negligence, 14 anacardium, 225 injury, 93
k
oo
oo
oo
Professional secrecy, 12 Seminal fluid, 152 Still birth, 159
Pseudocyesis, 136 Serious professional Stomach-bowel test, 162
eb
eb
eb
Pseudostrangulation, 116 misconduct, 11 Stomach, emptying
m
m
Psychopath, 175 Sex, differences in time, 63
Psychoses, 175 skeleton, 24 Strangulation, 116
Ptomaines, 265 Sexual asphyxias, 128 Strychnine, 253
Pugilistic attitude, 105 Sexual offences, 140 Subarachnoid
om
m
Punch drunk, 94 Sexual harassment, 141 haemorrhage, 90
co
co
Punctate basophilia, 217 Sexual oralism, 151 Subdural haemorrhage, 90
e.
e.
Puncture wounds, 74 Sexual perversions, 149 Subendocardial
fre
fre
fre
Putrefaction, 59 Sewer gas, 259 haemorrhages, 41
Q Sin of gomorrah, 148 Subpoena, 2
ks
ks
ks
Shock, 100 Sudden infant death
Quod, 130 Shotguns, wounding
oo
oo
oo
syndrome, 166
R by, 78 Suffocation, 121
eb
eb
eb
Railway spine, 91 Shored exit wound, 83 Suicide, 96
Skeleton, sex, 24
m
m
Rape, 140 Sulphuric acid, 206
accused, 145 Skeletonisation, 60 Summons, 2
victim, 143 Skull, age and sutures, 31 Sunstroke, 103
Res ipsa loquitur, 14 firearm wounds, 78 Superfecundation, 137
om
om
Respondent superior, 18 fractures, 86 Superfoetation, 137

co
identification of sex Superimposition, 36

c
Restraint of insane, 177

from, 24
e.
e.
Revolvers, wounds, 81 Supposititious

Smothering, 121
re
fre
Ricochet, of bullets, 83
Ricinus communis, 223 Snakes, 226
children, 138
Suicidal poisons, re
sf
f
ks
ks
Rifling of firearms, 76 Sodomy, 147 ideal, 189
k
Solvent abuse, 251 Suspended animation, 52

oo
oo
oo
Rights of doctors, 12
Rigor mortis, 56 Somnambulism, 182 Swallow tails, 70
eb
eb
eb
Rule of Haase, 34 Sonography, 136 Syncope, 47

Rule of nincs, 105 Souvenir bullet, 84
m
Spalding’s sign, 136, 160 T

Run amok, 246
Spectroscopic exam, 168 Tail-gating, 94
S Spinal cord, concussion Takayama test, 168
om
Sadism, 149 of, 91 Tandem bullet, 84

co
co
Scalds, 108 Stab wounds, 74 Tardieu spots, 49

Scars, 36 Stalking, 141 Tattoo marks, 37
e.
e.
Schizophrenia, 176 Starvation, 111 Teeth, eruption, 27

fre
fre
fre
Scorpion, 229 State Medical Council, 10 Teichmann’s test, 168

ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Index.indd 271 04-03-2015 4:09:53 PM

e
e
m
m
om
m
co
co
e.
e.
Testamentary Unnatural offences, 147 Widmark’s formulae, 234
re
fre
fre
capacity, 180 Undinism, 152 Witnesses, 5
sf
Tissue bridges, 70 Wounds, 65
ks
ks
V
Thanatology, 47 abrasions, 64
k
Vagal inhibition, 50
oo
oo
oo
Therapeutic antemortem or
misadventure, 17 Vaginismus, 131 postmortem, 101
eb
eb
eb
Therapeutic privilege, 20 Vagitus uterinus, 161
cause of death in, 100
Verdigris, 219
m
m
Thermal injuries, 103 certificate, 99
Thrombosis, 100 Vernix caseosa, 163
chop, 74
Throttling, 119 Viability, of foetus, 160
contusions, 66
Torture, 97 Video superimposition, 36
om
m
defence, 75
Toxalbumen, 223 Vicarious
fabricated, 76
co
co
Trace evidence, 186 responsibility, 18
firearms, 78
Viper bite, 227
e.
e.
Traffic accidents, 92 incised, 70
occupants, 93 Virginity, signs of, 133
fre
fre
fre
lacerated, 69
motorcyclists, 94 Virtual autopsy, 42
Viscera, preservation, 42 self-inflicted, 76
ks
ks
ks
pedestrians, 92
Vitriol throwing, 207 stab, 74
Trafficking, 141
oo
oo
oo
Transvestism, 150 Volunteering, of a X
eb
eb
eb
Traumatic asphyxia, 122 statement, 8 Xanthoproteic
Tribadism, 148 Voyeurism, 141, 151 reaction, 207
m
m
Troilism, 152 W
Truth serum, 187 Y
Turner’s syndrome, 24 War gases, 261 Yellow oleander, 255
om
om
Warning notice, 11
U Washerwoman’s Z
co
c
Umbilical cord, 163 hands, 124 Zinc phosphide, 204

e.
e.
Universal antidote, 197 Whiplash injury, 93 Zenana, 147

re
fre
re
sf
f
ks
ks
k
oo
oo
oo
eb
eb
eb
m
m
om
m
co
co
e.
e.
fre
fre
fre
ks
ks
ks
oo
oo
oo
eb
eb
eb
m
Index.indd 272 04-03-2015 4:09:53 PM

Concise Forensic Medicine and Toxicology Narayan Reddy

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om om om om

Honorary Professor of Forensic Medicine,

(Retired Principal, Osmania Medical College, Hyderabad)

The Health Sciences Publisher

New Delhi | London | Philadelphia | Panama

00 Prelims.indd 3 16-03-2015 11:44:58 AM

© 2015, Jaypee Brothers Medical Publishers

those of editor(s) of the book.

Inquiries for bulk sales may be solicited at: [email protected]

Concise Forensic Medicine and Toxicology

Fourth Edition: 2015

00 Prelims.indd 4 16-03-2015 11:44:58 AM

00 Prelims.indd 5 16-03-2015 11:44:58 AM

Sixth Edition, 2011, 24cm. x 18cm. PP 236, Price ` 270/-

(5) Medicolegal manual for police officers

Second Edition, 2002, 17cm. x 11cm. PP 4+209, Price ` 60/-

(6) Medical jurisprudence and toxicology re

Published by Andhra Law Times, Hyderabad.

00 Prelims.indd 7 16-03-2015 11:44:58 AM

16. Abortion 154

17. Infant Deaths 159

18. Blood Stains 167

22. General Considerations 188

25. Metallic Poisons 212

26. Inorganic Irritant Poisons 221

28. CNS Depressants 230

29. Miscellaneous Poisons 241

30. Stimulants 243

00 Prelims.indd 9 16-03-2015 11:44:58 AM

00 Prelims.indd 10 16-03-2015 11:44:58 AM

medical negligence, consent, professional misconduct, duties of

Inquest : An inquest is an enquiry or investigation into the

cause of death (S.174, Cr.P.C). It is conducted in cases of unnatural

and suspicious deaths, such as suicide, murder, accident, etc.

(1) Police inquest : (1) It is conducted throughout India.

(2) The officer - incharge of police station, informs the Executive re

is. (3) He conducts investigation (panchanama), in the presence of

two witnesses (panchas). (4) The report includes the description

The report is signed by police officer and witnesses. (6) If foulplay

authorised Government doctor. (7) If no foul play is suspected, the

dead body is handed over to the relatives for disposal.

Magistrate (who are revenue officials), such as District Collector,

deputy Collector, Tahasildar, etc. It is done in cases of (1) death in

Ch-01.indd 1 04-03-2015 12:07:10 PM

Coroner’s inquest is not done in India, but is done in U.K., some

Class of Magistrate Imprisonment Fine

Chief Judicial Magistrate Up to 7 years Unlimited

I Class Judicial Magistrate Up to 3 years 10,000 rupees

II Class Judicial Magistrate Up to 1 year 5,000 rupees re

In Metropolitan cities (population more than one million), Chief

Judicial Magistrate and First class Judicial Magistrates are designated

as Chief Metropolitan Magistrate and Metropolitan Magistrate

Cognisable offence is an offence in which a police officer can

forfeiture of property; (5) fine.

Ch-01.indd 2 04-03-2015 12:07:10 PM

Direct evidence is evidence of a fact which is actually in issue,

e.g. a prescription or a consent form. Indirect or circumstantial

evidence is evidence of a fact which is not actually in issue, but which

is derived from the circumstances. Hearsay evidence is any statement re

Documentary evidence is of three types.