FORENSIC MEDICINE

Legal
Inquest: Inquiry or investigation into the cause of death.
Two types of inquest are held in India
 Police inquest:
 Magistrate's inquest
Police inquest:
o Is section 174 of CrPC (criminal procedure code)
o Should be conducted by a minimum rank of assistant sub inspector.
o He visits the place of death investigates and makes a report on probable cause of death
o Two or more witness are called as PANCHAS.
o Panchanaama is inquest report signed by witness and investigating officer.
o In case of suspected foul play the dead body is send for autopsy and autopsy becomes
part of inquest.
o If no foul play is suspected dead body is handed over to the relatives
Magistrate's inquest:
o Is section 176 of CrPC
o It is conducted by executive magistrate, district magistrate , sub-divisional magistrate
and Tehsildars in cases of
 Death in prison
 Death in police custody or during police interrogation
 Death during police firing
 Dowry deaths
 Exhumation
 Death in psychiatry hospitals
 Death in borstal schools and reformatories
 Unnatural death within 7 years of marriage
Coroner's inquest:
o It is conducted by coroner
o Was practiced in India in Bombay and Calcutta empowered to summon witness and
record their evidence.
o It can also order post-mortem examination and exhumation but has no judicial power to
punish
Medical examiner's system:
o It is practiced in USA conducted by forensic pathologist who gathers first hand evidence
and conducts autopsy
o He submits the report to the district attorney.
o It is better than other types of inquests
 
 Cognizable offence is a criminal offence in which the police is empowered to register an FIR,
investigate, and arrest an accused without a court issued warrant.
Examples:
o Rape
o Kidnap

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 o Murder
o Robbery
o Dowry death
 Non-cognizable offence is an offence in which police can neither register an FIR, investigate,
nor effect arrest without the express permission or directions from the court.
 
 
COURTS IN INDIA:
Two types of courts
 Civil court
 Criminal court
Categories of criminal court:
 Supreme court: Highest court in India
 High court: Highest court in state
 Session court (district court when exercises its jurisdictions on criminal matters)
 Assistant sessions court: can pass a sentence of imprisonment upto 7 years.
 Magistrate court (subordinate of district court in criminal matters)
 
Session court:
 It is the lowest court that can pass death sentence.
 A sessions judge can award any punishment under IPC but a death sentence must be
confirmed by the high court.
 Additional sessions judge has same powers as sessions judge
 Assistant sessions judge can award any punishment provided in IPC except death sentence,
life imprisonment or imprisonment for a term >10 years.
 
Magistrate Period of imprisonment Amount of fine
Chief judicial magistrate/ Upto 7 years No limit
Chief metropolitan magistrate
1st class or metropolitan magistrate Upto 3 years Upto Rs. 5000
2nd class Upto 1 year Upto Rs. 1000
 
Juvenile magistrate:
 It is of the rank of 1st class magistrate or metropolitan magistrate
 Preferably a lady
 
A pregnant women sentence to death cannot be hanged until delivery and attainment of 6 months
of age by the child.
 

SUMMONS/SUBPOENA:
 It is a written document issued by the court compelling the attendance of a witness for
giving evidence on a particular day, time and place and served under a penalty
 Criminal courts have priority over civil courts.
 A higher court gets preference over the lower courts.

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  If the summon is from two equal courts having criminal proceedings preference should be
given to the summons received first.
 Subpoena are of 2 types:
o Subpoena ad Testificandum- summons to give evidence in court
o Subpoena Ducis Tecum - summon to produce some document in court
 
CONDUCT MONETY:
 It is the fee paid to the witness at the time of serving the summons to meet the expenses
for attending the court
 It is paid by the party who calls him for witness
 Conduct money is paid only in civil cases.
 No fee is paid for witness in criminal cases.
 
EVIDENCE:
 Evidence of the witness is recorded as
o Oath: before giving evidence the witness swears by God that he will tell the truth,
whole truth and nothing but the truth.
o It is compulsory and binds the witness for the given evidence
o Keeping the hand on holy book does not apply to a child below 12 years.
 
PERJURY:
 Section 191 of IPC
 It means giving wilful false evidence under oath.
 Section 192 of IPC is fabricating false evidence
 Section 193 of IPC is the punishment for perjury with imprisonment upto 7 years.
 
EXAMINATION-IN-CHIEF: (DIRECT EXAMINATION)
 It is the first examination of the witness by the lawyer who has summoned him.
 In criminal cases it is done by public prosecutor. No leading questions are allowed except
when the witness is Hostile.
 
CROSS EXAMINATION:
 It is done by the defence lawyer (lawyer of Opposite party)
 Leading questions are allowed.
 No time limit for the gross examination
 The defence witness in the murder trial is cross examined by the public prosecutor.
 
REEXAMINATION:
 It is done by the lawyer who conducted the examination in chief.
 Leading questions are not allowed
 The objective of re-examination is to correct any mistakes
 
The judge can ask questions any time to clear his doubts.
 
MEDICAL EVIDENCE:
 Documentary evidence includes medical certificates, medico-legal reports, dying declaration
and dying deposition

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 Medical certificate:
o It is to be given by registered medical practitioner for sickness or death
o No fee should be charged for issuing death certificate
o Doctors can charge for issuing other medical certificates
o In case of suspected foul play the doctor should not give the death certificate and
should inform the police
 Medico-legal reports:
o These are prepared by the doctor (usually on requisition from authorised persons
like magistrate or police) in criminal cases like murder, rape, poisoning
o e.g. post-mortem report, MLC reports
o They are admitted as evidence in the court only when the doctor gives oral evidence
on oath.
 Dying declaration:
o Section 32 I.E.A (indian evidence act)
o It is written or oral statement made by a person who is about to dye relating to the
cause of his impending death.
o A magistrate should be called to record the statement. Before recording the doctor
should certify that the person is conscious and his mental state is normal. (compos
mentis=sound mind)
o If the condition of the patient is serious and no time to call a magistrate the doctor or
any other person can record the statement in presence of two witness.
o Oath is not administered as it is believed that a dying person does not lie.
o Leading questions should not be asked. Declaration should be taken in exact words
the person uses. It should be free and spontaneous without prompting or suggestions
from other people. A signature of the declarant should be taken and also be signed by
the doctor and the witness. If person survives he is called to give oral evidence and dying
declaration becomes useless.
 Dying deposition:
o It is superior to dying declaration
o It is given under oath in presence of a magistrate
o The opposite party lawyer, accused is present
o Cross questioning is permitted
o Dying deposition is not practiced in India.

Dying declaration Dying deposition

It can be recorded by magistrate, doctor, even a lay It can be recorded only by the
person magistrate.
The person is not put under oath The person is put under oath
The person is not cross examined The person is cross examined
Less superior to dying deposition Superior to dying declaration
Accepted in India under section 32 IEA Not accepted in India

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 Less legal value More value
 
Oral evidence:
 It is the evidence given orally by a witness under a oath in court of law
 It is more important than documentary evidence, because in this cross examination can be
done.
 It can be of
a. direct or circumstantial evidence: it is evidence of a person who has personal
knowledge of the facts related to that incidence (eye witness)
b. Indirect or hearsay evidence: the witness has no persona knowledge of the facts but
repeats what he has heard others say (not permitted by the law)
 Documentary evidence is accepted by the court only on oral testimony by the concerned
person
 Documentary evidence is accepted without oral evidence (exceptions to oral evidence) in
the following conditions
a. Dying declaration
b. Expert opinion expressed in a treatise (printed in books)
c. Evidence that is recorded in a lower court
d. Evidence given by a witness in previous judicial proceedings
e. Public records e.g. birth and death records, marriage records, hospital records
f. Reports of certain government, scientific experts like
 Chemical examiners report/Assistant chemical examiners report
 Chief inspector of explosives
 Director of finger printing bureau
 Director Central forensic science laboratory(CFSL) and state forensic science
laboratory(SFSL)
Circumstantial evidence:
 It consists of facts from which an inference can be drawn e.g. blood stained cloths,
matching of bullet with recovered weapon etc.
Witness
 Types of witness
o Common witness: is a person who gives evidence about facts observed by him (first-
hand knowledge rule)
o Expert witness: e.g. doctors, fire arm experts, hand writing experts
 Doctor is a common as well as experts witness
o Hostile witness: is an unfavourable witness who purposefully makes statements
contrary to the statements made earlier before the investigating officer or has some
interest or motive for concealing the truth. He can be charged under perjury. Section
154 of IEA allows a hostile witness to be put leading questions by the party who called
him.
 
EXHUMATION:
 It is digging out a buried body from the grave.
 Written order from the first class magistrate (chief judicial magistrate), judicial or executive
is required
 Can be conducted both in criminal and civil cases

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  It should be started in the morning (natural light). Disinfectants should not be sprinkled.
Hair nails and long bones are preserved in suspected mineral poisoning. 6 - 7 samples of earth
are also taken.
 The time limit of exhumation in India is - NO LIMIT
 

Thanatology
 Thanatology is study of death in all its aspects.
 Death is permanent irreversible cessation of nervous, circulatory and respiratory systems
(tripod of life).
 Death occurs in 2 stages
o Somatic or systemic or clinical death:
 It is complete irreversible stoppage of respiration and brain function. (tripod
of life)
 If the heart sounds and respirations cannot be detected the doctor should
measure rectal temperature. If the rectal temperature is below 75 oF or 23.9oC it is
diagnosed to be death.
 Brain is superior to heart and lung because brain cannot be kept on artificial
support.
 Extinction of the personality is the immediate sign of vital process.
 In somatic death tissues and cells respond to chemical thermal or electrical
stimuli.
o Molecular death:
 It is a progressive disintegration of the body tissues due to lack of oxygen
 Brain cells die within 5 min of somatic death
 Liver 15min
 Kidney 45min
 Heart 1Hr
 Cornea 6Hrs
 Skin 24 Hrs
 Bone 48 hrs
 Blood vessels 72 Hrs (this time interval is important to know the viability of
transplantable organs)
 Brain death:
o Types of brain death
 Cortical death (cerebral death) with an intact brain stem producing vegetative
state that is capable of spontaneous breathing
 Brain stem death: it is incapable of spontaneous breathing
 Whole brain death
o Brain death is defined on the basis of Harvard's criteria
 Lack of responsiveness to internal external environment with complete
unresponsiveness to the most painful stimuli
 No muscular movements
 No spontaneous breathing
 Absence of spontaneous cardiac rhythm
 Absence of refluxes (occasional spinal reflux may be present)
 Bilateral dilated and fixed pupils (non-reactive)

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  Flat EEG
o Brain stem death:
 Brain stem death is the point of no return
 Brain stem is responsible for many vital functions (respiratory and circulatory
centres)
 Brain stem is also the gateway for all motor and sensory neurons going to the
cortex
 Medullary neurons are the most resistant to anoxia. Thus if they are dead the
higher centres will also be dead.
 Minnesota criteria is for brain stem death.
 Known but irreparable intracranial lesion
 No spontaneous lesion
 Apnoea
 Absence of brain stem reflexes
 Dilated and fixed pupil
 Absence of corneal reflexes
 Absence of doll's head phenomenon
 Absence of ciliospinal reflexes
 Absence of gag reflex
 Absence vestibular response to caloric stimulation
 Absence of tonic neck reflex
 EEG not mandatory
 Spinal reflex is not important
o Suspended animation:
 It is apparent death
 The person appears dead due to minimal vital functions
 There are no signs of life but resuscitation is successful
 Suspended animation can be seen in
 Anesthesia
 Barbiturates overdose
 Cholera, cerebral concussion, coma
 Drowning, deep shock
 Electrocution
 Heat stroke, hanging, hysteria, hypothermia
 Insanity
 Mesmeric trance
 New born
 Opioid overdose
 Sun stroke, Shock
 Typhoid
 Voluntary act (death trance)
 Yoga
 
Signs of death:
 Immediate death:
o Insensibility and loss of power and movement is the earliest sign of death
o Cessation of respiration tested by

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  Feather test
 Mirror test
 Winslow's test: no movement of surface of water when kept on the chest or
no movement of reflection from mirror kept over the chest.
o Cessation of circulation tested by
 Magnus test: when a ligature is applied on a finger the finger swells and turns
blue if the person is alive
 I-card test: bright fluorescent dye injected i.v does not produce change in
colour if the person is dead
 Diaphanous or transillumination test: failure to show redness in web spaces
between the fingers when trans illuminated from behind
 Early changes(cellular death)
o Changes in skin
o Changes in the eye
o Primary flaccidity of muscles
o Cooling of the body (algor mortis)
o Post-mortem staining (post-mortem lividity)
o Rigor mortis
 
a. Changes in skin: skin becomes pale and loses elasticity
b. Changes in eyes:
i. there is loss of corneal reflex, opacity of cornea, Taches Noire Sclerotiques (develop
due to drying or desiccation when eyelids are open for few hours), a film of cell
debris and mucus forms 2 yellow triangles on the sclera at each side of rhe iris
which turns brown and then black.
ii. There is fragmentation (segmentation) of blood column in the retinal vessels within
minutes after death called as Kevorkian sign.
iii. There is opacity of the cornea, flaccidity of the eye ball with decrease in the
intraocular tension
b. Algor mortis (cooling of the body)
i. Rectum is the ideal place to record the temperature (using a thanatometer)
ii. Rough idea of the time since death is calculated by
 
(NORMAL BODY TEMP (37.2OC) - RECTAL TEMP)/RATE OF FALL OF TEMP PER HOUR
 
iii. In India the average heat loss is 0.5oC and the body attains the environmental
temperature by 16 - 20 Hours after death.
iv. The rate of fall of body temperature water: air: grave=4:2:1
d. Post mortem caloricity:
i. The temperature of the body remains raised for the first two hours after death. The
causes are
1. Heat stroke
2. Pontine hemorrhage
3. Gastroenteritis (cholera, typhoid)
4. Asphyxial conditions
5. Strychnine poisoning (and tetanus) ,septicemia
b. Livor mortis (post mortem staining/hypostasis/lividity/suggillation/vibices

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 i. It is the purplish discoloration of the dependent parts of the body after death due to
capillovenous distention.
ii. It also occurs at the dependent parts of the internal organs
iii. Usually well developed within 4Hrs and gets fixed maximally within 6 - 8Hrs
iv. It persists till it merges with the discoloration of putrefaction
v. Sites of post mortem staining
1. It depends on the position of the body
2. If the body is lying on its back, post mortem staining occurs on whole of the
back except pressure areas
3. If the body is in prone position as in drowning the post mortem staining is
more prominent in the face, neck and chest.
4. In running water post mortem staining does not occur
5. In hanging post mortem staining will be more prominent in the legs, external
genitals, lower parts of forearms and hands
ii. It the position of the body ic changes before the lividity is fixed (6 - 8Hrs) fresh areas
of lividity develop in the new dependent areas
iii. If the position of the body is changed after the lividity is fixed, lividity is seen in the
earlier position as well as the new dependent area.
iv. post mortem staining colour and poisoning
Cherry red Carbon monoxide
Bright red Cyanide
Dark brown Phosphorus
Chocolate or Poisoning by nitrites, potassium chlorate, potassium
coffee brown bicarbonate, nitrobenzene, methemoglobinemia
Deep blue Aniline dye
Bluish green Hydrogen sulphide
Black Opium
Bright pink Hypothermia
Bronze C.perfringens
 
ix. Medico legal importance:
1. Reliable sign of death
2. Estimate time since death (from degree of development)
3. Idea about position of death at the time of death
4. May suggest cause of death
5. Distribution may suggests manner of death e.g. hanging or drowning
 
Muscular changes:
1. Primary flaccidity lasts for 1 or 2 hours (due to somatic death)
2. Rigor mortis (cadaveric rigidity- cellular death)
3. Secondary relaxation - due to autolysis of actinomyosin due to putrefaction
The primary relaxation is the time between somatic death and rigor mortis.

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Rigor mortis: it is the state of stiffing of muscles after death due to depletion of ATP,
leading to failure of separation of actin and myosin filaments producing rigidity.
 Order of appearance of rigor mortis:
 Both voluntary and involuntary muscles are involved
 Nysten's rule:
 Rigor mortis does not start in all the muscles simultaneously
 It first appears in the muscles of the heart (1hr)
 The time of onset of rigor mortis in skeletal muscles is directly
proportional to the distance from the brain.
 Among the voluntary muscles it first appears in the eye lids (3hrs)
 It spreads gradually in the next 3hrs in the muscles of the face, neck, jaw
thorax, upper limbs, abdomen and lower limbs
 The last muscles to develop rigor mortis are the small muscles of fingers
and toes
 Rigor mortis disappears in the order of its appearance
 
 Rule of 12:
 1 - 2 hrs to settle, well developed in 12hrs, maintains for 12hrs and pass
off in another 12hrs
 Conditions stimulating rigor mortis
 Heat stiffening: heat stiffening develops due to coagulation of proteins
when temperature is above 650C.
 Cold stiffening: it occurs due to solidification of the subcutaneous fat and
muscles at a temperature below 3.5oC.
 Gas stiffening: occurs due to putrefaction
 Embalming: in this the contents of the body cavities are removed and
40% formaldehyde and 10% methyl alcohol is injected into the vascular
system which acts as an antiseptic and preservative and prevents
putrefaction.
The other chemicals used are phenol (germicide), sodium borate (buffer),
glycerine (wetting agent/humectant), sodium citrate (anti-coagulant) The
proteins get coagulated, tissues are fixed, organs are bleached and
hardened. The best technique is discontinuous injection and drainage.
Autopsy is done and organs are removed before embalming.
 Cadaveric spasm: is the instantaneous rigor or cataleptic rigidity. The
muscles become rigid without passing through the initial stage of primary
relaxation. In this a single group of muscles are involved usually the
voluntary muscles of the hands. It is due to exhausted ATP in the affected
muscles. It cannot be produced by any method after death. It is usually
associated with violent deaths and great force is required to overcome
the stiffness. It persists until the true rigor develops
 Predisposing factors:
 Sudden asphyxial death
 Cerebral hemorrhage
 Injury to the nervous system

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  Drowning (grass, weeds firmly grasped in the hand in AM
drowning)
 Soldiers in action
 Fire-arm injury (pistol/knife firmly grasped in victim's hand in
suicide, not in homicide.)
 Excitement
 Fear
 Severe pain
 Exhaustion
 Medico-legal importance of cadaveric spasm:
 As the finding of a weapon etc firmly grasped by the fingers
represent the last act of life, detection of a case being suicidal
or homicidal
 Factors modifying rigor mortis:
 Age:
 It does not occur in a foetus of less than 7 months
 It has rapid onset and rapid disappearance in a foetus.
 Rigor mortis in children and old is feeble and rapid
 In healthy adults it is well marked and develops slowly
 Nature of death:
 In diseases with great exhaustion and wasting e.g.
cholera, typhoid, TB, cancers, tetanus, convulsions etc. as
well as in violent death as in cut throat, fire-arms and
electrocution, it appears quickly and passes off quickly.
 In drowning it appears early and lasts longer
 In arsenic poisoning also the rigor lasts longer
 Influence of CNS:
 It has no effect
 Removal of nerve or brain does not alter the rigor mortis
 Atmospheric conditions:
 In cold weather the onset of rigor is slow and longer
duration, in hot conditions the onset is rapid and short
duration.
 The longer it takes to appear, the longer it stays
 Rigor mortis may last 3 - 4 days in refrigerated conditions.
 
 Late changes of death (decomposition and decay)
o Putrefaction
o Adipocere formation
o Mummification
 
a. Putrefaction: it is the final stage of death, with softening and liquefaction of tissues
occurring due to bacterial enzymes chiefly lecithinase produced by Clostridium welchii
and autolysis of tissues by the release of cytoplasmic enzymes. Autolysis can occur in a
sterile condition as in a macerated dead foetus.
i. Features of putrefaction:
 Liquefaction of tissues

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  Collection of gases
 Change in colour and development of foul smelling gases
The first external visible sign of putrefaction is greenish discoloration of the skin over the
right iliac fossa caused due to sulfmethemoglobin. The colour changes appear 12 - 18
hours in summer and after 1 - 2 days (36hrs) in winter. The earliest internal colour
change is reddish brown discolouration of the inner surface of aorta (vessels).
 Marbling: it is the staining of the wall of the superficial veins occurring due to
hemolysis of RBCs prominent in 36 - 48 hrs
 Development of foul smelling gases: it occurs between 12 - 24 hours. The gas
accumulates inside the abdominal cavity, makes the abdomen tense, pushes the
diaphragm upwards leading to blood stained froth coming from mouth and nostril
(post-mortem purge).
 Colliquative liquefaction: it is the liquefaction of tissues occurring 5 - 10 days after
death. Abdomen burst and stomach and intestines protrude. Soft tissues become
semi solid and separate off from bones.
 Putrefactive changes occur in the following order (tissues which have more water
content putrefies first)
1. Larynx and trachea
2. Stomach and intestines
3. Spleen
4. Liver (Liver has honey combed or foamy appearance due to formation of
gases. Occurs on 2nd or 3rd day)
5. Brain (brain of infants putrefies early)
6. Heart and lungs
7. Kidneys and bladder
8. Blood vessels
9. Uterus- the last organ to putrefy in females is virgin uterus(gravid uterus
decomposes earlier than a non-gravid uterus)
10. Prostate- it is the last organ to decompose in males
11. Skin, muscle tendon
12. Bone (least water content)
 Rate of decomposition
1. Casper's dictum: it is related with the rate of decomposition in different
media. A body decomposes in air twice as rapidly in water and eight times as
rapidly in earth. (damp marshy or shallow graves speeds up putrefaction)
2. Optimum temperature of putrefaction is 21 - 38oC
3. Decomposition is arrested below 0oC and above 48oC
4. Decomposition is fast in deaths due to peritonitis, anasarca, asphyxia, and
septicemia (ASAP).
5. Putrefaction is delayed in wasting diseases, anemia and by poisonings due to
carbolic acid, zinc chloride, strychnine and arsenic
6. Entomology: it is the study of the life cycle of insects which infests dead
bodies
Maggots 1-2 days
Pupae 5 days

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 Flies Next 5 days (8 - 10 days)
Liquefaction or colliquative putrefaction 5 - 12 days
 
b. Adipocere (saponification)
 It arrests the further progression of putrefaction. (Modification of putrefaction).
There is hydrolysis and hydrogenation of fat by intrinsic lipases and lecithinase
(clostridium welchii)
 Body fats are converted to adipocere consisting of palmitic acid, oleic acid, stearic
acid and hydroxystearic acid. (Waxy soapy). Occurs first in subcutaneous tissues.
 adipocere formation occurs in hot and humid environment (warm and damp
environment, body immersed in water)
 Cold delays adipocere formation
 Features of adipocere
 Fresh adipocere is soft, moist, greasy, white and translucent resembling rancid
butter. Has ammoniacal offensive smell
 Old adipocere is dry hard, yellowish, cracked and brittle
 It is inflammable and burns with a yellow flame
 Changes are more marked in cheeks, female breast and buttocks
 Time required for adipocere formation
 In temperate countries the shortest time taken is 3 weeks in summer
 In India it is observed within 3 days
 adipocere may persists for decades
 Foetus <7 months does not show this change
 Medicolegal importance
 Adipocere is the surest sign of death. Helps in estimating the time since death
 If it involves the face, the facial features may be preserved
 
c. Mummification:
 It is another modification of putrefaction
 Hot and dry climate favours it (Sandy and shallow graves) [absence of moisture in air
and continuous action of dry air]
 Dehydration and drying causes evaporation of water and shrinkage if cadaver
 The natural appearance and body features are preserved
 A mummified body is odourless, dry, leathery brown
 It begins in the exposed parts of the body like face, hands and feet and then extends
to the internal organs
 The time required is 3 months to 1 year
 Arsenic and antimony poisoning favours mummification
 
 
Adipocere Mummification
Hydrolysis and hydrogenation Dehydration and dry
Soft, whitish, translucent, greasy resembling Dry, leathery and brown in colour
Rancid butter

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 Smell is offensive Odourless
Time required is 3 weeks 3 months
 
 
Medicolegal aspects of injuries
INJURY: Any harm caused to the body, mind, reputation or property illegally (section 44 IPC)
HURT: It is the bodily pain, disease or infirmity caused to a person (section 319 IPC)
GRIEVOUS INJURY: An injury that is extensive, does not heal rapidly and causes permanent
disfigurement and deformity (Section 320 of IPC). Punishment for grievous injury is 7 - 10 years.
 Clauses of grievous injury:
o Emasculation
o Permanent privation of sight of either eye
o Permanent privation of hearing of either ear
o Privation of any member or joint
o Destruction or permanent impairment of the power of any member or joint
o Permanent disfiguration of the head or face
o Fracture dislocation of a bone or tooth
o Any hurt which endangers life or which cause the victim to be in severe bodily pain
for 20 days or unable to follow his ordinary pursuits for a period of 20 days
ASSULT: A threat or attempt to apply force to the body of another person in a hostile manner.
(section 351 IPC)
MURDER: defined under section 300 IPC, punishment under section 302 IPC
 
CLASSIFICATION OF INJURIES:
1. MECHANICAL
a. Abrasion
b. Bruise or contusion
c. Laceration
d. Incised wound
e. Fracture and dislocation
f. Firearm wounds
2. THERMAL
a. Exposure to heat
i. General effect: heat stroke, heat exhaustion, heat cramps or miner's cramp
ii. Local effect: burn (due to application of dry heat) and scald (due to application
of moist heat)
b. Exposure to cold
i. Localized effect: trench foot, immersion foot, frostbite
ii. General effect: hypothermia
2. CHEMICAL INJURIES:
a. Corrosion (due to application of strong acids or alkalis)
b. Irritation (due to application of weak acids or alkalis)
2. MISCELLANEOUS INJURIES
a. Electrical injuries (electrocution)
b. Lightening injuries

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 c. Radioactive injuries
 
1. MECHANICAL INJURIES:
a. Abrasion: it is destruction of the superficial layer of epidermis. It is the most
superficial of all injuries. Has only length and breadth.
Types:
 Scratches or linear abrasions: it is caused by a sharp pointed objects, like finger
nails, pins or thorns passing across the skin. (horizontal)
 Grazes: it is the most common abrasion. It tells the direction of applied force
(heaping of epidermis in the direction of force). Violent lateral rubbing by friction
as in dragging over the ground. It is called as brush burn or gravel rash (occurs
during RTA) (horizontal). Friction rash: abrasions formed on the skin underlying
clothing.
 Pressure abrasion or friction abrasion or crush abrasion: crushing of superficial
layer of epidermis as in ligature marks during hanging or strangulation and teeth
bite marks.(vertical)
 Imprint/impact/contact abrasion: impact of a rough object like tyre or shoe. E.g.
tyre marks seen in RTA. (Vertical).
Impact and pressure abrasion reproduce the pattern of the object causing it. Called
as patterned abrasions.
Age of abrasion:
 Fresh- bright red
 12 - 24 hrs - bright reddish scab
 2 - 3 days - brownish scab
 4 - 7 days - epithelium grows and covers the defect under the scab
 >7 days - scab dries and falls off
Antemortem abrasions shows intravital reaction and congestion is seen.
Ant bites (artefacts) may be confused with antemortem abrasions. They are pale with
multiple whitish eggs over them.
 
b. Bruises or contusions: it is the effusion of blood into the tissues due to rupture of
subcutaneous vessels caused due to blunt force.
Loose and lax tissues like face, eye lids, scrotum and labia show large bruises occurring
due to slight trauma and less force.
Strong supported tissues like abdomen, back, scalp, palm and soles shows small bruises
and are less prominent in these resilient areas.
Children old people and women bruise more easily.
There is no discontinuity of skin in bruising.
 
Delayed bruising: it ia a deep contusion taking several hours to appear
Ectopic bruise: it is also called migratory bruising. The bruise does not appear at the
actual point of impact but at a site different from the site of injury
Example of ectopic bruise:
o Battle sign: it is the fracture of posterior cranial fossa producing a bruise over the
mastoid process.
o Raccoon's sign: it is the fracture of the anterior cranial fossa producing a bruise of
bilateral periocular region (Black eye of spectacle hematoma).

15
 o Fracture pelvis may produce contusion in the thigh.
 Patterned bruising: E.g. railway bruise or tramline bruise are two parallel linear
hemorrhages with a intervening unbruised area resulting from hitting by a rod or a stick.
 Artificial bruises: they are produced by Semicarpus anacardium, calotropis, and
plumbago rosea.
o Dark brown in color, margins covered by vesicles, adjoining skin red and inflamed
with itching.
o Medico-legal importance: to make false charges of assault (malinger).
 Incision test: it differentiates bruise from hypostasis. In bruise, on incision, blood is seen
in surrounding tissues and cannot be washed away. Whereas in hypostasis on incision
blood is seen on blood vessels and is easily washed away.
 Age of contusion (bruise)
o Fresh - reddish
o Few hours to 3 days - blue (reduced Hb)
o 4 - 5 days - brow (hemosiderin)
o 5 - 6 days - greenish (hematoidin)
o 7 - 12 days - yellow (bilirubin)
o 2 weeks - clear
 Antemortem vs postmortem contusion:
o Antemortem contusion shows swelling, extravasation, coagulation, and infiltration of
tissues with blood and color changes. The margins are less sharp and indistinct.
o Postmortem bruise: the margins are distinct and sharply defined.
 
 Laceration:
o It is the tear of skin, mucous membrane, muscle or internal organs produced by blunt
force to a broad area of body.
o Types of laceration:
 Cut laceration
 Avulsion: detachment of the traumatized surface from its attachment.
 Flaying: it is the separation of the skin
 Tear: tearing of skin and tissues from impact by irregular or semi sharp objects
 Stretch: it is due to over stretching of skin.
 Split: it is the crushing of the skin between two hard objects, common over
scalp and other bony prominence. It is an incised looking wound.
 Incised wounds:
o They are the cuts through the tissues caused by a sharp weapon.
o Length of the wound is greater than width and depth.
o It is deeper at the beginning (head) and shallow at the end (tail) called as the tailing
of the wound. It indicates the direction.
 Bevelled cut:
o It is an oblique strike by a sharp weapon.
o Tissues will be visible at one margin and other margin is undermined
o It is usually homicidal
 Tentative cuts or hesitation wounds
o These are hesitation wounds or trial wounds which are multiple small and superficial
cuts seen at the beginning of a suicidal incised wound.
o Eg. Wrist slashes or cut throat

16
 Chop wounds:
o These are deep gaping wounds caused by a heavy sharp cutting weapon like axe and
is usually homicidal in nature.
 Stab wound:
o They are caused by a thrusting pointed weapon.
o The depth being the greatest dimension.
o Depending on the severity, it is of two types
 Penetrated wound: when the wound that terminate inside a body cavity or
viscus.
 Perforated wound: when the weapon pass through and through the whole
thickness of any part of the body having an entry and exit wounds.
o Features:
 If it is an incised stab the margins are clean cut.
 If it is a lacerated stab caused by a blunt cutting edge then the margins are
ragged and abraded.
 Depth is greater than the length and breadth of the wound. Length is slightly
less than the width of the weapon.
 It is slit shaped with two acute angles or gape open depending on their
location and orientation.
 Fish tailing shape is seen in single edged weapon.
 Langer lines and shape of stab wound:
 Cleavage lines: corresponds to body creases. Lines of tension
determined by direction of elastic and collagenous fibers in skin.
 Stab injury occurs across these lines transversely, they will gape open
with edges pulled apart.
 Injuries parallel to these lines will appear slit like.
 
 
 Concealed puncture wounds — stab through natural openings eg. ear, nasal openings or
axilla or nape of neck.
 Hara-kiri — it is unusual type of suicide practiced in japan using a short sword to inflict
stab wound on the abdomen and pulls out the intestines causing death due to sudden
cardiac collapse due to fall of intra-abdominal pressure.
 Defence wound: it is an immediate reaction of the victim to save himself by raising the
hand or grasping the weapon.
 Self-inflicted wounds: they are the wounds inflicted by a person on his body.
 Self-suffered wounds: they are wounds produced by a person or by another person on
his body by his consent. (fictitious, forged or invented wounds)
 Pedestrian injury:
o Types:
i. Primary impact injury: these are produced by the initial contact by the vehicle
in the form of abrasion, laceration or contusions. Most commonly both legs
get fractured at the region of impact with the bumper of the vehicle (bumper
fracture).
ii. Secondary impact injuries: they are caused by subsequent contact of the body
with the vehicle after primary impact. Occurs when the victim is flung and

17
 lands against hood, wind screen or roof of the vehicle. Head injuries are
common.
iii. Secondary injuries: these are caused by striking against surfaces or objects
such as road surfaces or street pole. Grazed abrasions, flaying injuries due to
being dragged on the road are common.
 Motor cyclist fracture:
o It is due to secondary impact to the ground
o A fracture is produced across each middle cranial fossa, passing through the pituitary
fossa seen in the classical fatal injury in both motorcyclist and pillion passenger.
o At autopsy the base of the skull is seen divided into two halves moving independent
of each other like a hinge.
o When the motorcyclist drives into a large vehicle like a truck it is called under
running or tail gating.
 
 
Regional injuries:
 Skull fractures:
o Types:
i. Fissured fracture: it is a linear fracture involving the whole thickness of the
bone or the inner or outer table only. It is the most common type of skull
fracture.
ii. Depressed fracture: when the fracture bone is driven inwards due to the blow
of a heavy weapon over a small area e.g. hammer, axe, stick or stones. The
outer table is driven inwards and the inner table is fractured. It is also called
signature fracture or fractures la signature.
iii. Communited fracture: it is the multiple fracture of the skull, also known as
spider web fracture.
iv. Pond or indented fracture: it is seen in elastic skulls of infants.
v. Gutter fractures: is when a bullet glances strikes tangentially. A part of
thickness of the bone is removed forming a gutter.
vi. Ring fracture: it encircles the base of the skull around the foramen magnum
vii. Diastic fracture: involves the sutures seen in children.
 Concussion (commotio cerebri): it is temporary unconsciousness as a result of blunt
impact to the skull. It comes immediately after the injury and is followed by amnesia,
recovery is spontaneous and does not show any evidence of structural cerebral injury.
 Coup injury: it is blunt force applied on the stationary head and the injury is located
beneath the area of impact.
 Counter coup: it is present in an area opposite to the side of impact, when a moving
head strikes a stationary object.
 Diffuse axonal injury: it is immediate loss of consciousness and coma for more than 6
hours retraction balls after 12 hours.
 Spinal injuries:
o Whip lash injury: it is due to violent acceleration or deceleration force e.g.
hyperflexion followed by acute hyperextension in the region of C4 - C6. it is
laceration or contusion of the spinal cord without fracture of the spine.
o Concussion of the spinal cord is called as railway spine.

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  Boxing injury: repeated blows to the head produces small haemorrhages and
degenerative changes in the brain. Fracture of the skull is rare but subdural
hemorrhages occur. Traumatic encephalopathy are chronic changes in the brain of
boxers, which can lead to parkinsonian like symptoms called as Dementia pugilistic or
punch drunk syndrome.
o Clinical features: defective memory, slurred speech, broad based gait, stiff limbs,
parkinsonian features, dementia and subdural hemorrhages.
 Intra cranial hemorrhages:
o Extra dural hemorrhage or epidural hemorrhage: it is the least common variety.
Occurs due to trauma and rupture of anterior branch of middle meningeal artery.
Lucid interval may be observed. Heat hematoma resembles extra dural
hemorrhage.
o Sub dural hemorrhage: it occurs due to rupture of superficial bridging veins. More
common than extradural hemorrhage. Subdural hemorrhage is seen in punch
drunk syndrome, chronic alcoholism, old age, infantile whiplash syndrome.
o Sub-arachnoid hemorrhage: it is the most common form of traumatic intracranial
hemorrhage. It occurs due to rupture of berry aneurysms. Usually associated with
cerebral contusions and lacerations.
o Intracerebral hemorrhage: then most common site of intracerebral hemorrhage is
putamen. It is due to rupture of lenticulo-striate branch of middle cerebral artery
(Charcot's artery).
 

 
Thermal injuries
Thermal injuries:
1. Burns:
a. It is an injury produced by application of heat or chemical substances to external or
internal body surfaces.
b. Burns are due to application of dry heat, a minimum temperature of 44 oC for an
exposure of 5 - 6 hours or at 65oC for 2sec is sufficient to produce burn.
Scald: it is caused by application of liquid above 60oC or steam. Skin becomes sodden
and bleach. Clothes are wet but not burnt.
c. Duputyrayn's classification:
i. 1st degree- epidermal burns
ii. 2nd degree- epidermal burns with blister formation
iii. 3rd degree- dermal but not involving full thickness
iv. 4th degree- full thickness dermal burns
v. 5th degree- involving subcutaneous tissues and muscles
vi. 6th degree- involving bones
b. Wilson's classification:
i. Epidermal: a blister is formed covered by the white avascular epidermis surrounded
by red hyperaemic skin, painful and heals without scarring.
ii. Dermo-epidermal: whole thickness of the skin is destroyed, skin and subcutaneous
tissue is effected and it is most painful.

19
 iii. Deep: muscles and even bones are destroyed painless as even nerve endings are
destroyed.
b. Rule of 9:
i. Rule of 9 by Wallace tells the extent of burn
ii. In case of patchy burns rule of palm (palm of an individual is 1% of its body surface
area)
iii. Involvement of 50% body surface area will be fatal even if they are superficial 1st
degree.
b. Cause of death
i. neurogenic shock due to pain
ii. Secondary shock due to fluid loss
iii. Toxemia or sepsis
iv. Acute renal failure
v. Suffocation
 
g. Post mortem findings:
 Pugilistic attitude (boxing, fencing or defence attitude): it is the generalised flexed
position of the major joints of upper and lower limbs occurs due to coagulation of
muscle protein. It is due to heat stiffening seen in both antemortem and post-
mortem burns. Occurs when the body is exposed to temperature more than 75 oC.
 
 Features of antemortem burns:
 Presence of sooth or smoke in the respiratory tract (trachea)
 Elevated carbon monoxide saturation, elevated CO Hb level in the blood
(absolute sign of antemortem burn).
 Red line is the vital reaction at the site
 Blister fluid containing albumin and chloride.
 Cyanide level is elevated.
 
Trait Antemortem burn Post-mortem burns
Line of Present Absent
redness
Blister Contains mucous fluid with proteins Contains air only. Base is
and chlorides. Base is inflamed dry, hard and yellow.
Vital Present Absent
reaction
Enzymes Increase in enzyme reaction and SH Does not show increase in
group enzyme reaction.
Co Hb >5% of CO Hb <5% of CO Hb
 Heat hematoma: it occurs when head is exposed to intense heat sufficient to cause
charring of skull. It resembles extradural hemorrhage but has no signs of injury. It
has a soft friable chocolate coloured clot with honey comb appearance. Most
common site is the parietotemporal region. The heat hematoma contains CO Hb.

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  Heat ruptures: if a very great amount of heat is applied the skin contracts and heat
ruptures occur due to contractures.
 Thermal fractures: The skull fractures occur most commonly in areas where the
skull has been severely burned, can occur due to intracranial increase of steam
pressure causes separation of ununited sutures or due to rapid drying of the bone
with contraction. The thermal fractures usually do not cross the suture lines.

2. Heat:
 
1. Heat cramps or miners cramps or fireman's cramps: it is due to rapid dehydration, profuse
sweating and loss of sodium ions.
2. Heat exhaustion/prostration/syncope/collapse: It is collapse without increasing the body
temperature following exposure to excessive heat. Main cause of death is vascular collapse
and syncope.
3. Heat stroke or heat pyrexia: it is characterized by rectal temperature greater than 41 oC and
neurological disturbances like psychosis, delirium, stupor, coma and convulsions. Skin is dry
hot and flushed with complete absence of sweating.
High temperature, increased humidity, infections, muscular activity and lack of
acclimatization are principle factors for initiation.
Failure of cutaneous blood flow and sweating leads to break down of heat regulating centre
of hypothalamus. Breathing is rapid, deep and Kussmaul type. On autopsy there is edema of
Purkinje cell of cerebellum.
4. Sunstroke or thermic fever: it is due to direct exposure of the sun.
 
Cold:
 Trench foot or immersion foot: it results due to prolonged exposure to severe cold and
dampness (5 - 8oC) typically seen in soldiers during winter warfare.
 Frost bite: it is infraction of peripheral digits due to exposure of extreme cold (-2.5 oC). The
skin becomes hard and black.
 Hypothermia: it is defined as oral or axillary temperature <35 oC. When the temperature falls
below 30oC hypothalamus fails to regulate the temperature. It passed through 3 stages
leading to death:
i. Patient feels cold and shivers
ii. Shivering stops at or below 32oC, depressed, lethargic, drowsy gradually passes to
stupor and coma
iii. Temperature<27oC which if maintained for 24 hours or longer is fatal.
Just before death the patient shows paradoxical undressing and terminal burrowing
behaviour.
 Post-mortem findings: blood is often bright red due to unreduced (oxygenated) Hb, as the
cold tissue has little O2 uptake. A variable degree of fat necrosis of pancreas is the most
consistent finding.
 
Electrical injuries:
 Electric mark - joule burns: it is diagnostic of contact of electricity found at the point of
contact. It has a round shallow crater and endogenous burn produced by the conversion of
electricity into heat within the tissues

21
  Lightening injury: it is due to electrical discharge from the clouds
 Crocodile flash burn: it is a high voltage burn producing multiple lesions due to arc effect.
Metal particles on the skin at the site of entrance. Death is due to ventricular fibrillations.
Current pulse and wax drops are seen on autopsy.
 Filigree or Arborescent burns/Lichtenberg's flower:
o It is a superficial irregular thin and torturous marking over the skin mainly the
shoulders and flanks resembling a branches of a tree (fern like erythema)
o It is caused by staining of tissues by hemoglobins from the lysed RBCs along the path
of current.
o It does not corresponds to vascular channels and is not associated with burning.
o It indicates the path taken by the current and disappears in 1 - 2 days if the patient
survives.
 
 
 
Fire arms
Forensic ballistics — dealing with the investigation of firearm, ammunition and problem, arising
from their use.
Types:
1. Proximal — internal ballistics: study of firearms & projectiles.
2. Intermediate — external ballistics: study of motion of projectile.
3. Terminal - wound ballistics:
Classification:
 Rifled weapon
o Revolver, automatic pistol, carbine, AK 47, M-16 etc.
o The barrel is rifled with lands and groves inside
o Handgun: It short barrelled and operated easily with hands
 Pistol: Magazine carrying the cartridge, empty cartridges are ejected out from
the automatic pistol
 Revolver: magazine carrying the cartridges is in the form of a revolving wheel
located at the breech end. Empty cartridges remain inside the revolver.
o Rifle: it is comparatively long barrel.
 Ex: single shot, multi shot, semi-automatic (self-loading), fully automatic
(machine gun).
 Smooth bored weapon (shotgun) — e.g. single barrel, double barrel.
o Shotgun: breach loading, muzzle loading and magazine loading
Effective range:
Shot guns 30 - 35 m
Air rifle 40m
Revolver 100 m
Automatic pistol 100 m
Carbine 300m
Rifle 1000m
Military rifle 3000m
 
 Calibre of a firearm: It is the difference between the two diagonally opposite lands

22
  Bore or gauge: it is used for shot guns only. It is the number of lead balls of equal size and
weight that can be made from 454g of lead.
 Choking: constrictive device at the muzzle of the short gun which lessens the rate of speed
of the shot after it leaves the rifle.
 Paradox gun: when the muzzle end of the shot gun is rifled.
 Black gun powder: potassium nitrate(oxidizing agent) 75% + sulphur (increase density) 10%
+ charcoal(fuel) 15%
 Smokeless powder:
o Single based: nitrocellulose (gun cotton)
o Double base: nitrocellulose + nitro-glycerine
o Triple base: nitrocellulose + nitro-glycerine + nitro guanidine
 Semi smokeless: 80% black powder + 20% smokeless powder
 Primers: priming mixture contains lead peroxide + lead styphnate +tetrazene + barium
nitrate and antimony sulphide (BLAST)
 Parts of a cartridge:
o Primer cup or percussion cap or detonator cap at the centre of the base
o Gun powder
o Wad is separated from gun powder by cardboard only in short gun.
o Shot (pellet or bullet)
 Morden cartridge contains
o The bullet itself which serves as the projectile
o The casing which holds all parts together
o The propellant for example gunpowder or cordite
o The rim, part of the casing used for loading
o The primer which ignites the propellant
NOTE: the basic features of cartridges used in guns. The primer when struck by firing pin, ignites
the powder. It is the residue left by the primer that is characteristic for a fired round, because it
leaves traces of lead, antimony, copper and barium.
 
Tests used for firearm discharge residues:
 Harrison and Gilroy test: detects the presence of antimony, barium and lead
 Neutron activation analysis: detects the presence of antimony and copper
 Flameless atomic absorption spectroscopy (FASS): detects antimony, barium, copper
 Scanning electron microscopy with x-ray analyser (SEM-EDX)
 Paraffin test (dermal nitrate test): it is used to determine if the suspect has discharged a
firearm. The blowback powder residue on the back of the palm and web of the alleged firers
hand are collected on the paraffin cast and tested for nitrate using diphenylamine. It is
absolute these days because of false positive results.
 
 Wounds from shot gun:
o Contact wound: it is a single large round wound with ragged and charred margins
due to flame. The subcutaneous and deeper tissues show severe disruption. Muzzle
impression can be seen. On the skull cruciate, stellate or ragged laceration.
o Close range (upto 1m): single wound with burning of skin and singeing of hairs (due
to flame and hot gases), blackening (carbon deposition by burnt powders) and tattooing
(stippling and peppering) - deposition of unburnt and semi burnt powder.

23
 o Near range/medium range (upto 4m): beyond about 1 yard satellite pellet holes
begins to appear around the main entrance wound
o Long range (over 4m): shots spread widely and enter bodies as individual pellets.
Features Entry wounds Exit wounds
Size Smaller, except contact Larger
Edges Inverted except contact Everted
Abrasion and grease collar Present Absent
Singeing, blackening and tattooing Present absent
Types of bullet:
 Dumdum bullet: tip is chiselled out. It fragments extensively upon striking
 Ricochet bullet: changes path after striking some structure
 Tandem or piggyback bullet: 1st bullet gets stuck and the same comes out in front of the
second fired bullet.
 Souvenir bullet: long presence of bullet inside the body (lead poisoning)
 Incendiary bullet: army bullet used to cause fire in target. Uses white phosphorus
 Tracer bullet: leaves a visible mark indicating the track.
 Duplex bullet: contains 2 bullets.
 

Asphyxial death
Asphyxia:
A condition in which an extreme decrease in the concentration of oxygen in the body accompanied
by an increase in the concentration of carbon dioxide leads to loss of consciousness or death.
Triad of asphyxia:
1. Cyanosis
2. Petechial hemorrhage
3. Visceral congestion
 
Tardieu's spot: petechial hemorrhages due to asphyxia. Appears under the pleura.
 
Types:
1. Hanging: constricting force being the weight of the body
2. Strangulation: constricting force being other than the weight of the body
3. Suffocation: means other than compression of the neck
o Smothering
o Chocking
o Traumatic asphyxia
o Inhalation of irrespirable gases
4. Drowning: submersion in water or other fluids
 

HANGING:
 Types of hanging:

24
 o Depending on the position of the knot
 Typical hanging: knot at the nape of the neck
 Atypical hanging: knot of ligature may be at any site other than the nape of
the neck
 Common sites: angle of the mandible, below the chin or over the either
side of mastoid
o Depending on the degree of suspension:
 Complete hanging: body is fully suspended and no part of the body touches
the ground.
 Incomplete or partial hanging: lower part of the body touches the ground.
 Causes of death in hanging:
o Asphyxia
o Venous congestion: jugular veins blocked
o Combined asphyxia and venous congestion (most common cause)
o Cerebral ischemia: following pressure on carotid and vertebral arteries.
o Reflux vagal inhibitions: (following pressure on vagal sheath or carotid sinuses)
o Fracture or dislocation of the cervical vertebrae
 Causes of delayed death in hanging:
o Laryngeal edema
o Edema lungs
o Aspirational pneumonia
o Infection
o Hypoxic encephalopathy
o Infraction or brain abscess
 Post mortem finding:
o External: ligature marks in the neck is the most important and specific sign of death
from hanging.
o Ligature produces a groove or furrow in the neck skin
 Position of ligature marks:
o 80% above thyroid cartilage
o 15% at the level of thyroid cartilage
o 5$ below the level of thyroid cartilage
 
 Other important findings:
o Dribbling of saliva: sign of ante-mortem hanging
o Le facie sympathique: vital sign of antemortem hanging when knot presses cervical
sympathetic trunk, the eye on that side remains open and the pupil is dilated.
o Peculiar distribution of post-mortem staining (glove and stocking)
o Muscles of the neck (platysma and sternomastoid) may be ruptured.
o Horizontal intimal tears of carotid artery.
o Hyoid bone fracture:
 15 - 20% in persons above 40 years
 Rare before 40 years due to elasticity of cartilage and mobility of joints
 Commonly involves the great horns at the junction of inner 2/3rd and outer
1/3rd.
 Types of fractures:
 Inward compression

25
  Antero-posterior compression
 Avulsion
 Judicial hanging:
o Drop from a reasonable height
o Length of the rope: 5 - 9 ft. never less than height
o Hypertension and longitudinal distraction of upper cervical spine produces fracture
mainly through C2 and C3 with injury to medulla and spinal cord.
o Hangman fracture
 Site of knot:
o Between chin and angle of mandible
o Sub-mental
o Angle of mandibular arch
o Over mastoid
Medico-legal aspects of hanging:
 Suicides most common
 Lynching: is an example of homicidal hanging which was practiced in America.
 Accidents during play or masochism

 
STRANGULATION:
 Constricting the neck by means of a ligature or by other means without suspending the
body
 There are 2 common types
o Throttling: manual strangulation
 Marks of pressure by the thumb and fingertips are usually found on either
side of trachea.
 Linear concentric abrasion marks produced by the nails
o Ligature strangulation
 Ligature mark completely encircling the neck horizontally, usually at or below
the level of thyroid cartilage
 Face is highly congested and cyanosed, eyes are prominent and open,
conjunctiva are congested
 Strangulation by other means:
o Bansdola: strangulation with the help of two bamboo sticks often done in north
India.
o Garrotting: official method of execution in Spain.
o Mugging: strangulation caused by compressing the neck in the elbow bent or knee
bent.
 Medico-legal aspects:
o Homicidal strangulation (common method of murder)
o Accidental: foetal death following umbilical cord compression around the neck
o Masochism
SUFFOCATION DEATHS:
 Smothering: respiration is prevented by closure of mouth and the nasal opening
o Importing findings:
 Crescent shaped nail scratch abrasions and contusions over and around the
mouth and nose

26
  Inner aspects of the lips may show abrasions, contusions and even laceration
due to friction with teeth.
TRAUMATIC ASPHYXIA:
 Results from forceful compression of the chest, which prevents respiratory movements of
the chest wall
o Circumstances:
 House collapse
 Stampede
 Vehicular run over
 Peculiar post mortem finding: an intense congestion, petechial and confluent hemorrhages
and cyanosis of deep purple or purple red colour of head, neck and upper chest above the
level of compression.
CHOKING: it is caused by obstruction in the air passage
 Choking is almost always accidental
 Café coronary: stimulation of vagal nerve endings
GAGGING:
 Cloth or soft object is pushed inside the oral cavity
 Mostly homicidal and victims are mostly unwanted infants.
BURKING: smothering + traumatic asphyxia
OVERLYING: it is compression of chest under the body of another person. Usual victims are infants
and children. 
 
 
DROWNING:
 
 Asphyxia due to aspiration of fluid into the air spaces:
o There are two types of drowning
 Type I : dry drowning
 Type II : wet drowning
 Fresh water drowning (type IIa)
 Sea water drowning (type Iib)
 Dry drowning;
o Water does not enter the lungs
o Death results from immediate sustained laryngeal spasm following inrush of water in
the nasopharynx or larynx.
o 10 - 20% of drowning deaths
 Fresh water drowning:
o Water passes rapidly from the lungs to blood causing
 Hemodilution and hemolysis
 Serum K+ levels increase whereas Na+ and Ca2+ levels decreases.
 Ventricular fibrillation
 Death occurs in about 4 - 5 minutes
 Mnemonic: Fresh, Fibrillation, Fast
 Sea water drowning:
o Due to high salinity of sea water, water is drawn from blood to the lungs
o Massive pulmonary edema, hemoconcentration and hypovolemia

27
 o Raised plasma Na+ levels leading to bradycardia and slow death occurs from
asphyxia.
o Death is delayed to about 10min.
Features Fresh water drowning Sea water drowning
Changes in Hemodilution Hemoconcentration
blood Hyperkalemia Hypernatremia
Hyponatremia
 
Changes in Ballooned and light Ballooned but heavy
lungs Pinkish Purple or bluish
Emphysematous Soft and jelly like
Retained shape after removal from the Flattens out after removal from
body body
On cut section - crepitant with less No crepitus
froth Froth present
 
Fatal period 4 - 5 min 9 - 10 min
 
 Other supportive findings:
o Post-mortem staining: found on face, upper part of chest, hands and lower arms as
the body floats face down
o Washer woman's hands: soddening of the skin due to absorption of water in
superficial layers
o Cutis anserina or goose skin: because of spasm of erector pilae muscle
o Cadaveric spasm: weeds, gravel, grass etc. present in the water may be firmly
grasped in hands.
o Froth at mouth and nostrils: fine, white leathery, increases on pressure on chest
(diagnostic of drowning)
 Similar froth may be seen in strangulation, opium poisoning and putrefaction
o Emphysema aquosum
 Voluminous, edematose balloon like lungs
 On section frothy blood stained fluid is seen
 Present in about 80% of cases - presumptive evidence of drowning death
o Paltauf's hemorrhage:
 Subpleural hemorrhages
o Other types of drowning:
 Immersion syndrome:
 Cold water drowning or hydrocution
 Condition found in temperate or cold zones
 Death results from cardia arrest due to vagal inhibitions as the result of
cold water stimulating nerve endings of the body and epigastrium.
 Secondary drowning:
 Post immersion syndrome/near drowning:
 Complications develop after resuscitation like pulmonary edema,
infection, electrolyte imbalance etc.

28
 o Bilateral temporal bone hemorrhage may be seen in
 Hanging
 Head injury
 Carbon monoxide poisoning
o Flotation of body in water
 Depends upon production and accumulation of putrefaction gases in body
tissues and cavities
 In India - submersed body may come to surface usually by 24hours in summer
and 2-3 in winter
o Tests for drowning:
 Gettler test: estimation of chloride content in left side of heart
 Normal: 600mg/100ml
 Fresh water: lower upto 50% than normal due to hemodilution.
 Sea water: increased upto 30 - 40% due to hemoconcentration
 Diatom's test:
 Diatoms are unicellular algae
 Outer cell wall strongly impregnated with silica
 Resist heat and acid
 Size 2µ to 1mm
 Diatoms of size upto 60 microns enter the pulmonary circulation during
drowning.
 Method
 Tissue samples: lung/liver/brain/bone marrow + conc. nitric acid
 Heated
 Centrifuged and examined under microscope
 Diatoms are readily recognizable as radially or axially
symmetrical structures.
 Finding of similar diatoms in tissues and water sample is in
favour of drowning
 
 
Starvation and infant death
Starvation death:
 Results from the deprivation of a regular and constant supply of food.
 2 types:
o Acute: occurs when there is sudden and complete withhold of food.
o Chronic: (partial starvation or malnutrition) - occur when there is gradual deficient
supply of food
 Acute starvation:
o Feeling of hunger in first 30 - 48 hours
o Followed by pain in epigastrium, which is relieved by pressure
o By 4 - 5days general emaciation and absorption of subcutaneous fat is evident
o Intellect remains clear till death
o Loss of 40% of body weight is usually fatal
o Fatal period:
 Simultaneous deprivation of water - death may occur in about 10 - 12 days.

29
  Food alone is withdrawn: death occurs in 6 to 8 weeks
 Chronic starvation:
o Loss of wellbeing, hunger and hunger pain
o Progressive weight loss
o Mental and physical lethargy and easy fatigue
o Polyuria, hypothermia, hypotension
o Increasing cachexia, body weight is reduced to about 40% of normal
o Edema first in feet and lower limbs
o Frequent intercurrent infections causing diarrhoea dysentery and tuberculosis
o Blood sugar, chlorides and cholesterol are lowered.
 Post mortem appearances:
o Lack of subcutaneous, omental and other distribution of fat, is a constant feature
o Fat of female breast and orbit is spared till late
o Heart is small due to atrophy and chambers are empty
o Liver and spleen are atrophied and shrunken in size
o Gall bladder is distended with bile
o Brain size remains unchanged
o Wall of intestine appears like tissue paper with atrophy of mucosa
 
INFANT DEATH: 
 Infanticide means killing of an infant within one year of its live birth
 Foeticide: it is killing of foetus at any time prior to birth
 Still born:
o Born after 28 weeks of pregnancy
o Foetus was alive in utero
o Does not breath or show any signs of life after being completely born
 Dead born:
o Died in uterus before the birth process begins
o May show one of the following signs after it is completely born
 Rigor mortis: 2 - 3 hours prior to birth
 Maceration: aseptic autolysis
 Earliest sign skin slippage
 Soft flaccid - with sweetish disagreeable smell
 Mummification:
 Deficient blood supply
 Scanty liquor amnii
 No air entry in uterus
 Spalding sign: loss of alignment of cranial vault (overriding) -- X-ray finding
 Robert's sign: gas shadow in chambers of heart and great vessels
 Signs of live birth:
o Shape of chest: after respiration chest expands and becomes arched or drum shaped
o Position of diaphragm: at the level of 6th or 7th after breathing. 4th or 5th before
breathing
o Changes in lungs: margins become rounded, consistency, soft, spongy, elastic and
crepitant. Before respiration lungs are dense, firm and non-crepitant.
o Weight changes:

30
  Static or Fodere's test: average weight before respiration 30 - 40gm and after
respiration is 60 - 66gm
 Ploucquet's test: weight of lung is almost doubled from 1/70 of the body
weight to 1/35 after respiration.
 Breslau's second life test: to see presence of air in GIT
 Osborn's no touch technique - histological examination
o Hydrostatic test:
 Based on the fact the lung of respired foetus will float in water due to
decrease in specific gravity of the lungs.
 Specific gravity before respiration: 1050
 Specific gravity after respiration: 940
 Liver is used as controlled, if liver also floats test is of no use.
 False positive:
 Unexpanded lung may float
 Presence of putrefactive gases
 Artificial respiration
 False negative:
 Expanded lung may sink as in atelectasis, acute edema of lung
 Hydrostatic test is not necessary:
 Foetus born before 180 days of gestation
 Foetus is a monster
 Foetus shows signs of intrauterine maceration
 Umbilical cord separated and scar is present
 Stomach contains milk
o Respiration before and during birth:
 Vagitus uterinus: child breaths (cry) while in uterus after rupture of the
membranes.
 Vagitus vaginalis: child breaths (cry) while its head is in the vagina after
rupture of the membranes, while the head is protruding from the outlet.
o Battered baby syndrome:
 Caffey's syndrome/non-accidental injury of childhood/child abuse
syndrome/maltreatment syndrome in children
 Obvious discrepancy between the nature of injuries and the explanation
offered by the parents
 Delay between the injury and medical attention.
 Repetition of injuries in different dates often progressing from minor to more
severe.
o Infantile whiplash syndrome:
 Repeated shaking of unwanted and neglected child
 SDH + intraocular bleeding
 Shaken baby syndrome
o Munchausen's syndrome by proxy:
 A type of child abuse usually involving mother
 Repeated pretensions of illness or inflictions of repeated minor injuries with
object of gaining admission to hospital
 Child is admitted to hospital for non-existent conditions.
o SIDS:

31
  Cot or crib death
 Sudden and unexpected death of a seemingly healthy infant.
 Cause of death of which remains unexplained after a complete autopsy
 Important features:
 Incidence: 0.2 - 0.4%
 Age- 2weeks to 2 years (majority occurs between 6weeks to 6months)
 M:F - 3:2
 Twins- increased risk among the members of twin pairs
 Prematurity has no effect
 Most accepted hypothesis: prolonged sleep apnoea
 Other causes:
 Conduction system anomalies, hypersensitivity to cow's mile,
deficiency of parathyroid, selenium, calcium, magnesium and vitamins.
 
 
 
Sexual perversions
 
Sadism- sexual gratification by torturing/inflicting pain on someone.
Masochism-opposite to sadism.
Bondage- it's the combination of sadism and masochism.
 
Lust murder- murder serves as stimulus for sexual act.
Necrophilia- sexual intercourse with a dead body.
Necrophagia- sexual gratification by eating the dead body.
 
Fetishism- sexual satisfaction by contact with articles of opposite sex like hanky, sandals, clothes.
Frotteurism- rubbing the genitalia with the body of the person of other sex for sexual satisfaction.
Transvestism/Eonism- whole personality is dominated by the desire of being identified with the
opposite sex.
 
 
Satyriasis- incessant sexual desire in males.
Triolism- getting sexual pleasure by inducing his wife to have sex with another person.
Uranism- general term for perversion of sexual instinct.
 
Voyeurism/ Scoptophilia- It’s the sexual satisfaction by watching the sexual act (Peeping tom).
Undinism- sexual satisfaction by watching the act of urination.
Pyromania- sexual stimulation while seeing flames.
 
Exhibitionism- sexual gratification by exposing one's genitalia. Punishable under sex 194 I.P.C. with
imprisonment unto 3 months or fine.
Masturbation/ Ipsation/ Onanism. It’s an offense when practiced openly like in telephone booths
or lavatories.
Indecent Assault- it’s an offense committed on a female with the intention or knowledge to
outrage her modesty.
Punishable under sec 354 I.P.C. 2 years imprisonment or fine.

32
 
Unnatural sexual offenses- voluntary sexual intercourse against the order of nature with any man
or women or animal (sec 377 I.P.C). Punishable with imprisonment for life or unto 10 years.
Tribadism/ Lesbianism- female homosexuality.
Bestiality- sexual intercourse with lower animals.
Sin of Gomorrah: Buccal coitus/ Coitus per os. Obtaining sexual pleasure from application of the
mouth to the sexual organs.
Fellatio- oral stimulation of penis.
Cunnilingus- oral stimulation of the female genitalia.
Sodomy/Buggary: anal intercourse with a male or female. Only proof is semen in anus.
Gerontophilia-
Paederasty- the passive agent is a young boy k/a catamite.
The active agent is an adult k/a paedophile.
The consent of sodomy has no value as both the partners are punishable.
 
Natural sexual offences:
Incest- intercourse with a close relative (Oedipus complex, Electra complex, pharaoh).
Rape
Adultery.
 
Rape:
Sec 375 I.P.C defines rape.
Sec 376 I.P.C defines punishment for rape.
A man commits rape if he has sexual intercourse with a women.
. Against her will
. Without her consent
. With her consent when her consent has been obtained by putting her on any person in whom
she's interested in fear of death or hurt.
. With her consent when the women believes he's another man whom she is lawfully married to.
. With her consent when she is unable to understand the nature of consequence of that to which
she gives consent.
. With or without her consent when she's under 16 years of age; exception sexual intercourse of a
man with his wife is not a rape if she is above 18 years of age.
 
Whether the alleged consent by the victim was a mere submission or a willing consent depends
upon the circumstances of each case. However, when the victim is <16 years of age, the sexual
intercourse in any case amounts to rape and the question of consent or non-consent doesn't arise
as a women of only 16 years and above can give a consent for sexual intercourse and this has been
described as Statutory rape.
 
The slightest Penetration of penis within the vulva with/without the emission of Semen or rupture
of hymen is required.
Rape can be committed even when there is inability to produce the
Erection of penis.
Rape on virgin causes tear at Postero-lateral aspect of hymen.
In India, there is no age limit under which a boy is considered physically incapable of committing
rape.

33
Medical proof of intercourse is not legal proof of rape.
Rape is a cognizable offence.
Under the law, rape can only be committed by a man and a woman cannot rape a man except in
France where even a female can be charged of rape. In India, a woman can be charged to have
committed ‘INDECENT ASSAULT on a man.
Punishment for rape is not less than 7 years, may extend to 10 years or life imprisonment + fine in
the following cases
EXCEPT in case when the woman raped is his own wife and not <12 yrs, the punishment is
imprisonment up to 2 years or fine or both (376 A).
1) Custodial rape: being a police officer/public servant (376 B)/staff of the jail or remand home
(376 C) or of the
Hospital (376 D), commits rape on a woman in his custody or in his premises or within his
jurisdiction.
2) Commits rape on a pregnant female.
3) Commits rape on children under 12 years of age.
4) Gang rape: when a woman is raped by more than one person.
“
LUGOL’S IODINE TEST: washing of the glans penis of accused gives brown colour up to 4th day due
to presence of glycogen in vaginal epithelial cells.
 
 
Detection of seminal stains is done in rape, sexual murder, sodomy and bestiality.
If smegma ¡s present around glans of penis, it suggests that the person did not have sexual
intercourse in the last 24 hrs.
Chemical examination:
1. Florence test: (Choline per iodide crystals) : Florence solution is potassium iodide, iodine and
water. Dark brown, rhombic crystals of choline iodide resembling haemin are seen
2. Barberio’s test: presence of spermin is detected Spermine picrate crystals are seen
3. Acid phosphatase test: the prostatic secretion has a very high % of acid phosphatase
4. Creatine phosphokinase: CPK is high in seminal fluids and can be detected even ¡n 6 month old
stains.
5. Ammonium molybdate test: it detects the presence of phosphorous
6. Glycoprotein P30 test
7. MHS — S1: highly reliable for semen
8. Serological typing by precipitin method
9. Saliva detection by 1- amylase test
 
 
Forensic psychiatry
 Delusion: false belief in something without any basis
 Hallucination: false sense of perception without any external stimuli
 Illusion: false interpretation of some external stimulus
 Impulse: sudden and irresistible force compelling him to conscious performance of some act
 Delirium: disturbance of consciousness in which orientation is impaired, critical faculty is
blunted or lost and thought consent is irrelevant or inconsistent

34
  Oneiroid state: dream like state with mental confusion, amnesia, illusions, hallucinations
etc.
 Automatism: conduct performed by a person whose consciousness is so impaired that he is
not fully aware of his actions. Seen in epilepsy, concussion or cerebral disease,
somnambulism, hypoglycemia etc.
 Twilight state: field of consciousness is narrowed for a short time followed by amnesia. Seen
in epilepsy, head injury etc.
 
Diagnosis of insanity:
Purpose of clinical examination —
To form an opinion about patient’s mind and degree of responsibility.
 
Observation —for a period not exceeds 10 days, which may be Extended if required with the
Permission of Magistrate for further periods of 10 days up to a maximum of 30 days.
Certification of mental illness
Should not be issued after a single examination.
3 examinations on different days and different hours are recommended.
 
The Mental Health Act, 1987 —
Repeals the Indian Lunacy Act, 1912
Outdated terms - Lunatic
New terms - mentally ill person
Asylum - psychiatric hospital / nursing
Defines ‘Mentally ill person’ as a person who is in need of treatment by reason of any mental
disorder other than mental retardation for treatment as in patient a person can represent himself
or be represented by family or friends in writing to the director of a psychiatric hospital.
For preliminary diagnosis he can be kept in the hosp. for 10 days, if more time is required then it
has to permit by the magistrate who can give extension of 10 days twice.
Punishment:
Detains or keeps mentally ill person otherwise than in accordance with the Act
Punishable with — up to 2 yrs. imprisonment or Rs 10001 fine or with both.
 
 
Mental disorder & responsibility
Civil responsibility: question of civil responsibility arises in:
a. Management of property
b. Contact
c. Competency as a witness
d. Consent
e. Testamentary capacity —mental ability of a person to make a valid will.
 
Conditions:
 He/she must be major
 Have Sound disposing mind at the time of making the will.
 Have thorough knowledge about his wealth & property
 Should be free from undue influence, fraud etc.
Holographic will is one, which is written by a testator in his own handwriting.

35
Criminal responsibility:
A person may plea insanity to avoid:
Conviction- lithe accused was insane at the time of commission of crime.
Trial when accuse is insane and cannot plead.
Capital punishment - when a convict is insane.
Law presumes that every person is sane and responsible for his actions. The defence has to prove
that the accused is insane
 
 
Tests for criminal responsibility
 Mc Naughten Rule:
o The right or wrong test! legal test: An accused person is not legally responsible, if it is
clearly proved that at the time of committing the crime, he was suffering from such a
defect of reason from abnormality of mind that he did not know the nature and quality
of the act he was doing or that what he was doing was wrong ‘.
o Mc Naughten rule is followed in India under Sec. 84/PC which state as: Nothing is an
offence which is done by a person, who at the time of doing it, by reason or
unsoundness of mind, is incapable of knowing the nature of the act, or that lie is doing
what is either wrong or contrary to law.
 Durham Rule .1954:
o An accused person is not criminally responsible, if his unlawful act is the product of
mental disease or mental defect
 Curren’s Rule •1961
o An accused person is not criminally responsible, if at the time of committing he did
not have the capacity to regulate his conduct to the requirement of law, as result of
mental disease ir defects
 
American law Institute test
Irresistible impulse test — New Hemisphere Doctrine
Doctrine of partial responsibility
 
Responsibility and drunkenness:
Sec. 85 IPC — an act done by a person who is incapable of knowing the nature of the act due
Intoxication is not an offence, if the thing which intoxicated him was administered to him
without his knowledge or against his will.
Sec. 86IPC — an intoxicated person (voluntary drunkenness) is criminally responsible if he
had the intension or knowledge of committing a crime.
 
 
Conditions in which person is not criminally responsible for his acts:
o Somnambulism (sleep walking)
o Delirium
o Automatism
o Somnolentia (steep-drunkenness i.e. midway between sleep and waking)
o Oneiroid states (dream like state)
o Twilight state
Conditions in which person is criminally responsible for his acts

36
 o Impulse
o Hypnotism
o Psychopath or sociopath
o Voluntary drunkenness

 
Medical laws and ethics
Erasure of name from register:
 On proof of infamous conduct in any professional respect following serious professional
misconduct.
 Penal erasure:
o 2 types:
 For a limited period
 Permanent- professional death sentence
 Deprives the RMP of all his professional privileges
 
Professional misconduct:
Infamous conducts: 6As
 Association with unqualified persons in professional matters
 Advertising
 Adultery
 Abortion (criminal)
 Addiction
 Alcohol
Some other conditions:
 Dichotomy- fee splitting
 Convicted by court
 Conducting sex determination tests
 Issuing false, misleading or improper certificates
 Disclose professional secrecy
 Covering
 Use of agents/touts for getting patients
 
Rights and privileges of RMP's:
Right to
 Choose a patient
 Practice medicine
 Dispense medicines
 Possess and supply dangerous drugs to patients
 Add title, description to the name
 Recover of fees
 Appointment to public and local hospitals
 Issue medical certificates
 Giving evidence as an expert

37
 
Professional secrecy:
Doctor should not divulge anything which he has learnt in confidence from the patient or found in
examination.
A patient can sue the doctor for damage if
 Disclosure is voluntary
 Has resulted in harm to the patient
 Is not in public interest
Privileged communication:
 A statement made bonafide upon any subject matter by a doctor to the concerned
authority due to his duty to protect the interest of the community or of the state.
 If the doctor discloses professional secrets for the purpose of protecting the interests of
community, he will not be liability to damage.
o Infectious diseases like TB, typhoid
o Venereal diseases
o Non infectious diseases of certain employees- drivers (train, bus), pilot or ship
navigator suffering from epilepsy, hypertension, alcoholism, drug addiction, defective
vision, colour blindness etc.
o Notifiable diseases: statutory duty to notify infectious diseases to public health
authorities.
o Suspended crimes
o Doctors also can divulge professional secrecy if asked by the court.
o Patient's own interest
 AIDS (professional secrecy or privileged communication)
o The Supreme Court has ruled in favour of disclosure of HIV positive status of a
patient to his wife/spouse.
o If a person is suffering from AIDS knowingly marries a women and thereby transmits
the infection to the women, he would be guilty of committing an offence.
o Section 269 IPC- negligent act likely to spread infection of disease dangerous to life
punishment of 6 months
 Malpractice:
o Lack of reasonable care and skill or wilful negligence on the part of a medical
practitioner in the treatment of a patient, which causes bodily injury or death of the
patient
o Black's law dictionary: mentions 4D's to be established by patients/party
 existence of doctor's duty
 Violation of a standard care/treatment- dereliction of duty
 Damage
 Connection between dereliction of duty and injury caused- direct causation
o 2 types:
 Civil suit against the doctor for compensation
 Criminal- section 304A IPC
o Civil negligence:
 Patient or party begins a civil suit against the doctor claiming compensation
against damage or injury
 Extent depends on the amount of damage done
 Burden of proof rests upon patient/party

38
  Must be instituted within 2 years
 Res judicata- once case is decided cannot be taken/reopened in another court
o Criminal negligence:
 Doctor shows gross absence of skill or care during treatment resulting in
serious injury to or death of the patient
 Section 304A IPC- rash or negligent act
 Maximum punishment 2 years
o Defence to negligence
 No duty owed to patient- no physician-patient relationship was established
 Treated according to prevailing standard
 Contributing negligence
 Therapeutic misadventure
 Res judicata
 2 years period passed off
o Doctrine of Res Ipsa Loquitur
 Things speaks for itself
 Normally it is for the patient to establish the guilt of the doctor whose
innocence is otherwise assumed. But in cases where the rule RIL id applicable
patient need not prove negligence.
 Applied when the following conditions are satisfied:
 In absence of negligence the injury would not have occurred
 The doctor had exclusive control over the injury producing
instrument or treatment
 The patient didn't contribute to his own injury
 RIL applied in both civil and criminal negligence
 Examples:
 Wrong prescription, prescribing overdose etc.
 Mis matched blood transfusion
 Failure to give TT in case of injury
 Leaving swab, gauge and surgical instruments in body cavity
after surgery
 Operation on a wrong limbs or organs
o Contributory negligence
 Undesirable or negligent act or carelessness in the part of patient or his
attendant or at times these are in combination with the negligent act of the
physician. A good defence for doctor in civil negligence but not in criminal ones
(limited by doctrine of last chance)
 Examples:
 Not taking proper/full history
 Not following instructions/advice
o Therapeutic misadventure
 An accident or unexpected damage caused by a doctor or hospital
 Can occur during
 Diagnosis
 Treatment
 Experimentation
o Vicarious liability

39
  Respondent superior/ let the master answer
 An employer is responsible not only for his own negligence but also for the
negligence of his employees.
o Euthanasia/mercy killing:
 Physician-assisted suicide, aid-in-dying, self-deliverance
 Types:
 Active or positive- act of commission- by giving a lethal dose of drugs
e.g. morphine
 Passive or negative- discontinuing or not using life sustaining measures
to prolong life.
 
 The transplantation of human organs:
o Regulation of removal, storage and transplantation of human organs for therapeutic
purposes
o Prevention of commercial dealing of human organs
o Certification of brain death by a board of medical experts consisting of
 RMP in charge of hospital where brain death occurs
 An independent RMP
 A neurologist or neurosurgeon
 RMP treating the patient
o Offences and penalties:
 Removal of human organs without authority- 5years with fine upto Rs.10,000/
 RMP if convicted- state medical council can erase his name for 2years and
professional death sentence for subsequent offences
 Commercial dealing of human organs- 2 - 7 years imprisonment with fine of
not less than Rs.10,000 may extend upto Rs.20,000/
 Consent in medical practice:
o Voluntary agreement, compliance and permission
o Types:
 Implies
 Express- oral or written
o Rules of consent
 Consent should be full, free, voluntary, clear, informed, direct and personal
 There should be no undue influence, fraud and misinterpretation of facts and
treat
 Patients has the right to refuse- refuse to consent- an absolute bar for
examination. Exception:
 Section 53CrPC: an arrested person can be examined without consent
of requested by the SI
 Section 54CrPC: an arrested person can request for his own
examination in front of a magistrate.
 Age and consent:
 Simple medical examination and treatment: 12 years and above
 Any diagnostic and operative procedures: 18 years and above
 Loco parentis: in place of parent
 Medico-legal importance:

40
  To examine, treat or operate upon without consent- is assault in law-
patient may sue the doctor for damage
 If doctor fails to give requisite information before taking consent for
operation or treatment, he may be charged for negligence
 
 
 
 
Miscellaneous
Important IPC sections:
 Section 44- injury any harm whatever illegally caused to any person in body, mind,
reputation and property
 
 Section 82: act of a child under 7 years
 Section 83: act of a child above 7 and below 12 years of immature understanding
 Section 84: act of a person of unsound mind.
 
 Section 92: act done in good faith for benefit of a person without consent
 
 Section 191: giving false evidence (PERJURY)
 Section 192: fabricating false evidence
 Section 193: punishment for 191 and 192 (upto 7 years)
 
 Section 228A: disclosure of identity of the victim (upto 2 years)
 Section 269: negligent act likely to spread infections of disease dangerous to life (6 months)
 Section 294: obscene acts and songs (3months)
 
 Section 300: murder
 Section 302: punishment for murder
 
 Section 304A: causing death by negligence (2 years)
 Section 304B: dowry death
 Section 312-316: criminal abortions
 Section 317: exposure and abandonment of child under 12 years by parent (7 years)
 Section 318: concealment of birth by secret disposal (2 years)
 
 Section 319: hurt
 Section 320: grievous hurt
 Section 323: causing hurt
 Section 325: causing grievous hurt

 Section 336: endangering life by negligence (3 months)

 Section 337: simple hurt by negligence (6months)
 Section 338: grievous hurt by negligence (1 year)

 Section 354: outrage of modesty of women (2 years)

41
  Section 361: kidnapping

 Section363: punishment for kidnapping (7 years)

 
 Section 375: definition of rape
 Section 376: punishment of rape
 Section 377: unnatural sexual offences with punishment

 Section 497: adultery (5 years)

 Section 498A: cruelty to women by husband and relatives (3years)

 Section 510: misconduct in public by a drunken person (imprisonment for 24hrs or fine)
 
Important acts in forensic medicine:
 Indian lunacy act 1912 (replaced by mental health act, 1987)
 Indian medical council act 1956 (amendments in 1958,64,93,01)
 MTP act of 1971
 Narcotic drugs and psychotropic substance act 1985
 Consumer protection act 1986
 Prenatal diagnostic technique act of 1994
 The transplantation of human organs act 1994
 Juvenile justice act (care and protection of children) 2000
 Delhi artificial insemination act 1995
 
Test to detect truth:
 Lie detector test: polygraphy
o Records physiological changes e.g. H/R, BP, RR, electrodermal reaction etc. while
asking a series of question
o Indicators of anxiety die to sympathetic stimulation which accompanies lying
 Narco-analysis
o Giving drugs(true serum) to lower a subject's inhibition commonly
 Thiopentone sodium
 Scopolamine hydrobromide
 Amylobarbitone
 Brain fingerprinting:
o Invented by Lawrence Farwell
o Determination whether special information is stored in a subject's brain by
measuring electrical brain wave (EEG)- in response to words, phrases or pictures
o Originally used P300 brain response
o Later discovered MERMER- memory and encoding related multifaceted EEG
response.
 
Types of torture:
 Falanga/falaka or bastinado:
o Beating on soles of feet
 Asphyxial torture:
o Wet submarine
o Dry submarine

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  Telepfono: slaps on either sides of head on ears
 El planton: made to stand in hot sun on one leg
 Black slave: pushing heated metal rod into anus
 Electric torture
 Sham torture

IDENTIFICATION

1. Super Imposition Technique :

X-ray of skull is taken and superimposed on face of missing person of then matching is done.

2. Cheilo scopy :
Study of lip prints i.e. on glass, spoon etc.,

3. Podogram:
Foot print

4. Trichology :
Study of hair which is used for race and species identification

5. Dactylography (fingerprinting)
- 1st discovered by Galton in Calcutta, India,
- It is the most accurate method
- 4 types of fingerprints loop (mc)
Whorl
Arch
Composite (LC)
→ Quetelet rule : Even identical twins will not share same fingerprints.
- There is no inheritance in fingerprints so no role in disputed paternity. (DNA, blood group, HLA
helps)
How to get rid of fingerprints ? All layer of skin should go off as in burns leprosy, rad exp,
electrical inj. Dermatitis, eczema.

6. Poroscopy :
- Study of pores at fingerprints i.e. sweat glands openings
- proposed by locard
When 2 bodies come in contact, there has to be exchange of something.
Locard’s principle of exchange : it says that the criminal will bring something into the crime scene
and leave with something from it and both can be used as forensic evidence ex: A bullet cartridge
left.
He formulated the basic principle of forensic medicine “Every contact leaves a trace” Tattoo is
putting dye into dermis (India ink, carbon black, Prussian blue vermillion red)tattoos can be made
more visible using infrared photography

7. Teeth Exam :
- Identification with help of teeth is x/a forensic odontology
- Helps in estimation of age by studying Transparency of root which can be done in individuals >
21 yrs of age (Gustafson’s method)
Anthropometry : Study of body measurements

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2 sets of Teeth :
10/ Temporary Teeth – lighter, whiter, no enamel
20/ Permanent teeth – heavier, paler, enamel +

1 Dentition : 6 Months - LCI

7 Months - UCI
8 Months - ULI
9 Months - LLI
1 Year - 1st molar
11/2 Year - Canines
2 Year - 2nd Molar

2 Dentition : 6 Years – 1st molar

7 years - Central Incisor
8 Years - Lateral incisor (both)
9 Year - 1st premolar
10 Years - 2nd premolar
11 Years - Canine
12-14 Years - 2nd Molar
17-25 - 3rd Molar

Age Estimation and Skeleton Radiology :

-Elbow - Wrist - Shoulder - Iliac Crest -Ischial Tuberosity - Clavicle
14 yrs. 16 Yrs. 18 Yrs. 20 Yrs. 22 Yrs. 24 Yrs.

- Ant. Fontanelle closes at around 18 months of age

- Post Fontanelle closes at first several months of infants life.
- Sagittal sutures closes at 30-35 yrs.
Coronal suture at 35-40 Yrs.
- Mandible : Child – obtuse
Adult – Rt angle
Old – Obtuse

- Mental foramen : Inferior – child

Middle – Adult
Superior – Old

Sex Determination:

- Whole skeleton > Skull + pelvis > pelvis > Skull

(100% accuracy) (95%) (90%) (85%)

Male Female

Density : - Heavier, darker, prominent - Lighter, whiter, less

Muscle marking muscle marking
Vol of skull: 1500 ml -1400ml
Orbital openings:  square O circular
Frontal and parietal

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Eminences : Less prominent - More prominent

Pelvic inlet : Deep, narrow funnel like, - Wide, shallow, oval shaped
Heart shaped

Sub pubic angle : ^ acute -  obtuse

Greater sciatic notch : small, narrow, deep <70 0. Large, wide, shallow > 900
Ischial tuberosity: - Inverted - Everted
Obturator foramen -O -
Preauricular sulcus : Less prominent - More prominent

Identification of Race :

Cephalic Index (CI) : Breadth

X 100
Length

Based on this formula skull is divided into 3 types, Dolichocephalic mesaticephalic, brachycephalic

Features Aryans, Africans Europeans Mongols

(long faced)
C.I. 70-75 75-80 > 80
Type Dolichocephalic Mesaticephalic Brachycephalic

Nasal, orbital, Square  O (gol in Mongols)

palate openings Rect

Stature Estimation :
- Stature can be estimated by a bone c the help of Pearson’s formula.
steele method for estimating stature from fragments of long bone.

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