Medical Jurisprudence & Forensic Science (Royal Law College, Arifwala)

Prof.
R K Sharma
MD, FIAFM, FRSH
Professor and Head of Department of Forensic Medicine
Kathmandu University Medical School, Nepal
Formerly
Professor and Head of Department of Forensic Medicine, MGM Medical College, Jamshedpur, India
Principal, MGM Medical College, Jamshedpur, India
Dean, Faculty of Medicine, Ranchi University, Bihar, India
Visiting Professor, University of Wales, UK
Commonwealth Medical Fellow, UK
Chairman, Department of Forensic Medicine, Al-Fateh University, Tripoli, Libya
Director– Professor of Forensic Medicine, Subharti Medical College, Meerut, India
Director (Addl.), Medical Education, Health Services, Govt. of Bihar, Patna, India
Consultant, Health Services, Delhi Govt., India
ASSOCIATE EDITOR
Rishav Shrestha
MBBS, 1st Batch
Kathmandu University Medical School, Nepal
“A person may be a poor writer, a bad AUTHOR
painter, or a bad actor but a man cannot Prof. R K Sharma
and must not be a bad doctor.”
MD, FIAFM, FRSH
Professor and Head of Department of
Prof. M.P. Konchalovsky
Forensic Medicine
Kathmandu University Medical School
Nepal
drrksharma@hotmail.com
EDITOR
Rishav Shrestha
MBBS, 1st Batch
Kathmandu University Medical School
Nepal
rishavmania@gmail.com
First Edition 2006
Medical knowledge is constantly changing. As

information becomes available, changes in
treatment, procedures, equipment and the use
of drugs change. The authors and publishers
have, as far as possible, taken care to ensure
that the information given in the text is accurate
and up to date and can not accept any legal
responsibility or liability for errors or omissions
that may have occurred. However, readers are
strongly advised to confirm that the information,
especially with regard to drugs and toxins, com-
plies with current legislation and standards of
practice.
Printed in Nepal
DEDICATION
This volume is dedicated to:
Dr N.B. Rana, Dean, School of Medical Sciences, Kathmandu University, who inspired me
to write a book on Forensic Medicine specially designed to meet the requirements of Nepa-
lese Medicos covering the relevant legal aspects of Nepal.
My late parents, Mr. D. P. Sharma, my father and Tara Sharma, my mother, who brought
me in this lovely world and nurtured me to become a doctor.
And my sweet wife, Deval Sharma, who always insisted and looked after me for this edition
of the book. During many odds, she rendered every possible help to see the project com-
pleted.
I owe gratitude to all of them.
R.K. Sharma
Author
i
ACKNOWLEDGMENTS
Fundamentals of Forensic Medicine and Toxicology (Medical Jurisprudence) would not
have been possible were it not for the following remarkable persons who have helped a lot
in creating the contents and design of this book.
We are glad to be associated with the following persons:
• Dr. Nastu Sharma, MD, MPH, PhD, CEO of Kathmandu University Medical School
(KUMS) has been instrumental in providing facilities of offices for preparation of draft
and printing, and other matters whenever his help was sought.
• Prof. Dr. CR Pant, MS (Ophthalmology), Program Director, KUMS, for his unequivo-
cal support toward the writing of this book.
• Prof. Dr. RKM Shrestha, Associate Dean and Professor of Surgery, KUMS, for the
help in acquiring TExtract ®, the indexing software.
• Dr Nandita Basu, retired associate professor of Pharmacology, AIIMS, for the advice
on the chapter on Vegetable Poisons.
• Mr. Dinesh Chapagain, formerly Dean of School of Engineering for his advice on le-
gal procedures in Nepal.
• Mr. Mukunda Upadhyay, MA, Chief of Management Division, Kathmandu Universi-
ty, for lending every possible assistance as and when required.
• Mr. Bang Vijay Sharma, Administrative officer, KUMS, for legal assistance while writ-
ing this book.
• Ms. Shilu Shrestha, MBBS, 1st Batch, KUMS for her remarkable advices and help
on the design and layout, presentation, and editing.
• Mr. Sudip Shrestha for typing of the draft and arranging for collection of required
documents and the preliminary formatting of the document.
• Anica Mann, Akshaay Sharma, Aarushi Sharma, Reva Mann, and Avani Sharma,
Professor R.K. Sharma’s grandchildren, for assisting in the first few chapters of pre-
paring his lecture notes.
• Mr. Roshan Dahal, Network Administrator, KUMS, for providing the necessary com-
puter facilities for the design and layout and editing of the book.
• Mr. Harry Bego, www.texyz.com, the creator of TExtract ®, the amazing book index-
ing software , for his help on use of TExtract ® to create the index.
RK Sharma
R Shrestha
ii
ABOUT THE AUTHOR
P rofessor R K Sharma has had a distinguished career
in Forensic Medicine. He is currently the professor
and head of Department of Forensic Medicine in Kath-
mandu University Medical School (KUMS), the on-
campus medical college of Kathmandu University.
He started his teaching career at AIIMS, New Delhi and

subsequently he worked in reputed Medical colleges in
India, serving as the professor and head of department of
Forensic Medicine in MGM College, Jamshedpur at a re-
markable age of 35 ; then as the Principal in the same
institution; and as Dean, Faculty of Medicine in Ranchi
University, Bihar.
He was conferred the title of Visiting Professor at the Uni-

versity of Wales in 1977. He was also a Commonwealth
Medical Fellow, UK.
His was also the Chairman of Department of Forensic

Medicine at Al-Fateh University in Libya in 1978-82.
He has also been a consultant to the Government of Del-

hi Administration, for upgrading the facilities of autopsy
work in all the hospitals of Delhi.
He was examiner of MBBS, MD, and PhD of various uni-

versities of India and was expert in selection of the teach-
ers by Union Public Service Commission of India.
His qualifications were sought by the Medical Council of

India to serve as Inspector for postgraduate courses in
Forensic Medicine of various Medical College for granting
recognition during 1992-94.
He was awarded the coveted Chikitsa Ratna Award dur-

ing the IMA Meet at the Institute of Medical Sciences
(IMS) of Banaras Hindu University (BHU) in 2003 for his
outstanding services to the field of Medical Education by
the director of IMS, BHU.
He has two sons, both in Australia and a daughter who is

the vice chairperson of Delhi Public School, Sonepat, In-
dia.
iii
FOREWORD
This book, written by an authority in the subject of Forensic Medicine and Toxi-
cology is specially designed to meet the requirements of Nepalese medicos
covering the relevant legal aspects of Nepal.
In Nepal, number of medical colleges grew phenomenally in the last decade

and as a result, over a thousand students gets admitted every year. All these
students have to study forensic medicine as a part of their undergraduate cur-
riculum.
This is a timely publication since there has been a great need of such a book
for the undergraduate medical students who are studying in the Medical Colleg-
es of Nepal.
I am sure Fundamentals of Forensic Medicine and Toxicology will help the

medical doctors in discharging their duties as a medical legal expert.
I hope the book will stimulate greater interest both among the students and fac-
ulty in the teaching and learning process.
We, on behalf of Kathmandu University, thank Professor Sharma for taking

pains in writing the book.
I also thank Dr. N.B. Rana, Dean, School of Medical Sciences for taking initia-
tive to bringing out this publication.
Prof Dr. Sitaram Adhikary

Registrar
Kathmandu University
v
FOREWORD
Prof. R.K. Sharma, the Head of the Department of Forensic Medicine at Kathmandu
University Medical School at Dhulikhel, Nepal has written a textbook on Forensic
Medicine for medical students in Nepal for the first time.
This book will definitively give sufficient knowledge about the rules, regulations and
findings of our nation, law as such, especially in the field of Forensic Medicine. It will
enable the medical students to practice on Forensic Medicine after their graduation.
I am specially thankful to Prof. Sharma not only because of his dedication towards
his work and writing this book, which will be printed for the first time in Nepal in
Nepal’s context, but also his deep wish to dedicate this book to our institution.
My sincere congratulations to him.
Prof. Dr. Ram K. M. Shrestha, MD

Associate Dean and Professor of Surgery
Kathmandu University Medical School, and
Dhulikhel Hospital, Kathmandu University
Teaching Hospital
vii
PREFACE
The author aims to provide an easily read, concise, and up-to-date account of Forensic
Medicine, which will meet the needs of medical students, service medical officers, lawyers,
and all connected to Medicolegal practice.
The author assembled his lecture notes meant for teaching the students of his lifetime
teaching materials of forty years in this book with thorough revision to keep the subject ma-
terial up-to-date.
It was felt by Dr NB Rana, the Dean of Kathmandu University School of Medical Sciences
that there should be a book of Forensic Medicine incorporating the Nepalese law for the
Nepalese Medicos.
Until recently, the medical students were referring to foreign books of Forensic Medicine
which do not contain the Nepalese laws regarding abortion, wounding, sexual offenses etc
and the functioning of Nepal Medical Council.
The preface to this book would concentrate more on Nepalese Legal System, Nepal Medi-
cal Council, Forensic Pathology and Toxicology besides other regular topics on Forensic
Medicine.
RK Sharma
June 2006
Dhulikhel
ix
EDITOR’S NOTE
Late in January 2005, I went to discuss with Professor RK Sharma about compiling his lec-
ture notes because they contained only the relevant information of forensic medicine, when
he told me about his project of writing a book of Forensic Medicine in the context of Nepal.
Much of the text on Forensic Medicine available to the students contain voluminous infor-
mation, which are not relevant while dealing with the common Medicolegal problems of Ne-
pal. They, thus, study the book only with the background of foreign countries. Also most of
the books contained outdated poisons which are not required to be studied. Hence, this
book took birth to cater to the needs of the Nepalese Medicos and all other concerned in
Medicolegal cases.
As I became interested in Forensic Medicine, Dr. Sharma persuaded me to join this project,
and before long, he also offered me to be the editor of this book. The turning point was
when he told me to make this book appeasing to the students as well as to service medical
officers of this country.
This book has therefore been such an immense learning experience. I owe a lot of gratitude
to my colleagues Pawan, Rajesh, Nabin, Saurav, Bibhuti, Resha, Chheki, Belmaya and oth-
ers for typing many of the important chapters. My friend Shilu Shrestha has been instru-
mental in the layout and design of the chapters and the illustrations by providing suitable
designs. I thank them all very much for the support they have provided for the completion of
this book.
I am privileged and fortunate for being part of a book that I believe will be the foundation of
Forensic Medicine for many medical students.
I express my sincerest gratitude to Professor RK Sharma who is the author of this book, for
the faith he had on me, the responsibility he gave me, and the opportunity he entrusted on
me. It has indeed been an achievement for which I am grateful and thankful.
R Shrestha
June 2006
Dhulikhel
CONTENTS
1 Introduction to Forensic Medicine, Medical Jurisprudence and Toxicology 1
2 Terms Used In Forensic Medicine 5
3 Legal Procedures In Nepal 9
4 The Ethics Of Medical Practice 18
5 Nepal Medical Council 29
6 Indian Legal Medicine 41
7 British Legal System 49
8 Medicolegal Autopsy 54
9 Death 63
10 Post Mortem Changes 71
11 Identification 85
12 Mechanical Injuries 107
13 Automobile Injuries 121
14 Head Injuries 125
15 Forensic Ballistics 131
16 Burns And Scalds 141
17 Electrocution, Lightning 149
18 Mechanical Asphyxia 155
19 Drowning 169
20 Starvation 175
21 Virginity 177
22 Pregnancy And Delivery 181
23 Abortion 185
24 Other Issues In Marital Life 195
25 Issues In Infants And Children 203
26 Sexual Offenses And Perversions 215
27 Forensic Psychiatry 227
Contents
28 Toxicology 237
29 Treatment Of Poisoning Cases 243
30 Mineral Acids 251
31 Organic Acids 257
32 Lead Poisoning 263
33 Mercury 269
34 Arsenic 273
35 Phosphorus (Inorganic -Non Metallic) 277
36 Organophosphorous Poisons 281
37 Alcohol 287
38 Barbiturates 297
39 Opium Poisoning 303
40 Food Poisoning 309
41 Carbon Monoxide 311
42 Petrol/Kerosene/Paraffin 315
43 Hydrocyanic Acid 317
44 Hallucinogens 321
45 Animal Poisons 327
46 Belladonna Alkaloid Intoxication 331
47 Castor Seed (Ricinus Communis) 335
48 Croton Seeds (Croton Tiglium) 337
49 Abrus Precatorious 339
50 Cardiac Poisons 341
51 Strychnine Poisoning 347
52 Ergot 349
53 Calotropis 351
54 Hemlock 353
55 Argemone Mexicana 355
INDEX 357
Chapter
1
INTRODUCTION TO FORENSIC MEDICINE,
MEDICAL JURISPRUDENCE AND TOXICOLOGY
Forensic Medicine 2
Medical Jurisprudence 2
Toxicology 3
1
1 INTRODUCTION TO FORENSIC MEDICINE, MEDICAL JURISPRUDENCE, AND TOXICOLOGY
FORENSIC MEDICINE
Forensic medicine means the application of knowledge of medical and paramedical
sciences for the purposes of the administration of Justice in the Law courts.
Medicine
Pediatrics Gynecolo-
gy
Geriatrics
Surgery
Pharmacology
And Forensic Obstetrics
Toxicology Medicine
Physiology Anatomy
Law Pathology
Laboratory
Results
Fig. 1.1 Forensic Medicine is connected
MEDICAL JURISPRUDENCE
The term Jurisprudence is derived from Greek where Juris means of court and Prudence
means Knowledge.
Medical Jurisprudence is thus, the knowledge of law and court procedures while practicing
medicine.
In short, a doctor is required to know some aspects of law during medical practice.
2
INTRODUCTION TO FORENSIC MEDICINE, MEDICAL JURISPRUDENCE, AND TOXICOLOGY 1
Dr. P.C.H. Brouardel, a famous late nineteenth-century French medico-legalist, has said
something which holds true now as when he wrote it, if not more so: “If the law has made
you a witness, remain a man of science. You have no victim to avenge, no guilty or
innocent person to convict or save- you must bear testimony within the limits of science.”
TOXICOLOGY
Toxicology is a science that deals with the signs, symptoms, diagnosis, and treatment as
well as post-mortem appearances in the event of death from poisoning. In death due to
poisoning, a doctor has to preserve the viscera, blood, urine or some other parts of the
body depending upon the feature while dissecting the body.
Purpose of Forensic Medicine
Scientific investigations of a dead body demands a good knowledge of medicine and allied
subjects. The medical evidence is essential to prove the innocence or guilt of a person. A
careless autopsy or inadequate knowledge of medical science may lead to conviction of an
innocent person or acquittal of a convict.
A doctor who finds difficulty in any matter pertaining to autopsy, particularly in ascertaining
the cause of death should consult a senior fellow colleague.
A doctor should not overestimate himself while giving his opinion in a court of law as an
expert, otherwise he may land in trouble.
3
Chapter
2
TERMS USED IN FORENSIC MEDICINE
Homicide 6
Jusfiable Homicide 6
Excusable Homicide 6
Suicide 7
Corpus Delic 7
Muluki Ain 7
Consent 7
Evidence 7
Witness 8
5
2 TERMS USED IN FORENSIC MEDICINE
HOMICIDE
It means the killing of a human being. It is defined legally as the destruction of the human
life by the act, agency, and culpable omission of some other person or persons. It can result
from an act or from failure to perform an act where the duty to act is imposed by law.
Act e.g. smothering
Homicide
Agency
Failure to perform an act
E.g. Omission to provide food to children – failure to

prevent from exposure (Battered child syndrome)
An inebriated doctor killing a person when operating
Fig 2.1. Causation of a homicide

Homicides are a) criminal or b) non- criminal.
Criminal homicides are legally classified as (a) murder or (b) manslaughter.
Non criminal homicide is classified into (a) justifiable homicide and (b) excusable
homicide.
Justifiable homicide
• Execution on legal orders
• Arising in the course of making legal arrest or preventing the commission of murder
• Self defense when there is imminent danger of death or serious injury and that
only way to prevent is to kill his assailant. The doer must not have provoked the
quarrel or been the aggressor in creating danger.
Excusable homicide
A homicide is excusable when accident or mishap results in an unanticipated and

unintended death of some other person. This must have occurred as a result of a lawful act
carried out in a lawful way with lawful means. For example, in the event of cardiac arrest
occurring during anesthesia when everything is perfect there is no medical negligence.
6
TERMS USED IN FORENSIC MEDICINE 2
SUICIDE
Suicide means the killing of oneself.
CORPUS DELICTI
Literally, it means the body of the offense or the body of the crime. Actually, the corpus
Delicti of homicide is the fact that a person died from unlawful violence. Proving a
charge of homicide involves proof of two propositions;
A. First, an unlawful lethal act was performed and
B. Second, it was done by the person or persons charged with the crime and none other.
The old phrase “Dead men tell no tales” is untrue. A dead body is fully informative if one
listens to the tales it tells. The anatomic findings and the evidence in and on the body may
furnish the only key which unlocks the door to the correct solution.
" sL
dn
MULUKI AIN (d "sL P]g)
Muluki Ain is a general Act first codified in 1853 AD for lawful rules and practices in 1853
A.D. in Nepal.
CONSENT
Consent is voluntary agreement, compliance or permission.
Consent may be
a) Informed or
b) Implied.
Informed consent means consent obtained after explaining the need to perform an act.
Implied consent means consent obtained for an act for which the patient normally would
agree to, like holding out the arm for an injection, or the patient would normally do if he/she
were in a sound state, like treating a case of psychosis with antipsychotics despite the
patient’s refusal.
EVIDENCE
Evidence is information that gives a reason for believing something or proves something,
and it includes any statement or document a court of law permits or requires in relation to
the case.
7
Evidences are
A. Direct- Any fact that is seen, heard, perceived or attested by witnesses orally
B. Indirect- Inferences drawn in relation to events and circumstances
C. Hearsay- Evidence gathered from someone else
D. Documentary- Evidence which have been documented i.e. written.
WITNESS
Witness is a person giving evidence or confirming evidence in a court of law.
Witnesses can be
A. Common– A person giving evidence observed by himself or known to him
B. Expert– A person trained to/skilled in technical aspects and capable of deducing
opinions and inference from facts observed
C. Hostile- A person who gives false evidence or conceals part or whole of truth with some
motive
EUTHANASIA (MERCY KILLING)

Euthanasia is bringing about a gentle and painless death for a person suffering from an
incurable painful disease or a debilitating condition which leads to miserable existence.
Euthanasia can be:
A. Active - It is a positive merciful act to end useless suffering or a meaningless
existence brought about by an act of commission like giving large doses of drugs to
bring about death.
B. Passive - It is discontinuing life sustaining measures to prolong life, which involves
acts of omissions like failure to resuscitate a terminally ill patient.
Euthanasia can also be:

A. Voluntary, given according to will of person
B. Involuntary, against the will of the person
C. Non voluntary, referring to persons incapable of making their choices known like a
person with coma
See Chapter 4 Ethics for ethics regarding euthanasia
Chapter
3
LEGAL PROCEDURES IN NEPAL
Cases 10
Punishment 10
Invesgaon Of Government Criminal Case 10
Medicolegal Role Of Doctors 11
Level Of Courts 12
The District Court 12
The Appellate Court 12
The Supreme Court 12
The Provision For Invesgaon Regarding Post Mortem 13
Medical Evidences Provided By The Medical Praconer 13
Medical Cerficates 14
Death Cerficates 14
Birth Cerficates 14
Medico-Legal Reports 14
Dying Declaraon 14
Phase Of Nepalese Criminal Jusce System And Role Of Related Agencies 15
Process Of Appearing In A Court Of Law 16
Summons Or Subpoena 16
Conduct Money 16
Oath Taking 16
Examinaon-in-Chief 16
Cross Examinaon 16
Re-examinaon 17
Quesons By Judge 17
9
3 LEGAL PROCEDURES IN NEPAL
CASES
Cases are matter that are being investigated into and may be decided in a court of law.
Cases are classified according to Section 9 of the Muluki Ain into two groups: a) Civil and
b) Criminal
Cases such as offense against state, homicide, theft, robbery, burglary, extortion,
defamation, arson (setting fire to), forgery, rape, illegal marriage etc. are criminal cases.
Under criminal cases, there are provisions of fine and imprisonments that can be imposed
on defendants, if found guilty.
Cases such as partitions, transactions, land related cases, contracts, donations,

inheritance, adoptions, trust etc. are civil cases. Under civil cases,
individual rights are adjudged. Court fee is to be paid at the time
of filing the civil cases as provisioned under Court Fee Act 2017. Cases
Civil and criminal cases are again classified into two groups: Civil Criminal
1. Government case Civil
2. Civil case
Government
Provisions under various prevailing acts, homicide, theft, robbery,
rape, drug and human trafficking, extortion, swindling, carrying
unauthorized arms and ammunition etc. are considered offense Fig 3.1 Cases
against the society at large and taken as government criminal
cases. State operates as plaintiff in such cases. Public prosecutor files the case in the
court.
Cases such as unauthorized utilization of government land fall under civil case as specified
by annex 2 of Government Case Act 2049. Both types of cases are pleaded by plaintiff
themselves either by the government or individual.
PUNISHMENT
The court can impose punishment as follows:
• Fine
• Restitution and compensation
• Imprisonment
INVESTIGATION OF GOVERNMENT CRIMINAL CASE

The responsibility of government criminal case is of the police. Criminal cases such as
rape, homicide, abortion, etc. are filed in the District Court by the government as specified
under Government Case Act 2049, annex-1. Anyone who gets the information about any
10
LEGAL PROCEDURES IN NEPAL 3
act of violence or the violence about to be carried out, or being carried should give notice to
the police either verbal or in writing with evidences, if any.
The first information is called First Information Report. Police personnel should keep such
report in record. If the concerned police official denies recording the information, it should
be given to the Chief District Officer or the concerned one level higher police office. The
information so received should be sent by the Chief District Officer or the Police office to the
concerned police office with proper instruction.
District Police Office has the responsibility to investigate and detect the criminal and search
for the evidences of criminal cases. There are sub district level police offices under District
Police Office. These units also have the right to investigate government criminal cases.
Authority of investigation is delegated down to the Assistant Police Inspector, the lowest
level rank of junior officer. This officer enjoys authority to investigation and other related
works needed to collect, seize and preserve the evidences.
The legal provisions entrust police to search, capture and arrest and take the statement of
the accused at the presence of the Public Prosecutor. The Police Officer can prepare
statement of eyewitnesses and hearsay and offended persons. Investigation Officer can
conduct, search, prepare spot documentation, and handle postmortem activities at the cost
to be born by the government, and he can handover the dead body after postmortem, to the
relatives for funeral rites.
Prevailing law provides authority to the police to analyze specimen of blood, semen, or any
organ or part of the body of the accused or offended persons through a government
medical practitioner or at government laboratory. Investigation officer can obtain expert
opinion on any matter, if he thinks so necessary.
The police should make the accused present before the court within twenty four hours of
arrest except the time limitation of the journey. With the consent of the District Court, police
can continue investigation taking the accused in judicial custody for 25 days. The
investigation officer should send investigation report along with his opinion to the Public
Prosecutor Office. Thus, the total responsibility of investigation of government criminal
cases lies with the police officials.
MEDICOLEGAL ROLE OF DOCTORS

Medical practitioners have to submit medicolegal report on both civil and criminal cases
along with their opinion. They should provide their expert opinion to the police, public
prosecutor, and the court after conducting different types of investigations.
They have to go to the court for deposition as expert witnesses if summoned. In the court,
they will have to face examination, cross-examination, re-examination and court question.
(See below, Process of Appearing in a Court of Law)
Medicolegal report on criminal cases like homicide and rape carries a great importance.
11
LEVEL OF COURTS
Supreme Court
Article 85 of the constitution of Nepal, 1990 has provisioned
three levels of court as under:
• The District Court Appellate Court
• The Appellate Court

• The Supreme Court District Court
The District Court

Fig. 3.2. Courts in Nepal
This is a court of first instance. There is one District Court in
each district of Nepal. Currently, there are 75 district courts located in district headquarters
except in Sankhuwasava district. There is a provision for the appointment of the district and
additional district judges as per requirement. His Majesty the King upon recommendation of
the judicial council appoints district judges. The district judges and additional judges are of
equal rank. District courts have authority to administer justice on both civil and criminal
cases within their area of jurisdiction except otherwise is
provisioned by the prevailing law. Appeal on the decision of the Some Legal Definitions
district court can be made in appellate court.
In Contravention to
The Appellate Court
Be contrary to
Upon the advice of the council of minister His Majesty the king Null and void
shall establish appellate court in numbers he desires. Currently,
Not valid
there are 16 appellate courts in the country. The chief justice
and other justices in required numbers are appointed by His Jurisdiction
Majesty the king upon recommendation of the final order or the Authority to carry out justice and
decision made by the district court, semi-judicial authority and to interpret and apply laws
issue writs of habeas corpus, mandamus and prohibition.
Appellate courts conduct initial trial on matters as provisioned by Habeas corpus
the Judicial Administration Act 2048. Order requiring a person to be
brought before the court
The Supreme Court
Mandamus
The Supreme Court is the apex court of the Nepalese judicial A writ from a superior court to an
system. All courts are subordinate to the Supreme Court except inferior one or to an officer, insti-
tution etc
court-martial. The Supreme Court can inspect, supervise and
instruct all other courts and judicial bodies. It is a court of record. Certiorari
A writ from a supreme court call-
There shall be, in addition to the Chief Justice, 14 other ing up the record of the proceed-
permanent judges in the Supreme Court. If the number of cases ing for review
goes high, temporary judges can be appointed for a specified Quo warranto
time. His Majesty the king appoints the Chief Justice and other
A writ calling upon a person to
judges upon recommendation of the judicial council. show by what authority s/he
claims an office/liberty/franchise
12
The Supreme Court can declare any law or Act in contravention to the constitution as null
and void, and possess the authority of extra-ordinary jurisdiction to issue writ of Habeas
corpus, Mandamus, Certiorari, Quo warranto and Prohibition and the like as are deemed
proper for the execution of fundamental, legal or public interest rights.
The Supreme Court has general jurisdiction under which it acts as court of first instance as
specified by Acts, hears appeal, conduct review, ratification and revision. The interpretation
of the law and the doctrine propounded by the Supreme Court in connection of the hearing
should be observed by the His Majesty’s government, all other courts and public officials as
precedents.
THE PROVISION FOR INVESTIGATION REGARDING POST

MORTEM EXAMINATION
Dated 2020 Bhadra 1: Post-mortem or Injury, Investigation, Legal Procedures
The provision for investigation regarding post mortem examination and/or injuries was
legally established following the amendment in 2020 Bhadra 1 of the National Act (Muluki
Ain). For such procedures, a medical officer/chief medical officer appointed in the nearby
hospital or dispensary will perform the duty.
Government Legal procedure 2018, Section 4(3) has the provision for investigation in case
of unnatural death, when reported to legal authorities.
Certification of Post mortem Act 2031, applied from 2032.1.1 is as follows:
In case of no controversy regarding post mortem report, even without the presence of an
expert in the court, the report is acceptable legally. Otherwise, presence of an expert in
court as a witness is necessary for the same.
Section 23(1) states that the court can ask an expert for opinion regarding foreign medico-
legal act, forensic science, or verification of writing and finger prints, in his presence at the
court as a witness.
Section 11(3) of the Act amended in 2049.9.8 authorize a sub inspector of police to send a
dead body, when suspected of foul play, for postmortem examination.
Medical Doctors, who perform post mortem examination or give any other medical opinion,
is not a witness for either the defense or accused. They are only accessory for helping the
court.
MEDICAL EVIDENCES PROVIDED BY MEDICAL PRACTITIONER

These are all Documentary Evidences and consists of a) Medical Certificate, b) Death
Certificate, c) Birth Certificate, d) Medicolegal Reports and e) Dying Deposition
13
1. Medical certificates- e.g. Birth, death,
fitness etc.
Medical Evidences
It must be written by a qualified medical
practitioner duly registered with Nepal Medical
Council. It must be duly signed by the medical Medical Certificates Death Certificates
person along with his/her qualifications. It must
also be signed by concerned person in his/her
presence. Birth Certificates Medicolegal Reports
2. Death Certificates
It must be signed by a medical person. It must Dying Declaration
state the cause of death, time, date and place.
One must not issue a death certificates in case
of doubt due to suspicious conditions or
unnatural causes, and must report to police in Fig. 3.3. Medical Evidences
such circumstances.
3. Birth Certificates
A medical person will issue birth certificates in case when the baby is born in a hospital,
nursing home or health institution along with mother’s name, date and time of delivery of
the baby.
For cases other than above the medical person must issue a certificate on circumstantial
evidence.
4. Medico-legal Reports
A medico legal certificates regarding injury, post mortem certificates should only be issued
by a registered medical officers authorized by the government.
5. Dying declaration
It is a written or oral statement of a person, who is dying as a result of some unlawful act,
relating to the material facts of cause of his death or bearing on the circumstances. Before
recording the statement, the doctor should certify that the person is conscious and his
mental faculties are normal. The doctor should take the declaration in the presence of two
witnesses. The statement should be taken down in the man’s own word without any
alteration of terms or phrases. Leading question should not be put. The signature or thumb
impression of the declarant should be taken and the doctor and the witness should sign. If
the dying person is unable to speak, but is able to make signs in answer to questions put to
him, this can be recorded and it is regarded as a verbal statement. The declaration is sent
to court in a related envelope. A police officer may be available while recording dying
declaration.
14
PHASE OF NEPALESE CRIMINAL JUSTICE SYSTEM AND ROLE OF

RELATED AGENCIES
Information of Crime
First Phase
Police Investigation
Investigation and Pros-
ecution
• Police
Arrest • Public Prosecutor
• Expert
• Victim
Preliminary Function of
Court Detention/Release
Second Phase
Verdict
Trial/Defense/Prosecution • Court
• Defense Lawyer
• Public Prosecutor
Release
Verdict
Punishment
Fine
Unable to pay fine condition
Prison/ Reforms House Third Phase

Reformation Rehabilita-
tion and Socialization
• Jail Administration
Back to Society/Home • Police
• Rehabilitation or Correc-
tion center
• Society
• NGOs and INGOs
Fig. 3.4. Phases of Nepalese Criminal Justice System

After "A STEP TOWARDS VICTIM JUSTICE SYSTEM (NEPALESE PERSPECTIVE)" by Dr. Shanker Kumar Shrestha, PhD,
Pairavi Prakashan, KTM, page 10
15
PROCESS OF APPEARING IN A COURT OF LAW

SUMMONS OR SUBPOENA
It is a document compelling the attendance of a witness in a court of law under penalty. It is

issued by the court in writing, in duplicate, signed by the presiding officer of the court and
bears the seal of the court. It is served on the witness usually by a police officer. It may also
require him to bring with him any books, documents or other things under his control, that
he is bound by law to produce in evidence. A summons must be obeyed and the witness
should produce documents if asked for. The witness will be excused from attending the
court if he has a valid and urgent reason. If he fails to attend a court he will be liable to pay
fine or imprisonment.
Conduct Money
It is the fee offered to a witness in a civil case at the time of service of summons to meet his
expenses for attending the court.
In criminal cases, conduct money is not paid at the time of service of summons and the
witness is paid his expenses as per law by the court after his/her deposition.
Oath Taking
The witness stands on the dock and takes the oath before deposition.
The witness is to take the oath by reading or quoting the following with the help of Bench
clerk “The evidence which I shall give to the court, shall be the truth, the whole truth and
nothing but the truth. So help me god.”
If he is an atheist he may give evidence on solemn affirmation quoting “I solemnly affirm

that the evidence which I shall give in the court, shall be the truth, the whole truth and
nothing but the truth.”
After oath taking, recording of evidence will be done in the following order.
Examination-in-CHIEF
This is the first examination of witness and the questions are put to him by the lawyer for
the side, which has summoned him. The object is to place before the court all the facts that
bear on the case. Here, leading questions are not allowed, except when the witness is
hostile. A leading question is one which suggests to the witness the answer desired.
Cross Examination
In this, the witness is questioned by the lawyer of the opposite party i.e. lawyer for the
accused. The defense counsel tries to elicit out of the witness any fact in favor of defense
and to test accuracy of the statements made by the witness. He may put questions to test
16
his knowledge and to expose the errors, or omissions to discredit the witness. It may last for
hours or days. A doctor in witness box during cross-examination should not pose as super
expert lest he will land in trouble. In doubtful questions, he should better tell that he doesn’t
know than give a wrong answer.
Leading questions are permissible. A witness should not lose temper or argue during cross-
examinations as this will go in favor of the defense.
Re-examination
This is conducted by the lawyer who has conducted examination-in-chief. The object is to
clarify any discrepancy or obscure points or to rectify any ambiguity that has crept in, during
the cross-examination. The witness should not bring in any new subject at this stage.
Leading questions are not allowed.
Questions by Judge
The Judge may ask any question at any stage of the examination to clear up doubts.
On conclusion of the evidence, the witness should read over his own deposition very
carefully before he signs.
The witness can leave the court after taking permission of the court.
17
Chapter
4
THE ETHICS OF MEDICAL PRACTICE
Medical Ethics 20
Ethics Regarding Consent 20
Ethics Regarding Determinaon Of Death 21
Ethical Problems In Pediatrics 22
Ethics Regarding Euthanasia 22
Internaonal Code Of Medical Ethics 23
Rights And Privileges Enjoyed By A Registered Medical Praconer 24
Infamous Conduct (Professional Misconduct) 24
Privileged Communicaon 25
Medical Negligence 26
Defenses Of Doctor Against Charge Of Negligence 27
19
4 THE ETHICS OF MEDICAL PRACTICE
MEDICAL ETHICS
Medical ethics may be described as code of behavior accepted voluntarily within the
profession, as opposed to statutes and regulation imposed by official legislation. Much of
medical ethics consist of good manners and civilized behavior in the general sense, but
there are certain matters which are peculiar to the practice of the profession of medicine
and enforced through its ethical committee of Medical Council and Medical Association.
Clinical ethics is a practical discipline that provides a structured approach to assist

physicians in resolving ethical issue in clinical medicine. The practice of good clinical
medicine requires some working knowledge about ethical issues such as informed consent,
truth telling, confidentiality, and patient rights. Every clinician will acknowledge that ethics is
an inherent aspect of good clinical medicine and that clinician will become as proficient at
ethics as at clinical medicine.
One of the oldest codes of medical ethics is the Hippocratic Oath.

Although some 25 centuries old, its basic tenets remain as valid as
ever . This has lead to its restatement in the Declaration of Geneva.
Formerly, the Hippocratic Oath was pledged by newly admitted medical
practitioner and even today, the graduates still accept its spirit and
intentions. International code of Medical Ethics is based upon
Declaration of Geneva.
The oldest written code of medical Ethics written by Hammurabi, King

of Babylon at about 2200BC, dealt on practice of medicine, liability of
medical practitioner while dealing the delivery cases and the newly born
infants.
Fig. 4.1.Hippocrates
Egyptian or Indian Medicine including Manu-Samhita and
Agnivesh-Charak Samhita, were possibly composed around 7th century B.C. or even
earlier. There were directions how to record evidence and disregard the evidence of drunk,
children and weak individuals.
Susruta Samhita was composed in between 200-300A.D. Susruta, as father of Indian

surgery, dealt the surgical problems and how to treat them.
Charak Samhita prescribed for training duties, responsibilities, privileges, social status for
physicians. Charak, the father of Indian medicine not only outlined how the student was to
get his training under the direct control of preceptor, but also prescribed for professional
norms and conduct rules for him, as for example he was not to attend a woman in absence
of her husband or guardian, not divulging any secrecy etc.
ETHICS REGARDING CONSENT

Minors, that is, persons who are younger than the statutory age of consent viz. below the
age of 12 years, can not give valid consent to suffer any harm from an act done in good
20
THE ETHICS OF MEDICAL PRACTICE 4
faith and for the benefit of the patient. A person above 18 years can give valid consent to
suffer any harm from an act, not intended or known to cause death, and done in good faith
and for his benefit.
A physician may treat a minor without parental consent if the minor is emancipated. The
emancipated minor is a young person who lives independently of parents or guardians,
physically, financially or otherwise. The legal concept of “mature minor” is increasingly
invoked. A mature minor is one who is below statutory age and who is still dependent
upon parents but who appears to make reasoned judgment. Physicians may apply their
common sense and may respond to their requests when the medical measures are taken
for the patient’s own benefit and can be justified as necessary by medical opinion. If the
medical problem is an emergency a minor may be treated without the consent of the
parents or guardians to save life.
In life threatening emergencies, patients may be unable to express their preferences or give
their consent because they are unconscious or in shock. In such situations, it has become
customary for physicians to presume that the patient would give consent if able to do so,
since the alternative would be death or severe disability. This is a reasonable presumption.
This is also somewhat an implied consent. A psychiatrically disabled parent may constitute
a danger to the child. In such cases pediatricians should insist legal steps taken to provide
a surrogate decision maker. Sometimes there is failure on the part of the abuse on the body
of the minor. Legal remedies may be sought depending on the seriousness and urgency of
the situation.
General anesthesia should not be given to child without consent of his legal guardian; if
given, it should be given by a qualified anesthetist talking all possible precautions before
hand. In case of anesthetic deaths, the case must be reported to police by anesthetist or
surgeon for necessary enquiry as to cause of death. Doctor should not start any surgery or
experiment unless informed consent is obtained in writing.
ETHICS REGARDING DETERMINATION OF DEATH

Declaring death is one of the legal duties of physicians. The common definition of death in
medicine and in the law was irreversible cessation of circulation and respiration. In the
1960s it became possible to maintain respiratory function by use of mechanical ventilator.
The concept of “brain criteria” for death would compliment or replace “cardio respiratory
criteria” emerged in the 1960s.
Nowadays, brain death describes certain clinical characteristics of a nonfunctioning brain

viz. unreceptive and unresponsive to external stimuli, no movements or breathing, no
reflexes, fixed and dilated pupils, no reaction to aural irrigation and absent doll’s eyes
response.
Brain blood flow studies are confirmatory, particularly for children. E.E.G. which diagnoses
only absence of cortical function is not sufficient to establish total brain death. The clinical
method of determining death by brain criteria may be used for infants and children, but
21
special caution is advised to the pediatricians and should be familiar with special clinical
issues. E.E.G. and cerebral blood flow studies are confirmatory.
Pediatricians are advised not to apply the criteria to infants younger than 7 days. For infants
between 7 days and 2 months old, two examinations and EEGs should be done, 24 hours
apart; for children over 1 year, the observation extend over 12 hours. Organ transplantation
depends on having donors that are HLA compatible. Such donors are often siblings. Thus,
questions may occasionally arise about taking a kidneys or bone marrow from a healthy
child for a seriously ill sibling. Should there be parental disagreement, the plan should be
abandoned.
ETHICAL PROBLEMS IN PEDIATRICS

This proceeds in the same fashion as in adult medicine. In general, the responsibilities of
pediatricians are the same as those of other physicians viz. to benefit the patient and to
refrain from harm. The goals are restoration of health, relief of symptoms, and restoration of
impaired function, saving life and preventing untimely death. In pediatric medicine, the
exercise of those responsibilities has some special features:
• Infants have no preferences.
• Children are immature to formulate preferences.
• Parents or guardians have the moral and legal responsibilities to act in the child’s
best interest.
• The interest of the patient may be affected by the economic factors, religious beliefs
and interest of the siblings.
• As children mature, their preferences become important in reaching decisions about
appropriate treatment.
• These features may modify the basic responsibilities of a pediatrician. Practitioners
may be told to a more stringent duty to formulate as independent judgment of what
course would be in the patient’s best interest.
Cruelty to children is not recent. In 1946 Caffey, a radiologist published his observations on
the occurrence of “Multiple fractures of the long bones of infants suffering from
chronic subdural hematoma”. Battered children syndrome must be considered in any
child where the degree and type of injury does not match the history advanced, and where
the injuries of different stages of healing are found and when there is purposeful delay in
seeking medical attention.
ETHICS REGARDING EUTHANASIA

The Netherlands is the only country to legalize euthanasia in 2002. Strict rules govern
mercy killing. There should be evident that patient will have a future of unbearable suffering
and the patient must make a voluntary request to die. Another physician should be
consulted before ending patient’s life in a medically appropriate way.
22
INTERNATIONAL CODE OF MEDICAL ETHICS

The duties laid down in the international code of Medical Ethics are as follows;
1. Doctor’s duty to the sick-
a. A doctor must always keep in mind the importance of preserving human life
the day of conception until death.
b. A doctor owes to his patient complete loyalty and all the resources of his
science. When some examinations and treatments are beyond his capacity,
he should summon another doctor who has the necessary ability.
c. A doctor owes to his patient absolute secrecy regarding that which has been
confided to him or what he knows by virtue of the patient’s confidence on him.
d. A doctor must give necessary treatment in emergency circumstances unless
he is certain that it can and will be given by others.
2. Doctor’s duty to another doctor-
a. A doctor should behave towards his colleagues in a way which he will like to
have from them.
b. A doctor must not entice patient from his colleagues.
3. Duties of a doctor in general-
a. A doctor must always maintain the highest standards of professional conduct.
b. A doctor must not allow himself to be influenced merely by motives of profit.
c. A doctor should consider the following practices unethical-
• Any self advertisement.
• Participation in any health care system in which the doctor will not
have professional independence.
• Receiving money for the service to his patient other than acceptance of
proper professional fee or payment of money in such circumstances,
without the knowledge of the patient.
d. A doctor is not permitted to do anything which can weaken the physical or
mental resistance of a human being, without strict therapeutic or prophylactic
indication, in the interest of the patient.
e. A doctor should be very careful in publishing his observations or discoveries,
particularly in respect of a method of treatment which is not recognized by the
professional men.
f. In case of issuance of a certificate and when required to give evidence he
should only mention of what he can verify or prove.
23
RIGHTS AND PRIVILEGES ENJOYED BY A REGISTERED MEDICAL

PRACTITIONER
1. Right to choose his patient - A registered medical practitioner is free to choose his
patient. On this basis he may refuse a patient without showing any reason. He
however cannot refuse to treat a patient whom he has accepted to treat, if there is no
valid ground for such refusal. A registered medical practitioner should not refuse
emergency treatment required by a patient.
2. Right to use title and description of the qualification which he actually possesses.
3. Appointment in public and local Hospitals.
4. Right to prescribe and/or dispense medicine to his patient.
5. Right to realize fee and other expenses for attending his patient.
6. Right to issue medical certificates and medico-legal reports.
7. Right to give evidence in a court of law, as an expert witness.
8. Removal of organs from a dead body for transplantation purpose. A registered
medical practitioner, maintaining all legal and other relevant formalities in this regard
can remove organs from a dead body, if he is working in/for a center approved for this
purpose.
INFAMOUS CONDUCT (PROFESSIONAL MISCONDUCT)

Infamous conduct can be defined as “that act of a medical man done in the pursuit of
his profession, with regard to which it would be reasonably regarded as disgraceful
or dishonorable by his professional colleagues of good repute and competence”.
List of professional misconducts:

1. Adultery or improper conduct or association with a patient.
2. Conviction by court of law of offenses involving moral turpitude.
3. Issuance of fake certificates, report and other documents.
4. Contravention of drug acts and regulation.
5. Selling a scheduled poison to the public under cover of his own qualification, except
to his own patients who needs the same.
6. Performing or enabling an unqualified person to perform an abortion or any illegal
operation for which there is no medical, surgical or psychological indication.
7. Using touts or agents to procure patients.
8. Advertising for his personal gains.
9. Using unusually large signboards and writing on it anything other than his name,
qualification and name of his specialty.
24
10. Disclosing the secrets of his patients that have been learnt in course of exercise of his
profession. These may be disclosed only on the orders of the court or when he is
bound by the law to do so.
11. Failure to obtain consent before performing surgery. In case of an operation which
may result in sterility, consent of both husband and wife is needed.
12. Conniving with the doctors of other specialty for mutually referring the patients to
them and involving in fee splitting (Dichotomy). Similarly, he should not take
commissions from concerned persons for prescribing the medicines of a particular
company or from chemist shop for mutual gain.
PRIVELEGED COMMUNICATION
It is bona fide information to a concerned person or authority, given by a doctor by virtue of
his duty to protect the interest of the community or society.
To be bona fide, the information should only be sent to the concerned person or authority,
maintaining his confidentiality from all other persons, in all other respects, as otherwise the
doctor may be charged for disclosure of his patient’s secrecy. These information include:
1. Information about a Patient suffering from sexually transmitted disease. When a
doctor finds that one of his patients, who is suffering from some sexually transmitted
disease is planning to marry, he should first advice the patient not to marry until he is
cured of his disease. If the patient does not listen to the advice then the doctor can
inform the person about his illness to his would-be spouse. Though, in general
consideration, disclosure of the information of the patient suffering from sexually
transmitted disease is a breach of trust in the professional field, here it is rather the
duty of the doctor to disclose the information to the person whom the patient is going
to marry.
2. Information about infectious disease of some categories of employee. When a
person, suffering from or is a carrier of some infectious disease which is known to
contaminate through food and drink is employed in a hotel or a restaurant to prepare
food or serve food to the customers, then his doctor should advice him to abstain
from working till he is free from the disease or the infective germs. If he does not
listen to the advice, the doctor should inform the employer about the danger from the
particular employee.
3. Information about non-Infectious disease of some specific categories of
employees. Persons suffering from defective visual acuity or defective color vision or
such other perceptive or neurogenic defects, if engaged in job like driving a vehicles
or dealing a heavy machines may be dangerous to himself or others.
4. Information about the risk of contamination to public in general with infectious
diseases at places other than place of employment when a person suffering from a
contagious disease takes bath in a public swimming pool and can’t restrain from his
habit, then he should inform the caretaker of the bathing place.
5. Information about outbreak of a communicable disease.
6. Information about commission of some crime.
25
MEDICAL NEGLIGENCE
Definition of Negligence
“The omission to do something which a reasonable man would do or doing something

which a reasonable and prudent man would not do”
Medical Negligence could be defined as failure to perform the duty to exercise a reasonable
degree of skill in the treatment of the patient.
To constitute a charge of medical negligence there must be:

1. A duty owed
2. There has been a breach of that duty, either by an act of commission or of omission,
and
3. Damage is suffered by the person to whom the duty is owed.
If there is no damage, there is no ground for an action for negligence.
A doctor is under a duty to exercise skill and care from the moment he assumes
responsibility for giving advice or treatment to patient. This duty arises also when he
extends treatment gratuitously or when he treats person without reward in an emergency.
A doctor, merely because he is registered medical practitioner, is under no legal obligation

to accept a patient. He is at liberty to accept or refuse to treat private patients. A doctor who
enters into a learned profession undertakes to exercise it with a reasonable degree of care.
The standard of a doctor should be that of an ordinary, competent practitioner in his/her
specialty. A lesser degree of skill cannot be the grounds for the charge of medical
negligence but rather, there must have been a lack of competence, and of providing
ordinary care, and of average skills.
Doctors and nurses are not insurers and are not guarantors of absolute safety. They are not
liable in law merely because a thing has gone wrong but the law requires them to exercise
professionally that skill and knowledge that belongs to the ordinary practitioner. If the doctor
professes as art, he must be reasonably skilled in it. He must also be careful, but the
standard of care as a normally skillful member of the profession may reasonably be
expected to exercise in the actual circumstances of the case in question. It is not that every
slip or mistake should prompt for allegations of negligence.
A doctor must be well informed of newer developments in medical practice. Ignorance of

such might lead to an action of negligence and can lead to a lawsuit.
The doctor who accepts a patient does not promise to make accurate diagnosis. His
responsibility is fulfilled when he exercised reasonable care and skill in the treatment. He
does not warrant a cure. Nor, he is negligent by reason alone of errors in diagnosis. In the
event that diagnosis was palpably wrong or inadequate steps were taken to make the
26
diagnosis, the doctor may be found negligent. Erroneous interpretation of radiogram or C.T.
Scan/ MRI has been held negligent.
Retention of swabs or packs is clear sign of medical negligence. Similarly operations on the
wrong patient or on the wrong part of patient amount to gross medical negligence. Similarly
administration of the wrong substance, contamination of a spinal anesthetic by a
disinfectant, paralysis of hand due to negligent splinting, breakage of needles, fractures of
lower jaw during dental extraction etc. are some of the cases of medical negligence.
The patient however, needs not to prove negligence in cases Res Ipsa Loquitor
where the rule of Res Ipsa Loquitor applies, which means Latin for Things speak for
things or facts speak for themselves. themselves
Defenses of doctor against charge of negligence
A doctor may plead any or many of the following arguments as his defenses.
Transfu-
1. That, he had no duty to the sion
patient. Surgical
Mishaps
Wrong
Errors Patient
2. That, he discharged his
duties in accordance with
prevailing standard of Retained Anesthet-
Objects in ic Mis-
medical practice. body haps
3. That, damage could be due

to the act of any other
Negligent
person who was also Operation Doctor Paralysis
concerned with his on wrong from
side splints
treatment.
4. That, the damage was due
to third party who interfered Operation Tight
in the treatment without his on wrong Plaster
digits casts
knowledge and consent.
Removal Failure to
5. That, the patient did not of wrong xray
follow the advice properly or organs fractures
it was case of contributory

negligence.
Fig. 4.2. Common surgical mishaps leading to allegations of negligence
6. That, the damage complained of is an expected outcome for the particular type of the
disease suffered from.
7. That, it was a case of reasonable error of judgment.
27
Chapter
5
NEPAL MEDICAL COUNCIL
Introducon 30
Funcon Of Nepal Medical Council 30
Type Of Registraon Of Medical Praconers Permi<ed By Nepal Medical Council 30
Code Of Ethics 31
Declaraon 31
General Principles Of Medical Ethics 32
Dues Of Physicians To Their Paents 33
Dues Of The Physician To The Medical Profession 34
Dues Of Physicians To The Family Members Of The Professional Colleagues 35
Dues Of Physician In Consultaon 35
Disciplinary Acons 35
Professional Conduct And Personal Behavior Of The Physician 36
Unprofessional Acon And Misconducts 37
Power Of Professional Conduct And Health Commi<ee 37
Erasure Of Name From Medical Register 38
29
5 NEPAL MEDICAL COUNCIL
INTRODUCTION Post No Remarks

Nominated by Govt should have at least 20
Nepal Medical Council (NMC) is an Chairman 1 years experience with master degree in medi-
autonomous regulatory body of Nepal cal science.
formed by the Nepal Medical Council Vice-chairman 1
Elected from registered medical doctor with at
Act, 2020 BS. The Act has been revised least 15 years experience
1 Chairman, Nepal Medical Association
3 times, the last in 2055 BS. NMC 1 Nominated by Govt, from amongst the Dean
regulates the medical practice by or rectors of the medical colleges or health
registering qualified medical science academy
practitioners, hospitals, ensuring a 1 Nominated by Govt from amongst consumer
Members 8 Elected from the registered doctors
standard of medical practice and 1 Chairman, Nepal Dental Doctor Association
education, and by taking action against 2 Nominated by Govt, from amongst dental
negligent, unqualified, and unregistered doctors with master degree
practitioners. It has passed a Code of 3 Nominated by Govt from amongst medical
doctors with master degree
Ethics for all registered doctors and has
also formulated guidelines for medical Registrar 1 Nominated by government
and dental colleges, for undergraduate Total 20 (Tenure is of 4 years)
and postgraduate courses.
Table 5.1 Organization of NMC
Committees of NMC
The NMC regulates its work through it Registration, Dental, Education, Professional
Conduct and Health, Examination and Higher education committees.
FUNCTION OF NEPAL MEDICAL COUNCIL

1. To determine the qualification of doctors and to provide registration certificate by taking licensing
examination for new doctors.
2. To give recognition to medical institutions for providing formal studies in medical science and training.
3. To formulate policies related to curriculum, admission, term and examination system of teaching institute
of medical education and to make recommendation for cancellation of registration and approved by
renewing and evaluating such system/procedure.
4. To formulate necessary policies and to make Code of Conduct to run doctors profession smoothly.
5. Others - Active participation in making National Health Policy.
TYPE OF REGISTRATION OF MEDICAL PRACTITIONERS

PERMITTED BY NEPAL MEDICAL COUNCIL
Provisional Registration
For those doctors who have passed final MBBS or equivalent examination but have not
undergone Internship Training.
Permanent Registration
For Nepalese doctors who have had undergone successful Internship Training.
Temporary Registration
Only for foreign doctors wishing to work in Nepal.
Specialist Registration
For doctors who have Specialist Qualification plus Permanent NMC Registration.
30
NEPAL MEDICAL COUNCIL 5
CODE OF ETHICS
The Nepal Medical Council has in accordance with the Nepal Medical Council Act 1964,
passed a medical Code of Ethics, which all doctors registered under it, are to abide by. The
code is as follows:
1. DECLARATION:
The following declaration should be read and agreed upon by the applicant at the time of
registration:
1. I solemnly pledge myself to dedicate my life to the service of humanity.

2. Even under threat and duress I will not use my knowledge contrary to the norms of
humanity.
3. I will maintain the utmost respect for human life right from the time of conception
as per the laws of the land.
4. I will not allow consideration of age, sex, religion, nationality, ethnicity, politics, or
social standing to intervene between my duty and my patient.
5. I will carry out my professional duties with conscience and dignity.
6. The health of my patient will be my first consideration.
7. I will respect the secrets of my patients confided in me.
8. I will give to my teachers the respect and gratitude that is their due.
9. I will maintain, by all means in my power, the honor and noble traditions of the
medical profession.
10. I will maintain utmost rapport with my professional colleagues.
I make these promises solemnly, freely and upon my honor.
Signature……………………………………………………….
Name……………………………………………………….
Date……………………………………………………….
Reg. No.………………………………………………………..
Name of Witness…………………………………………………
Reg. No. If the witness is a registered medical practitioner………
Signature………………………………………………………...
31
2. GENERAL PRINCIPLES OF MEDICAL ETHICS
2.1 Character of the Physician
A physician should be as upright Person, instructed in the art of healing. S/he should
possess good character and be diligent in caring for the sick. S/he should also be modest,
sober, patient, alert, and prompt in action.
2.2 Responsibility of the Physician to Medical Profession
The main aim of the medical profession is to render service to the cause of humanity. S/he
should work with full devotion and should always try to improve medical knowledge and skill
so that patients and colleagues are maximally benefited. The physician should practice
medicine on scientific basis and should not be associated professionally with anyone who
violated this principle.
2.3 Advertising in Medical Practice
It is improper for a physician to use an unusually large signboard or to use other methods to
attracting patients for financial gain.
2.3.1 General Consideration
Nepal Medical council (NMC) does not wish to hinder the ethical dissemination of relevant
factual information about the services available at an institution or being provided by a
physician. This can help the patient to make informed choice seeking treatment and assist
physicians in advising their patients on the choice of specialist. The council recognizes the
duty the medical profession has in disseminating information about advances in medical
science and therapeutics, provided that it is done in an ethical manner.
Solicitation of patient directly or indirectly, by a physician, by groups of physicians or by

institutions or organization is unethical. Self-advertisement is not only incompatible with the
principles, which should govern relationships between members of a profession but could
be a source of danger to the public. A physician successful at achieving publicity may not
be the most appropriate physician for a patient to consult and also may raise illusionary
hopes of cure in extreme cases.
A physician is allowed to make a formal announcement of the following in the press

related to medical practice.
• On starting practice
• On change of type of practice
• On change of address
• On temporary absence from duty
• On resumption of another practice
• On succeeding to another practice
32
2.3.2 Privacy, Security and Confidentiality of Information of the Patients.
It is not a breach of confidentiality to release or transfer confidential health care information
required for the purpose of conducting scientific research, management audits, financial
audits, programmed evaluations, or similar studies provided the information released dose
not identify directly or indirectly any individual patient in any report of such research audit or
evaluation or otherwise disclose patient’s in any manner.
2.4 Terms of Payment of Professional Services
Fee for professional services provided to the patient should be clarified at the time of the
service given. It is unethical to enter into a contract of ‘no cure no payment’.
2.5 Running or Opening a Medical Shop
A physician should not run a shop for dispensing prescriptions prescribed by physician
other than himself or sale of the medical or surgical appliances.
2.6 Secret Remedies
It is unethical to prescribe drugs or formulations about which the physician has no
knowledge about its composition and pharmacoepial action.
2.7 Commission
It is unethical to receive or offer any gift, gratuity, commission, or bonus in consideration of
or in return for referring, recommending, or procuring of patient for prescribing medical and
surgical treatment, investigation and consultation.
2.8 Legal Restriction
A physician should always follow the Nepal Medical Council rules and regulation, which
regulate the practice of medicine. S/he should also abide by other laws enforced in the
country.
3. DUTIES OF PHYSICIANS TO THEIR PATIENTS
3.1 Obligation to the Patient

A physician is not bound to treat each and every patient asking for his services except in
emergencies, but s/he should be ready to respond to the calls of the sick and injured in
conformity with the high character of medical profession.
3.2 Patient’s Secrecy
Patient’s confidence concerning individual or domestic life entrusted by the patient to a
physician and observed during medical attendance should never be divulged unless the
laws of the country required its revelation. Even in such circumstances it should only be
made after formal protest.
33
3.3 Prognosis of the Disease
A physician should explain the nature of the illness to the patient. S/he should neither
exaggerate nor minimize the gravity of a patient’s condition but should always be
sympathetic to patient and his/her family.
3.4 Service to the Patients
A physician is free to choose whom to serve except in emergency cases. But once s/he
undertakes a patient for treatment s/he should not reject the patient without giving
reasonable time or information in advance to the patient and his/her relatives.
3.5 Consent
A physician must seek an informed written consent prior to performing a diagnostic or
treatment procedure. Consent should be taken from the patient if s/he is above sixteen
years, but in the case of minors or unconscious patients, consent from guardian can be
taken. If there is an emergency and nobody is available to sign consent on behalf of patient,
it is the responsibility of the physician to start the treatment. It is obligatory for the physician
to explain the nature of the procedure and the expected result.
3.6 Attendant
A physician should keep in all instances an attendant before examining a patient of the
opposite sex.
3.7 Continuity of Treatment
A physician should not discontinue the treatment except in the following conditions:
• Refusal to pay the fee for service
• Non-compliance with the recommended treatment
• Exerting undue pressure to prescribe unnecessary drugs
• Forcing to do an immoral act in his/her favor
• When physician himself is unwell
4. DUTIES OF THE PHYSICIAN TO THE MEDICAL PROFESSION
4.1 Honor of the Profession

A physician should uphold the dignity and honor of medical profession to the highest
standard.
4.2 Membership in Medical
For the advancement of profession, a physician is encouraged to affiliate with medical
societies and contribute his time, energy and other means so that these societies may
represent the ideals of the profession.
34
4.3 Safeguard to the Profession
The physician should not employ, in connection with his professional practice, any
physician who is neither registered nor enlisted under the Nepal Medical Council Act in
force, and should not permit such persons to attend, treat of perform operations upon
patients so as to endanger their life.
4.4 Exposure of Unethical Conduct
It is the duty of the physician to report to the NMC without fear of any incompetent, corrupt,
and dishonest member or unethical conduct on the part of members of the profession.
5. DUTIES OF PHYSICIANS TO THE FAMILY MEMBERS OF THE PROFESSIONAL

COLLEAGUES
It is not mandatory that a physician not charge fee from another physician or his/her
immediate family members for rendering professional services. But the physician should
consider it a pleasure and privilege to render such services to their professional colleagues
and their immediate family members, free of charge as far as possible.
6. DUTIES OF PHYSICIAN IN CONSULTATION
In case of any doubt or difficulty, a physician should request consultation with other
colleagues giving priority to the patient’s benefit. No insincerity, rivalry, or envy should be
indulged in during consultation.
During the temporary absence of one physician, if s/he requests another physician to attend
his/her patients, it is a professional courtesy to accept such a request. Upon such
temporary appointment, the physician acting under such privilege should give utmost
consideration to the interest and representation of the absent physician.
A physician should not usually take charge of or visit another physician’s patient in the
same illness except in emergency. If s/he does so in emergency, then it is his/her duty to
explain the reason of visit and treatment given to the patient to his/her colleague.
7. DISCIPLINARY ACTIONS
There are certain kinds of professional misconduct and criminal offenses, which lead to
disciplinary proceeding or which in the opinion of the Nepal Medical Council (NMC), could
give rise to a charge of serious professional misconduct. Any abuse of the professional
privileges accorded to him/her or restriction of professional duty or serious breach of
medical ethics may lead to charge of serious professional misconduct. In accordance with
the Nepal Medical Council Act and Regulations, NMC will form professional conduct and
health committee, which will then, recommended the gravity of conviction to Nepal Medical
Council.
35
8. PROFESSIONAL CONDUCT AND PERSONAL BEHAVIOUR OF THE PHYSICIAN
8.1.1 Neglect or Disregard by physician of Their Professional Responsibilities to patients for

Their Care and Treatment.
a. Neglect or Disregard on Medical Care
The Nepal Medial Council may institute disciplinary proceedings when a physician
seriously disregards or neglects professional duties to his/her patient.
b. Improper Delegation of Medical Duties
It is responsibility of a physician to delegate his/her responsibility of management of
the patient to his/her subordinates e.g., nurses, paramedical, medical personnel etc.
Therefore, she should be fully satisfied that the person to whom these duties are
delegated is competent enough to carry these out.
8.1.2 Abuse of Professional Privileges and Skills
a. Prescribing Narcotic Drugs to Addicts
All physicians must provide standards medical care as allowed by available
resources. A physician should not prescribe or supply controlled drugs to addicted
persons other than in the course of bonafide treatment.
b. Medical Certificates
Physicians are expected to exercise care in issuing medical certificates or similar
documents.
c. Termination of Pregnancy
The law of the country prohibits the termination of pregnancy unless medically
indicated. (Please see Chapter 23 Abortion, for revised guidelines on Abortion)
d. Sex Determination
Divulging the gender of a fetus should not be done in USG or other investigation
report as this may lead to subsequent termination.
e. Professional Confidence
A physician should not disclose information, which he obtained in confidence from
or about a patient except in conditions required by law. The infirmity of the patient
and prognosis should only be told to others directly concerned.
f. Improper Pressure
A physician should not exert improper pressure upon a patient to lend him money or
to alert the patient’s will in his favor.
g. Emotional or Sexual Relationship
A physician should not enter into any emotional or sexual relationship with patient or
a member of patient’s family, which may disrupt the patient’s life, danger, or distress
the patient or his or her family.
36
8.2 Personal Behavior
To keep up the reputation of the medical profession in the public, a physician should
maintain proper standard of personal behavior not only in professional duties but at other
times as well. The following are the three main areas of personal behavior, which may lead
to disciplinary proceedings:
a. Abuse of alcohol and drugs
Treating the patient under the influence of alcohol or drugs is liable to disciplinary
proceedings.
b. Dishonesty
Criminal deception, forgery, fraud, theft, and any other offenses involving morality
and honesty are liable to disciplinary action.
c. Indecency and Violence
Indecent behavior or violent assault on a patient would be regarded as a serious
professional misconduct.
9. UNPROFESSIONAL ACTION AND MISCONDUCTS
9.1 A physician should use as 18 x 14 inch size signboard and write his name, NMC
number, qualification, titles, and name of his specialty. The letters should be in blue
on a white background. S/he should not use the International Red Cross symbol to
make known the fact of being a physician. It is improper to affix a signboard on a
chemist’s shop.
9.2 A physician should not encourage any direct or indirect advertisement in the
media, with or without photograph, of a congratulatory nature that is linked with
professional services being offered.
9.3 A physician should not use touts or agent for procuring patients.
9.4 A physician should not insult or misbehave with fellow physicians by words or
behavior.
10. POWER OF PROFESSIONAL CONDUCT AND HEALTH COMMITTEE
The committee will initially enquire all the complaints and issue related to professional
misconduct. At the conclusion of any inquiry regarding professional misconduct, the
committee will decide one of the following alternatives, according to the severity of
misconduct.
10.1 Warn and conclude the case
In case the physician is found innocent, the committee will admonish and conclude the
case.
37
10.2 Put on probation by postponing judgment
The committee can recommend Nepal Medical Council to put a physician on probation for a
specified period, and in this period, professional referees are appointed to look after the
conduct of the convicted physician. If referees furnish the satisfactory report of conduct
after a specified period, then the case will be normally concluded.
10.3 Recommendation of name to be struck off the register
In case of unsatisfactory report of conduct from referees or it there is a serious professional

misconduct or conviction by court in criminal cases involving moral or ethical issues, the
committee may recommend erasure of physician’s registration to the Nepal Medical
Council. If a physician’s registration is erased, s/he ceases to practice as a registered
physician; the erasure of registration, in accordance with the NMC Act, will be for two years.
10.4 Application for restoration of registration
Application for restoration of registration can be made to the Professional Conduct and
Health Committee at any time after 2 years from the date of erasure. The Professional
Conduct and Health Committee determine every application on its merits any may
recommend unconditional or conditional restoration or registration or extend the period or
erasure for another one year. In case of unsuccessful application, a further period of at
least 12 months must elapse before a further application can be made.
11. ERASURE OF NAME FROM MEDICAL REGISTER
The NMC can order the erasure of name of physician from the medical register for two
years on recommendation of the Professional Conduct and Health Committee. The erasure
remains effective unless the physician’s application is accepted for restoration of name to
the medical register.
12. APPEAL AGAINST ERASURE IN COURT
If a physician’s registration is erased from the medical register for whatever reason, s/he
has got the right to appeal to the court against it.
MEDICAL EDUCATION
In the purview of protecting the public from incompetent practitioners, the Nepal Medical
Council has special interests in Medical Education in Nepal for supervision of the same.
Though the curriculum is not strictly controlled, Nepal Medical Council maintains a primary
interest in undergraduate and postgraduate courses because of the inclusion of all heads of
medical colleges, and it prescribes the standards of undergraduate and postgraduate
medical education in all the medical colleges.
38
The current provision allows the Nepal Medical Council to inspect the availability of
resource persons, library facilities, laboratory facilities, academic facilities of the medical
institution required as per the requirements set forth by the Nepal Medical Council.
Colleges fulfilling such criteria are eligible for accreditation of the council and the graduates
of such colleges are eligible for registration with the council and are allowed to practice
medicine.
The Council also holds periodic inspections for recognizing the medical qualifications of the
accredited medical colleges of Nepal under different universities for renewal of the
accreditation.
Chapter
6
INDIAN LEGAL MEDICINE
Inquest 42
Magistrate’s Inquest 42
Coroner’s Inquest 42
Police Inquest 43
Courts Of India 43
Supreme Court 43
High Court 43
Sessions Court 43
Court Of Magistrates 43
Legal Sentences That Can Be Passed Under Law 44
Death Sentence 44
Life- Imprisonment 44
Process Of Appearing In A Court Of Law 44
Summons Or Subpoena 44
Conduct Money 45
Oath Taking 45
Examinaon-In-Chief 45
Cross Examinaon 45
Re-Examinaon 46
Quesons By Judge 46
Professional Secrecy And Medical Witness 46
Evidence 46
Cerficates For Ill Health 47
Death Cerficate 47
Medico-Legal Reports 47
Cerficates Of Insanity 47
Dying Declaraon 47
Dying Deposion 48
Witness 48
41
6 INDIAN LEGAL MEDICINE
Medical officers are called as witness in the courts of law in relation to cases they have
examined like post mortem examinations, cases of sexual offenses or assaults etc. This
practice is rather universal and as such the doctors whether they are from Nepal, India or
other countries must have first hand knowledge about court of law and criminal procedure.
INQUEST
It means enquiry or investigation as to cause of death, especially when it is sudden,
suspicious and unnatural.
Three type of inquests are held in India

1. Magistrate’s inquest
2. Coroner’s inquest
3. Police inquest
Magistrate’s Inquest
It is usually conducted by an executive magistrate especially empowered by the

government. This enquiry is held as in case of:-
• Deaths in prison or police lock up and while under police investigation.
• Death of a person in police firing
• Dowry deaths viz. unnatural death of a spouse within 7 years of marriage and
• Exhumation
• Magistrate will hold the inquest in place of police or in addition to police inquest.
Coroner’s Inquest
The coroner is the specially appointed state government officer, entrusted with the duty of
enquiring into causes of sudden, suspicious and unnatural deaths occurring within his legal
jurisdiction. Coroner should have a legal qualification. He can order an autopsy
examination, if he thinks it necessary. He can order for exhumation of the body for any
subsequent medico-legal examination, investigation or identification. He can summon a
doctor to his court to give evidence. He examines the witness on oath and records their
evidence. At the end of the inquiry he has to return the verdict as to identify cause and
nature of death of the victim. If he suspects of foul play, he issues a warrant for the arrest of
suspected accused person and commit him to the empowered magistrate/ session’s judge
for trial. If the accused is not traced or when the cause of death is not found he gives an
OPEN VERDICT. In such circumstances, the inquest is adjourned indefinitely and could be
reopened later if further information becomes available.
This system was earlier enforced in Calcutta and Bombay and is no longer existent.
42
INDIAN LEGAL MEDICINE 6
Police Inquest
It is done throughout India, when sudden, unnatural and suspicious deaths are reported to
the police. On receipt of the information, the police officer on duty, ordinarily a sub inspector
of police or Assistant sub inspector of police proceeds to the place of occurrence, holds an
inquest in the presence of two or more witnesses and informs the nearest magistrate. He
prepares a report of the appearance and surroundings of body. The inquest report,
Panchanama report is then to be signed by the investigating police officer and the witness
present. If no foul play is suspected, the dead body may be disposed of without postmortem
examination. (In Bombay where the coroner’s inquest is present, the police and coroner’s
inquest become complimentary). The police officer has no power to arrest any person
without warrant except in cognizable offence. In case of suspicion of foul play, the body is
to be sent to mortuary for autopsy examination. Autopsy has to be done by a government
doctor duly authorized to undertake such examination. The report is forwarded to the
magistrate along with the inquest report and other papers for trial.
COURTS OF INDIA
Supreme Court
It is the highest judicial tribunal in India, situated in New Delhi. It is chaired by the chief
justice of India. It is the Court of Record and can punish for its contempt. The rulings given
by the Supreme Court are binding over all the courts of India.
High Court
It is the highest court of Judiciary in the state headed by chief justice of the court. Chief
justice of the High Court is appointed by President of India in consultation with chief justice
of India and Governor of state. It may try any offense and pass any sentence authorized by
law.
Sessions Court
A court of sessions is established at every district headquarters. It can only try cases which
have been committed to it by a Magistrate. A sessions judge or an additional sessions
judge may pass any sentence authorized by law, but death sentence, passed by him need
to be confirmed by high court. Assistant session judge, subordinate to the District session
judge can not pass death sentence or a sentence of imprisonment exceeding ten years.
Court of Magistrates
There are three types of Magistrates:

1. Chief Judicial Magistrate
2. First class judicial Magistrate, and
3. Second class Judicial Magistrate
43
The high court will appoint in every district one first class Magistrate as a chief Judicial
Magistrate who remains in charge of all other Judicial Magistrate in the district. In the
metropolitan cities, they are designated as Metropolitan Magistrates. The Chief Judicial
Magistrate can pass imprisonment up to seven years and fine without limit as per law. The
first class judicial Magistrate can pass imprisonment up to 3 years and fine up to IRs. 5000.
Second class Judicial Magistrate can pass imprisonment up to 1 year and fine up to IRs.
1000.
LEGAL SENTENCES THAT CAN BE PASSED UNDER INDIAN LAW

Death Sentence
This sentence is to be passed by Court of Session subject to confirmation by High Court.
Life- Imprisonment
The term is usually of twenty years and it can be reduced to fourteen years for good
behavior by the prisoner.
Imprisonments can be
• Rigorous imprisonment with hard labor
• Simple imprisonment, and
• Solitary imprisonment which should not exceed more than three months which should
be one month out of 6 months of rigorous imprisonment, 2 months out of 12 months,
3 months out of rigorous imprisonment for more than 1 year.
Fine
Beside the death sentence and imprisonment, the High Court and Court of sessions can
impose any amount of fine as per its discretion. First and second-class magistrate can
impose fine as per their power. Attachment of movable can be done by High court, session
court, and chief judicial/Metropolitan magistrates as per Courts discretion in power.
Detention in reformatories can be ordered by chief judicial magistrate or Judicial Magistrate

of the Juvenile Court, when youthful offenders under 16 years are involved in some crime
and then they are sent to reformatory or borstal schools.
Detention until rise of court can be ordered by any court, usually done for contempt of court.
PROCESS OF APPEARING IN A COURT OF LAW

SUMMONS OR SUBPOENA
It is a document compelling the attendance of a witness in a court of law under penalty. It is

issued by the court in writing, in duplicate, signed by the presiding officer of the court and
44
bears the seal of the court. It is served on the witness usually by a police officer. It may also
require him to bring with him any books, documents or other things under his control, that
he is bound by law to produce in evidence. A summons must be obeyed and the witness
should produce documents if asked for. The witness will be
excused from attending the court if he has a valid and urgent Process of Appearing in
courts
reason. If he fails to attend a court he will be liable to pay fine or
imprisonment.
Conduct Money
It is the fee offered to a witness in a civil case at the time of

service of summons to meet his expenses for attending the court.
In criminal cases, conduct money is not paid at the time of service

of summons and the witness is paid his expenses as per law by
the court after his/her deposition.
Oath Taking
The witness stands on the dock and takes the oath before
deposition.
The witness is to take the oath by reading or quoting the following

with the help of Bench clerk “The evidence which I shall give to
the court, shall be the truth, the whole truth and nothing but the Fig. 6.1. Process of
truth. So help me god.” Appearing in a court
If he is an atheist he may give evidence on solemn affirmation quoting “I solemnly affirm

that the evidence which I shall give in the court, shall be the truth, the whole truth and
nothing but the truth.”
After oath taking, recording of evidence will be done in the following order.
Examination-in-CHIEF
This is the first examination of witness and the questions are put to him by the lawyer for
the side, which has summoned him. The object is to place before the court all the facts that
bear on the case. In this leading questions are not allowed, except when the witness is
hostile. A leading question is one which suggests to the witness the answer desired.
Cross Examination
In this, the witness is questioned by the lawyer of the opposite party i.e. lawyer for the
accused. The defense counsel tries to elicit out of the witness any fact in favor of defense
and to test accuracy of the statements, made by the witness. He may put questions to test
his knowledge and to expose the errors, omissions to discredit the witness. It may last for
hours or days. A doctor in witness box during cross-examination should not pose as super
45
expert lest he will land in trouble. In doubtful questions, he should better tell I don’t know
rather than giving a wrong answer.
Leading questions are permissible. A witness should not loose temper or argue during
cross-examinations as this will go in favor of the defense.
Re-examination
This is conducted by the lawyer who has conducted examination-in-chief. The object is to
clarify any discrepancy or obscure points or to rectify any ambiguity that has crept in, during
the cross-examination. The witness should not bring in any new subject at this stage.
Leading questions are not allowed.
Questions by Judge
The Judge may ask any question at any stage of the examination to clear up doubts.
On conclusion of the evidence, the witness should read over his own deposition very
carefully before he signs.
The witness can leave the court after taking permission of the court.
PROFESSIONAL SECRECY AND MEDICAL WITNESS

A doctor should not volunteer the secrets of his patient confided to him but when ordered by
the court, he will divulge these on protest.
In this respect, a lawyer is in a better position. He has not to divulge the court, any secrets
confided to him by his client, except with his express consent.
EVIDENCE
It may be of the following types:
1. Direct Evidence
This is in respect of any fact pertaining to what is seen, heard or perceived, being attested
by the actual witnesses through oral evidence.
2. Indirect Evidence
This is evidence in which inference is drawn with reference to the happening in the
surrounding.
3. Hearsay evidence
This is evidence, which was gathered from someone else.

46
4. MEDICAL EVIDENCE (DOCUMENTARY EVIDENCE)
These are of following types

• Certificates for ill health
• Death Certificate
• Certificates of insanity
• Medico-legal reports
• Dying Declaration
Certificates For Ill Health
The doctor while issuing a certificate of ill health should mention the disease and duration of
sickness. The certificate should bear the doctor’s signature, registration number with the
signature or (Left Thumb Impression) L.T.I. of the patient affixed on the certificate before it
is delivered to him.
Death Certificate
A doctor should mention the exact cause of death like “Coronary artery disease” etc. but not
a vague term like cardio-respiratory failure or heat failure etc. No certificate should be
issued without inspecting the dead body and without excluding the medical grounds for
suspicion of any foul play. A doctor who was in charge of the patient during the last period
of his illness is legally bound to issue such certificate without any delay and free of any
charge.
Medico-Legal Reports
They are reports made by a medical man to the investigation authority at his request in
cases of assault, rape, murder, poisoning etc. The reports will not be admitted as evidence
unless the doctor attends the court and testifies to the facts under oath. In case of assault,
the report shall include description of injuries, as to their nature, number, measurements,
situations and opinion about the causative agent responsible, and the injury whether
simple, grievous or dangerous.
Certificates Of Insanity
When a lawyer or relative of a person charged for a crime pleads insanity to make his
defense he should be examined by a psychiatrist. The report has to be prepared and
submitted after proper observations and examinations of the subject taking all the
precautions against malingering etc.
Dying Declaration
It is a statement, written or verbal, made by a dying person since then dead, as to the
cause or circumstances bearing material facts relating to his/her impending death. Dying
declaration is acceptable in the court of law without any reservation, as it is presumed that,
a dying man will speak nothing but truth during the last moment of his life. The dying
47
declaration must preferably be made before any magistrate or in his absence, before a
registered medical practitioner treating the patient. The declaration thus made should be
witnessed by two witnesses who should sign in the statement. The person making the
declaration has to sign or affix his thumb impression. The doctor is to assess that the
person making his dying declaration is in a fit mental state (‘COMPOS MENTIS’) before the
declaration is recorded.
The statement should be recorded by the doctor himself when the patient is moribund or
unable to write. The recording should be done in full details, in question and answer from in
the vernacular and identical words used by the patient in the presence of respectable
witness without any alteration. Suggestions or leading questions should always be avoided.
The doctor should ensure that there is no influence on the declarant. If the victim is unable
to speak and can only make sign in answer to questions put to him, then the questions and
answers put together may be regarded as dying declaration.
The declaration should be read over to the dying person and signature or finger print affixed
at the bottom of the statement. This should be followed by the signature of the witnesses
and doctor.
If the declarant dies or becomes unconscious while making the statement, the doctor
should note down the information, as much as he has obtained and sign it and get it signed
by the witnesses. The dying declaration should be forwarded under sealed cover to the
respective authority.
Dying deposition
It is a statement of a person on oath, recorded by the magistrate in the presence of the

accused or his lawyer who is allowed to cross examination the witness. In short, the court
comes to the bedside of the patient.
Witness
1. Common witness: A person who gives evidence about the facts he observed.
2. Expert witness: A person who has been trained or is skilled in technical or scientific
subjects, and capable of deducing opinions and inferences from the facts observed
by himself, e.g. a forensic pathologist.
3. Hostile witness: One who gives false evidence or conceals part of the truth with some
motive.
48
Chapter
7
BRITISH LEGAL SYSTEM
Cases Reportable To The Coroner 50

The System Of The Courts In Britain 52
Magistrates’ Court 52
County Court 52
Crown Court 52
High Court Of Jusce 52
Court Of Appeal 52
The Sco@sh Procurator- Fiscal 53
Medical Examiner System 53
49
7 BRITISH LEGAL SYSTEM
In case of obvious violence whether criminal, accidental or suicidal, reporting will usually be
done directly by the police force, though where death has been delayed and occurs in
hospital, it may well that a doctor first brings it to the notice of the coroner.
The coroner system is one of the most ancient in the English Legal system. The power of
coroner has lessened over years. There are about 180 coroners in England and Wales, the
vast majority being practicing solicitors who carry out coroner’s work on a part time basis.
The coroners are employed by the local authority, and are appointed for life or until
voluntary retirement. The office of the coroner enjoys a large degree of autonomy and can
not be dismissed except for grave breach of behavior.
CASES REPORTABLE TO THE CORONER

All cases in which the cause of death is not absolutely clear to the satisfaction of the
medical attendant, must be reported to the coroner, as well as all cases in which death was
not natural.
Murder, manslaughter, infanticide and causing death by dangerous driving are reportable to
the coroner usually by police. In all these cases the power of the coroner has been severely
curtailed and he merely being obliged to identify and then adjourn for a long period under
section 20 of the Coroner’s (Amendment) Act, to allow time for criminal proceedings to take
place. The clerk of the Crown Court will notify the coroner of the verdict, of conviction or an
acquittal, then there will then be no need for the inquest to be resumed. Only where no
person is apprehended and charged with causing a criminal death, does the coroner have
to hold a full inquest.
Suicide. All cases of suicides are reportable to the coroner.
Accidents. All accidents are reportable to the coroner.
Death in custody. Death in police lock up or in prison is reportable to the coroner.
Death associated with medical treatment. Where death occurs either during medical or
surgical procedures, the case must be reported to the coroner.
Alleged negligent treatment. This is the most important of all the circumstances reportable
to the coroner, as an open, unbiased inquiry into the circumstances are best means of
clearing the doctor’s reputation and restoring his peace of mind.
Sudden death. The largest group of cases reportable to the coroner is those natural deaths
which have occurred either suddenly and/or unexpectedly.
Miscellaneous deaths. Any death following abortion, unless definitely known to be a natural,
spontaneous miscarriage, should be reported. Death from any form of neglect is reportable.
Chronic alcoholism is reportable, if thought responsible for death. Any death suspected of
following drug addition must be reported.
50
BRITISH LEGAL SYSTEM 7
Cot deaths and suspected battered babies must be reported.
The coroner has full powers to commit for contempt of court and to subpoena witnesses.
The rule of evidence whether in Coroner’s court or Crown court the doctor should take the
case notes with him. He will be sworn in witness box followed by examination-in-chief,
cross-examination, re-examination or question put to him by the presiding coroner or judge.
The procedure while attending the coroner’s court or crown court remains the same viz.
taking oath in the dock etc.
Alcohol-
ism
Industrial
Homicide
Accidents
Drugs
Death in
and
Custody
Toxins
Domestic
Suicide
Accidents
CORO-
NER
Operation Doubtful
Death doctor
Sudden
Abortions
Death
Allega-
Road
tions of
Accidents
Negli-
Industrial Infant
Diseases Deaths
Fig. 7.1. Types of death which must be reported to the coroner
51
7 BRITISH LEGAL SYSTEM
THE SYSTEM OF THE COURTS IN BRITAIN

Magistrates’ Court
The vast majority of criminal cases are dealt within the Magistrates’ courts. The
Magistrates’ Court may not impose a sentence of imprisonment for more than six months in
respect of any one offence and when consecutive sentences are imposed in respect of two
or more offenses, the maximum length of sentence is12 months. The maximum fine that
may be imposed on conviction is £ 1000. The magistrate may commit an offender to the
crown court for higher sentence depending on the offender’s crime. Upon committal to the
crown court, the Magistrates’ Court has the power to decide whether an accused person
shall be admitted to bail or not.
County Court
They have to provide simple inexpensive method of resolving civil disputes. A county judge
must be a barrister of at least 10 years standing.
Crown Court
These courts have to deal the cases of more serious crimes. The Crown Court has
jurisdiction to hear all proceedings on indictment, all committals for sentence from
Magistrate Courts and appeals from Magistrates’ Courts against both sentence and
conviction.
High Court of Justice
The jurisdiction of the high court is both original and appellate. The Judicial membership of
the high court includes the Lord Chief justice, the President of the family division, the Vice
Chancellor of the Chancery division and technically the Lord Chancellor. The main body of
work is carried out by the puisine judges who are barristers of not less than 10 years
standing and are appointed upon the recommendation of the Lord Chancellor.
Court of Appeal
The court of Appeal deals with appeals upon the basis of the transcript of the evidence and
judgment. Its jurisdiction is divided into two parts, the first civil and second criminal. On
appeals in criminal matters, there must be an uneven number of judges not less than three.
Those who are entitled to sit in the court of appeal are the Lord Chancellor, ex- Lord
Chancellors, any Lord of Appeal. In civil cases these must be at least two judges on
interlocutory issues and in final matters there must be three judges. Appeals can be heard
before five judges where it is considered to be an issue of exceptional importance. The
house of Lords is the ultimate court of Appeal. It can hear about any decision of the court of
appeal in criminal matters from an appeal to that court and decision of the high court in
England.
52
BRITISH LEGAL SYSTEM 7
THE SCOTTISH PROCURATOR- FISCAL

In Scotland there is procurator-fiscal in place of coroner. The duties of the procurator-fiscal
differs from the English system that there is no public inquest.
Procurators fiscal are appointed by the Lord Advocate and most of them are full time
officers. In a few areas, local solicitors act as fiscals on a part time basis. Procurator fiscal
is comparable to the public prosecutor of the continental legal system.
The main function of procurator-fiscal is in initiating prosecutions and has the duty to
investigate any sudden, violent, suspicious, accidental death or deaths from unknown
causes, which are reported to him. His main interest is to establish whether or not there has
been any criminality or possible negligence involved in the death. He is not obliged to
ascertain the precise cause of death of cases where the criminal proceedings have been
ruled out. This is parallel to the continental system.
Unlike coroner system of England and Wales the procurator will decide whether or not an
autopsy is necessary and they also take into account the wishes of the relative which is not
so in the coroner system. If the procurator considers that an autopsy is necessary, he must
apply for authority for this from the Sheriff.
MEDICAL EXAMINER SYSTEM

Medical examiner’s system exists in New York City and many other states of U.S.A.
The chief medical examiner must be a medically qualified man and a trained pathologist.
The medical examiner has to enquire into deaths which are suspect of homicide in nature,
suicides, sudden or unexpected, accidents and other similar instances where the medical
attendant is unable to certify that death occurred from natural causes.
If he discovers or suspects that a death is due to criminal action, he is obliged to notify the
District Attorney, who is responsible for initiating prosecutions. Unlike the coroner, the
medical examiner has no power to initiate an enquiry or to hold an inquest. Chief medical
examiner receives the cases from a variety of sources viz. police, doctors, any citizen etc.
Once the information is received the chief medical examiner or one of his expert medical
staff examines the body and takes charge of the medico-legal aspects of the investigation.
It is the rule for the medical examiner to attend the scene of death.
The autopsy is done at the chief medical examiner’s official premises and if the death is
homicide, the autopsy must be witnessed by at least one other medical examiner. The
advantage of the medical examiner’s system is that all deaths are viewed by trained
forensic pathologist and in suspicion of homicide; a detailed autopsy is carried out with full
forensic investigation.
53
Chapter
8
MEDICOLEGAL AUTOPSY
Introducon 56
Steps In Medicolegal Autopsy 56
External Examinaon (Visit To the Scene Of Crime) 56
Internal Examinaon (Dissecon) 57
Head 57
Spine And Spinal Cord 58
Neck And Thorax 58
Abdomen 60
Stomach 60
Liver 60
Kidneys 60
Urinary Bladder 60
Spleen 61
Pancreas 61
Abdominal Aorta 61
Intesnes 61
Collecon Of Viscera 61
Preservaon Of Blood 61
55
8 MEDICOLEGAL AUTOPSY
INTRODUCTION
An autopsy is the complete examination of a dead person. It is also called post-mortem
examination.
In Forensic Medicine, autopsy always means Medicolegal Autopsy i.e. the autopsy
conducted is within certain legal parameters.
Objectives
The objectives of a medico-legal autopsy are:

• To establish the identity of a person.
• To determine the cause of death whether Natural or Unnatural.
• If death is unnatural whether it is
• Suicidal
• Accidental, or
• Homicidal
• If death is homicidal, to determine if trace evidence was left behind by assailant.
• To determine the time elapsed since death.
• In case of newly born infants, to determine if they are human; and if human, the age,
sex and probable cause of death.
A carelessly performed autopsy is legally useless.
Mistakes particularly omissions, may be hard or impossible to correct later.
It is therefore very essential to proceed step by step while dissecting and noting all the
external findings, internal findings and also the important negative findings. In all cases
whose identity is not known the doctor should dissect the entire thickness of skin from the
terminal phalanx of each finger and keep in 10% formalin separately labeled in a small
bottles or vials. Sometimes, doing so may be objected by the relatives, then both plain and
rolled finger print impressions should be taken for ascertaining identity.
STEPS IN MEDICOLEGAL AUTOPSY

External Examination (Visit to the scene of crime)
In the evident of homicide, whenever possible a medical examiner is immediately

dispatched to the scene death and with firsthand knowledge of the circumstance is in a
better position to perform the autopsy.
The locality itself may provide some clue. As for example, a body with a cut throat lying in a
house of ill fame or a gambling den indicates, most probably, murder. One with similar
56
MEDICOLEGAL AUTOPSY 8
injuries at one's house could be suicidal. A body with multiples injuries near bus station or
on road may suggest accident.
An injured body lying in a bed in an attitude of deep sleep is probably that of a person dead
due to natural causes or narcotic poisoning.
An injured body lying in bed with disarranged clothing is likely to be that of a murdered
person.
Internal Examination (Dissection)
HEAD
Measure all the injuries with the ruler or measuring tape. Note its shape, pattern and exact
location. If you suspect obscure injuries in the scalp the scalp hair may be shaved. When
Fig. 8.1. Making a scalp incision (See text for details)
there is doubt whether the injury is ante-mortem or post mortem, a portion of the tissue is
retained for histological or histochemical examination.
The head of the body should be placed firmly on a head rest. An incision is made from the
temple to temple and is done by pushing the scalpel at the right mastoid and cutting the
full thickness of the scalp curving to the opposite mastoid. The scalp flap is opened and
pushed forwards on the forehead and backwards over the occipital region. See for any
injury, fracture of the skull bone or hemorrhage.
Incise the temporalis muscle and remove the skull cap either by mechanical or electrical
saw. The removal of the cap becomes easy by gently inserting the chisel at various places
through the cut. Examine the dura for any hemorrhage in between the inner surface of the
vault of the skull and outer surface of duramater viz. extradural hemorrhage. Also look for
any antemortem thrombus in the superior sagittal sinus which can lead to subdural
hemorrhage because of pressure in the bridging veins.
Now the duramater is removed by pulling gently following the line of severed skull cap from
front to back. Look for subdural or subarachnoid hemorrhage if any.
57
Brain is then removed by inserting four fingers of the left hand between the frontal lobes
and the skull, the frontal bones are drawn backwards, when the blood vessels and nerves
at the base of the brain are cut. The cerebellum is then exposed by cutting the tentorium
on both sides. Remove the brain with the cerebellum. After removing the brain, the
remaining venous sinuses are to be opened for evidence of any ante-mortem thrombus.
Then the duramater is completely taken out from the base of the skull. The base of the skull
is sponged and viewed for any fracture of the skull. Pituitary gland is seldom removed
and if removed examine it after fixation in 10% formalin solution.
The brain is examined on all sides, including Circle of Willis for evidence of any injury or
other pathological changes. Separate the cerebellum at the Pons transversely.
Cut the brain in serial coronal sections about 1 cm apart and examine for thickness of gray
matter, hemorrhage or other abnormality. Shrinkage of gray matter is common in chronic
alcoholics. There may be punctate hemorrhage visible to the naked eye in the white
matter. Tardius spots are commonly found in the white matter in death due to
anaphylactic shock. The coronal sections of the brain may show edema or other injuries of
the brain. Edema of the brain can be seen in case of trauma, hemorrhage, tumor, abscess
of brain etc.
Cerebellum is cut to expose the fourth

ventricle and look for any disease, injury
or hemorrhage.
SPINE and SPINAL CORD
They are not examined as a routine

measure, unless there is an indication of
disease, poisoning or injury. Fig. 8.2. A spine incision
The body is turned over the face and
place a block beneath the chest.
An incision is made in midline from the base of the skull to the sacrum. The muscles are
dissected out into flaps on both sides. The laminae of the vertebral column are to be sawn
on both sides throughout the entire length of spine and the dura is exposed.
Examine the dura for any pathological condition such as inflammation, hemorrhage,
suppuration or tumor. The cord is separated from the spinal canal and then examined for
laceration, hemorrhage, softening, inflammation etc. Examine the vertebral column with
special reference to fracture of the odontoid process and cervical vertebrae. In cases of
whip lash injury, hemorrhage is seen under the prevertebral fascia.
NECK AND THORAX
An incision is made on the neck from the point of suprasternal notch and the skin is
reflected.
58
A V shaped incision is made on the neck commencing from the point of suprasternal
notch. The skin is reflected on each side of the neck to the inner side of the mandible. Any
bruising of the skin subcutaneous tissue and palpable fractures of neck bones should be
viewed and noted. Cut through the floor of the mouth close to the inner side of the
mandible to separate the tongue from its attachment. Pull the tongue through the
mandibular arch. The structures of the neck in continuity with those of the thorax should
Fig. 8.3. Opening the body anteriorly
now be removed. Using gentle pull downwards on the tongue and few touches of the knife,
gently detach the whole contents of the neck. The neck structures like hyoid, epiglottis,
larynx, trachea and upper part of bronchi are studied in detail at this stage.
Pull the trachea and esophagus downwards, and lift the thoracic viscera out of the cavity.
The whole structures of the neck along with heart and lungs are thus removed for detailed
examination, preferably on another table. Hyoid bone, thyroid and cricoid cartilages are
examined for any fracture or dislocations. Tongue is examined for evidence of bruises,
lacerations, marks of teeth bite etc. Esophagus is examined after making a longitudinal
incision from the pharynx to its cardiac end. The mucosae are examined for erosion,
inflammation, injury etc. Vocal cords should be examined for edema of glottis or for
impaction of any foreign object. Agonal regurgitation of food matter may cause suffocation.
The larynx, trachea, bronchi and lower bronchioles are to be examined for presence of
carbon soot in case of antemortem burn, mud, sand or some marine vegetation in case of
drowning etc.
Heart is examined after separating it from the vessels.
The pulmonary artery needs special attention for the presence of thrombus which is the
cause of pulmonary embolism. In leg vein thrombosis, the thrombus may detach and enter
the pulmonary artery which can be pulled out by making a longitudinal incision in the
pulmonary artery and probing the artery with a pair of forceps. Sometimes the postmortem
clots are mistaken for antemortem thrombi. An antemortem thrombus is firmly adherent to
the lining endothelium, whereas the postmortem blood clot is weakly adherent to the lining
endothelium and appears yellow or soft and red which is called chicken fat or currant jelly.
The heart is studied as regards to its size and color of the myocardium, vessels and valves.
59
The left and right coronary arteries are examined by making serial incisions down the
course of the vessels about 2-3mm apart for demonstrating the narrowing because of
atheroma. The cutting of the coronary arteries may be felt hard because of calcification of
the arteries. The aortic valve is examined for presence of calcific aortic stenosis. The
coronary ostea, both left and right be looked for its patency. The myocardium is sliced at
places for demonstrating recent or old myocardial infarction. Endocardium is exposed to
view the endocardial fibrosis and papillary muscles. The old infractions in the myocardium
looks white in color in the involved area and are called myocardial fibrosis.
Aorta is examined after making longitudinal incisions for the aortic valve for demonstrating
atheromatous plaques or dissecting aneurysm.
Pericardium is examined in situ for demonstrating the presence of blood in its cavity.
Presence of hemopericardium will show bluish discolored pericardium. Pericardium should
also be examined for any effusion and adhesion between its two surfaces.
LUNGS
The pleural cavity is inspected and pleural fluid observed for empyema. Adhesions are
broken. After detaching the lungs from primary bronchi, each lung is weighed for edema
and inspected other pathologies (consolidation, tumors, occupation lung diseases). Then
slices are made and squeezed to detect any pulmonary edema and inspected for
pathologies.
ABDOMEN AND GENITALIA
Routine incision is made and the peritoneum and abdominal contents as a whole should be
examined and the course of any injury traced. The organs should be examined individually.
Examination of external genitalia should be done especially in suspected rape cases.
STOMACH
Ligature is tied at the lower end of esophagus and at the pyloric end. The stomach is
removed and placed in a tray. Cut along the greater curvature and examine the mucous
membrane, contents, state of digestion of food, and presence of pills or suspicious
matter.
LIVER AND GALL BLADDER
Remove the liver. Palpate and open the gall bladder and examine for calculi and
stricture. Weigh the liver, section the liver and describe any injury or pathological
process.
KIDNEYS
They are removed and weighed. It is then cut longitudinally through the convex border to
the hilum and opened. The capsule is stripped from the cut halves by a toothed forceps.
The cut surface is examined for any pathological conditions. The renal pelvis is
60
examined for calculi and evidence of inflammation. The ureters is freed and examined
their entry to the urinary bladder.
URINARY BLADDER
It is incised and urine retained for examination if suspected for any poison. The bladder
should be examined for congestion, hemorrhage and inflammation of mucus membrane.
SPLEEN
Remove the spleen, weight and examine adhesions and rupture.
PANCREAS
Pancreatic duct is exposed and traced to its entrance into the duodenum.
ABDOMINAL AORTA
Examine for aneurysm and look for atherosclerotic changes.
INTESTINES
Open the small intestine with the enterotome along the line of mesenteric attachment.
Examine the appendix for any pathological condition. Large intestine is cut from
enterotome and examined for congestion, ulceration etc. The possibility of traumatic
perforation of the intestine should be kept in mind. The abdominal cavity should be
viewed after the viscera have been removed.
UTERUS
In females, the uterus should be removed and cut open to see any changes or any
products of conception.
COLLECTION OF VISCERA
Ordinarily in poisoning deaths, the following viscera are preserved:
• Whole stomach with its content about 300cc; if less, then the whole stomach and its
contents
• Small intestine about 100cm in adults, 200cm in children, whole in infants probably
tied at some length.
• Liver, preferably with gall bladder and its contents about 500g in adults and whole in
children should be taken.
• Spleen- Half in adults and whole in children
• Kidney- Half from each kidney in adults and both from children
• The gall bladder should be routinely preserved because examination of bile or if the
gall bladder was empty at postmortem, the gall bladder itself will show the presence
of a large number of drugs including Morphine, Cocaine, methadone and its
metabolites and major tranquilizers.
Viscera should be preserved in super saturated solution of common salt.
61
PRESERVATION OF BLOOD
In alcohol poisoning death, the blood should be collected from axillary or femoral vein and
not from heart because percolation can occur.
For 10 cc of blood 30 mg of Potassium oxalate (Anticoagulant) and 10 cc of Sodium fluoride

(Enzyme inhibitor) is added.
In death from oxalic acid and ethylene glycol, the blood is preserved in 30 mg of Socium
Citrate in place of Potassium oxalate. In carbon monoxide poisoning death, 1-2 cc of liquid
paraffin should be added immediately over blood sample to avoid atmospheric oxygen.
62
Chapter
9
DEATH
Death 64
Somac Death 64
Molecular Death 64
Suspended Animaon 64
Determinaon Of Death 65
Cessaon Of Circulaon 65
Moment Of Death 65
Establishment Of Brainstem Death 65
Tests Of Brainstem Death 65
Cause Of Death 66
Manner Of Death 66
Mechanism Of Death 66
Modes Of Death 66
Vagal Inhibion Or Sudden Cardiac Arrest 67
Sudden Natural Death 67
Causes (Classificaon) Of Sudden Death 67
Disease Of Cardio-Vascular System 67
CNS Causes 69
Abdominal Causes 69
Eclampsia 69
Exhumaon 70
63
9 DEATH
DEATH
The common definition of death in medicine and in the law was irreversible cessation of
circulation and respiration. In the 1960s it became possible to maintain respiratory function
by use of mechanical ventilator. The concept of brain death for death has replaced the
previous criteria of cardio-respiratory failure.
A person is thus dead if the brain has stopped functioning. Brain death is ascertained by
absence of functions of brainstem (Midbrain, Pons and Medulla).
Death will be SOMATIC or CLINICAL when it is early and MOLECULAR when it is late.
Somatic Death
In somatic death, there is complete stoppage of the functions of circulation, respiration and
brain functions but cells or tissues retain its life and may react to mechanical, electrical or
chemical stimulation.
Although the occurrence of somatic death is usually obvious, knowledge of the signs of
death is required by the doctor in order to distinguish death from suspended animation. The
diagnosis of death is normally ascertained by ordinary clinical methods but there are
occasions when the distinction between death and suspended animation is one of special
difficulty. Difficulty arises in death usually occurring from Hypothermia, Electrocution,
Drowning and Barbiturates over dosage where it can be revived by undertaking quick
measures with the help of modern resuscitation.
The development of transplant surgery and the need for transplant material in satisfactory
condition created new problems relating to the diagnosis of death since the principle source
of supply is the bodies of patients recently dead. Transplantation is allowed once Somatic
death occurs.
Molecular Death
In molecular death, there is progressive disintegration of body tissues and they do not
respond to mechanical, Electrical or chemical stimulation. Molecular or cellular death will
exhibit the signs of death viz. cooling of body, skin changes, Eye changes, rigor mortis and
putrefaction.
SUSPENDED ANIMATION
The death like state is the involuntary result of severe shock following an accident, electrical
shock, hypothermia and over-dosage of barbiturate or opium. Suspended animation can be
induced voluntarily by practitioners of yoga.
The distinction between suspended animation and death is not certain when based on
ordinary clinical methods and mistakes can occur unless additional tests are made with
special instruments e.g. the E.C.G. or E.E.G.
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DEATH 9
DETERMINATION OF DEATH
Cessation of circulation
Complete and permanent stoppage of circulation for five minutes or more, when observed
with accuracy with the help of a stethoscope preferably in complete silence, may be
accepted as evidence of “death”.
Molecular death signifies death of the tissues and cells of the body individually, it does not
occur before 2 to 3 hours of somatic death.
The distinction between somatic and molecular death has importance because of
transplantation surgery. The organ transplantation is usually performed, soon after the
death of donor (somatic death).
Moment of Death
To ascertain the moment of death is the legal responsibility of the physician and has great
bearing in the field of organ transplantation surgery. For purposes of transplantation surgery
of liver, kidneys and heart the organ must be reported within 15 minutes to 45 minutes and
cornea should be removed within 2 hours of the death of donor. If any body tissue is
removed from the donor, before he is legally pronounced dead, it will amount to culpable
homicide not amounting to murder.
Establishment of Brainstem Death
To avoid legal complications, brain death should be established and prior consent of
respective persons concerned should have been obtained.
Tests of brainstem death

• Pupillary reflex absent and pupil fixed and
dilated.
• Absence of corneal and conjunctival
reflexes
• Oculocephalic reflex or doll’s head eye Fig. 9.1. Doll’s Eye Movements
Note how both eyes move conjugately in the same
movement absent direction when head is turned in a live person
• Vestibulo- ocular reflexes absent.
• Absence of superficial and deep reflexes.
• No response to pain touch and temperature
• Loss of gag reflexes.
• No spontaneous respiratory movement on stoppage of mechanical ventilation
• Flat EEG
• Irreversible coma for more than 24-30 hours.
65
9 DEATH
Some of the problems would be resolved if brain death is established and the consent of
the legal heir is obtained, the person may be considered dead and the machine could then
be stopped. This would allow for the immediate removal of an organ and enabling grafting
within minutes of the arrest of the donor’s breathing and circulation. However, care must be
ensured, that the doctor who makes the diagnosis and stops the machine must not be a
member of the transplant surgical team and in deciding to stop the machine. The decision
must be that which is in the best interest of the patient.
CAUSE OF DEATH
The cause of death is the injury, disease or the combination of the two. When trauma kills
so rapidly that there was no opportunity for sequelae or complication to develop, the injury
is both the immediate and proximate cause of death.
When a person died at a prolonged interval after receiving the injury which resulted in the
development of serious complications viz. pneumonia, empyema etc. the latter is the
immediate cause of death and the original injury becomes the proximal cause of death. The
complications must be ascribable to the initial trauma.
MANNER OF DEATH
It talks about the intention with which the death occurred. The manner of death is either:
A. Natural
B. Unnatural
1. Accidental
2. Homicide
3. Suicide
MECHANISM OF DEATH
It means the physiological decompensation following any cause of death. For example, if
death was caused by multiple stab injuries, the mechanism of death was due to
hemorrhagic shock.
MODE OF DEATH
Death occurs primarily due to failure of functions of any one of the three main organs heart,
lungs, and brain. These three organs comprise “TRIPOD OF LIFE”. The modes of death
thus could be due to syncope, asphyxia, or coma.
Syncope: stoppage of function of heart and circulatory system
Asphyxia: stoppage of respiration
Coma: stoppage of functions of brain

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DEATH 9
VAGAL INHIBITION OR SUDDEN CARDIAC ARREST

This is the state of sudden stoppage of heart and respiration following reflex stimulation of
the vagus nerve endings.
Common causes are as noted below:

• Pressure on the carotid sinuses- (throttling, hanging and strangulation)
• Sudden blow on abdomen, scrotum, larynx etc
• Introduction of instruments into the bronchus, cervix or uterus
• During sudden evacuation of effusions from the body cavity
• Sudden immersion of body in cold water
SUDDEN NATURAL DEATH

A forensic pathologist is required to be familiar with the features of the various natural
causes of death otherwise he will not appreciate when there is insufficient natural disease
to account for death.
A forensic pathologist when not acquainted with the uncommon varieties of natural death
may incorrectly diagnose unnatural death when it was a natural death.
It must be admitted that in the majority of cases the cause of death ascertained is correct,
but a significant proportion of causes of death are terribly incorrect, being not even in the
correct anatomical system.
CAUSES (CLASSIFICATION) OF SUDDEN NATURAL DEATH
Disease of cardio-vascular system
Coronary artery disease
Occlusion of the coronary arteries by the deposition of the coronary arteries by atheroma is
the commonest condition to be found.
Coronary thrombosis
It is another cause of sudden death. The thrombosis occur most frequently in the
descending branch of the left coronary artery, next in the right coronary artery and then the
left circumflex, and least frequently in the left main artery. Thrombus is formed due to
disturbance of the intima from the presence of atheroma completely resulting in sudden
death.
67
9 DEATH
Myocardial infarction
It is one of common cause of death following

complete occlusion of the coronary artery.
Due to infarction the pumping action of the
ventricles become irregular. Sudden death
may be due to massive infarction by
occlusion of a coronary vessel which causes
cardiac arrest or ventricular fibrillation. Again
sudden death may occur from fibrillation or
cardiac arrest due to conducting systemic
defects. These are commonly seen in old
infarcts showing myocardial fibrosis due to
previous healed infarcts.
Hemopericardium
It may cause sudden death, which occurs

from rupture of recent infarct. This commonly
occurs in the left ventricle.
Instantaneous death is usually due to

coronary artery disease, hypertensive heart
Fig. 9.2. Causes of Sudden Death disease or aortic stenosis. The mode of
death is a cardiac arrest.
Calcification of aortic valve or aortic stenosis is another frequent cause of sudden death.
This is a primary degenerative condition affecting the aortic valve usually in elderly persons.
With a history of hypertension an extremely common finding at autopsy is hypertrophy of

left ventricle. Hypertensive heart disease is the diagnosis of sudden death when there is
hypertrophy of left ventricle with no other evident cause of death. There may be associated
coronary artery disease in a person having enlarged left ventricle with history of
hypertension. In such cases the diagnosis is better labeled as coronary artery disease.
Myocarditis has been attributed to causing sudden death amongst young adults. There is
no gross pathological lesion found. Investigations have revealed minute foci of inflammatory
calls in the myocardium.
Dissecting Aneurysm
This is a degenerative condition of the tunica media. There is deposition of

mucopolysachharides in the muscle fibers. Sometimes, the intima tears and blood seeps
between this and media. Tearing of intima is close to aortic valve and the blood tracks
between this and layers of the media. The blood tracks in both directions and usually burst
through the wall completely. Many a time, walls rupture into the pericardial sac causing
cardiac tamponade.
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DEATH 9
Pulmonary Embolism
Usually there is leg vein thrombosis and on the pelvic veins. These thrombi may be
detached and embolize to the lungs. Pulmonary embolism frequently causes death in
people who are confined to bed for some ailment particularly in the post-operative period.
The thrombosis is formed due to slowing and stasis of blood flow.
CNS Causes
Most of the cause of sudden natural death associated with C.N.S. is from variety of
conditions.
Cerebral hemorrhage
Death in these conditions are not instantaneous as seen in

cardiovascular conditions but may be preceded by a period of coma. The
site of the rupture can never be found as the vessels are very small.
Death is usually due to raised intracranial pressure affecting the vital
centers. Pontine hemorrhage exerts its pressure effect on the vital
centers causing hyperthermia, pupillary constriction and raised blood
pressure. Constriction of pupils may be mistaken for opium poisoning.
Subarachnoid hemorrhage
Fig. 9.3. Subarachnoid
This is due to rupture of a berry aneurysm. In this there is
Hemorrhage
diffuse bleeding into the subarachnoid space. Subarachnoid
hemorrhage is also common in people with hypertension. Not
all subarachnoid hemorrhages are natural but can occur due to trauma in head and in these
cases the diagnosis is rather obvious.
Cerebral thrombosis and infarction are rarely the cause of sudden death. This usually is
pervaded by coma.
Abdominal causes
Massive hemorrhage into the alimentary tract from a bleeding gastric or duodenal ulcer or
colon in ulcerative colitis, malignancy or diverticulitis, rupture of abdominal aneurysm and
ectopic pregnancy when the fertilized ovum is implanted in the wall of the fallopian tube. As
it grows in size may ruptures the tube causing instantaneous death.
Eclampsia
In some cases, eclampsia occur abruptly causing death due to convulsions.
Peritonitis is often completely symptoms free and death may occur without any warning
signs or symptoms.
69
9 DEATH
Acute pancreatitis is often associated with hyperthermia or may develop in alcoholic.
Beside the cause of sudden death in C.V.S., Pulmonary system and Gastrointestinal Tract
there are various other causes viz. sudden infant death syndrome, abuse of drugs,
anesthesia and even endocrinal causes can result sudden death.
EXHUMATION
Exhumation is digging out of a buried dead body from the grave. Exhumation of a buried
dead body is ordered in suspected cases of homicide, since it may have been buried to
conceal the crime. The body is exhumed for undertaking the postmortem examination. The
body is exhumed only when there is a written order from the government or the designated
court authorities.
It should be done in broad daylight preferably in the early morning hours to avoid crowds.
The doctor and an authorized court official should be present during exhumation. In India,
the exhumation is done under the supervision of a doctor and magistrate. The graveyard
should be properly identified by the persons or relatives who were present during the burial.
The area should be screened off. The details of the burial place should be noted and
photographed. When the lid is opened it should be again photographed. Disinfectants
should not be sprinkled on the body. Attempts should be made to ascertain the identity of
the dead body. All personal effects, clothing, hair, nails etc. should be picked up for
examination.
The viscera should be preserved for chemical analysis. If the body is reduced to skeleton,
the bones should be looked for fractures and other injury marks.
If the body exhumed had earlier been autopsied the interpretation of the findings of a
second autopsy is difficult due to the various artifacts resulting from the first autopsy.
Detailed autopsy should be carried out and sometimes the valuable results may be
obtained.
In cases of suspected poisoning, samples of the earth in actual contact with the body and
also from above, below and from each side should be collected.
The time limit of exhumation varies from country to country. In India and England there is
no time limit of exhumation. In France, this period is limited to 10 years and it is 30 years in
Germany.
70
Chapter
10
POST MORTEM CHANGES
Determining The Time Since Death 72

Cooling Of The Body 72
Postmortem Lividity (Hypostasis, Livor Mors, Or Suggilaon) 74
Rigor Mors 76
Condions simulang Rigor Mors 78
Putrefacon, Adipocere Formaon, Mummificaon, Flotaon Of Body 78
Putrefacon 78
Adipocere Formaon 80
Mummificaon 81
Flotaon Of Body 81
Contents Of The Stomach 82
Urinary Bladder And Large Intesne 83
Chemical Changes 83
Cerebrospinal Fluid 83
Blood 83
Vitreous Humor 83
71
10 POST MORTEM CHANGES
DETERMINING THE TIME SINCE DEATH

Determining the precise time since death is impossible. A time bracket should be worked out which
reasonably includes the actual time of death. A doctor who has written an absurdly accurate time of
death will undoubtedly suffer at the hands of opposing learned council and the rest of his evidence is
discredited.
A forensic doctor who is authorized to undertake autopsy examination should be familiar with
changes that occur in the body after death. These signs of death, would enable, a doctor in making
the proper interpretation in deducing the time elapsed since death.
These changes include
1. Changes in Eye and skin
2. Cooling of the body
3. Postmortem hypostasis (Suggilation or Livor Mortis)
4. Rigor Mortis
5. Putrefaction, Adipocere formation and/or Mummification
6. Other Associated Factors
As the conduction of post mortem lengthens, associated factors may furnish more reliable data for
estimation of time since death. These are:
1. Contents of the stomach
2. Contents of the bowel
3. Urinary bladder whether full, partially full or empty and
4. Chemical Changes
5. Circumstantial evidence
Changes in Eye
Following Death, eyes lose their luster, corneal reflex is lost and cornea is opacified. The pupils lose
reaction to atropine and esserine after an hour of death. When pressed, corneal shape changes.
Intraocular pressure falls. Fundoscopy shows fragmentation of retinal vessels with "Rail
roading" (movement of group of RBCs).
Changes in Skin
Skin becomes paler and ash-white in color in fair people. It loses elasticity and an incised wound will
not gape.
COOLING OF THE BODY
When a person is dead the body loses its heat by conduction, convection and radiation and
ultimately attains the same temperature as that of the environment.
The temperature of the dead body is recorded by a chemical thermometer which is 25 cm
long with a range from 0-50º C. It is inserted about 10 cm in the rectum, vagina, or under
the liver making an incision in the abdomen. The thermometer is left there for about 3
minutes. Side by side, the atmospheric temperature is recorded and the time noted. The
rate of fall of temperature is recorded at intervals of 1 to 2 hours. During life, the normal
body temperature in rectum is 37.2º C and in axilla 37ºC. When the body temperature at the
time of death is normal, there is generally no fall in rectal temperature for about 45 minutes.
72
POST MORTEM CHANGES 10
After this, the rate of cooling is almost proportional to the difference in temperature between
the body and its surroundings. In the first two hours, the average rate of fall of temperature
is approximately half the difference between the temperature of the body and its
surroundings. In the next two hours, the temperature falls at half this rate and in the next
two hours at quarter this rate. Therefore, it falls much slowly till the body is in equilibrium
with the temperature of its surroundings. In a tropical country the average heat loss in a
body is roughly 0.5 ºC per hour, and the body attains environmental temperature in about
16-20 hours after death.
There are certain conditions in which the body temperature may be retained or even
increased in the first two hours.
Such conditions include:
1. Death from sunstroke – mechanism of heat regulation is disturbed
2. Pontine hemorrhage – mechanism of heat regulation is disturbed
3. Tetanus and strychnine poisoning when there has been production of heat in muscles
due to spasm.
4. Lobar pneumonia, typhoid fever, encephalitis when these have been of bacterial or
viral origin
5. Violent asphyxial deaths when there may be rise of 2-3ºC at death
This phenomenon is known as post mortem caloricity (post=after, mortem=death,
calor=heat). After the initial rise of temperature, the body begins to cool.
Factors that influence the cooling of a dead body
1. Clothing
Clothing will retard the rate of cooling. A naked body will lose heat faster than one with
clothes on.
2. Body size and physique
The fatty body retains the heat for a longer time and the cooling is slow. An emaciated
corpse will cool faster than a well built body.
3. Age
The bodies of children and old people cool more rapidly than those of middle age and
young age group.
4. The body kept in open air loses heat by convection, radiation and conduction through
the material on which the body lies.
5. Dead bodies retain heat longer in case of death from accidents, asphyxial deaths,
carbon monoxide poisoning and lightning death.
6. Cooling of the body is more rapid in deaths from severe hemorrhage, chronic wasting
and debilitating disease.
73
The formula for fixing appropriate time of death is as follows:
Normal Body Temperature (98.4°F)-Rectal temperature of body
Approximate number of hours=
Rate of fall of temperature per hour
There are many variations of the above formula and hence it is not reliable.
POSTMORTEM LIVIDITY (HYPOSTASIS, LIVOR MORTIS, OR SUGGILATION)
Following stoppage of heart function, blood gravitates to and accumulates in the most
dependent portions of the body, distending their capillary beds, venules and giving them a
dark purple color. This discoloration of the skin is called Livor Mortis, Postmortem
Lividity, hypostasis, or Suggilation. When death has occurred from carbon monoxide
asphyxia, dependent hypostasis is Cherry red; when death is caused by cyanide poisoning,
Livor Mortis is often scarlet; when death is caused by mechanical asphyxia, Livor is bluish
or brownish purple. This is only seen on those parts of the body which is dependent and
hanging without compression from some objects and allows the accumulation of fluid blood
in the capillaries and small veins.
If blood hemoglobin content is low as a consequence of chronic anemia or terminal blood

loss the lividity is less marked.
Bodily areas in contact with a firm surface do not demonstrate dependent lividity and if the
dead body remains in a supine position on hard surface, pressure points of pallor include
occipital scalp, scapular areas, buttocks, posterior aspects of thighs and calves. The
decedent who dies from prone has areas of pressure pallor over the anterior aspects of his
head and trunk including the forehead, nose, chin, chest, lower abdomen, and anterior
thighs. Regardless of body position, areas of constriction by belts, neck ties etc. are pale.
The process of discoloration of the skin commences within an hour after death. It presents
itself as a series of mottled patches on the dependent parts within about 1-3 hours. These
patches gradually increase in size and coalesce in about 3-6 hours. The Livor is fully
developed and fixed in about 6-12 hours. The fixation of lividity is commonly due to
stagnation of blood in the distended toneless capillaries and small veins. If the position of
the body is altered before fixation of lividity, fresh areas of lividity develop in the new
dependent parts but the old patches may persist because of staining of tissues caused by
hemolysis.
It can be said that if the pressure of the thumb blanches the area, the lividity is not fixed and
the time since death is probably less than 6 hours.
The discoloration of skin in lividity is due to filling of the blood vessels, it is not developed on
the areas of contact flattening i.e. those areas of the body which are in actual contact with
the surface on which the body is lying because in these areas the capillaries and small
veins are occluded by the pressure of the body. Lividity will not develop in that area even
though it may be the dependent part.
74
Lividity thus furnishes 3 useful information
1. Its degree of development may help establish the postmortem interval,
2. Its distribution may indicate that the body was moved after death and
3. Its color may indicate the cause of death
Post mortem lividity has sometimes been mistaken for contusions caused by blunt force.
Lividity can be differentiated from contusion on the following points:

1. Lividity occurs on the dependent parts of the body and usually involves the superficial
layer of the skin. A bruise (contusion) can occur anywhere on the body and usually
takes the shape of the weapon and generally affects the deeper tissues.
2. Lividity has clearly defined margin and does not appear elevated above the surface. A
bruise appears raised above the level of the surface and its edges are not sharply
defined edges.
3. Lividity is uniform in color and may become green due to decomposition. A bruise
changes its color.
4. Lividity has no abrasion whereas in bruise abrasion is invariably present.
5. Incision shows few minute drops of blood coming out from small vessels in case of
lividity. In case of bruise there is extravasation of blood in the tissues which cannot be
easily washed away.
6. Microscopically, the lividity will not show any sign of inflammation whereas in
contusion there is evidence of inflammation and blood elements are seen outside the
blood vessels.
Due to putrefaction, the areas of lividity undergo changes. There is hemolysis of blood.
Owing to the pressure of gases developed in the blood, the positions of postmortem
hypostasis is altered.
A B C
Fig. 10.1. Postmortem Hypostasis

Note the lividity is present only in dependent regions and is not present in the regions which
are in contact with a firm surface (floor in A & B, and hand in C)
75
A B C
D E
Fig. 10.2. Patterns of Postmortem Lividity

A. The Livor mortis looks like an injury D. The person was moved after lividity
B. After incising, there is little blood was fixed. Lividity does not change
C. The lividity is seen on the face but not upon change in position once it has
on a portion of the scalp because the set in.
head was rested on the deceased E. Note the imprints of a sole of shoes in
hand 10. E (arrows)
RIGOR MORTIS
Rigor Mortis is ordinarily followed immediately after the muscles have lost the power of
contractility. Following death there is relaxation of the whole muscular system of the body
and the joints can be flexed easily. The average duration of this primary relaxation lasts for
1-2 hours. During this period the body can be folded and pushed in a gunny bag or trunk for
disposal at a distant place to conceal the crime.
This total muscular relaxation is succeeded by the development of rigor mortis, a condition
characterized by stiffening, shortening, and opacity of the muscles. Rigor Mortis involves
voluntary and involuntary musculature and results from physiochemical changes in muscle
protein.
76
The voluntary muscles consist of a large number of fine fibers. Each fiber has contractile
elements called myofibrils. These are formed by two types of protein filaments known as
myosin and actin. Adenosine triphosphate plays an important role in contraction and
relaxation of the muscles. Its production and utilization is constantly balanced during life.
Following death there is a gradual fall in its concentration as it cannot be resynthesized

leading to primary flaccidity. Then fusion of actin and myosin filaments into stiff
actinomysin producing rigidity of muscles, known as Rigor Mortis.
Transformation of muscle glycogen into lactic acid after death results in a fall of pH of
muscle protoplasm. When the time passes the muscle acidification increases and rigor
mortis passes off, leading to secondary flaccidity. Rigor cannot be established now.
Rigor Mortis first appears in involuntary muscles and then in voluntary muscles. It is tested
by gently bending the various joints o f the body. In the involuntary muscles, rigor mortis
appears in the heart within an hour after death. In the voluntary muscles, rigor mortis first
appears in the muscles of the eyelids, and then in the muscles of the jaws, in the muscles
of the face, neck and trunk, followed by muscles of the upper extremities and then the legs.
The last to be affected are the small muscles of the fingers and toes.
The rigidity generally passes off in the same order in which it appeared due to autolysis of
muscle proteins. The appearance and disappearance of the rigor mortis may help in
ascertaining the time since death. For example, if the lower limbs elicit presence of rigor
mortis but the upper limbs are flaccid, wound suggests that the rigor mortis has started
disappearing after its full development. The time since death may be regarded in such case
more than twelve hours, close to eighteen hours. Generally, rigor mortis commences in 1-2
hours after death, takes about 12 hours to develop from head to foot, stays for another 12
hours, and takes 12 hours to pass off. The appearance of Rigor Mortis, its extent or
absence helps to provide a rough estimate of the time since death. A joint which is stiff, if
forcibly flexed becomes flaccid and will remain so thereafter. This is called Breaking of
Rigor mortis.
Factors affecting development of Rigor Mortis

1. Onset and disappearances of rigor are hastened by high
fever, elevated atmospheric temperature, and strenuous
muscular activity.
2. The appearance of rigor is delayed by cold environmental
temperatures
3. The onset of rigor is slow but lasts for a longer time in those
cases where the muscles have been healthy and relaxed
before death
4. Rigor is feeble and passes off early in elderly people,
children and emaciated persons and also in deaths occurring
from chronic wasting disease Fig. 10. 3.Rigor Mortis of Left lower limb
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Condition simulating Rigor mortis
1. Cadaveric Spasm
This is also called instantaneous rigidity and occurs at the moment of

death. This usually happens in sudden violent deaths especially fall in
waters where objects may be clutched in a desperate attempt to save
life. Cadaveric spasm is invariably seen in suicidal deaths where the
weapon is held firmly in the hand in cases of cut throat or wrist cuts.
This state of affairs cannot be simulated after death. Cadaveric spasm
is usually localized to one group of voluntary muscles and is associated Fig. 10.4.
with the last voluntary act performed under extreme mental tension. Cadaveric Spasm
of hand
2. Heat Stiffening
There is hardening and stiffening of muscles of body exposed to intense heat, above 50°C.
There is coagulation of muscle proteins due to heat. The body may assume an attitude
called Pugilistic Attitude, where the limbs are frequently drawn up into flexion contractures
and clenched fingers resembling boxer’s posture. This is due to shortening of muscle fibers
due to heat.
3. Cold Stiffening
When a body is exposed to freezing temperature, the muscles start stiffening due to
solidification of fat. On forceful bending of the stiffened joint, it may make sound similar to
cracking of ice due to frozen synovial fluid. If the body is moved to a warm atmosphere, the
stiffening disappears and normal rigor mortis develops but lasts for a short duration.
PUTREFACTION, ADIPOCERE FORMATION, MUMMIFICATION, FLOTATION OF BODY
Putrefaction
Post mortem putrefaction consists of destructive tissue changes produced by uncontrolled

bacterial multiplication and fermentation. Putrefaction is brought about by two processes:
1. Autolysis
2. Bacterial multiplication and its action
Autolysis, an aseptic chemical process in which enzymes are released after death from
tissue cells causing softening and liquefaction of muscles.
Simultaneously, ferments are produced by living saprophytic microorganisms, which

resolve the complex organized tissues of the body into simpler inorganic compounds.
These microorganisms are Clostridium welchii, B. proteus, B. coli and others which during
life are found and the alimentary canal and soon after death are scattered in tissues, blood
and organs. Enzyme lecithinase causes hemolysis and helps in the hydrolysis and
hydrogenation of body fat.
78
Due to putrefaction the body shows two features viz. the color changes and the emission of
foul smelling gases.
Putrefaction is usually first manifested by blue green discoloration of the skin over the
cecum and the flanks, and internally on the under surface of the liver. This green
discoloration is due to conversion of hemoglobin of
the blood pigment into sulfmethemoglobin by the
action of sulfureted hydrogen diffusing from
intestine. This green discoloration is visible on a fair
skin than on a dark one. In summer, the green
discoloration spreads over the entire abdomen and
the external genitals in about twelve to eighteen
hours after death. As time passes, the green
discoloration spreads over the chest, neck, face,
arms and legs. The color may be deeper and
become purple and dark blue.
Fig. 10.5. Blue Green Discoloration of
Gradually the whole skin of the body appears
skin over the right iliac fossa
discolored. This is followed by the appearance of an
arborescent skin pattern called Marbling indicating
vessels in which hemolyzed blood has reacted with
hydrogen sulfide to produce characteristic greenish
black discoloration.
With the appearance of greenish patch on the

abdomen, the body emits an unpleasant smell due to
development of the gases of decomposition which
are mainly H2S, marsh gas, CO2, Ammonia and
Phosphoreted hydrogen.
In summer, from twelve to eighteen hours these

gases collect in the intestine and abdomen swells Fig. 10.6. Marbling
up. The sphincters relax, and the urine and feces
may escape. From eighteen to forty hours of death in summer, the gases collect in the
tissues. Face and trunk start to bloat. The scrotum, penis, eyelids and other sites of loose
skin attachment may be strikingly inflated, and crepitus is readily elicited on palpation of
these areas. These gaseous accumulations in the tissues make the feature unrecognizable.
The cellular tissues are inflated throughout so that the whole body appears stouter and
older than actually is. Eyes are forced out of socket, tongue protrudes and the lips are
swollen and everted. Frothy blood comes out from nose and mouth. These gaseous form
blisters under the skin containing a reddish colored fluid. When these burst, the cuticle is
peeled off. These are characterized by absence of vital reaction.
Common houseflies are attracted to the body and lay their eggs in the open skin. The eggs
hatch into maggots within one day during hot weather. The maggots crawl into the interior
of the body and help in destroying the soft tissues. The maggots become pupae in four or
79
five days and adult flies in the course of three to five days. They are of some help in
estimating the time since death. Ants can also cause abrasions which can readily be
distinguished from ante mortem abrasions showing no vital reaction.
In about 2 to 3 days of death in summer, the rectum and uterus protrude. The gravid uterus
may expel its contents, and
may prolapse. Hair and nails
loosen and shed off. In about
3-5 days or more the skull
sutures are separated and the
liquid brain may run out. The
teeth become loose in their
sockets and may fall off.
The next stage of putrefaction

known as colliquative Fig. 10.7. Putrefied Body
putrefaction which begins from
5-10 days or more in which the abdominal wall may burst open protruding the stomach and
intestine. Ultimately, all the soft tissues collapse into an unrecognizable greasy mass, and
finally only osseous tissue remain. The body is thus skeletonized in one to three months.
The time taken up be these changes varies widely depending on the manner of burial, the
temperature, and the medium in which the body lies and therefore is generally not possible
to express any definite opinion on the time since death from these changes. In cold climate,
all these changes are considerably retarded. Internally, the various organs putrefy at
different rates, depending on structure, Vascularity, and the access of air and bacteria.
Stomach will show dark red irregular patches first on the posterior wall and then on the
anterior wall. This should not be mistaken for effects of irritant poisoning. Irritant poisons
generally affect the mucous membranes while decomposition involves the whole thickness
of the stomach wall.
Liver becomes softened and flabby. Due to gases, it present honey combed appearance.
The organs which putrefy early are larynx, trachea, stomach, liver, spleen, and brain. The
organs which putrefy late are heart, lungs, kidneys and prostate in males and non gravid
uterus in females. Prostate and the non gravid uterus are the last organs to decompose.
Adipocere formation
A unique feature of postmortem decomposition observed when the decedent remains in a

damp environment is Adipocere formation, where the process of putrefaction become
arrested at some stage and the fatty tissues of the body may become converted into fatty
acids.
The rate of Adipocere formation is modified by humidity, temperature, fat contents of the
body and bacterial activity. It is probable that several weeks, if not months, must elapse
80
before Adipocere formation. However, no
precise time can be stated and there are
cases on records in which it was present
within three and a half weeks after death.
The medicolegal importance of Adipocere

lies in its ability to preserve the body to an
extent which can permit identification long
after death. Adipocere commences first in
the subcutaneous fat, and then in the skin,
muscles and organs. Presence of fat is Fig. 10.8. Adipocere formation
essential for the formation of adipocere.
Besides identification, wounds inflicted
before death may also be easily
recognized.
Mummification
Putrefactive changes may be inhibited and

replaced by mummification, which is
characterized by drying and shriveling of
Fig. 10.9. Putrefaction with gaseous swelling
the tissues. The moisture is lost from body due

to excessive dry heat. It is occasionally seen in
bodies that have been buried in dry soil viz.
desert sand. The exposed parts of the body
such as lips, tip of nose, fingers and toes
mummify first. A mummified body is often black
Fig. 10.10. Mummification in color, shriveled and practically odorless. It
provides the following information:
1. It helps identification
2. It gives and indications of cause of death since injuries are easily recognized.
3. The time of formation of mummification varies from 3 months to 1 year.
Flotation of body
Due to putrefaction, the gases developed within the submerged body causes flotation of a
body on the surface of the water. Flotation time in Nepal and India is about 24 hours in
summer and within 2 to 3 days or more in winter. The flotation time in temperate climate is
about a week in summer, and is about a fortnight in winter. The flotation time is increased if
the dead body is entangled in weeds etc or tied with heavy weight before immersion. The
period of flotation depends on the age, sex, fatty bodies, temperature and type of water. A
81
fully developed well nourished infant floats rapidly. Female bodies float sooner because of
the lightness of the bone and more fat. Fatty bodies float quicker than lean and thin bodies
as fat has a lower specific gravity. Dead bodies float quicker in summer than in winter.
Flotation time is early in shallow and stagnant water of a pond than in the deep water of a
running stream.
The rate of putrefaction is slower in water than in air. As the submerged dead body floats
face down with the head lower than the trunk, the postmortem greenish discoloration and
gaseous distention are first seen on the face.
CONTENTS OF THE STOMACH
The position and condition of the decedent’s last meal is useful for establishing the post
mortem interval. Extent of gastric emptying and progression of the meal in the intestinal
tract can be useful for estimating the time of death if one is familiar with the decedent’s
eating habits and meal times, quantity of his last meal and the gap between his last two
meals.
The stomach usually starts to empty within ten minutes after the first mouthful have
entered. A light meal ordinarily leaves the stomach within one and a half to two hours after
ingestion, a medium sized meal requires three to four hours and a heavy meal takes about
four to six hours before it is expelled into the duodenum. The digested food reaches the
distal ileum and cecum in about six to eight hours after eating. In cases of severe shock,
head injury there is inhibition of the secretion of gastric juice, the motility of the stomach and
the opening of the pylorus. In such cases the undigested food may be seen in the stomach
for more than one day. Similarly in illness, worry, fear etc the emptying time of pylorus is
prolonged. Further, the emptying time of the pylorus varies in different persons depending
upon the type of food ingested.
Roughly, the carbohydrate meals leave the stomach more rapidly than a protein meal and a
protein meal leaves the stomach early than a fatty meal. The head of the meal reaches the
hepatic flexure in about six hours, splenic flexure in 9 to 12 hours, and pelvic colon in about
12 to 18 hours. The digestion of food is very variable and hence much reliance cannot be
placed to ascertain the time of passage of food and time interval of death.
Nevertheless, if one can ascertain the time at which the victim ate his last meal, one should
not disregard the opportunity of utilizing its position for estimating the time of death.
The external (environmental) associated evidence is also very important while deducing
time of death. For example, broken and stopped wrist watch on the victim’s body, may
indicate the time of assault or quarrel. Condition of clothing can be highly informative
particularly if it is blood stained and papers in the pockets show soiling or damage from
exposure.
Establishment of the time since death is more reliable if it is associated with other factors
than that determined by the classical postmortem anatomic observations viz. rigor mortis,
postmortem hypostasis and putrefactive changes.
82
If a dead body lies on grass, the underlying grass soon turns yellow or brown and dies. A
botanist familiar with such studies provides help in establishing the time when the body was
placed at the place of discovery.
During putrefaction the house flies, insects may lay eggs on the open wounds or orifices of
the dead body which hatch to larvae, pupae and young flies which may furnish information
for helping to establish the minimum postmortem interval. Help of entomologist may be
required in such cases.
URINARY BLADDER AND LARGE INTESTINE
The urinary volume may help in estimating time since death. In case of an individual having
been found dead in bed at night, one can state that the individual had lived for sometime
after going to bed if the bladder was found full of urine or partially filled up since people
usually empty their bladder before going to bed. Similarly, one can give an opinion that the
death occurred some time after he had got up in the morning if the large intestine was
found empty of fecal matter.
CHEMICAL CHANGES
Changes in chemical composition in body fluids e.g. blood, CSF, vitreous fluid have been
studied but none has proved to be useful and authentic.
Cerebrospinal fluid
Lactic acid concentration rises from the normal 15mg% to over 200 mg% in 15 hours
following death. Non protein nitrogen increases from 15 to 40 mg% in 15 hours. Amino
acids rise evenly from one to twelve mg% in 15 hours.
However, the changes must be independent of variations in environmental and body

temperatures.
Blood
Potassium, Phosphorus and magnesium level, rise after death where as sodium and
chloride level decrease. Non protein nitrogen, amino acid nitrogen, ammonia, lactic acid
and bilirubin levels rise after death. The enzymes acid phosphatase, alkaline phosphatase,
and amylase increase after death.
Vitreous Humor
Increase in potassium concentration and decrease in the sodium concentration during the
first 85 hours after death. Lactic acid is increased and the glucose is decreased.
83
Chapter
11
IDENTIFICATION
Data For Establishment Of Identy 86

Idenficaon Of Species And Race 86
Clothing 86
Complexion 87
Eyes 87
Hair 87
Cephalic Index 88
Determinaon Of Stature 89
Esmaon Of The Age 89
Esmaon Of Age From Teeth 89
Esmaon Of Age From Bones 92
Determinaon Of Sex 96
Determinaon Of Sex From Bones 96
Determinaon Of Sex From Microscopic Study Of Sex Chromans 100
Esmaon Of Individual Identy 101
Ta<oo marks 101
Scars 102
Dactylography 102
DNA fingerprinng 104
Poroscopy 105
Superimposion Technique Of Idenficaon 105
85
11 IDENTIFICATION
Identification is the establishment of the identity of an individual based on certain physical
characteristics, which are unique to each person. The identification of both living and dead
may play an important part, sometimes constituting the only evidence that establishes the
identity of a person. Identifying the dead body, particularly in criminal or suspicious causes
may require expertise of anatomist, radiologists and dentists for the forensic pathologist to
come to the conclusion of precise identity.
Identification of a living person is necessary in:

• Criminal cases like absconding soldiers, persons accused of assault, murder, rape
etc. and mixed up of newborn babies in hospitals, and in cases of impersonation.
• Civil cases, like inheritance, marriage, insurance claims, disputed sex, passport,
missing persons etc.
Identification of a dead body is necessary for:
1. Notification of next of kin
2. Settlement of asset and insurance claim
3. Criminal court proceedings particularly in homicidal cases
Post mortem identification has to be established in unknown, decomposed, mutilated
skeletonized or burnt remains, Corpus Delicti in homicide cases, mass disasters and
accidental deaths.
Data for Establishment of Identity
It is derived from records with data obtained by examination of the persons, such as race,
sex, age, stature, complexion and features, external peculiarities, such as moles, birth
marks, scars, tattoo marks, malformations, wounds, occupation marks, finger prints and
foot prints, pattern of teeth and bite marks, handwriting, speech and voice, gait, trick of
manner and habit etc.
IDENTIFICATION OF SPECIES AND RACE

The question of determination of race arises for identification of unknown and unclaimed
bodies received from railway carriages, seaports, international town or meeting places
where people of different countries flock together.
This can be done by noting various appearances on the body.
Clothing
The typical nature and manner of wearing apparels may differentiate Nepalese, Chinese,
Indian and Europeans. Nowadays the style of wearing of clothing is so mixed up that the
authentication of race from clothings is rather impossible.
86
IDENTIFICATION 11
Complexion
This is of limited value except in

case of fair complexioned European
subjects or dark Negroes.
Eyes
These are obvious features which

can be recorded without trouble viz.
Europeans are both blue or gray
eyed where as blue eyes are
conspicuous around Mediterranean
coasts. Nepalese and Indians as a
rule are dark eyed. Few Indians may
have "gray eyes". The eye color is
often extremely difficult to
distinguish when death has occurred
more than a few days previous. In
decomposing bodies, much of this
evidence may not be of original
color. Interracial marriages reduce
the authenticity of ascertaining race
from the color of iris.
Fig. 11.1. External features in establishing identity
Hair
Curly, wooly black hairs are characteristic of Negroes. Coarse black hairs are found
amongst the Chinese and Japanese. Europeans hair is usually light brown or lightly
blackish or reddish hair. Nepalese, Indians Mongolians and other Asians have usually
straight black hairs.
Hairs may be artificially dyed for masking white hairs or to conceal age and identity. Sikh
males grow beard and keep long scalp hair. Some upper caste Hindus of Nepal and India
put up long hairs over the back of head.
Medico legal aspect of Hair
Hair resists putrefaction for long time and its examination is helpful towards identification.
Hairs or fibers recovered from the weapon, clothes or in death clutch may prove immensely,
helpful towards crime detection. Sometimes the hair has to be differentiated from fibers.
Vegetable fibers burn readily without disagreeable odor and leave sharply bent ends.
Animal hairs emit odor of burnt feathers and get curled, shriveled and twisted. Linen fibers
when examined under microscope show narrow lumen cross lines. Cotton fibers have long
87
11 IDENTIFICATION
tubular cells and flattened twisted filaments. Jute fibers have smooth tubes and are
yellowish brown.
Silk fibers are transparent threads without any cells. Wool fibers have flattened outer layer
cells and sometimes medulla is present.
There are occasions when human hair has to be differentiated from animal hair.
Hair can help in ascertaining the age. Hairs of the newly born infants are known as
LANUGO HAIRS which are soft, non-pigmented and no modulated. Graying of hair usually
begins after 3rd decade.
Human Hair Animal Hair
Small flattened cuticu- Cuticular scales are large

Cuticle
lar scale and projecting
Medulla is often patterned

Medulla is small or and diameter is usually
Medulla
even absent more than 1/2 of the shaft
diameter
A B
Pigment may be absent Fig. 11.2.Human Hair(A) Animal
Pigment invariable
Pigment and mostly present near
present hair (B)
medulla.
Table 11.1. Differences between Human and animal hair
In arsenic poisoning, hairs will retain the arsenic for a long time and will be important
evidence in diagnosing arsenic poisoning. Blood grouping can be done from root hair.
Neutron activation analysis of hair can be helpful in establishing the individuality of a

person. It is possible to find out the nature of various trace elements in the hair and
compare these with those in the hairs of suspect. Sex determination of human hair is
possible when sex chromatin can be detected in 70% of the female hair but only 7% of the
male hair.
In rape and sodomy, the finding of hairs of the victim on the body or clothing of the accused
will be important corroborative proof. Similarly it can provide vital clue in many crime. DNA
Analysis is possible with hair.
Cephalic Index Maximum breadth of skull

C.I.= X 100
Maximum anteroposterior length of skull
Race can be determined from skull by
adopting cephalic index method.
It is ascertained by multiplying the maximum breath of the skull measured between two
parietal eminences by 100 and dividing the result by maximum length of the skull measured
88
IDENTIFICATION 11
between the external occipital protuberance and the frontonasal junction with help of a pair
of calipers.
A measurement between 70 to 74.9 is known as Dolicocephalic or Long headed and is

found amongst pure Aryans, Negroes and aboriginal Dravidians.
A measurement between 75 to 75.9 is known as Mesaticephalic or Medium headed and

found amongst Chinese and Europeans.
A measurement between 80 to 84.9 is found amongst Mongoloids because of racial mixing.

The cephalic index may not precisely tell about race.
DETERMINATION OF STATURE
In case of dismembered body, the height may be ascertained approximately by
measurement of the out-stretched upper limbs from the tip of one middle finger to the tip of
that of the other hand, which closely equals the individual's height. Also if one superior limb
is available the height can be deduced by multiplying the measurement it with two and
adding 30 cm from the length of 2 clavicles and 4 cm from the width of the sternum. The
length from the suprasternal notch to the Pubic symphysis if multiplied by 3.3 will give the
stature.
Using multiplying factors, stature can be estimated. Commonly used factors are Length of
femur (cm) X3.8, Length of Humerus (cm) X 5.3, Length of Skull with mandible (cm) X7,
Length of Skull without mandible (cm) X 8
Stature in Centimeters
Bone Male Female
Available Wet Bone Dry Bone Wet Bone Dry Bone
(length-0.7)x1.88 + lengthx1.880+81.30 lengthx1.945+73.16
lengthx1.945+72.884
Femur 81.231 6 3
(length-0.5) lengthx2.376+78.66 lengthx2.352+75.36
lengthx2.352+74.774
Tibia x2.376+78.807 4 9
lengthx2.754+71.475
Humerus x2.894+70.714 1 6
lengthx3.343+81.224
Radius x3.271+84.465 5 9
Table 11.2. Karl-Pearson’s Formulae to determine Stature (Obsolete)
ESTIMATION OF THE AGE

Estimation of Age From Teeth
The examination of teeth for identification purpose is a highly specialized task and help
from a forensic odontologist becomes necessary. The general state of dentition, absence of
89
11 IDENTIFICATION
natural teeth, and the presence of dental plates should be recorded and any obvious signs
such as gold fillings or a bridge work should be recorded.
Chronological appearances of the Chronological appearances of permanent set of
temporary set of teeth teeth
Lower central incisors 6th months First molar-6th year
Upper central incisors 7th month Central incisors- 7th year (Both upper and lower)
Upper lateral incisors 8th month Lateral incisors -8th year (Both upper and lower)
Lower lateral incisors 9th month First premolars-9th year
1st molar-1 year Second premolars-10th year
Canines-1 and 1/2 year Canines -11th year
Second molars-2 years Second molar- 12-14 year
Hence incisors start erupting from 6th Third molar- 17-25 or later
month and complete erupting at 9th Temporary teeth 20 in number; permanent-32
month.
Temporary teeth are replaced by permanent
teeth.
Some permanent teeth erupt without replacing.
Table 11.3. Chronological Appearances of teeth
Temporary Teeth Permanent Teeth
Small and lighter in weight Larger and heavier
China white Ivory white
Vertical Slightly projected forward
Presence of ridge in between body and No ridge present

neck
Table 11.4. Difference between temporary and permanent teeth
Mixed dentition
From the day of eruption of one permanent 1st molar till before the day eruption of last
permanent canine, there will be both temporary and permanent teeth in the jaws. This
period, when both permanent and temporary teeth are present in the jaws is known as the
period of mixed dentition. This is so because all permanent molars erupt at new sites
behind the most rear temporary teeth, the 2nd temporary molar. All other permanent teeth
90
IDENTIFICATION 11
Fig 11.3. Dentition
A. Temporary Teeth
B. Permanent Teeth
C. At 6 years of age
D. At 8 years of age
E. At 12 years of age
A B
C D E
91
11 IDENTIFICATION
i.e. all incisors, canines and premolars erupt by replacing the temporary teeth. Hence total
no of teeth between 2-5 years is 20 and all are temporary, at 6th year the number is 21-24
due to eruption of first permanent molars. At 7th to 12th there are 24 teeth. At 12-14th year
there are 28 teeth.
Estimation of age from the teeth in elderly subjects
This can be ascertained by application of Gustafson's formula

1. Attrition: This change occurs on the opposite surfaces of teeth due to friction and
attributed in degrees.
2. Periodontosis: When maintenance of teeth and gums is bad, there may be loosening
of teeth and exposure of length of roots where there may be often deposition
hardened debris which gradually occurs over a long period of time.
3. Secondary dentition: With advances in age there is deposition of secondary dentine
tissue in the pulp cavity. There is different rating as age advances.
4. Root resorption: Decaying change of the root, resorption of root is more extensive
involving both cementum and dentine tissue.
5. Cementum opposition: Occurs on the surface of root and occurs in 4 grades
depending upon layer of cementum.
6. Transparency of root: this occurs due to rarefaction of the dentine tissue.
Of all the above criteria, transparency of root is single most important one; these are highly
technical and require Forensic Odontologist for approximate interpretation of age beyond
25 years of age.
ESTIMATION OF AGE FROM BONES
In elderly subjects,
Skull vault suture closure. The sagittal suture is the first to start closing at about 25 years
and is completed by 32-35 years. The coronal suture starts closing at about 25-30 years
and completed by 35-40 years. The lambdoid suture starts closing at about 35 years and is
completed between 45-50 years. The sphenotemporal, occipitomastoid, parietomastoid or
sphenoparietal sutures may not start closing before 50 years and completes as late as 60
to 70 years.
Union activity of sternum
Sternum show bony union with one another from below upwards between 14-25 years and
the xiphoid process unites with the body around 40-45 years. Manubrium sterni, fuses with
the body above 60 years.
Changes in shape of mandible. These also help in ascertaining age.
92
IDENTIFICATION 11
Infancy Adult Old Age
Body Shallow Thick and long Shallow

Ramus Forms obtuse angle Less obtuse angle with Obtuse angle with body
body
Mental Foramen Near the lower margin Mid way Near the alveolar mar-
gin
Condyloid Lower than coronoid Above coronoid Bent backwards.
Table 11.5. Changes in shape of mandible

Identification of age from fusion of epiphyses of bone
Humerus
Upper epiphysis unites with shaft at 17-18 years in females and 19-20 years in males.
Lower epiphysis unites with shaft at 13-14 years in females and 15-17 years in males.
Femur
Lower epiphysis unites with shaft at 18-20 years upper epiphysis unites with shaft at 16-18
years. The neck of the femur forms almost a right angle with the shaft in female and an
obtuse angle in males.
Tibia
The upper epiphysis joins the shaft at 18-20 years and the lower at 16-18 years.
Sternum
Body of sternum shows bony union with one another from below upwards between 14-25
years. Xiphoid process unites with the body around 40-45 years, where as, manubrium
sterni fuses with body above 50 years.
Sacrum
The five sacral vertebrae fuse by 20-25 years from below upwards.
Clavicle
Sternal ends of the clavicle unite with the body at about 20 years in females and 22 years in
case of males.
93
11 IDENTIFICATION
Fig. 11.4. X ray of carpal bones Fig. 11.5 X ray of wrist Fig.11.6. X-ray of wrist
Four carpal bones seen The lower end of radius and The lower end of radius and ulna
age estimation for children ulna have fused with the shaft have fused and united with the
Age around 4 years Age above 18 years shaft
metacarpals have ossified.
Age >18 years
Fig. 11.7. X ray of wrist Fig. 11.8. X-ray of the wrist Fig. 11.9. X-ray view of ossifica-
tion activities of elbow joint
The lower ends of radius and Lower end of radius and ulna ap-
ulna have not fused with the peared but not fused Centers for medial epicondyle,
shaft metacarpals have not All carpals appeared trochlea appeared but not
fused. Base of 1st metacarpal appeared fused; upper end of radius
but not fused. appeared but not fused.
Age below 17 years Age 15-16 years Age around 12 years
94
IDENTIFICATION 11
Fig. 11.9. X-ray of knee joint showing distal Fig. 11.10. X ray of pelvis
femur, proximal tibia and patella
Appearance of the crest of ilium but no fusion
Lower end of femur and upper end of tibia Age 14-19 years
have united with their shafts.
Age above 18 years
Fig. 11.11. Metopic Suture
Anteriorly the frontal bone articulates

with the pair of parietal bones at the cor-
onal suture. The original two halves of
the frontal bone occasionally fail to fuse
leaving a midline Metopic suture. Metopic
Suture if present is helpful in establish-
ing identity of a person if it is known to
exist in a person during life.
This condition is usually rare.
95
11 IDENTIFICATION
Medicolegal Importance of Age
1 year infanticide
7 years clinically not responsible for his act
7-12 years a child may or may not be held responsible for his act by the court.
14 years below this age cannot be employed in factory
15 years sexual intercourse even with ones own wife, below this age is rape
16 years age of consent for sexual intercourse
18 years minimum age for marriage for female
21 years minimum age for marriage for male
35 years minimum age for president
55-65 years retirement
Table 11.6. Medicolegal Importance of Age
DETERMINATION OF SEX
DETERMINATION OF SEX FROM BONES
It is only possible with full amount of certainty in individuals who have reached puberty.
Although sex can be determined from all the bones, the bones that are commonly used for
such purposes are
1. Pelvis
2. Sacrum
3. Femur
4. Skull
5. Thorax, and
6. Mandible
96
IDENTIFICATION 11
Female Pelvis Male Pelvis
1 It is wider, smoother and the ilium is less sloped Not so
2 Posterior borders are more rounded, the anterior Not so

superior iliac spines are more widely separated and
the greater sciatic notches are wider forming almost
a right angle than the male.
3 Preauricular sulcus is usually present which is broad Not frequently present. Narrow
and deep.
4 Ischial tuberosity is everted Inverted
5 Pelvic Cavity broad and round Conical and funnel shaped
6 Obturator foramen triangular Ovoid
7 Acetabula narrow Wide
8 Pubic symphysis is less deep and the pubic arch is Deep and less wider than fe-
wider and more rounded male
9 Dorsal border of the pubic symphysis is irregular and Not so

may show marks of parturition in the form of depres-
sion
Table 11.7. Differences between Male and Female Pelvis
Female Sacrum Male Sacrum
1) Short and wide and sharply curved for- Long and narrow and has a uniform curva-
ward in the lower half ture along its whole length
2) The auricular surfaces extend over 2 to Over 2 ½ to three elongated bodies.

2 ½stunted bodies
Table 11.8. Differences between Male and Female Sacrum
Female Femur Male Femur
1 Neck of femur forms almost a right angle Forms an obtuse angle

with its shaft
rd
2 Head of femur forms less than 2/3 of a Forms about 2/3rd of a sphere.
sphere
Table 11.9. Differences between Male and Female Femur
97
11 IDENTIFICATION
Fig. 11.12. Pelvis Fig. 11.13. Femur
Female Skull Male Skull
1 Lighter and smaller and the cranial capaci- Heavy and bigger
ty is about 10% less than of male
2 Glabella, zygomatic and supercilliary arch- Prominent, well defined and massive.
es, mastoid process and the occipital pro-
tuberance are less prominent.
3 Facial bones are small Comparatively big
4 Frontal sinuses are less developed Developed.
5 Orbital cavity is little higher and roundest in Lower and square shaped.
shape
Table 11.10. Differences between Male and Female Skull
98
IDENTIFICATION 11
Female Thorax Male Thorax
1 Short and wide Long and less wide
2 Sternum is short and its upper margin is Upper margin is on a level with the low-
on a level with the lower part of the body er part of the body of the second thorac-
of the 3rd thoracic vertebrae ic vertebrae.
Table 11.11. Differences between Male and Female Thorax
Female Mandible Male Mandible
1 Smaller Larger
2 Anatomical angle inverted Everted
3 Chin rounds Square shaped
4 Height at symphysis menti is less More
5 Lighter with smooth surface Heavier having rough surface
6 Teeth small Large
Table 11.12. Differences between Male and Female Mandible
Fig. 11.14 Male and Female Skull Frontal and lateral views
However the determination of sex from bones in mixed up races are difficult. The
skeleton of well developed Negroes of a female may look like that of male of an
Indian or Nepalese.
99
11 IDENTIFICATION
Determination of Sex from Microscopic study of sex chromatins
Each body cell contains 46 chromosomes-22 pairs are autosomes and one pair is sex
chromosomes. In normal male the pattern of sex chromosome is XY and a normal female is
XX. Davidson bodies in neutrophils are found only in females about 3% in squamous cells
of mucous membrane of month or vaginal mucus membrane and sex chromatin are
demonstrable in the form of BARR BODIES. In males, drumsticks of BARR BODIES are
either not demonstrable in their typical shapes or are visible in too less numbers of cells.
Inter sex
It is the presence of intermingling of features of both sexes, in varying degrees, in one

individual. This is not of much forensic importance.
The following types may be kept in mind:
Gonadal agenesis: No development of gonads or sex.

No sex chromatin can be demonstrated. Sex pattern is
00 (no sex chromosomes)
Gonadal dysgenesis: In these cases gonads or sex

organs are present but they fail to develop during
puberty.
Two varieties may have medicolegal involvement
Turner's syndrome. Here the subject is

morphologically female but there is no proper
development of feminine features during puberty. She
Fig. 11.15. 45 X0 Karyotype has amenorrhea and she is sterile. The nuclear sexing
(Turner’s Syndrome) is negative and sex chromosomal pattern is X0. The
total no of chromosomes is 45 instead of 46.
Klinefelter syndrome. Here the anatomical structure

is that of male but the secondary sexual characters are
not developed during puberty. The nuclear sexing is
positive like that of females and the sex chromosomes
pattern is XXY, the total number of chromosomes
being 47 instead of 46. Size of penis is small and there
is gynecomastia.
True hermaphroditism or bisexuality:
In this condition the individual possesses two testicles

and two ovaries or one testicle and one ovary, neither
Fig. 11.16. 47 XXY Karyotype of which functions fully and properly. The nuclear
(Klinefelter Syndrome) sexing is either positive XX-females type or negative XY
100
IDENTIFICATION 11
-male type. When male gonads are present nuclear sexing being XY the individual is a
male pseudohermaphrodite. When female gonads are present, the individual is a female
pseudohermaphrodite and nuclear sexing is XX positive.
Fig. 11.18. Female Pseudoher-

Fig. 11.17. Male Pseudohermaph-
maphrodite
rodite
ESTIMATION OF INDIVIDUAL IDENTITY Tattoo
Tattoo marks
Tattoo over the thighs, arms chest and other parts are often of
the greatest value. Tattooing has always been a valuable
source of identification, not only during life but also after death.
Gods of worship, names or other designs are commonly

tattooed over forearms and arms.
Several forms of tattoos can be seen on the body and they

may indicate race viz. Dragon for Chinese or eastern Asia
people etc.
The blue bird tattoo between the base of the thumb and index finger was formerly a
recognition sign amongst homosexuals. A tattoo mentioning number 13 on the inside of the
lower lip is said, to be indicative of peddlers of 'hard' drug addiction. Similarly tattoo designs
of nude female or sexual organs over different body parts indicate the moral standard of the
person.
Tattoo marks are produced by causing multiple small puncture wounds on the skin surface
with the help of needles dipping in coloring material. The coloring materials usually
employed are Indian ink or Chinese ink for blue-black color; cinnabar, and vermilion, ultra
marine for red color; chromic oxide for green and Prussian blue for blue coloration.
101
11 IDENTIFICATION
A fading tattoo mark can be detected by use of ultraviolet lamp, infrared photography or by
examining from magnifying lens. Regional lymph glands of a tattoo mark will always reveal
the pigment used.
The tattoo marks may be removed by

1. Surgery like excision of the tattooed part or by inflicting burn on that area
2. Electrolysis
3. Application of Caustic substance
4. Laser Beam -Dye particles are expelled in gaseous forms.
Fig. 11.19. Tattoos
Scar
Occupational scars are sometimes useful in identification. Steel workers frequently have
multiple tiny scars from metal burns. Coal miners may have multiple scars on the face and
arm due to coal dust contamination of small lacerations. It is essential to record operation
scars, acquired or physical defects.
DACTYLOGRAPHY
It is the study of the impression of patterns formed by the papillary ridges on the bulbs of
fingers and thumbs. The patterns of two different hands of different persons or even finger
prints of identical twins do not resemble each other. Finger prints can be classified primarily
into four main groups
The system is easy for classification especially by a trained personal. The identification of
any finger print is done by matching 8-16 ridges which will show characteristic details.
Dactylography is useful for identification in the field of criminology.

102
IDENTIFICATION 11
Fingerprints Description
Arch (6-7%) The ridges run from one side to another in arch like fashion without making
a backward turn.
Loop (about-65%) The ridges are arranged more or less like a loop, the ends of which being
directed downwards in slanting fashion.
Whorl (Approx. 25%) The circular design of ridge grouping takes either the clock-wise or anti
clockwise turn.
Composite (3-4%) There may be combination of "arch", "loop" or “whorl" or double of one pat-
tern e.g. "Double Core".
Table 11.13. Types of Fingerprints
Areas where fingerprints are also important

1. To maintain Identity cards
2. To identify impression left at scene of
crime
3. To establish identify of a missing
person
Finger print should not be taken
1. In case of lepers as leprosy can
permanently destroy finger prints.
Fig. 11.20. Fingerprints (c– core, d– delta)
2. In case of persons suffering from any
contagious or infectious disease, but it can
be taken after recovery.
Detection of finger print impression
Identification by dactylography to establish the absolute identity of a person is the best

method especially in our part of the world. Fingers soiled with blood, oil grease or sweat
can leave their impression on weapons, utensils, door handles, furniture etc.
The faded or light finger prints on paper or on other surface can be rendered distinct by
dusting them lightly with powdered graphite or antimony or with aluminum powder.
Impression left on glasses, can be developed by gray powder, Magnesium Carbonate
white, lead, red Lead or Ferric oxide.
Finger prints are taken with the help of printers ink on non-glazed papers.
It can be taken in two ways

1. Plain method
2. Rolled method
103
11 IDENTIFICATION
Invisible Fingerprints
Due to oily sebaceous secretion a person leaves his fingerprint impression over the
material whenever he touches something. These are not ordinarily visible but by dealing
with certain chemicals these can be developed and made visible.
Lifting of fingerprints
Latent fingerprints on paper or small articles can be preserved after development. But when
they are on large immovable hard surface, the print can be lifted for preservation after being
developed. An adhesive cellophane paper may be used in these cases. After photography
of the fingerprint developed with powder, the adhesive surfaces of the cellophane tape is
pressed on the print and taken out gently and pasted against a cardboard sheet. This is
preserved permanently.
Fingerprints study by computer system
The computer is used for automatic reading, classification and codification. This light
reflected from a fingerprint can be measured and converted to digital data which is
classified in the computer which stores it in its memory for future comparative study with
others.
FINDER II is a computerized automatic fingerprint reading system used by FBI of USA. The
FINDER computerized system records the data on the basis of ridge endings, ridge
bifurcation and ridge direction.
DNA Fingerprinting
Using the Polymerase Chain Reaction (PCR) technique, a technique to amplify and
reproduce DNA, a person can be identified from his old dead body remains, if his or her
parents or offspring are available, as an alternative to fingerprints known as DNA
fingerprinting.
The nucleus of a cell contains 46 chromosomes. The mother and father contribute 23
chromosomes each in their offspring .The chromosomes are the folded and packed DNA
strands.
DNA finger printing is unique to each individual and is based on the pattern in the DNA
found in human cells.
In modern days DNA finger printing plays a major role in criminal investigation. The culprit
can be traced from the identical DNA finger print, as every individual produces a unique
band pattern. In the DNA finger printing test the paternity and motherhood can be
established by examining the bands where an inherited bands of whether mother or father
is discarded the remaining bands must match the disputed person. DNA fingerprinting is the
also one of the most conclusive methods of identification.
104
IDENTIFICATION 11
POROSCOPY
The ridges on fingers and hands are studded with microscopic pores, formed by mouths of
ducts of subepidermal sweat glands. Each millimeter of a ridge may contain 9-18 pores.
These are permanent throughout the life. They vary in shape, size, position, arrangement
and number over a given length of ridge in each individual. This
method of examination and study of pores of sweat glands
described by Locard is known as Poroscopy. Poroscopy
becomes very helpful in case of availability of a small fragment
of finger print or palm print for comparison.
SUPERIMPOSITION TECHNIQUE OF IDENTIFICATION
Superimposition technique can be used to establish the identity

of the deceased when a bunch of bones consisting of skull or
skull and mandible are present. There should be life time frontal
view photograph of the missing person. Photograph of the skull
is taken from an angle corresponding with the view of the
photograph. Transparent of the skull photograph and the
negative of the life time photograph are focused on the same
sensitive printing paper. Anatomical land marks of the face from
both the negatives, will have maximum alignment with due
consideration to the thickness of the soft tissues in the
transparent of the life time photograph. If the two negatives Fig. 11.21. Superimposi-
match properly it may be assumed that the skull could belong to tion technique
the missing person.
105
Chapter
12
MECHANICAL INJURIES
Abrasions 108
Bruises (Contusions) 110
Lacerated Wounds 112
Incised Wounds 114
Stab Wounds (Punctured) 114
Fabricated And Self Inflicted Wounds 116
Defense Or Protecve Wound 116
Dangerous Injury 116
Simple And Grievous Hurt 116
Suicidal Cut Throat 118
107
12 MECHANICAL INJURIES
Injuries caused by the application of physical violence to the body are known as mechanical
injuries which include:
A. Those caused by fall or friction with rough surface, blunt weapons etc.
1. Abrasion
2. Bruise or contusion
3. Lacerated wounds
4. Fracture of bones and dislocation of joints
B. Those caused by sharp cutting weapons:
1. Incised wounds
C. Those caused by piercing weapons
1. Penetrating- incised or lacerated
2. Perforating- incised or lacerated
D. Those caused by firearms
1. Shotguns
2. Rifled weapons
3. Country made weapons
ABRASIONS
An abrasion is a superficial injury of the body surface which
does not penetrate the full thickness of the skin. It is usually
caused by rubbing against rough surface, or by scratching
etc. Abrasions are simple, superficial, blunt impact injuries.
Abrasions bleed very slightly; heal rather rapidly in a few
days without leaving permanent scar.
Abrasions will be produced by Fig. 12.1. Abrasion
a. Sharp objects, such as fingernails, pin running across the skin. The direction of
impact can often be defined by noting the small skin tags which are found at farther
end, where the striking object left the skin surface. When a weapon strikes the body,
the skin tag will indicate the direction and angle of blow. This is called scratch or
crescentic abrasions when produced by nail.
b. Graze or brush abrasion will be caused when broader surface of skin of the body is
projected across the rough graveled surface of a road. The direction of impact or skid
can be deduced by evidence of piling up of detached epithelial tags over the large
area of denuded skin. The distribution of such abrasions will depend upon the
108
MECHANICAL INJURIES 12
position of the body, while it is being dragged. Close study of this type of abrasion
may help in the reconstruction of sequence of events in traffic accidents. Presence of
mud, grit, coal dust, brick particles etc in and around the abraded area will suggest
the nature of ground surface or agent responsible for its causation. Abrasion resulting
from friction against rough surface during fall from height, will be mostly seen over
prominence of elbows, knees, hands, sides of trunk and limbs. These may be
associated with bruise, fractures, lacerations or other serious internal injuries.
c. Pressure abrasion will be caused by linear pressure over the skin accompanied with
slight movement. This type of abrasion will be found in the ligature marks in case of
hanging and strangulation. Strike with a whip with force may also produce similar type
of abrasion.
d. Impact abrasions take a fairly detailed impression of the shape of the object causing
them. Some very characteristic marks may be imprinted as abrasions, especially by
the tread of motor tires, the weave of coarse fabrics, vehicle radiators etc.
Medico legal aspects:
1. Abrasions over the face, chin, cheeks, nostrils and angles of the mouth indicate death
from smothering.
2. Crescentic nail mark abrasions over the front and sides of neck will indicate throttling.
These are usually accompanied with bruising underneath from the pressure of the
finger tip on the neck.
3. Ligature mark around the neck, of pressure abrasion, will indicate death from hanging
or strangulation.
4. Multiple brush or graze abrasions over the body will suggest traffic accidents.
5. Abrasions over breast, back of chest, inner thighs, cheek may suggest forcible sexual
attempt against will. Teeth mark abrasions over exposed body parts of assailant or
victim will suggest struggle.
6. Extensive graze (brush) abrasion over the back suggests dragging of the body over a
hard and rough surface.
7. Abrasions precisely lie at the point of impact.
Age of Abrasion
Fresh abrasion will look reddish from exudation of little blood and lymph.
The exudation dries up to form brownish scab in about one day. In about 7-10 days the
scab dries up, shrinks, then falls off, leaving some hypopigmented areas underneath. They
heal in about 10-14 days without leaving any permanent scar.
109
Antemortem abrasion Postmortem Abrasion
Looks brownish or reddish Appears brown or yellowish
Scab formation No scab formation
Healing process No such process
Area feels moist from exudation of serum Surface looks dry as there is no exudation
Table 12.1. Difference between Antemortem and Postmortem Abrasions

BRUISES (CONTUSIONS)
Bruising is the escape of blood from small vessels into
subcutaneous tissues due to blunt impact which may not
rupture skin. It varies in size from a small pinhead bleeding
called ecchymosis or petechiae to a large collection of
blood known as hematoma.
A superficial bruise is raised above the surface of akin
due to extravasation of blood in the subcutaneous tissues.
A bruise may not always be seen at the site of impact as
seen in the case of abrasion, since blood can gravitate to Fig. 12.2. Bruise
some distance away from the seat of violence in the deeper
tissues following the line of least resistance and law of gravitation. The ecchymosis or
petechiae result from minute bleeding to a wide spread area commonly known as
hematoma from rupture of bigger blood vessels.
Black eye may develop following contusion of the forehead and hence the site of bruise
does not always suggest the site of violence. The appearance of black eye may take one or
two days.
Appearance of bruise will depend on the following points
1. Severity of the force
When the blow is severe, the extravasation will be large and the bruise will be bigger.
2. Vascularity
The effusion and extravasation will be large over the more vascular region of the body such
as vulva, scrotum and lips.
3. Type of tissue affected
Slight violence may produce bigger bruise in a short time when the area struck is lax with
good amount of fat such as breasts in females and eyelids. But if the tissues are strongly
110
supported by thick dermis, large quantity of firm fibrous tissues there will be little bruising
from a blow for example palms and soles.
4. Situation of the body skin
A blow on the abdomen may not show any bruises since it is compressible and yields on
pressure due to the abdominal cavity. A full force on the anterior abdominal wall may
rupture or lacerate the liver or spleen.
5. Females, young children. Bruising is readily produced in females than in males owing
to delicate tissues and greater amount of fat. Similarly infants and young children bruise
easily. In well built muscular adults, bruising needs a relatively greater violence.
6. Bleeding Diseases. Person suffering from scurvy, hemophilia, leukemia and other blood
disorders bruise easily.
Trait True Bruise False Bruise
1. Caused by Blunt Force Irritant juice of Semicarpus anacardium,

Calotropis, Plumbago rosea etc.
2. Situation Anywhere Over accessible body parts and never

over covered and inaccessible parts
3. Color Shows usual color changes No color changes
4. Shape It may take up the shape of the Never so it is irregular

weapon used
5.Vesicle No vesicle formation May show evidence of small vesicle and

trickling from the margins
6.Staining of finger Nil Similar stained marks as that of the irri-

tips tants used because of scratching
7. Itching No Present
8.Chemical Tests No response of scraping to chemi- Positive chemical reaction

cal tests
9.Extravasations Presents under the skin which can- It is never found

not be easily washed away
Table 12.2. Difference between True and False Bruises

Color changes in a Bruise
A bruise passes through a series of color changes. The color changes are due to
hemolysis, and the breakdown of hemoglobin into the pigments hemosiderin, hemotoidin,
and bilirubin by action of tissue enzymes and histiocytes. Hemosiderin is dark blue or brown
111
in color and is an iron containing pigment. Hemotoidin is an iron free compound and is
greenish in color. Bilirubin is yellow in color. A fresh bruise is red at first. During the next
three days, it appears blue, bluish black, brown or livid red. It becomes green in 5-7 days
and yellow in 7-10 days. It acquires normal color in 14-15 days. Subconjunctival
hemorrhages do not show usual color changes because the hemoglobin is persistently
oxygenated by air. It is red at first, then becomes yellow and finally disappears.
Bruises can be produced postmortem, though a more severe degree of injury is needed to
produce a visible small bruise. Such bruise can occur within about two hours of death.
Antemortem Bruise Postmortem Bruise
Swelling Present No swelling
Color Changes Present No color changes
Extravasation of blood Into skin and subcutaneous No such changes

tissues with infiltration
Microscopic Exam Presence of infiltrated blood No such findings

Table 12.3. Difference between Antemortem and postmortem bruises
LACERATED WOUNDS
These are wounds which penetrate the full thickness of the skin and have been caused by
blunt injury. These are produced from
1. Hard blunt weapon
2. Falls
3. Accidents- machinery, traffic etc.
4. Overstretching of skin
In lacerated wounds the margins are ill defined, irregular,
and uneven and the hair bulbs are compressed. There will
be scanty bleeding as the blood vessels are crushed. They
Fig. 12.3. Laceration
are frequently associated with underlying fracture of bones or
rupture of organs.
Types of Lacerations
1. Split laceration (INCISED LOOKING WOUND)
This occurs when soft tissues under impact get crushed between the two hard blunt
objects. Laceration of scalp or skin over shin bone are good examples. Such
lacerations may be spindle shaped and under naked eye examination the margins
may appear rather smooth. When examined with a hand lens the irregular, uneven
and ill defined margins will be obvious. These may bleed profusely.
112
Hypostasis Bruise
On dependent parts of the body which are Any where
not compressed
Due to accumulation of fluid blood in the Due to ruptured blood vessels
smaller blood vessels
Clear margins Margins not clear
Uniform in color becoming green due to pu- Shows series of color changes
trefaction
No swelling Swelling
Incision will show drop of blood coming out Extravasation of blood in tissues which can-
from the severed capillaries which can be not be easily washed away
easily washed away
No abrasion Abrasion may be present
Microscopically, no evidence of inflammation Evidence of inflammation
Table 12.4. Difference between Hypostasis and Bruise
2. Avulsion
An avulsion is a laceration produced by a large force delivered at an acute angle to
detach (tear off) a portion of a traumatized surface. There may be flap-like skin tears
with one portion still attached to the skin.
3. Stretch lacerations
These are caused by forceful compression of whole thickness of skin and
subcutaneous tissues between external forces over bony surfaces or margins. Many
lacerations reflect approximately the shape of the striking surface. Blows produced by
instrument with a firm, small striking face (e.g. hammer, butt end of a gun) usually
give rise to round, crescentic or semicircular lacerations which furnish good
diagnostic leads to the character of the weapon.
3. Tears
Tearing of skin and soft tissues can occur from localized pressure or impact against
irregular or blunt objects, like door handles, broken glass or fall over rough projected
objects etc.
4. Cut Lacerations
This is from heavy cutting weapon which causes bruised margins. Wounds produced
by sharp edge of broken glass piece, crockery, sharp flints of stones or similar objects
are essentially lacerated injuries having jagged irregular contused margins and are
better seen under magnifying lens. Presence of fragments of glass, crockery, stones
etc. lying embedded inside will suggest the nature of the wounding object.
113
INCISED WOUNDS
Incised wounds are cuts caused by the sharp edge of a weapon like knife, sword, dagger,
Khukuri etc.
Characteristics of typical incised wounds
The margins are always regular, clean cut and well defined when
examined under magnifying lens. Margins are not contused when
caused by light sharp cutting instrument, but bruising and some
irregularity of the margins may be noticed, when heavy and not so
sharp edged weapon like Axe or sword etc. is used.
In incised wound, the length is greater than the breadth and depth of
the wound. The length is greater than the weapon used, as the sharp
edged part can be drawn to any length across the body surface. The
breadth of the wound is much wider than the edge of the weapon
causing it because of retraction of the divided tissues.
Fig. 12.4. Incised The incised wound will be more or less spindle shaped. The wound
Wounds will gape more, if the underlying muscle fibers are cut transversely or
obliquely and less so when cut longitudinally in the direction of fibers.
There will be free and profuse hemorrhage because of the clean division of the vessels.
The incised wounds produced by drawing are deeper at their commencement, as more
pressure is exerted at this point, except in case of suicidal cut throat injuries, with hesitation
cuts at the beginning. The cut becomes increasingly shallow, until it ends in a mere scratch
known as “Tailing of the wound”. Thus the depth of the incised wound with its tailing will
indicate the direction in which the cut was made.
There may be “beveled cuts” where one edge of the injury is found to be beveled at the
expense of the other. Beveled cuts are usually homicidal and points towards the relative
position of the victim and the assailant at the material moment.
When the weapon is used like a saw, there may be sawing cuts with more than one cut on
the skin at the commencement.
STAB WOUNDS (PUNCTURED)

Stab or punctured wound is caused by sharp pointed objects, such as knife, dagger,
needle, spear, arrow, screw driver etc. When the weapon enters a body cavity such as
thorax or abdomen the injury is termed as penetrating wound. When the weapon comes
out from the other side making an exit wound, the injury is termed as perforating wound.
114
Characters:
The depth of the wound is greater than the

width and length of the wound. The edge of
the wound will depend on the sharpness or
otherwise of the weapon. A blade with a
single cutting edge and a blunt black may
show corresponding appearances in the
wound, whereas a two edged dagger may
cause very sharply cut edges at either end.
Some knives may have serration at the top of
the blunt edge, which may leave a wide Fig. 12.5. Stab Wounds
ragged margin at one end. A round blunt
pointed object may produce a circular wound with ragged bruised edges. If a single edge
weapon is used, the surface wound will be triangular or wedge shaped. The wound of entry
is generally bigger than the wound of exit because of the tapering tip of the weapon. During
the process of stabbing and the movement of accused and victim, the shape of the entry
wound may not correspond to the weapon used.
In case when the weapon is partially withdrawn from the body and again pushed inside the
body there will be more than one track of the wound with only one end of the entry. Wound
of entry is generally inverted and may be smaller than the weapon due to elasticity of the
skin. The wound of exit in perforating wound is invariably smaller than the wound of
entrance. The wound may be labeled as punctured incised, punctured lacerated,
penetrating lacerated, penetrating incised, perforating incised or perforating
lacerated. The margins of the entry wound are clean cut or bruising of the edge may be
seen due to thrusting force or if the weapon is not quite sharp.
When a punctured wound is produced by a fall on some sharp object such as glass pot or
sharp stone, the fragments of the foreign body responsible for the wound may be found
embedded in the wound.
Punctured wound produced by needles or similar object is difficult to detect. They are
concealed punctured wounds and are commonly found on such parts of the body as chest
(cardiac region), fontanels, spiral cord, nape of the neck etc. They should be carefully
looked for. Death may result in an infant if a pin or needle is pushed into the brain through
the fontanels. During attempted criminal abortion the pointed instrument may enter the
peritoneal cavity and may cause death.
The direction of a perforating wound can be ascertained by drawing a line joining the wound
of entry and wound of exit. If the weapon enters obliquely, it will bevel the side from which it
enters and produce a wound with an overhanging margin, it thus tells the direction.
115
FABRICATED AND SELF INFLICTED WOUNDS

Fabricated or fictitious wounds are produced by a person on his own body or get it done by
someone else in order to bring a charge of assault or attempted murder to the other.
Besides this, a fabricated wound is produced on the body to avoid duty, to claim more
compensation or to extract more money from the alleged assailant.
Fabricated wounds are mostly incised wounds usually caused by razor blade, sharp knife,
and can occasionally be produced from vegetable irritants poison mainly from Semicarpus
anacardium. Extensive lacerated injuries and true bruising is rarely fabricated wound.
The favorite site selected for inflicting the injury are the accessible parts of the body. It has
to be remembered that the fabricator will only inflict that much of injury, which will confirm
his story. The fabricator rarely injures himself through the clothings. The number of cuts on
clothings at different levels may not correspond with injuries underneath.
DEFENSE OR PROTECTIVE WOUND

The defense wound results when the victim makes an attempt to
ward off the blow or weapon towards self protection. The character
of these injuries will depend on the nature of weapon and force of
thrust.
In an attempt to ward off the blows by attacking with the sharp

cutting weapon, the victim will throw up his upper limb, usually the
left hand and may sustain injuries. These are incised wounds if
sharp cutting weapon is used. If the weapon is heavy, sharp cutting
Fig. 12.6. Defense and force is powerful, it can even cut off the wrist from the forearm or
Wound on Wrist dorsum of hand from the wrist joint. The victim may grasp the knife
and then the nature of defense cuts will depend upon whether the
sharp weapon is single or double edged. Defense wound suggest homicide and can be
seen anywhere on the body depending upon the posture of the victim whether standing,
sitting, bending etc. and the assailant.
DANGEROUS INJURY
A dangerous injury is one which poses imminent danger to life by its direct or imminent
effect, because of, being extensive in nature, for involving important structure or organs of
body and also being likely to prove fatal in absence of surgical aid.
SIMPLE AND GRIEVOUS HURT
Simple Hurt
Simple Hurt are those which are simple in nature, do not fall under the domain of grievous
hurt, are neither serious nor extensive, and heal rapidly without leaving any permanent
deformity or disfigurement.
116
Grievous Hurt
The following injuries fall under grievous hurt in Nepal

1. Permanent privation of the sight of either eye
2. Permanent privation of the smell of the nose
3. Permanent privation of the hearing of either ear
4. Permanent privation of the speech of the tongue
5. Destruction or permanent impairing of the breast of the women
6. Emasculation
7. Fracture or dislocation of vertebrae, privation of any member or joint such as hand or
leg etc.
Punishment
1. Offender who commits any other two offence permanent blindness and emasculation,
shall be awarded a fine of Rs. 10,000 and imprisonment of 8 years.
2. Offenders who aggravates any grievous hurt other than those two shall be awarded a
fine of Rs. 5,000 and imprisonment of 8 years.
3. If any one of the organ of the body such as hands, legs etc. is grievously hurt and
permanently impaired, the punishment shall be half as mentioned above.
4. If cured and the member is useful the punishment of 2 years imprisonment.
The following injuries fall as per section 320 of Indian Penal code (I.P.C.)
1. Emasculation
2. Permanent privation of sight of either eye
3. Permanent privation of hearing of either ear
4. Privation of any member or joint
5. Destruction or permanent impairing of powers of any member or joint
6. Permanent disfigurement of the head or face
7. Fractures or dislocations of a bone or tooth
8. Any hurt which endangers life or which causes the sufferers to be, during the space of
20 days in severe bodily pain and unable to follow his ordinary pursuits.
Punishment
Imprisonment of either description for a term extending up to 7 years and also fine
117
SUICIDAL CUT THROAT

When made by a right handed person, normally begins high on the left side of neck and
pass downward across the front, to end on the right side of the neck. It is deeper at its
origin and tails off on the right. It is usually a linear clean-cut wound having some tentative
cuts which are shallower incisions at the upper end of the wound. Hesitant or tentative
incisions are strongly indicative of self infliction The victim throws back his head to clear
path for the weapon and some stand before a mirror to direct the hand. The throat injury
may be accompanied by incised wounds of the wrist or tentative incised wounds elsewhere.
Suicidal cut throat is one of the modes of death which may lead to Cadaveric spasm and
the weapon is firmly held in the victim’s hand. The homicidal wounds lacks the planning of a
self inflicted wound and is unaccompanied by tentative incisions on the contrary, it may be
accompanied by deep cuts elsewhere on the head and neck. The deep cuts on the neck
usually lie lower in the neck and is, perhaps more horizontal.
Traits Suicidal Homicidal
Site Front of upper part of left or Both side of front of neck below
right side of neck depending thyroid cartilage
whether the victim is right
handed or left handed
Direction Obliquely from above down- Usually transverse, will depend

ward upon the relative position of victim
and assailant
Number of wounds Several superficial cuts and Absence of tentative cuts and
one merging in the main and deep cuts
fatal cut
Sign of struggle No May show signs of struggle in

shape of contusion, abrasions etc.
Weapon and Cadaveric Weapon is usually grasped No such finding

spasm firmly in the hand
Hemorrhage Trickling of blood over the front Blood will be found on the front or
of body, Blood stains may be back, shoulder etc.
seen on the mirror if the person
stands before it.
Position Of the body Usually victim falls over his Any position
face
118
Fig. 12.7. Post mortem Artifact
Rat bites of corpse
A B
Fig. 12.8. Penetrating Injuries

A woman fell from the top of 5th storey, landed on a
chair, a leg of which passed through the right side of
her neck and came out through the left axilla
119
Chapter
13
AUTOMOBILE INJURIES
Injuries To Pedestrians, Motorcyclists 122

Injuries To The Driver And Passengers 123
121
13 AUTOMOBILE INJURIES
The type of injury sustained varies according the situation of the victim is the accident i.e.
whether he was driving the vehicle, or occupant of the vehicle or a pedestrian. The driver
tends to receive a different pattern of injury than the occupants of font seat.
INJURIES TO PEDESTRIANS, MOTORCYCLISTS

These are of three distinct types:-
1. Primary impact injuries
2. Secondary injuries
3. Secondary impact injuries
Primary impact injuries occur when the vehicle hits the victim usually the pedestrian for
the first time. Usually the projecting part of the vehicle i.e. bumper bar strikes the pedestrian
and injures the leg somewhere beneath the knee. It is important to measure the distance of
injuries from the heel. The dimension of the injuries and it height from the heel may be
correlated with the suspected vehicle. The primary impact of the victim may lift the
pedestrian up on to the bonnet where further primary impact injuries may occur from
contact from the windscreen. As a result, besides the fracture or other injuries of the legs
likely to have already occurred from the primary impact further primary injuries may occur
from contact with the windscreen. There may be severe head injuries from striking the
windscreen pillars or lacerations from the glass screen. More commonly, the victim is
thrown sideways, and may be run over by a passing vehicle.
Secondary injuries occur by the victim from contact with the ground. The injuries usually
encountered are grazed abrasions, lacerations, fracture and other internal injuries. If,
instead of being lifted up on the bonnet, the pedestrian is knocked further secondary
injuries on the knees, hands and other parts of the body. Secondary injuries will depend on
the result of impact between the body and the vehicle for the second time.
Secondary impact injuries. When a victim falls on the ground from primary impact of a
vehicle with the vehicle is still in motion, it will run over the victim. Run over may be caused
by the front on the rear wheels. Because of the grinding compression of the wheel there
may be avulsion laceration. Quite frequently there may be tire mark imprint which should be
photographed for matching the offending vehicle. The print if found is just like thumb print
and helps in identification.
Fig. 13.1. Injury to Pedestrians, Motorcyclists, Cyclists

122
AUTOMOBILE INJURIES 13
INJURIES TO THE DRIVER AND PASSENGERS

The driver of a motor vehicle may receive injuries to
the chest resulting in fracture of sternum or other chest
bones due to steering wheel impact. Fractures of the
leg, pelvis, , wrist, arm and forearm bones from
pressure against the foot pedals are commonly seen.
Due to grip on the steering wheel and its presence as
an obstruction, the driver sustains less injury than the
front and rear passenger. The driver usually do not
sustain whiplash injuries because of the presence of
steering which prevents forward and backward
movement but can get injuries on the side of the face
from impact of the side window. Fig. 13.2. Injury to Driver
The front passengers usually sustain injuries to the

knee region and ankle joint due to moving the lower
limbs on the side of the driver to applying the brake.
Severe whiplash, injury to the spine may occur due to
rapid acceleration or deceleration. The front and rear
passenger may sustains severe frontal or parietal head
injuries from contact with the windscreen pillar.
Laceration on the face from the impact of windscreen is

common.
Passengers in the rear seat often escape such

injuries due to the absence of windscreen. Injuries from
door handles, interior light, etc are the common Fig. 13.3. Injury to front passen-
occurrences amongst rear passengers. gers
Occasionally, the driver, front seat passenger and back seat passenger may be thrown out
from the vehicle and may receive sever injuries from fall on the ground or may be run over
by a passing vehicle.
123
Chapter
14
HEAD INJURIES
Introducon 126
Types Of Fracture Of Skull 127
Types Of Fractures Of Base Of Skull 129
Intracranial Hemorrhage 129
125
14 HEAD INJURIES
Introduction
These comprise a variety of trauma:
1. Scalp
Laceration avulsion of a flap of skin, exposing the skull bone, contusion, abrasion, incised
looking wound, incised wound and cut laceration.
2. Skull
Indirect blow or impact may result in scalp injury, fracture of the vault of skull, base of skull
or both.
3. Fracture of the base of skull
It occurs due to indirect violence as fall from height onto the feet or buttocks and when a
forced blow fall over the vertex.
4. Brain stem injuries
Injuries to the Pons resulting in hemorrhage may produce a clinical picture of hyperpyrexia,
pin point pupils and raised blood pressure. This has to be differentiated from opium
poisoning (pin point pupils, cold clammy skin, and fall in BP).
Traumatic pontine hemorrhages have to be distinguished from spontaneous hemorrhages,

which is usually single and involves about half of the substance of Pons. Traumatic
hemorrhage appears in a number of foci in the Pons. If the person survives for a sufficient
time, these may coalesce to resemble a spontaneous hemorrhage.
5. Boxing injuries
Fracture of skull is uncommon against boxers as it is difficult to fracture skull with a gloved
fist. A few of the victims sustain a pontine hemorrhage known as boxer’s hemorrhage. The
condition of “punch drunk” occurs when the head receives repeated blows producing small
hemorrhages in the brain producing deterioration in speech and coordination.
6. Contrecoup Hemorrhage (Bruising of Brain)
It is the injury in which hemorrhage in the cranial cavity, damage of the brain or fracture of
the skull bone is noted exactly opposite to the site of impact. This will occur only when a
moving head is struck or comes to a sudden halt on impact. Commonly occipital impact will
result in contrecoup bruising, laceration of the undersurface of the frontal lobes of brain with
occasional fracture of frontal bone. Contrecoup injury follows sudden rotation of the head,
which cause swirling movement of the brain inside the skull due to sudden halt on impact.
Contrecoup bruises or hemorrhages are rarely seen on the occipital lobes.
126
HEAD INJURIES 14
Mechanism of contrecoup and coup injury
When the head is thrown forward but the brain lags behind for a
while, then the skull strikes the brain (Acceleration injury). When
the moving head strikes a hard fixed object, the skull stops all of a
sudden but the moving brain moves on and strikes the skull
(Deceleration injury).
A blow to a fixed head

usually causes damage to
the brain directly under the
impact area- the so called
coup injury. Instead of the
brain damage being confined
Fig. 14.1. Coup Injury to the area immediately
beneath the outer injury
there is usually damage
diametrically opposite on the outer side of the brain
usually known as contre-coup and is a cardinal sign
of damage to a moving head by impact against a hard,
stationary surface.
Fig. 14.2. Contre-Coup Injury
TYPES OF FRACTURE OF SKULL
A. Linear fracture
These are also known as fissured fracture without any displacement of the broken bone
and either involves the whole thickness of the bone, or one or other table only. Depending
upon the severity of blow, fissured fractures can extend from one side of the skull to the
other. The line of fissured fracture is like that of a hair’s breadth and should not be mistaken
with markings by meningeal vessels during autopsy examination.
B. Depressed Fractures
When fractured bone is pressed inside, it is know as depressed fracture. This is also known
as fracture ala signature as the shape of the fracture acquires the shape of the offending
weapon. Impact with heavy weapon having small striking surfaces such as hammer, stick,
axe, brick etc. will cause a localized depressed fracture of skull. The impacts to the head
often produce depressed fracture with localized damage to brain as well as linear fractures
extending from the margins of inwardly displaced broken bone. Linear fractures begin in
areas of out bending and extending toward and away from the point of impact.
C. Comminuted fracture
In this type the skull bone is shattered into pieces, occurring often as complications of
depressed fractures. These are usually caused by fall from height, vehicular accidents, by a
127
14 HEAD INJURIES
bullet, etc. In absence of displacement of bone fragments, the look resembles like a
spider’s web with fissured fractures radiating for varying distances. At times, the
comminuted fractures may be displaced and enter the brain substance.
D. Pond fracture
These are commonly noticed in case of forceps delivery where there is a compression of
the skull like a pin pong ball. In this type of fracture, the meninges and brain are not
damaged ordinarily.
E. Gutter Fracture
They are caused when part of the thickness of the bone is removed so as to form a gutter.
Such type of injury is seen when bullet glances the bone without entering the inner table of
the bone. They are usually accompanied by irregular depressed fractures of the inner table
of skull.
F. Ring Fracture
This is a type of fracture that encircles the base of the skull around the foramen magnum.
This type of fracture is usually seen in case of fall from height, on to feet or buttock with
force transmitting upwards through the spinal column or violent twisting of the head on the
spine.
G. Contrecoup Fracture
This type of fracture occurs to the opposite side of

coup violence. This will occur only when the head at
the moment of strike is not fixed but moving i.e. in
motion.
Medico legal significance
The majority of fractures of skull occur as a result of

an accident, which may be due to a fall or injury by a
motor vehicle. A smaller number of cases follow as
attack as in murder when the weapon may be
hammer, chopper, stick or bottle. Multiple fractures
Fig. 14.3. Fracture of base of skull
however when localized and depressed raise the
possibility of a determined attack. Suicide by head
injury is a rare event since the process is painful and not easy to accomplish. It may be
attempted by striking the head against the wall and can be recognized because they must
lie in an accessible area.
128
HEAD INJURIES 14
TYPES OF FRACTURES OF BASE OF SKULL

a. Fracture of anterior cranial fossa
These may be fracture of frontal, ethmoidal or sphenoidal air sinuses. There may be
bleeding from the nose, in the orbit, and at times from the mouth also. Black eye may be
seen.
b. Fractures of middle cranial fossa
When it involves the temporal bone, there may be bleeding from the middle ear.
c. Fracture of the posterior cranial fossa
This will produce extravasation of blood behind the mastoid process and back of nape of
neck. In case the foramen magnum is involved, there will be cellular contusion.
INTRACRANIAL HEMORRHAGE
It is convenient to group intra cranial bleeding according to the location. The bleeding may
be between the inner table of the skull and the outer part of the duramater; between the
duramater and arachnoidmater; between the arachnoidmater and piamater; and bleeding
into the substance of the brain.
a. Extradural Hemorrhage
Bleeding which occurs between the inner table

of the skull and the duramater is termed the
extradural hemorrhage. These hemorrhages
are usually the result of rupture of the middle
meningeal artery or one of its branches.
Extradural hemorrhage is commonly due to
fracture of squamous temporal bone, which
lacerates the middle meningeal artery or
fracture of the occipital bone lacerating the
posterior meningeal artery. Rupture of the
middle meningeal artery causes extradural
hemorrhage in the middle cranial fossa, while Fig. 14.4. Extradural Hemorrhage
that of posterior meningeal causes
hemorrhage in the posterior cranial fossa. Extradural hemorrhage is usually arterial in origin
with rapid accumulation of blood exhibiting signs of raised intra cranial pressure promptly.
b. Subdural hemorrhage
This occurs between the duramater and arachnoidmater. This is due to rupture of bridging
veins, which carry blood from the subarachnoid space to the superior sagittal sinus, or
129
laceration of other venous channels. Initially the blood is
fluid, which becomes thicker and undergoes clotting with
formation of typical currant-jelly clot. As the hemorrhage
is mainly venous, the accumulation is slow and may be
localized over a small area; however, it can get diffused
over the cerebral hemispheres and also gravitate to the
base of the brain. The hemorrhage may undergo
reparative changes. The duramater provides vascular
fibrous tissue and the blood is organized encapsulated in
a fibrous envelope. Young capillaries develop in chronic
subdural hematoma encapsulated cyst. This may remain
in this form without exhibiting any signs or symptoms,
but sometimes, these new capillaries may rupture even
with slight injury to the head causing fresh bleeding.
Chronic subdural hematoma is actually the late stage of
an acute injury in a
person who survived. Fig. 14.5. Subdural Hemorrhage
These are sometimes
detected during autopsies when there is no record of any
head injury.
c. Subarachnoid hemorrhage
It occurs between the arachnoidmater and piamater

mixed with cerebrospinal fluid. It is commonly seen
following blunt injuries on the head and is usually
associated with cerebral contusion and lacerations. The
most frequent cause of spontaneous subarachnoid
hemorrhage is a rupture of a congenital berry aneurysm
located in the circle of Willis or one of its major branches.
The aneurysm is no small that it is not always
demonstrated at autopsy. It occurs commonly in young
Fig. 14.6. Subarachnoid Hemor- adults due to development of congenital aneurysm. The
rhage leakage point is seen from the side of ruptured berry
aneurysm. Subarachnoid hemorrhage can also occur in
subjects suffering from degenerative arterial changes and hypertension.
d. Intra- cerebral Hemorrhage
It occurs from spontaneous hemorrhage in the middle aged or elderly persons suffering
from hypertension. This is commonly seen in head injury cases and commonly noticed with
laceration or contusion of brain. Quite often, tiny punctuate hemorrhages can occur in the
brain stem directly from different types of pathological lesions.
Chapter
15
FORENSIC BALLISTICS
Classificaon of Firearms 132

General Make Up Of Firearms 132
Shotgun 132
Rifled Firearms 132
Shot Gun Wounds 134
Rifled Fire-Arm Injuries 136
Ricochet Bullet Wound 138
Tandem Bullets 139
131
15 FORENSIC BALLISTICS
It is the science which deals with firearms, ammunitions and the problems arising from their
uses. Wound ballistics implies study of the injuries produced in the body by the firearm. An
elementary knowledge of firearms and ammunition will be essential for proper interpretation
of injuries caused by firearms.
Classification of Firearms
1. Rifled weapons:
a. Rifles (Long Barreled)
b. Short Barreled Rifles
i. Revolvers, having a revolving chamber with cartridge moving after
each discharge
ii. Automatic pistols, with self firing mechanism of magazines/ cartridges
iii. Machine gun (It may have varying barrel lengths)
iv. Stengun
2. Smooth Bored Weapons (Shot Gun)
a. Single barrel
b. Double barrel, firing several lead pellets of standard sizes.
3. Firearms which fire slugs by means of compressed air or gas which include
a. Air pistol
b. Air gun
c. Air Rifles
GENERAL MAKE UP OF FIREARMS

SHOTGUN
Its barrel has a smooth interior. The barrel is long, hollow cylinder of steel. The lumen of the
barrel is termed the bore; the rear end in which the cartridge is inserted is called the breech
end and the front end the muzzle. The spreading of the shot pattern can be reduced to a
certain extent by tapering the barrel. The narrowing is called choke. Three grades of choke
are used:
a. Narrowing by 15 to 20 thousandths of an inch represent half choke
b. Full choke is a narrowing from 35 to 40 thousandths of an inch
c. Narrowing by 3 to 5 thousandths of an inch is an improved cylinder.
Ordinarily, the shotguns are effective within a range of 30-40 yards (lethal range). Shotgun
is described by their bore or diameter of the barrel. The usual model of shot gun is a 12-
bore gun. The size of the bore is determined by the size of the lead ball which will precisely
fit the barrel and by the number of such ball as can be made from one pound of lead.
132
FORENSIC BALLISTICS 15
Thus the definition of 12 bore would fit
12 balls and 16 bore would fit 16 balls.
In more modern terms, the bore has a
diameter of 0.7inch or 18mm.
The cartridge used in a shotgun is a

cylinder of cardboard, mounted in a
brass head into which a small
detonator cap of copper, holding Fig. 15.1. Shotgun
fulminate mercury, is set. Next to the
detonator is the propellant charge a
greased or waxed cardboard or
feltwad. The pellets are kept into the
end of the cartridge case by a wad.
The rimmed base of the cartridge is to
prevent its forward movement into the Fig. 15.2. Choke of barrel of a shotgun
chamber. The propellant may be black
powder consisting of potassium nitrate, sulfur and charcoal.
These days smokeless powder is used which consists of
nitrocellulose and nitroglycerin. Semi smokeless powder is a
mixture of 80% of black and 20% of smokeless type.
RIFLED FIREARMS Fig. 15.3. A shotgun shell
Rifling refers to the manner in which the barrel is cut to produce spirally directed towards
grooves and ridges or lands. This cut is to give rotatory motion to a bullet for greater
accuracy of impact and longer range. The caliber is measured between the lands. The
rifling varies in number, direction, depth and width which may be clockwise or anticlockwise.
Because of this arrangement, one
make of weapon differs from the
other. The bullet gets squeezed in
between lands and a spin is
imparted to it because of spiral
rifling .Spiral rifling also provides a
greater power of penetration and
prevents “wobbling”, making a
straight flight. Rifling thus improves
accuracy and efficiency of firing.
Several makers of Rifling have
different designs, so that there
may be from four to seven lands Fig. 15.4. Revolver
and the spiral may twist to the right
or to the left, according to the make. Because of rifling, the surface of the bullet will get
marked with grooves corresponding in number, size and direction of the lands. When the
weapon is fired these primary marking which are transferred to the bullet from the barrel,
will be peculiar to the firearm which has discharged it hence these “thumbprints of the
weapon” will help to identify the offending weapon.
133
Ammunition for rifled firearm has metal cartridge case, in the head
of which a small copper detonator is fitted. The missile is single
and is propelled by a charge of powder, detonated by fulminate of
mercury or mixture of tetrazene, lead typhanet, lead peroxide,
barium nitrate, and antimony sulfide. The cartridge base is rimmed
except that used in automatic pistol. Rimmed cartridges are
usually used in rifles, revolvers and machine guns. In case of Fig. 15.5. Pistol
automatic pistols, the empty casing gels ejected when the shot is
fired.
All cartridges whether used for rifled weapon or shotgun have a

percussion cap fixed up at the base of the cartridge cylinder. The
percussion cap contains explosive mixture known as priming
mixture which is sensitive ignition powder comprising of mixture of
tetrazene, lead typhanet, lead peroxide and barium nitrate. Also
sometimes mercury fulminate, potassium chlorate and antimony
sulfide is used as ignition powder. This is on being hit by the firing Fig. 15.6. Interior of
pin, explodes resulting in formation of a very hot piercing flame barrel of rifled gun
which is turn, ignites the propellant charge in the cartridge, to be
converted rapidly in to gas. Enormous gas is produced to eject the
bullet through the bore out of the muzzle.
Rifled firearms fall into two categories, those of a low velocity Fig. 15.7. Bullets
weapon i.e. revolver and high velocity weapons i.e. pistol or
service rifle.
SHOTGUN WOUNDS
Contact and close dermal entrance shot gun wounds are round or elliptical, the shot enters
as a mass, the smoke and powder residue deposits surrounding entrance, defects are
usually quite heavy. The effect of flame damage may be prominent. A difference between
close dermal shotgun wounds and those made by rifled weapon lies in the fact that the
former usually present more damage from muzzle blast, flame and powder, and the
entrance wound is larger due to larger quantity, of powder present in their cartridges.
Scorching of the skin, singeing of hair and blackening are seen around the wound. The
powder residues are driven into the skin often very deeply and tattooing may be seen
around and also in the depth of the wound. With smokeless powder, there is relatively less
blackening and tattooing. In case of contact shotgun wound to the temple there is gross
disruption of tissues and the scalp and skull may be burst open and parts of the scalp, skull
and brain blown from the body for a distance of a several feet. The wad is often found in the
wound which will indicate the type of cartridge used. The exit wound if present may show
greater disruption of tissue than is seen in the entrance wound. A number of exit wounds
due to multiple pellets and bony fragments may be seen. Sometimes, in contact or near
shot there may not be wound of exit, the pellets and wad may remain in the body.
In shotgun injuries within about 6 inches, the tissue, or clothing, may singed by flame as
well as blackened by the smoke and unburnt powder. There will be tattooing of the skin
134
surrounding the hole because the unbent powder is driven in the tissue. The halo of
tattooing also gradually widens up to about a meter. The estimation of range may be
ascertained by intra-red photography for the determination of powder marks particularly on
dark colored clothing. The shot enter as a single mass about a meter. The wad may be
seen in the body up to two meters and can produce injury up to about three meters. At
range of up to 1yard carbon monoxide may be present in the blood from the damaged
tissues.
Blackening of the tissues or clothing by smoke is unlikely at a range of over 12 inches and
tattooing by unburnt powder is unlikely at a range of over 2 feet.
As the range increases, the shot diverge more and more widely.
Spread of shot at Assuming the barrel to be a

cylinder, half choke or full choke,
Choke Type 5 yards 10 Yards 15 Yards 20 Yards the diameter of the area in which
Cylinder 8“ 20 “ 26 “ 30 “ the pellets lie, when measured in
inches can give the rough idea of
Half Choke 5“ 12 “ 16 “ 20 “ the distance of the firearm used in
Full Choke 3“ 9“ 12 “ 15 “ yards. As the range of fire
increases, the charge of shot
Table 15.1. Approximate Spread of Shot in Inches at begins to spread so that small
various distances apertures, due to separate pellets
entering the body, appear round
the central opening caused by the main mass of shot.
Distinguishing between entrance and exit shotgun wounds is simple. Explosion and flame
effects are readily seen at the site of entrance of contact and close wounds, and absent at
sites of entrance of exit. Distant shotgun entrance wounds are readily diagnosed because
more of the pellets which entry the victim are usually retained. The autopsy surgeon need
Fig. 15.8. Patterns of shotgun wounds according to the distance

135
not recover every shot gun pellet present. However, every rifle, pistol or revolver bullet, if in
the body, has to be recovered.
Medico-legal aspect in relation of shotgun injuries
In case of a fatal gunshot incident, the autopsy surgeon has the responsibility of preserving
medical evidence essential for establishing the cause of death and manner of death. A
contact entrance wound in the temple, forehead, mouth or ear or in the precordial region,
without other injury, points strongly to the probability of self
destruction. The above target areas represent favorite
sites of election for suicide.
Homicidal contact gunshot wound are almost always

incurred during hand-to-hand scuffles involving a gun. As
such the victim of the fatal gun shot injury, usually
presents, additional traumas sustained in the fight.
The presence of blood on the hand or hands, which held

the suicide gun along with the impression of the trigger or
triggers guard on the finders, enhances the probability that
one is dealing with an intentional gunshot wound. A similar
conclusion derives from the presence of abundant powder
residue on the hand of the victim This can be elicited by
performing “Dermal Nitrate Test “ in which a paraffin cast is Fig. 15.9. Splaying of wound in
taken of the fingers and hand to which diphenylamine is a shot gun injury
added which gives bluish discoloration. The presence of
multiple superficial incised wounds on the flexor surfaces of the forearm or neck in the
victim of a contact or close gunshot wound is practically, positive proof of the suicidal origin
of the fatal shot. A person may have shot himself accidentally as he was cleaning his gun
and failed to check carefully the cartridge leaded in the gun. A bullet in a deformed
condition recovered from a victim would indicate that the missile first struck some hard
object and then ricocheted, striking the victim secondarily and inadvertently and was not
intended target.
RIFLED FIREARM INJURIES

Contact wounds would invariably show
the muzzle imprint on the entry point. In a
contact shot with high velocity weapons
and a single projectile, entrance and exit
wound may be expected, except where
the projectile has hit a solid bony
structure. The discharge from the muzzle Fig. 15.10. A bullet penetrating the skin
consisting of flame, powder, metallic The skin is pressed inwards, stretched and perforated. It then par-
tially returns to its original position. The entry wound is therefore
particles, may be forced into the track smaller than the diameter of the bullet. Immediately around the
taken by the bullet through the body. opening is the abraded collar of contusion ring (After Svensson and
Wendel)
136
Consequently, there may be burning, soot and
tattooing around the entrance wound. The
entrance wound is usually inverted, the margins
being pressed in and abraded by the passage of
bullet, sometimes with a greasy ring where the
bullet has cleaned itself upon the skin. The
abraded collar or contact ring result from the
spinning bullet’s initial attempt at perforating the
skin. In addition to the abraded collar, the soft
Fig. 15.11. The marks which may be found around the
entry wound of a bullet in a close shot. A Abraded
metal of the bullet or dirt, is transferred to the skin
collor or contusion ring B Grease/dirt collar C powder and deposited round the entrance wound internal
distribution (tatto marks) D deposit of smoke to the abraded collar. The interposition of clothing
(Blackening) (After Svensson and Wendel)
may remove sign but fibers from the cloth may be
forced into the wound, giving a definite

indication of direction. The size of the
entrance hole may be less than that of
the actual diameter of the bullet, due to
stretching of the skin before penetration
occurs, with subsequent elastic recoil.
This will cause a reddish brown ring of
abraded skin.
The skin wound is usually everted and

may be much larger than the entrance Fig. 15.12.
wound. This is due to “tumbling” of bullet A handgun discharge. Close shot. Both incompletey burned
from disturbance of its straight path through powder grains (tattooing) and smoke deposits (blackening)
are seen. The powder grains are concentrated immediately
the body and also because of the piece of around the entrance wound (After Svensson and Wendel)
tissue or bone fragment being carried out

with the projectile. Where the skin at the
site of the exit wound is tightly compressed
by clothing or resting against a firm surface
such as door or wall, the eversion of the
wound will be lessened or even prevented
from coming out of skin. There is possibility
of multiple exits wounds in a single bullet
due to fragments of bone being expelled
Fig. 15.13. A handgun discharge. Contact shot on the head. out. In a near shot, that is within 1-2 feet in
The gases from the explosion expand between the scalp and case of hand guns and more in case or
skull resulting in a bursting effect and a ragged entrance wound
(After Svensson and Wendel) other weapons, the deposit of soot and
tattooing is spread out over a larger area
but there is singeing of hair or charring of the skin and the entry wound has the appearance
or distant shot as the range increases, tattooing from the powder diminishes and is absent
beyond a yard. Infrared photography may be helpful to detect the ‘halo’ of the soot and
137
tattoo marks, when it is difficult to do so
otherwise. In a distance shot, there is no
burning, no soot and no tattooing. The
wound is circular with inverted margins
and may be of the same size or even
slightly smaller than the bullet due to
initial stretching of skins. The edges may
be slightly confused and may show two
zones, an outer abraded zone and an Fig. 15.14. powder grains (tattooing) is seen but there is no
inner zone soiled by grease known as smoke deposit (blackening) around the entrance wound. (After
grease collar or dirt collar. Track near the Svensson and Wendel)
entry wound may be bright pink due to carboxyhemoglobin in near discharge. Entrance and
exit wound in skill bone needs special attention. There is appearance of “punch in hole”
Fig. 15.15. Different types of gunshot wounds

A. Exit and Entrance wounds on the head
B. Contact wound on the temple
C. Close range shot with contusion ring
D. Close range shot with ring collar
caused by bullet on the skull bone at the wound of entrance. There is sharp margin at the
outer table and beveled margin at the inner table incase of entry wound. In case of exit
wound there is “ punched out hole” caused by bullet on the skull bone at the wound of exit,
beveled margin at the outer table and sharp margin at the inner table.
RICOCHET BULLET WOUND
A ricocheted bullet is one which is deflected from its flight by striking a hard object. This
results in deformity, loss of velocity and loss of strategy. A ricochet bullet when strikes a
body will produce abrasion, bruise and it seldom penetrates the skin since the velocity is
lost. If it enters the skin it will produce deformed shape of the bullet.
138
TANDEM BULLETS
When the first bullet fails to leave the barrel, and is ejected by the subsequently fired
bullets; the bullets are ejected one before the other and are known as tandem bullets.
Comparative study of the bullet recovered from the body and the test bullet fired from the
suspect gun may be confirmatory to conclude whether a particular gun was actually used or
not. The bullet may show primary marking due to land to grooves present on the rifled gun
which will be similar on all bullets fired from any rifle gun of the same make. There may be
secondary marking on the bullet which is due to certain individual feature of the inner
surface of barrel which is specific of particular gun.
CAUSE OF DEATH DUE TO FIREARM INJURIES

1. Hemorrhage
Bleeding can kill by hypovolemic shock or other mechanisms. The blood may escape
externally, internally, or into both areas. The visible external blood does not tell to the
gravity of internal injury or the quantity of internal bleeding in the cavities. A small
penetrating wound in the upper anterior chest region, accompanied by minimal external
bleeding could penetrate or perforate the pulmonary artery or the aortic arch with
accumulation of blood in plural of pericardial cavities or both. This will cause immediate
death. A stab wound of the heart associated with a pericardial injury causes death by
cardiac tamponade. There may be accumulation of blood and air in the thoracic cavity
(Hemopneumothorax).
2. Injury to vital organs
Injury to vital organs like brain, heart, kidneys, liver may result in immediate death.
3. Delayed Causes
Infections arising as a direct consequence of injuries provide a group of lethal sequelae.

Infection can be initiated by organisms by wounds through dirty skin or contaminated
clothing. Infection can also arise as a result of the escape of organisms from some injured
site within the victim viz. peritonitis, abscesses and blood stream infection are additional
potential septic threats to life. Tetanus or gas gangrene is uncommon but important
possible cause following traumas.
139
Chapter
16
BURNS AND SCALDS
Classificaon Of Burns 142

Factors Which Influence The Prognosis Of Burn Injuries 143
Age Of A Burn 144
Causes Of Death 144
141
16 BURNS AND SCALDS
Burn injuries are commonly referred to as injury resulting from the application of dry heat to
the body. Thus, burning may occur from contact with the flame, hot metal or any other hot
solid substance. Burns due to flame may produce singeing of hair, roasted patches of skin
or tissues, deposition of carbon particles on the body and burning of apparels. There may
be vesication or blisters around the affected part of the skin. Burns produced by radiant
heat from hot bodies cause whitening of the skin. Burn produced by chemicals, x-rays, ultra
violet rays, radiation is also considered as tissue injury resulting from the dry heat. Burns
produced by corrosives do not cause singeing of hair and the vesicle is rarely found.
Corrosive burn is characterized by inflammatory redness and discoloration of skin and
presence of chemical substances in the stains of skin and clothings.
Scalds are moist heat injuries. Accidental scalds are common in kitchen. Their effects
however are not as severe as in burn. They occur when boiling water or fluid falls on the
body. They can also occur when hot fluid in a gaseous form comes in contact of the body.
Scalds occurring from hot oil produce severe injuries as oil boils at a higher temperature
and sticks upon falling on the body. Vesication is an important feature. Burn produced by x-
rays becomes red and inflamed. The skin may blister and the nail may show degenerative
changes. Subsequently, there may be shedding of hair and ulceration of the effected part.
There may be tendency to malignancy. The cicatrix formed from the healing of ulcers is
radial in shape with pigmentation of surrounding skin. The ulcers so formed from radiation
are difficult to heal. Ultra violet rays may cause burn when there is over exposure in the
sunlight.
CLASSIFICATION OF BURNS
The older surgical classification describes six degrees of burning called the Dupuytren
classification of burn.
It is sufficient for description purposes and employs the following

First degree. Erythema (Mere redness of skin due to momentary application of heat)
Second degree. Vesication surrounded by a red line.
Third degree. Here part of the thickness of the true skin is involved. This degree is painful
as the nerve ending are exposed. The ulcer heals by scar formation. There is singeing of
hair and blackening due to deposition of soot.
Fourth degree. Full thickness burning of the skin with exposure of underlying tissue. There
is contraction of the scar tissue producing disfigurement and impaired function of the
affected part.
Fifth degree. Subcutaneous tissue is involved. This degree is less painful due to total
damage of the sensitive nerves. They heal with scarring and may cause contracture and a
joint function is restricted.
Sixth degree. The burn injury extends deeper to the subcutaneous tissue, involving the
muscles and bones. They heal with difficulty and results in scarring and contracture limiting
its function, when nearer to a joint.
142
BURNS AND SCALDS 16
Dupuytren’s classification was later modified by Wilson as follows:
Epidermal. Erythema and vesication (1st and 2nd degree of Dupuytren)
Dermoepidermal. Full thickness burning (3rd and 4th degree of Dupuytren) of skin with
exposure of underlying tissue
Deep burn. Complete destruction (Includes 5th and 6th degree of Dupuytren’s), complete
destruction with carbonization with exposing of muscle and possibly bone
FACTORS WHICH INFLUENCE THE PROGNOSIS OF BURN

INJURIES
1. Involvement of the body surface. The percentage of the body surface involved is
calculated by “The rule of nine”.
Head and Neck 9%

Upper limb 9% each
Lower limbs 18% each (9% front
and 9% back)
Front and back of chest 18%

Front and back of abdomen 18%
Pudendal area 1%
Total 100%
Recovery can occur after a considerable area has

been involved even in 2nd degree burns, but the
prognosis becomes worse with advancing in
years. Children may survive having half their Fig. 16.1 Rule of Nine
body surface burnt, but in old age; 10-20% may prove fatal. As a general rule, prognosis is
very poor if a third or more of the body surface is involved.
2. The severity of the burns in various areas. A deep wound over a small area of the
body is less dangerous than a superficial injury spread over an extensive of the body
surface.
3. Sex. Males withstand burn injury better than female.
4. Effect of heat. The severity of burns, whether of epidermal, dermal or deep burns,
depends on the degree of heat. The higher the temperature, the more severe are the burns.
5. Duration of exposure. The greater the duration of exposure, the more severe are the
burns.
143
16 BURNS AND SCALDS
AGE OF A BURN
Different stages of its reparative process of wound give a rough estimate of its age.
Redness occurs soon after a burn, blisters within 2-6 hours and pus formation takes 48
hours to 72 hours but not earlier than thirty six hours. Superficial sloughs of epidermal
burns are wiped out in about 7 days and deeper sloughs in about a fortnight. Subsequently,
granulation tissue beings to cover the surface of the burnt area and scar are formed.
Epithelialization is liable to be delayed due to infection. If the injury extends to the full
thickness of the skin or beyond, scarring is liable to be severe.
CAUSES OF DEATH
Death may occur at once from primary neurogenic shock within 1 to 2 days from pain. If the
patient survives the primary shock, merges into the stage of secondary shock due to
exudation of serum from burnt areas and consequent depletion of blood volume and death
usually occurs in a week from toxemia of burn.
Combination of carbon monoxide poisoning associated with shock is the commonest cause
of death in house fires. Delayed causes of death from burn include sepsis of skin, tubular
necrosis leading to anuria, gross fluid and electrolyte disturbances due to exudation from
the burnt areas and bronchopneumonia. A condition which may occasionally develop in one
or two week after severe burning is acute duodenal ulcer which is known as Curling’s
ulcers. The manner in which these ulcers are produced by the burns is not known.
Differentiation between ante mortem and post mortem burns
Though both are commonly present in a dead body, it is the absence of ante mortem burns
that raises the presumption that death was due to other causes, possibly criminal. For
practical purposes, the presence of line of redness is the most useful sign. Blisters may be
present on either antemortem or postmortem burns. It is possible to distinguish antemortem
from postmortem vesication by the chemical content of their fluid. Those formed ante-
mortem will contain aluminous fluid and chlorides whereas the postmortem bullas will
contain air. Histochemical techniques are far more reliable and enzyme is increased in ante
mortem burn whereas no such increase is seen in post-mortem burning. Ante mortem burn
will show sign of reparative process in the form pus formation, sloughing and
epithelialization. No such changes will be seen in case of postmortem burning. In ante
mortem death from burning carbon soot’s can be demonstrated in air passage which will be
absent in postmortem burning. In ante mortem burning the blood will be of cherry red color
due to carboxyhemoglobin which is not found in postmortem burning cases.
Post mortem signs
External
Occasionally a body recovered from a burnt house may not reveal any injury from heat
inhalation of fumes cause death. There are occasions when a victim died from inhalation of
144
BURNS AND SCALDS 16
carbon monoxide and carbon dioxide and subsequently receiving fire injuries on the body.
Naturally the body will bear postmortem burn injuries but such injuries become difficult to be
differentiated from ante mortem burn injuries and are sometimes
labeled as perimortem burns.
The clothes should be carefully examined for the presence of

kerosene, petrol or some other combustible substance and
retained for sending to forensic science laboratory. The distribution
of burns on the clothing may throw light upon the manner in which
it was lighted as well as the position of the victim. Ante mortem
burnt area will be red, blistered or charred. Vesicles are formed Fig. 16.2. Burns
due to increased permeability of the superficial blood vessels due
to heat. They contain jelly like substance which is rich in albumin and chlorides. The fluid of
vesicles will coagulate on heating due to albumin. When examined under microscope, it
shows the presence of red and white blood corpuscles.
The tongue is quite often protruded and bitten between the teeth. Owing of the effect of
heat on the blood, the veins give a marbled
appearance. Postmortem hypostasis is cherry red in
color from carbon monoxide poisoning.
When a body is left to heat for a considerable period

there is coagulation of proteins and the body presents
an attitude of generalized flexion. This is called
pugilistic attitude or boxing attitude or fencing posture.
It is due to heat stiffening and it differs from rigor mortis
in that it is permanent and does not pass off. The
Fig. 16.3. Pugilistic Attitude limbs are flexed with the clenched fists and the body
slightly bent.
Quite often due to heat the skin splits, and can be mistaken for incised or lacerated
wounds. These can be distinguished from violence by the presence of vessels and nerves
running across the split from side to side. Further there is no burning of skin or tissue.
In case of death from scalding there is absence of burning of clothes, singeing of hair,
deposition of carbon soot’s on the burnt area and charring of tissues. Vesication is always
present in case of moist heat injuries.
Internal appearance
Air passage yield reliable proof of life at the time of burning. In fire in a building where there
is a considerable production of smoke air passage is coated by a layer of soot. Quite
frequently the victim also vomits, and the vomitus can be inhaled in the air passage which
can be seen in the air passage mixed with carbon soot. Heat ruptures occurs when the
body is exposed either before or after death to considerable heat. They may resemble
lacerations or incised wounds. A distinction can be made of heat ruptures from incised or
lacerated wounds as there is no bleeding in heat ruptures. Vessels and nerves are intact in
145
16 BURNS AND SCALDS
the floor of rupture and run across, or in the long
axis of the rupture. On close inspection, its margins
are not clean cut as in incised wounds or bruised
which is seen in lacerated wounds.
There may be rupture of the skull with herniation of

the brain if the head has been lying in heat for
considerable time. This condition has the
appearance of an extradural hemorrhage, but it is
not accompanied by any signs of injuries by blunt
force. There may be accumulation of fluid blood in
the upper surface of duramater known as heat
hematoma, looking like extradural hemorrhage.
This may occur without the heat fracture of skull Fig. 16.4. Internal burn injuries
bone.
All the other internal organs are congested.
Medico-legal aspects of the death due to burn injuries
Accidental death from burn injuries usually occur in the kitchen while cooking food or at the
place of work in factories, house conflagration incidents, bursting of gas cylinders, burning
of highly inflammable substance and in number of unforeseen happenings like fire inside
the train compartments, bus etc. On some occasion, electrical short circuit cause serious
outbreak of fire in the buildings. The circumstances easily suggest the manner of death in
these cases.
Suicidal deaths from burn injuries usually occur inside the house. Self immolation in protest
of some grievances takes place in open place. Suicidal burning is more common in
females. In these burning usually kerosene or petrol is used which is poured on the head,
so that the whole body catches fire. There will be typical odor of kerosene or petrol.
There are cases when suicides, to have inflicted burn injuries when they failed to achieve
the goal by some other means. In such cases there will be self inflicted wounds usually on
the forearm or neck besides the burn injuries.
Homicidal burning is rare but there are several reports of authentic cases of bride burning
death particularly in India usually related to dowry. In homicidal burning there may be some
evidence of external injuries on the body due to resistance. Sometimes the victim is
rendered unconscious by way of poisoning and then burned after pouring fuel on the body.
On many occasions hands and feet of the victim are tied, mouth gagged and strangled
before burning the body. During autopsy the features of mechanical asphyxia viz. gagging,
constriction of neck or compression of the chest etc will be seen which wound confirm the
manner of death viz. homicide.
In deaths occurring from explosives or bombs there will be burn injuries on the body as well
as tattooing of skin since the carbon particles are driven in the subcutaneous tissue.
146
BURNS AND SCALDS 16
The teeth may withstand extensive thermal injury and decomposition. Even though the
body is charred, the teeth remain a good source for identification.
In severe burn cases, the age and sex may be ascertained by examining the bones or other
contents on the dead body. The presence of prostate or uterus if available can ascertain the
sex of the person. Age can be ascertained if teeth, skull bones or long bones are available
and sometimes the dental data alone is useful in ascertaining the precise identity of the
person. The characteristics dental feature or the filling of the teeth of the person may be
helpful in establishing the identity.
147
Chapter
17
ELECTROCUTION, LIGHTNING
Electrocuon 150
Lightning 153
149
17 ELECTROCUTION, LIGHTNING
ELECTROCUTION
Electric current may be direct or alternating. Alternating current is more dangerous than
direct current.
Electrocution is rare at less than 100 volts and most fatal cases occur at more than 200
volts. However, if resistance is low, the strength of the current is increased and fatality may
occur. Where earthing of the body is poor, as with dry or rubber soled shoes, wooden floors
then fatal electrocution is unlikely. The converse is true where damp conditions, metal fitted
shoes, damp concrete floors are present. The resistance of the skin varies greatly
according to its dryness. Wet skin in the bathroom may have a ten fold reduction in
resistance compared to dry skin and even the presence of perspiration may increase the
hazard.
Effect of passage of current
This depends on the

1. Strength of the current in amperes
2. Length of the exposure
3. Direction of current
4. Resistance offered
Strength of current
Amperage: Voltage/ Resistance
Ordinarily 5 amperes of a lightning circuit of 15 amperes of a power circuit. Electrocution is

rare below 100 volt but if resistance is low, fatality may occur.
Length of Exposure
If a lower ampere current is passed for a longer time, death can occur.
Direction of current
The direction of current is also important. If the contact point is on the upper limb and the
earthing point in the opposite foot, then the current will pass across the chest in a diagonal
direction and be most likely to produce myocardial fibrillation. Currents passing from one
arm to another arm are less dangerous in producing myocardial fibrillation. Contacts in the
lower part of the body may not cause fibrillation at all. Current across the head without
earthing on the lower part of the body may not affect heart but may cause brain stem
effects with central respiratory paralysis.
150
ELECTROCUTION, LIGHTNING 17
Resistance
The skin when dry is bad conductor of electricity. When it is wet, the resistance is reduced.
Post Mortem Appearances
An electric mark is found at the point of

entry of the current. The electric mark is
specific and diagnostic of contact with
electricity.
Characteristically, these marks are round or

oval, shallow craters, bordered by a ridge of
skin. The crater floor is lined by pale
flattened skin. Sometimes the lesion is
raised blister containing either gas or a little
fluid. Firm contact lesion is characteristic,
and often seen on the pads of the fingers or
thumb. When contact is prolonged there
may be charring. These changes are due to
burning, the so called Joule burn
(Endogenous burn).
Injury by high tension current is either by

direct contact or an indirect result of flash
over the body. Considerable heat is
generated in the flash and causes thermal
burns. The indirect production of high
tension injuries is likely to occur when
anyone climbs an electric pole supporting
high tension cables with a view to suicide or
theft of cable. There is risk of flash over if
he comes close to the cables. Flash burns
may be extensive and may be exaggerated Fig. 17.1. Electrocution injuries
by burns from igniting clothing causing
destruction of soft tissue and even charring of bones. Bone injuries are usually due to fall
following an electric shock.
Exit Mark
They have some of the features of entrance marks. Instead of craters as in entrance mark
there may be more disruption of tissue which may be everted.
In electrical injury there is discoloration of the affected part due to volatilization of metal
particles of which are driven into the skin. Metallization may be detected under low
magnification or by histological or chemical examination.
151
17 ELECTROCUTION, LIGHTNING
Microscopic Examination
The epidermis is flattened. There may be separation of epidermis from dermis to the extent
of blister formation.
Diagnosis
Post Mortem
Features of electrocution are: Entrance Wound Exit Wound
1. Electric mark which may not be visible

always accompanied by hyperemia.
2. Joule burn which may be the signature of

the conductor.
3. High tension electrocution is usually Fig. 17.2. Entrance and exit electrocution
associated with gross thermal injuries, the wounds
result of direct contact or flash over or due to
ignition of clothing.
4. Exit marks will show disruption of tissues and splits in the skin.
5. Acro-reaction test – Detection of metals which are soluble in HCL and HNO3.
Internal Examination
There is no characteristic finding. In case of immediate death due to asphyxia the features
will be:
• Cyanosis of the face
• Petichiael hemorrhage in the skin of the face and beneath the pleurae and
pericardium
• There may be congestion of viscera

• Lungs will show marked pulmonary edema
• There may be Petichiael hemorrhage in the meninges. Other changes in the brain or
spinal cord can only be appreciated by histological examination which is not specific
• These are not specific signs and can be seen in other forms of asphyxia deaths. In
case of death from ventricular fibrillation little change may be found which are non-
specific
• The electric mark on the skin coupled with asphyxia signs will invariably diagnose the
death from electrocution.
152
ELECTROCUTION, LIGHTNING 17
Causes of Death in Electrocution
• Neurogenic shock due to vagal inhibition as a result of sudden surprise
• Myocardial fibrillation if current passes through the heart
• Paralysis of the respiratory center if the current passes through the medulla oblongata
• Severe electric burn may cause death from hemoglobinuric nephrosis
Medico Legal Importance
The majority of the fatalities are due to
1. Accidental contact occurring from domestic supply and the domestic appliances which
call for special attention include portable electric fires, electric kettle, irons, vacuum
cleaners, radios, TV, lamps, electric drills, soldering irons etc. New power of light points or
repairs of defective appliances should not be venture by the untrained. Defective wiring
sometimes causes accidental electrocution.
2. Suicidal electrocutions are also common by wiring wrist, neck or in bath by live wire
beneath the body.
3. Homicidal electrocution is uncommon. This may be committed by placing the live wire
where the person is expected to touch.
4. Judicial electrocution is practiced in some countries.
LIGHTNING
This is an electrical discharge from a cloud to earth
through an object. This generates huge amount of
electrical injury. The electric current is direct and is about
100 million volts or more.
If the object is human being where the discharge of

electricity passes the effects are as follows:
Fig. 17.3. Arborescent marks on
1. Burning which may have zigzag lines
the abdomen
2. Arborescent marks due to resistance. These look like
branching tree.
3. Magnetization of metallic articles, such as keys, ring, metallic buttons etc on the body
4. Physical damage
153
There may be entrance point which torn clothes, fractures bones etc and electrical
discharge finds it, way through the feet, the skin may be ruptured at the point of exit and
shoes may be torn.
5. Cardiac arrest due to flow of the current.
Medico Legal Importance
1. Burn injuries on the body due to extensive heat
2. Streaky surface burns which involve only the epidermal layer of the skin producing
pattern like the branches of a tree and therefore known as arborescent markings.
3. Lacerated wounds, fracture of bones and thermal injuries are the constant features.
Chapter
18
MECHANICAL ASPHYXIA
General Signs Of Asphyxial Deaths 156

Hanging 157
Strangulaon 161
Suffocaon 164
Smothering 164
Choking 165
Traumac Asphyxia 165
155
18 MECHANICAL ASPHYXIA
During the modern days there are enormous disputes about the meaning and use of the
word asphyxia.
Basically, it means, deficient oxygen supply to the tissue. Mechanical asphyxia may be
caused in a number of ways such as:
1. Hanging
2. Strangulation
3. Suffocation occurring from-
a. Smothering (closure of mouth and nostrils)
b. Choking (inhalation of solid object)
c. Crush or Traumatic asphyxia (affected by the compression of the chest)
Apart from the above causes the asphyxia may occur from overdose of alcohol,
barbiturates, cyanides and also when a person is exposed in an atmosphere containing
carbon monoxide or carbon dioxide or some other irrespirable gases. Asphyxia also occurs
quite rapidly amongst the persons entering tanks, wells, mines or ship compartments where
oxygen has been consumed due to some chemical action. Under such circumstances the
person abruptly dies because of absence of oxygen. These conditions do not come under
mechanical asphyxia. Even the death occurring from drowning does not come strictly under
mechanical asphyxia. The death occurring from drowning is complex and discussed
separately.
GENERAL SIGNS OF ASPHYXIAL DEATHS

There are three cardinal signs of asphyxia:
1. Cyanosis
This is due to diminished oxygen tension in the blood and increased reduced hemoglobin.
Blood therefore appears purple or dark in color. The manifestation of cyanosis ordinarily
requires a minimum concentration of 5gm of reduced Hb/ 100cc of blood. A victim may not
show cyanosis if he is anemic and contain less than 5g of reduced Hb/100cc of blood.
2. Congestion
3. Petichiael hemorrhage (Tardius spot)
The above signs are due to raised venous pressure, deficient oxygenation in the lungs
damage to the capillary wall which may rupture producing petechiael hemorrhage.
Petechiael hemorrhages are small, of pinhead size, occur due to rupture of capillaries.
These are known as Tardius spots, which have been named after the French Police
surgeon who described them in the year 1866. Petechiael hemorrhages are best seen in
the area where the capillaries are least supported such as eyelids and lips. Petechiael
hemorrhages should be looked in the eyelids, sclera, conjunctiva, and on the face. In
several cases they may be visible on the other parts of the body.
156
MECHANICAL ASPHYXIA 18
The signs of asphyxia may be maximum in some form of deaths and minimum or even
absent in other from of deaths. When the asphyxia is due to ligature on the neck or
compression of the chest the sighs of asphyxia are more prominent above the line of the
compression. This is due to added mechanical obstruction of the blood flow from the head
and neck.
The signs of asphyxia may be summarized as following:
Asphyxia Oxygen tension reduced and increased reduced Hemoglo-

bin
P.M. Hypostasis purple or blue in color

Cyanosis
Capillary Engorgement
Visceral Congestion
Raised Intra Capillary Pressure and increased capillary permeability
Petechiael hemorrhages
Rupture
Fig. 18.1. Signs of Asphyxia
These hemorrhages may also develop before death during agonal period and as such it is
difficult to determine when they appeared. Naturally they lose the pathognomonic
significances in establishing lethal asphyxia. It is only diagnostic when it is in association
with the reliable features of compression of neck or chest or nose and mouth.
HANGING
Hanging is a form of death in which a rope, cable or strap or some other ligature material is
placed around the neck and body is suspended, the constricting force being the weight of
the body. Most of the suicide hangings are from low point suspension and as such the feet
157
may touch the ground.
This is partial hanging
and the constricting force
is the weight of the head.
Causes of Death
Hanging usually kills by

four mechanisms.
Asphyxia. This occurs

due to closure of air
passage by upward and
backward displacement
of the tongue and
adjacent soft tissues.
Venous congestion.
This is due to obstruction
of the venous return from
the brain.
Combined Asphyxia Fig. 18.2. Mechanism of death in asphyxia

and Venous
congestion. This is the commonest
mechanism.
Cerebral Anoxia. Due to prevention of

arterial blood flow to the brain.
Rarely, death may also occur from

cardiac arrest due to pressure on the
carotid bodies by the ligature. In such
deaths the asphyxial signs will be
absent.
In cases of sudden drop as seen in

judicial hanging the death is due to
fracture dislocation of the cervical
vertebrate. Usually the 2nd or 3rd
cervical vertebrate is involved. This A B C
lacerates the spinal cord causing AFig. 18.3. Hanging
instantaneous death. A. Partial Hanging
B. Complete Hanging
C. Hanging with feet touching the ground
158
Post Mortem Appearance
External signs
External finding on the neck by the ligature material is highly variable. They are dependent
on the texture, width, position of the ligature and the victim along with the duration of
suspension.
The ligature mark is ordinarily situated above the thyroid cartilage and runs obliquely
upwards, forwards and backwards. The ligature mark is usually deficient at the point of
knot. The appearance is pale, hard and leathery like when examined soon after cutting the
ligature. Subsequently it becomes dark brown or chocolate colored. The margins may be
red and congested. There are rarely bruising or abrasions present on the neck and if found
there, may be strong suspicion of throttling before hanging the victim. There may be more
than one ligature mark that may appear overlapping each other if the ligature material has
been rounded many times. There may not be ligature mark if the ligature happened to be
soft and the victim was removed soon after suspension. The pattern of the ligature material
is quite often reproduced on the neck. Sometimes tight neckwear of the victim may also
show a mark on the neck resembling hanging. These appearances should always be kept
in mind. Occasionally the natural folds of the skin in the neck appear pale by contact
flattening and simulate ligature mark as in hanging. Whenever, a doctor is called to
examine the scene of occurrence he should make sure that the ligature is not cut from the
point of knot. This would help him to reconstruct his opinion whether such a knot is possible
by victim or not. In homicidal cases the knot may be tied in such a fashion which is not
possible by the person attempting suicide by hanging.
The sign of asphyxia is not well marked in death due to hanging. The face appears pale in
most of the cases. The most important signs of hanging are the presence of saliva at the
angle of mouth. This can only happen when the person has been alive before application of
the ligature on the neck. Blood stained froth around the mouth and nostrils are uncommon.
The head is titled towards the opposite side of the knot. The tongue is quite often protruded
and may be bitten with the teeth or may remain even inside the mouth. The right eye may
be open and left closed with the left pupil small and the right dilated or vice-versa. Some
forensic experts believe them to be an important finding of ante mortem hanging. The
mechanism of this feature is presumed to be due to unequal tension on the neck structures.
Occasionally the petechiael hemorrhage may be seen on the face and under the
conjunctiva.
Post-mortem hypostasis is well marked on the limbs if the body has been suspended for a
longer duration. The genital organs are usually congested with emission of semen around
urethral meatus.
Internal Signs
The subcutaneous tissue under a ligature mark is usually dry and white. Occasionally there
may be bruising and rupture of the sternomastoid and platysma muscle. There may be little
hemorrhage between the pharynx and the spine.
159
In cases of high point suspension, the inner and middle coat of the carotid arteries may
show lacerations. The epiglottis may be found congested. The processes of the thyroid
cartilage are usually seen fractured amongst the elderly people. In younger people it is
seldom fractured because it is not hard and brittle as in elderly people. The hyoid bone is
seldom fractured. The viscera may be congested or even appear normal. In judicial
hanging, there will be laceration of the spinal cord.
Medicolegal Importance
Diagnosis of hanging. Ligature mark alone is not sufficient to establish death due to
hanging. Ligature mark may be produced if the body is suspended for sometime soon after
death. Again there may not be any ligature mark although the person dies of hanging. This
possibility occurs when the ligature material had been soft such as cloth and the victim was
taken down soon after suspension. However, the diagnosis can be made if besides the
ligature mark there is dribbling of the saliva, laceration of the intima of the carotid arteries,
some sign of asphyxia and no other trauma, poisoning and any other strong evidence of
natural disease.
Once the diagnosis has been made there may be enquiry to know whether it is suicidal,
accidental or homicide. Hanging is usually suicidal. There may be a suicidal note left near
the place of hanging. While committing suicide from hanging, a solitary place is chosen. If it
is committed in room, the same is almost always bolted from inside. There should be some
furniture or similar object to facilitating the suspension of the body.
Homicidal hanging is rare. It is a great task to hang a robust person. However it can be
possible when more than one person is involved in the crime. This would naturally leave the
signs of injuries on the body of the victim and the assailant. More over, the place will appear
disturbed suggesting resistance by the victim. Obviously, homicidal hanging is possible by a
single person if the victim is a child or when weak or debilitated or even drunk or
intoxicated.
Accidental hanging usually occurs amongst children while imitating punishment by hanging.
During the current days accidental hanging is seen amongst young white males while
masochistic practice. This is called sexual asphyxia or masochistic asphyxia or autoerotic
cervical compression. Mild asphyxia is known to give some sort of sexual pleasure. Such
person puts ligature on the neck, with a device that tension on the neck is not sustained
and relaxation should occur before it is too late. The common ingredient is the binding of
the extremities, ligature on the neck, wearing of the female dresses and presence of
pornographic literatures. Masochistic practice is always done in a lonely place such as a
toilet or closed room. The other end of the ligature is an applied to the shower pipe or the
handle or the flush pipe etc. Sometime the mechanism fails and the tension on the neck is
continued causing unconsciousness and subsequently the person dies.
160
STRANGULATION
This is caused by the constriction of the neck without suspension of the body. The
constriction of the neck is brought about by that the constricting material, and not the weight
of the victim. This differentiates it with hanging. The most important sign of hanging is saliva
at the angle of the mouth. This is commonly affected by placing a ligature round the neck.
This is termed Manual Strangulation or Throttling when the neck is compressed with the
help of fingers and palms. This is known as Mugging if it is done with the help of foot, knee,
elbow or some stick. Garroting is a form of ligature strangulation when the ligature is
applied on the victim’s neck abruptly from behind and the person is not aware of this. As a
mode of lawful execution, it is practiced in Spain and Turkey.
Causes of Death
• Commonly asphyxia that is due to closure of the air passage.
• Venous congestion of the brain

Fig. 18.4. Subconjunctival Hemorrhage
• Combined asphyxia and
venous congestion
• Cerebral anoxia caused

by construction of carotid
arteries.
• Reflex cardiac arrest due

to pressure of carotid
bodies on the neck.
Post-Mortem Appearances
External Signs - On The Neck
The ligature should be

removed by cutting it at a
distance from the knot. There
may not be any ligature mark if
it happened to be soft and was
removed soon after death. A
rough ligature applied with Fig. 18.5. Features in strangulation
great force, may produce
enormous bruising and abrasion on the neck.
The ligature mark is usually applied at or below the level of the thyroid cartilage and is
horizontal, completely encircling the neck. In cases of garroting, when the ligature is applied
suddenly from the behind, it lies on the upper part of neck close to chin and runs obliquely
behind the neck. Obviously, there will not be any ligature impression behind the neck.
161
There is a narrow zone of engorgement or bruising immediately above and below the
ligature groove. This suggests ante-mortem strangulation. The ligature groove is pale,
becoming chocolate color after sometime.
Quite frequently, there is a pattern that may point to a particular ligature material such as
belt or chain. Multiple turns of the ligature will produce several ligature impressions on the
neck overlapping with each other. Occasionally the fibers of the ligature material may be
found on the neck. This may be of great help particularly when the ligature material was
detected later and exhibits similar findings.
A closer scrutiny of ligature material may establish the flattering of the fibers on those areas
that were in contact with the neck during strangulation. Such trace evidences can be taken
off by applying thin adhesive tape around the neck. This can be examined under
microscope directly for fibers.
Examination of neck under ultra violet light may also reveal the pattern of nature of the
ligature.
In the cases of throttling (manual strangulation) there may be soft red bruises on the neck.
These are due to pressure of the fingers on the neck and are known as finger tip bruising.
Quite often one oval bruise is seen on the right side of the neck due to pressure of the
thumb and the other fingers leave their impression on the other side of the neck. This
happens when the assailant is a right-handed person. A left handed person would normally
leave the impression on the opposite side of the neck.
These fingertip bruising depends on the direction of the assailant, the victim’s position as
well as the application of one or both the hands. If both the hands have been used there will
be multiple bruising on the neck.
Further, there may not be any impression of the fingers on the neck if there had been
intervening cloth between them.
Since a great force is applied on the neck there may be crescent abrasions on the neck
because the nails of the assailant pierce the skin and can be helpful if the same is
compared. If the nails of the assailant contained some skin or blood traces of the victim, the
charge of homicide may be regarded as almost certain. In other words the nails of the
assailant if present may leave their own signature on the victim’s neck and can also take
some positive evidence from the victim’s neck.
External Signs - On The Body
The signs of asphyxia viz. Cyanosis, congestion and petechiael hemorrhage are well
marked.
The face appears swollen with prominent eyeballs and protruded tongue.
162
The body may bear other signs of assault. There may be signs of sexual assault showing
bruising around the inner thighs. Love bites either on the neck, breasts and cheeks besides
the injuries to genitals.
There may be bleeding around the mouth, nostrils, and ears.
Eyes are suffused and there may be subconjunctival hemorrhage.
In cases of death occurring due to reflex cardiac arrest there may not be any sign of
asphyxial deaths or bruising and fracture of neck structures. The diagnosis of death due to
reflex cardiac arrest is only possible when the other possible causes of death are excluded
and there is positive circumstantial evidence.
In cases of mugging there will be marks of violence on the front part of neck. The asphyxia
signs viz. cyanosis, congestion and petechiael hemorrhage are most prominent above the
constriction point.
Throttling shows disparity in strength between assailant and victim. Victims of throttling are
almost always females by adult males.
Homicidal manual strangulation is seldom a planned crime but indicates that the assailant
was extremely emotionally disturbed at the time of fatal assault. This is usually the outcome
when the assailant attempt to silence his victim by her cries as he was involved in some
other crime, usually rape or robbery.
Internal Signs
Ligature strangulation produces bruising of the neck structures at the same level.
In cases of throttling, there is hemorrhage in the wider area of the neck muscles because of
the shifting of the pressures of the fingers and palm.
There is severe engorgement of the pharynx, tonsils and the root of the tongue.
There may be laceration of the intima and middle coat of the carotid arteries.
Fractures of the thyroid cartilage and the hyoid bone are invariably seen.
The respiratory passages are filled up with frothy blood. Tracheal rings are rarely ruptured.
The viscera show signs of congestion. Petechiael hemorrhages can be seen on the pleura,
pericardium and meninges.
The asphyxia signs viz. cyanosis, congestion and petechiael hemorrhage are most
prominent above the constriction point.
163
Medicolegal Significance
Strangulation is almost always homicidal. Females are largely, the victim of strangulation
which is committed during sexual assault. As such in death of females from strangulation, it
is essential to look for sexual violence.
Strangulation is a common method of infanticide.
Cases of suicidal and accidental strangulation do occur and rarely presents any difficulty in
ascertaining the manner of death.
SUFFOCATION
Suffocation is applied to that form of death, which results from exclusion of air from lungs,
by means other than compression of neck.
This comprises the following:
• Smothering (Closure of mouth and nostrils)
• Choking (Entrance of solid material in the respiratory passage)
• Compression of the chest (Traumatic asphyxia)
SMOTHERING
This is the commonest method for killing an infant. If this is committed in a skilled manner,
the body may disclose no evidence of trauma. For example, if a soft pillow is kept around
the mouth and nostrils of an infant, death will certainly occur, and there will not be any sign
of local violence. Diagnosis of death will be based in such circumstances from the finding of
congestion of viscera and petechiael hemorrhages on pericardium, meninges and thymus.
There may be external signs of cyanosis and petechiael hemorrhages on the body. The
diagnosis of death due to smothering in cases of infanticide is more or less a guess work
and all other circumstances should be weighed properly. There are many other natural
deaths in infants such as “Sudden infant death syndrome” which exhibit more or less similar
post mortem appearances. Apart from the infants, the victim may be an adult who has been
rendered incapable of relieving the obstruction because of the diseases or the influence of
alcohol or drugs.
Accidental smothering may occur when a debilitated person falls on mud, sand or similar
other medium. Rarely an infant dies of accidental smothering. Suicidal smothering, although
rare, has been occurring amongst insane persons.
164
INTRODUCTION TO FORENSIC MEDICINE, MEDICAL JURISPRUDENCE, AND TOXICOLOGY 1
Post-Mortem Signs
Smothering committed by hand would normally show fingertip bruising and crescent nail
abrasions on the victim’s face. It is possible to detect the suspected person by comparing
their nails with that of the injury on the face of the victim. Presence of bloodstains and skin
or tissue fragments if found contained under the nail with that of the injury on the face of the
victim is of great significance and is helpful in corroborating the offense.
The other signs would include:
1. Asphyxia signs
2. Laceration of the inner lips
3. Fracture of the nasal septum and bone
CHOKING
In choking death occurs from inhalation of a solid object or food in the respiratory passage.
It is not necessary that the foreign material should be of such a size to completely occlude
the respiratory passage. Even a small object when inhaled may cause reflex spasm of the
respiratory muscles and death. Gagging is that form of choking where some other similar
object is plugged inside mouth. Ordinarily, it may not lead to death but when the material is
soaked with salvia it may block the air passage and cause death. Gagging is usually
homicidal but may be accidental during anesthesia.
There will be presence of foreign body responsible for choking. In cases of homicidal
gagging there will be external signs of struggle with injuries on the lips, tongue and inner
cheeks.
TRAUMATIC ASPHYXIA
Traumatic asphyxia is a form of asphyxial death occurring from the compression of the
chest. This results from a variety of conditions such as compression of the chest in a
vehicle, in a house collapse, stampedes in the crowd, steering of a motor vehicle impacting
the chest etc. It is essentially an accidental death. Occasionally, homicidal cases may
occur.
The signs of asphyxia such as cyanosis, congestion and petechiael hemorrhages are well
marked. They are very prominent above the line of compression of the chest. Bleeding from
the mouth, nose and ears are almost always present. Eyes are congested with
subconjunctival hemorrhage. There may be extensive bruising and abrasions on the chest.
Other parts of the body may show multiple injuries.
165
Hemorrhage in vocal cords in strangu-

lation
Ligature mark in Hanging Death due to Hanging
Suffocation (Plastic Bag, Pillow)
Gagging Ligature (Hanging, Strangulation)
Throttling
Choking (Jammed Food, Inhaled
Foreign Body)
Trauma (Road Traffic Acci-

dent, Collapse of house)
Food material in esophagus
Traumatic Asphyxia Suffused face of victim in traumatic asphyxia
Fig. 18.6. Deaths due to asphyxia
166
Internally, there may be bruising of the chest muscles with fractures of the ribs, manubrium
and sternum. lntrathoracic hemorrhage will be invariably seen. There may be lacerations of
the chest muscles or the pleura, lungs, pericardium or even cardiac tamponade resulting in
intra-thoracic hemorrhage.
HANGING STRANGULATION
Generally suicidal. Generally Homicidal
Ligature mark is situated high up in the Ligature mark is located on the lower part of
neck, which runs obliquely and is defi- the neck. This is usually complete.
cient, at the point of knot.
Abrasions and contusions are rare Very common.

around the ligature mark.
Subcutaneous tissue under the skin dry, Subcutaneous tissue ecchymosed.

white and shining.
Rupture of carotid arteries common in Rupture very common.

high point suspension.
Injuries on the other parts of the body are Very common.

rare.
Sexual assault absent. Usually present.
Saliva dribbles round the angle of mouth. Bleeding from orifices.
Table 18.1. Differences between Hanging and Strangulation
167
Chapter
19
DROWNING
Flotaon Of Body 170

Mechanism Of Drowning 170
Fresh Water Drowning 170
Sea Water Drowning 171
Diatom Test 173
169
19 DROWNING
Drowning is a form of death in which there is flooding of airways because of submersion of
a person in a fluid medium. Because of the buoyancy of the body and movement of the
limbs, the victim comes over the surface of the water and shouts for help. Consequently, air
is exhaled and water is inhaled. The person comes over the surface of the water and goes
underwater for a few times until the person dies. Occasionally, the people sink under water
and are detected at a later time on some distance from the place of submersion. The
process of drowning is variable from person to person and dependent on current of the
water, depth of the water, marine plants present under water.
Flotation of body
Due to putrefaction, the gases developed within the submerged body causes flotation of a
body on the surface of the water. Flotation time in Nepal and India is about 24 hours in
summer and within 2 to 3 days or more in winter. The flotation time in temperate climate is
about a week in summer, and is about a fortnight in winter. The flotation time is increased if
the dead body is entangled in weeds etc or tied with heavy weight before immersion. The
period of flotation depends on the age, sex, fatty bodies, temperature and type of water. A
fully developed well nourished infant floats rapidly. Female bodies float sooner because of
the lightness of the bone and more fat. Fatty bodies float quicker than lean and thin bodies
as fat has a lower specific gravity. Dead bodies float quicker in summer than in winter.
Flotation time is early in shallow and stagnant water of a pond than in the deep water of a
running stream.
The rate of putrefaction is slower in water than in air. As the submerged dead body floats
face down with the head lower than the trunk, the postmortem greenish discoloration and
gaseous distention are first seen on the face.
MECHANISM OF DROWNING
The precise mechanism of drowning is highly complex. In majority of cases the inhalation of
fluids causes obstruction to the air passage contributing death. The Inhaled fluids are
churned up in the lungs, which combines with mucus and surfactants of the alveoli
producing tenacious froth. The froth blocks the air vesicles.
FRESH WATER DROWNING
In fresh water drowning there may be rapid absorption of water across the alveolar space
raising the blood volume. Consequently, there is hypervolemia, hemodilution and
hemolysis. Due to hemolysis, the hemoglobin and potassium contained in the red blood
corpuscles are liberated. Potassium in high dose is an established poison to the heart.
Simultaneously, there is gross electrolyte imbalance. Besides obstruction to the air
passage, there is enormous load to heart because of hypervolemia. The presence of
liberated potassium further weakens the function of the heart. Accordingly, ventricular
fibrillation sets in and the blood pressure fall. They all combine together resulting in death
due to myocardial failure and cerebral anoxia. Normally the chloride content of both the
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DROWNING 19
chambers of the heart is same. In fresh water drowning, the chloride content of the left
chamber of the heart is diminished due to the flow of the diluted blood in the left side.
SEA WATER DROWNING
In majority of the cases, time of death in seawater drowning is delayed as compared to the
fresh water drowning. Seawater is hypertonic in nature. Accordingly, there is no
hemodilution, hypervolemia or hemolysis. Hemoconcentration occurs. There is no fall of
blood pressure and death is due to myocardial anoxia. The chloride content is higher on the
left side of the heart. Pulmonary edema is an important finding in seawater drowning.
In minority of the cases, only a small quantity of water is inhaled and there is neither
mechanical obstruction nor absorption of water into the circulation. In these cases, death
may result abruptly due to cardiac arrest. Sometimes a small quantity of water in the air
passage may cause reflex laryngeal spasm and abrupt death. Again immersion in cold
water may cause stimulation of skin receptors and immediate death. This is referred to as
“Cold immersion syndrome”. This should be regarded different from drowning since there is
no inhalation of water and post-mortem signs and the mechanism of death varies from
those who inhales water.
Water
Hypervolemia
Immediate cardiac arrest Acute Cardiac
from laryngospasm Failure
K+
K+
Massive
Absorption
K+
Hemolysis and hyperkalemia
Fig. 19.1. Mechanism of Death due to Fresh water drowning
POST-MORTEM SIGNS
External Signs
Postmortem hypostasis is usually confined to head and neck because of the position of
victim in water that is upside down. Immersion in cold water exhibits bright pink color post-
mortem hypostasis. This is due to exposure and oxygenation of the dependent blood. There
may be contraction of the arrector pili muscles of the hair follicles resembling goose flesh.
This is knows as “cutis anserine” .This happens when the body is immersed in cold water.
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19 DROWNING
This has no medico-legal significance, since this can happen also when a body is thrown in
the cold water soon after death.
There may be fine, white, leathery froth around mouth and nostrils. This is an important sign
of drowning. However, it must be remembered that froth may appear in cases of
strangulation, pulmonary edema, and opium poising and even in an epileptic fit. The froth in
drowning cases are abundant, long-lasting and have tenacious character and if wiped away
more froth will appear. This is essentially a vital phenomenon. It is unusual for other causes
to produce similar froth of that character. Even in cases of putrefaction, blood stained fluid
containing bubbles of gas is present but is not persistent neither tenacious in character as
seen in drowning and will show other signs of decomposition.
The conjunctivae are sometimes suffused. Occasionally petechiael hemorrhages may be

seen under the conjunctiva. Cadaveric spasm, although rare, is seen and the victim may be
holding weeds, seed etc. which would then indicate ante-mortem drowning.
There may be injuries on the other parts of the body due to striking the body on some hard
object.
There may be post-mortem injuries by fish or other insects when the body remains under
water. These can be differentiated from the ante-mortem injuries by noticing the absence of
Fig. 19.2. Drowning

(Left) Washerwoman’s hand (degloving)
(Top) Cadaveric Spasm with grass in fist
hemorrhage and other vital reactions. In case the body had been lying under the water for a
considerable period, the hands and feet would show signs of corrugation and bleaching
known as the “washer woman’s hand”. Sometimes the skin of the hand comes out as glove
if pulled with force.
Internal Signs
Froth is usually in the air passages. There may be variable amount of water in the lungs.
On changing the posture of body, water may come from the mouth. It is an important sign of
drowning. The pleura may be discolored due to presence of hemorrhages from the
compression of the interalveolar septa. Their absence does not exclude drowning but their
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DROWNING 19
presence is of high medicolegal value. The larynx and trachea may be congested
containing froth. The lungs are bulky, heavy and edematous. There may be rib markings
because of distention and close proximity with the ribs. They pit on pressure. Generally they
appear pale. On cut section frothy blood comes out. The picture of the lung in drowning has
been described as “Emphysema aquosum” and that is presumptive evidence of drowning.
Similar findings may be seen in other cases of death but can be eliminated by noticing other
signs. However, the appearance of emphysema aquosum will depend on the absence of
extensive pleural adhesions. This will not be seen in deaths occurring due to cardiac arrest.
Stomach always contains the similar type of water where the victim drowned. Absence of
water in the stomach may indicate that the person was dead before immersion or had
abrupt death as seen in deaths from reflex cardiac arrest. Other viscera may be found
normal or even congested. Water may be present in the middle ear. This occurs through
Eustachian tube during the violent act of drowning. Introducing a clean and dry thin glass
rod through tympanic membrane can demonstrate this - water may be seen running out
from the perforated membrane.
DIATOM TEST
This is an important test for ascertaining death due to drowning. Diatoms are unicellular
plants having silica coating. Most of the water of the sea, river, ponds and canals contain
them. When a person inhales water as in active drowning, diatoms are rapidly circulated in
the body. These are stored in the viscera and bone marrows. However, if a person was
thrown into the water after murder, diatoms won’t enter the circulation.
The test material is usually the bone marrow that is collected very carefully by avoiding any
contamination. The bone marrow, so collected, are dissolved in strong acid. They resist
acid digestion since they have silica coatings. Examination under microscope would show
various types of diatoms. For a positive test one has to demonstrate several diatoms in one
field.
FALLACIES OF DI-ATOMS
1. There may not be diatoms in the water
2. There may be pollutions of diatoms in atmosphere.
3. Contamination during autopsy.
However the most of the fallacies can be disregarded if one can demonstrate large number
of diatoms.
Medicolegal Significance
Most causes of drowning are accidental, occasionally suicidal and rarely homicidal. In
homicidal death, the body may bear some signs of struggle injuries. However, if the person
is thrown abruptly without any quarrel, the body will not show any sign of injuries and it will
173
be for the investigating agency to substantiate this. In cases of suicidal and accidental
deaths, the history will tell the whole story about the manner of death.
Diagram Of Diatoms
Fig. 19.3. Diatoms

Chapter
20
STARVATION
Starvation may occur from actual deprivation of food or from the administration of
unsuitable food.
It is two types:
a. Acute
b. Chronic
If both water and food are completely withheld, death occurs in 10 to 12 days. If food alone
is withdrawn, death occurs in about 6 to 8 weeks.
The chief features in the beginning include hunger pain, thirst weakness and lack of
concentration. Hunger pain is more marked on 2nd or 3rd day of starvation. Constipation and
oliguria occurs by this period. Gradually there is extreme emaciation and general reduction
in size and weight of all the organs except the brain. By 3rd day the blood sugar, blood
pressure and pulse rate starts falling.
Subsequently, fat is almost absent in the subcutaneous and intracellular tissues and also in
the omentum. Subcutaneous patches of edema are seen around the ankles, thighs, under
the chin, cheeks and eyelids. The skin becomes cracked and pigmented, hair is dry,
lusterless and brittle. In acute starvation, first the reserve fat and lastly the protein are
gradually lost due to use. Due to loss of fat, the cheeks and abdomen become hollow and
sunken. The scanty urine has a high specific gravity, is turbid in appearance and strongly
acidic in reaction. There may be presence of ketone in urine.
Postmortem examination will show enlarged gall bladder which contains thick bile.
Enlargement of gall bladder is due to decreased drainage of bile as the stomach is empty.
The intestinal wall is quite thin and translucent. The stomach and intestine appear like
tissue paper with atrophy of mucosae. There may be superficial and extensive nonspecific
ulceration of the bowel.
Medicolegal Aspects:
Mostly accidental natural calamities like flood, cyclone and earth quake etc.
Suicidal- in protests “hunger strike”
Homicidal- (Rare) To abort unwanted babies or when person is kept in confinement.
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Chapter
21
VIRGINITY
Virginity And Defloraon 178

Signs Of Virginity 178
Genital Findings 178
Breasts 179
Medico Legal Aspects 179
True Virgin 180
False Virgin 180
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21 VIRGINITY
VIRGINITY AND DEFLORATION

A woman is virgin who has not experienced sexual intercourse. Such woman is labeled as
‘Virgo intacta’.
Defloration means loss of virginity of a woman, who had experienced sexual intercourse for
once at least.
Virginity and defloration have legal importance. The question as to whether a woman is a
virgin arises in cases of nullity of marriage, divorce, defamation and rape.
Divorce involves the dissolution of a previously valid marriage, but in certain circumstances,
a “marriage”, may be annulled i.e. declared never to have existed in law.
SIGNS OF VIRGINITY
A virgin woman has certain classical features in her genitalia which may be lost during the
first act of sexual intercourse.
Genital findings
Hymen
The hymen is a thin fold of mucous membrane situated at the orifice of the vagina. It
ruptures during the act of sexual intercourse unless the hymen is thick fold of mucous
membrane. Hymen is generally annular with a central opening and may be of different
shapes and appearances. It may be semilunar or crescentic with the opening anteriorly. It
may be septum of hymenal tissue. Its free margin is sometimes fimbriated having numerous
notches which may be of cribriform type with multiple openings.
Sometimes, hymenal orifice may have vertical opening. Rarely, the hymen may be of
imperforate type when they form a complete septum across the lower end of the vagina.
During the first act of coitus the hymen is usually ruptured posteriorly at 5, 6 or 7 o’ clock
position. On repeated sexual intercourse the hymen will show the presence of tags of the
hymenal tissue which is known as carunculae hymenales. After delivery of a child the
hymen is almost abolished with presence of its remnant only near the marginal attachment
and then known as carunculae myrtiformis.
Besides the act of coitus, the hymen may be ruptured by-

1. Surgical interference.
2. Fall on a projecting substance but rupture of hymen alone is highly improbable and
presence of other injuries in the adjoining area of the genitalia will be seen.
3. Masturbation, if practiced with artificial phallus or some other foreign body. However,
hymen is not destroyed in most cases as the masturbation practice is limited to parts
anterior to hymen. However the clitoris is enlarged by the continued practice of
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VIRGINITY 21
masturbation. The hymen is liable to be ruptured by the forcible introduction of a stick
or finger.
4. The insertion of sanitary tampons.
5. A foreign body known as “solapith” or “laminaria tent” introduced purposely with
intention to making young girls fit for sexual intercourse. The usual procedure is to
insert a solapith as large as vagina can contain and then to make the girl sit in a tub
of water. The pith swells up as a sponge tent and dilates the vagina. This is known as
aptoe virus. Such procedure is adopted by the old prostitutes on young girls to
bargain a greater price from their clients for allowing sexual intercourse with them.
Now this is of historical importance.
6. Ulceration from diphtheria or threadworm infestation.
7. Chronic scratching
The labia majora
Labia majora of a virgin woman are usually thick, firm, elastic, well rounded and lie in
contact with each other and cover the vagina.
The labia minora and Clitoris
These are soft small and pink colored. The clitoris is small.
The vestibule
This is a triangular area between labia minora, with the clitoris as the apex and anterior
margin of the hymen at the base. It is narrow.
The vagina
It is narrow and tight.
Breasts
These are hemispherical, firm, with pinkish areola and small nipples. However these signs
do not change due to few sexual intercourse taking place at longer intervals. But frequent
acts of intercourse, the breasts are enlarged and pendulous. The pinkish color of the areola
in fair complexioned women becomes dark during pregnancy and usually do not exhibit its
original color after delivery.
Medico legal aspects
It is clear that the presence of an intact hymen is not an absolute sign of virginity. With an
intact hymen there are “true virgins” and “false virgins”.
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21 VIRGINITY
True virgin
With an intact hymen, the edges of the membrane are regular, with an orifice of small
dimension and when a terminal phalanx of finger is introduced the hymen is well stretched
and the woman experiences pain and hence there is every possibility that the girl is virgin.
False virgin
A woman who has experienced repeated sexual intercourse but the hymen is intact. This
may occur when the hymen is thick, tough, fleshy, elastic and loose. In such cases other
signs of defloration viz. labia majora, labia minora etc. are taken into consideration. If the
Labia majora are separated from each other, not in close apposition, have rather a gap in
between the two sides, through which the labia minoras peep out, the rugosity of the vagina
is minimized and the orifice spacious, there is every possibility that the lady in question is
not virgin. The vestibule becomes spacious with frequent coitus.
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Chapter
22
PREGNANCY AND DELIVERY
Pregnancy 182
Delivery 183
181
22 PREGNANCY AND DELIVERY
PREGNANCY
When does a doctor need to test for pregnancy in a female?
1. When a lady summoned as a witness in a court and says she may miscarry while
attending the court and so may be exempted for attending the court for witness. This
must be accompanied with the doctor’s advice.
2. When a condemned lady refuses to do hard work citing her pregnancy.
3. When an unmarried girl/widow/married lady residing apart from her husband is
accused of pregnancy.
4. In breach of promise for marriage when the lady advances pregnancy as a plea
5. If pregnancy is a motive for suicide.
6. When a lady demands greater compensation from the person from whose negligence
her husband died.
7. Concealment of birth or infanticide.
Absolute signs of pregnancy
1. Fetal Heart Sound- 18th- 20th week of pregnancy, 120-160/min and nonsynchronous
with maternal pulse.
2. Fetal Movements/Parts 16-20 weeks
3. X-ray exam after 16th week.
4. Sonography as early as 6th week (gestational ring), 8th week echo in gestational ring,
after 8th week embryo, 12th week heart movements, 14th week head and spinal
column seen.
5. Immunological test hCG, Latex Agglutination test
Presumptive and Probable signs of pregnancy
1. Cessation of menstruation.
2. Morning sickness.
3. Craving for sour/ spicy food (Sympathetic disturbances).
4. Discoloration of vagina and vulva in the first month of pregnancy (violet blue)
(Chadwick’s/Jacquemire’s sign)
5. Goodell’s sign: Soon after pregnancy, cervix softens. In 6th month: Bimanually soft
6. Softening and compressibility of lower segment of uterus (Hegar’s sign)
7. Braxton Hicks Contraction- Painless contraction and relaxation of uterus
8. Ballotment: External and internal (Due to movement of fetus in liqor amnii)
9. Enlargement of uterus
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PREGNANCY AND DELIVERY 22
10. Uterine soufflé: Pulsation in uterine vessels (Soft blowing murmur synchronous with
maternal pulse)
11. Brest Changes: Enlargement, darkening of areola, hypertrophy of perialveolar tissue
(Montgomery’s tubercles), at 4-6th month a silvery line on breast similar to linea
albicans is seen
If a pregnant woman is the dead, following changes will be seen

1. Uterine Changes similar to that of a pregnant living woman
2. Corpus luteum in ovary
3. Embryo may be present
DELIVERY
Signs of recent delivery
1. Exhausted look, sunken eyes and signs of general indisposition
2. Breast is enlarged and contains colostrum or milk. The areola is dark and the
Montgomery’s tubercles are seen. There are silvery lines on the breasts similar to
linea albicans of the abdomen.
3. Whole abdomen is flabby, lax, pigmented and presence of linea albicans
4. Uterus just below umbilicus and may be felt little hard above the pubic symphysis. It
descends one centimeter per day and is felt like a hard cricket ball for about 2-3 days
in the lower part of the abdomen above pubic symphysis.
5. Vagina bruised or even lacerated. Blood discharge from vagina which is red in color
and lasts for about 4 days. This is known lochia rubra. Next, 4 days it becomes
serous and pale known as lochia serosa. In about 9th day the discharge appears pale
brown or green in color known as lochia alba.
6. Cervix lacerated and shows transverse tears and the external os is opened which
closes by in few days time. The internal os closes during the 1st 12 hours of delivery.
Signs of remote delivery

1. Breast enlarged nipple prominent and areola dark in color.
2. Vagina is patulous, relaxed, bruised and lacerated. There may be blood around the
vaginal orifice which is the lochia rubra.
3. Cervix will show scars and the external os are usually opened and which closes in
about 2-3 days time.
4. Abdomen will show the similar signs as seen after delivery in living cases viz.
enlarged and pigmented with presence of linea albicans.
5. Uterus - in the first 2 or 3 days after delivery it measures about 18 cm. long and
10cm. broad. It turns to normal size in about 6 week’s time. Soon after delivery the
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22 PREGNANCY AND DELIVERY
uterus usually weighs about 900gm. The placental attachment can be seen soon after
delivery. The ovaries and fallopian tubes look hyperemic.
Signs of remote delivery in living:
1. Abdomen - It is relaxed and will show silvery lines called linea albicans.
2. Breast- These are soft enlarged and marked with silvery lines similar to abdomen.
The areola becomes dark and the nipples are prominent and larger from that of virgin
women.
3. Vagina- The vagina becomes roomy. The hymen is lost and replaced by small tissues
known as carunculae myrtiformis. The perineum may be found ruptured and the
posterior commissure and the fourchette are destroyed.
4. Cervix- The cervix will show the signs of old tears and the margins are irregular and
ragged. The external os is wider.
5. Signs of remote delivery in dead will show the similar signs as seen in remote
delivery. The uterus can be examined and the size will be more then that of lady who
has not delivered any child. The walls are concave from inside, forming a wider cavity
where as the nulliparous uterus is convex on the inner aspect and has a smaller
capacity.
184
Chapter
23
ABORTION
Access To Safe Aboron Services 186

The Comprehensive Aboron Care Service 186
Aboron Law Of Nepal 187
Medicolegal Types Of Aboron 188
Natural Spontaneous Aboron 188
Criminal Aboron 188
Methods Employed To Procure Aboron 188
Drugs 188
Mechanical Means Of Producing Aboron 189
Medical Methods Of Aboron 189
Surgical Methods 190
Manual Vacuum Aspiraon 190
Dilataon And Cure<age 191
Introducon Of Irritant Paste Into The Cervix 191
Abdominal Hysterectomy 191
Insufflaon Of The Uterus 191
Dilataon Of Cervix And Oxytocin Infusion 191
Amnioc Fluid Replacement By Hypertonic Glucose Or Saline Soluon 191
Causes Of Death In Criminal Aboron 192
185
23 ABORTION
Abortion or miscarriage means the premature, spontaneous or induced evacuation of the
pregnant uterus, at any time of pregnancy, before the term is completed.
Abortion, whether spontaneous or induced, is one of the most common obstetric events in
the world, second only to childbirth. Forty- six million women around the world have induced
abortions every year, 78% of whom live in the developing world and the remaining 22% live
in the developed world. Where abortion is legally permitted, safe, and available,
complications are rare. Where abortion is restricted, illegal, and not accessible, women
resort to unsafe abortion that results in complications, long-term health problems, and even
death. (Alan Guttmacher Institute .1999)
Each year, 75 million of women world wide experience unwanted pregnancy. For many of
these women, contraceptives are not easily available. Others might be victims of rape
incest. About two thirds of the pregnancies end in abortions, both safe and unsafe. As most
of the abortion-related death are due to the complications of unsafe abortion and are
preventable, the international conference on population and development (ICPD) called for
access to safe abortion services.
ACCESS TO SAFE ABORTION SERVICES

Access to compassionate, quality services for complications arising from abortion post
abortion counseling and family planning services to reduce unwanted repeated pregnancy
and repeated abortion.
Unsafe induced abortion is defined as a pregnancy termination attempted by an untrained

person usually in an unhygienic way often leading to complications such as injury, infection
and excessive bleeding.
Safe induced abortion is defined as a pregnancy termination by a trained, legal (listed)

medical practitioner (health service provider) in a hygienic environment.
Abortion is also defined according to the types of procedures used and/or the timing of the
pregnancy termination:
1. First trimester (early) abortion- abortion that occurs within the first 12 weeks of
pregnancy
2. Second trimester-abortion that occurs between 13 and 22 weeks
3. Medical termination- abortion induced using abortifacient drug
THE COMPREHENSIVE ABORTION CARE SERVICE

In Nepal the Comprehensive Abortion Training Course is designed for health service
providers who are motivated to provide safe and comprehensive abortion care services.
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ABORTION 23
The Comprehensive Abortion Training Course goals are:
1. To create positive attitudes among service providers regarding the provision of
abortion services.
2. To give providers the knowledge and skills to perform comprehensive abortion care
services.
3. To build upon the knowledge and skills of post abortion care services.
The Comprehensive Abortion Care (CAC) training manuals have been developed with
three purposes in mind:
1. To guide the trainer to teach the skills necessary for provision of comprehensive
abortion care services as stated in Nepal Comprehensive Abortion care service
Manual.
2. To set out the protocols and provide learning guides/ checklists required to learn the
skills needed to establish a standard of care, and
3. To help expand comprehensive abortion care services throughout Nepal as described
in the Nepal comprehensive abortion training strategy and 2 year implementation
plan.
ABORTION LAW OF NEPAL

The Government of Nepal amended the Nepal criminal code (Muluki Ain) on 1st Chaitra
2058 (16th March 2002). Royal assent was given on 10th Asoj 2059 (27th September
2002). The procedural process for the safe abortion was approved by the cabinet on 10th
Poush 2060 (15th December 2003) for the implementation of the law. The new law
legalizes abortion under the following conditions.
1. Up to 12 weeks of gestation upon the request of the pregnant woman
2. Up to 18th weeks of gestation in case of rape or incest with the request of the
pregnant woman
3. At any gestation, if the pregnancy is harmful to the pregnant woman’s physical or
mental health, as certificated by an expert physician.
4. Listed medical practitioners (Health service providers) will provide comprehensive
Abortion care services.
5. Only the pregnant woman holds the right to choose to continue or discontinue the
pregnancy. If the pregnant woman is a minor (less than 16 years of age) or not in a
position to give consent (mentally incompetent), the nearest guardian or relative can
give consent for abortion services
The law prohibits termination of pregnancy of any gestation for the sole purpose of
sex selection.
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23 ABORTION
MEDICOLEGAL TYPES OF ABORTION

1. Natural spontaneous abortion
This is an extremely common condition but chronic disease, syphilis or an abnormality of

the ovum itself, are frequently held responsible. The only medicolegal interest in natural
abortions is the difficulty in distinguishing them from deliberately induced abortion.
2. Criminal Abortion
A. Induced by the woman herself. After natural abortion, this is the second most
common situation, and very large numbers of self induced miscarriages occurring
annually.
B. Criminal abortion performed by other persons and these are the ones which are of
most medicolegal interest, as the woman who aborts herself is never prosecuted. The
abortion induced by other, may be the result of a professional abortionist, commonly a
doctor or nurse, or may be the well meaning efforts of friends or relatives.
METHODS EMPLOYED TO PROCURE ABORTION

Various Methods Applied are
1. Drugs
2. Mechanical
3. Medical
4. Surgical
DRUGS
These are almost invariably unsuccessful, but still enjoy considerable popularity as an early
method of attempted abortion.
Some drugs certainly have a specific effect on uterine muscle, but this is usually only
significant towards the end of pregnancy and not in the early stages where drugs are
commonly employed. One exception is the recently introduced ‘prostaglandin’ which is now
employed as a legitimate method of procuring abortion.
The other drug is relatively ineffective for procuring abortion unless given in very high dose
and follows the old adage “What will kill the baby, will probably kill the mother.”
Heavy metals, especially lead and Mercury, may produce abortion by generalized toxicity,
as well as some direct effect on the uterine muscle. Lead was formerly used to induce
abortion in the form diachylon paste.
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ABORTION 23
Allegedly, abortifacient substances were divided into:
1. Ecbolics: Drugs which excites the contraction of uterus
a. Ergot preparation
b. Quinine
c. Strychnine
d. Synthetic estrogens,
e. Pituitary extract: These are not always successful in low doses and in high
doses may cause danger.
2. Emmenogogs– which increases the menstrual flow- Borax, Savin, estrogen
3. Drugs which irritate genitourinary tract- cantharides, oil of turpentine, oil of tansy
4. Drugs which primarily irritate G.I.Tract and reflexly stimulates uterine contraction- viz.
Purgatives castor oil, Croton oil, Magnesium sulfate, Senna etc.
5. Drugs which are primarily toxic to other systems e.g. lead, arsenic, phosphorus,
Calotropis, unripe fruit and seeds of Papayas, Methi and Abrus precatorius etc.
One particular substance is of more modern usage; which is not taken by mouth, but
applied to the cervix and upper vagina in the form of crystals of potassium permanganate.
This can be extremely dangerous, causing ulceration, hemorrhage and toxic changes from
absorption.
MECHANICAL MEANS OF PRODUCING ABORTION
General violence is sometimes employed but is almost never successful. Extreme violence
to the abdominal wall is common and has in some cases lead to death from rupture of
underlying organs. Displacement of pregnancy is very rare even in these circumstances
and heavy blows with the fist or even foot having resulted in grave intra-abdominal injuries.
By far the most common and virtually the only effective method is local violence to the
contents of the uterus by means of instruments or local irritants. This is always the method
employed by professional abortionist. In some case, injuries are present in the vagina,
cervix, uterus, or its contents including dilatation of the cervix, ruptures, hemorrhage or
infection. Corrosion or tissue damage may be seen due to the use of antiseptics.
MEDICAL METHODS OF ABORTION
Medical methods of first trimester abortion are increasingly available world wide
(WHO2003), the most effective regime being Mifepristone (antiprogestogen also know
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23 ABORTION
as RU 486) followed by Misoprostal (synthetic prostaglandin analog). This combination
of drugs has been found to be highly effective, safe and acceptable for early first trimester
abortion up to 63 days or 9 weeks. Approximately 2-5% of women treated with this regime
will require surgical intervention to resolve an incomplete abortion, terminate a continuing
pregnancy, or control bleeding (WHO 2003).
Advantages of medical termination of pregnancy in pregnancy are:

1. Most clients do not require a surgical procedure
2. Clients can obtain the required advice and medications through a visit to their doctor
or health care provider and do not need to appear at an “abortion clinic”
Disadvantages of medical termination of pregnancy in early pregnancy are:
1. Repeated visits to the clinic may be required and surgical evacuation may be needed
if the medical method fails or if the abortion is incomplete.
2. Common side effects include nausea, vomiting, abdominal cramps, diarrhea and
prolonged bleeding.
3. Diagnosis of Ectopic pregnancy may be missed.
4. Contraindications to the use of these drugs include adrenal disease, liver disease,
bleeding disorders, heavy smoking, and allergies to these drugs.
SURGICAL METHODS
Surgical methods are used to terminate first trimester and early second trimester
pregnancies wherein the products of conception are removed by use of an aspiration
technique. This can be accomplished using a plastic cannula and vacuum created either
manually-Manual vacuum Aspiration (MVA) or by electric suction- Electric vacuum
Aspiration (EVA). In early secondary trimester termination of pregnancy, MVA or EVA may
need to be supplemented with manual extraction of products of conception with ovum
forceps.
MANUAL VACUUM ASPIRATION
Most abortion world wide is performed within the first 12 weeks of pregnancy using
vacuum aspiration as the most common method (AGI 1999). The manual vacuum
aspiration technique is a safe and simple technique for the termination of
pregnancy. It is performed by aspirating the products of conception using a plastic
cannula attached to a hand-held plastic syringe with minimal scraping of the uterine
wall. The vacuum produced in the syringe is approximately 600-650 mm of Hg,
which is the same the level of vacuum in an electrical suction machine. The
contents of the cavity are evacuated by the negative suction in the syringe. MVA
completely evacuates the uterine cavity in 98% cases.
MVA technique performed in the first trimester of pregnancy dose not requires
general anesthesia or an operating theater and it carries minimum complication risk.
190
ABORTION 23
A uterine size of up 12 weeks gestation can be terminated with this technique, often
under Paracervical block. The advantages of MVA over the traditional dilation and
curettage (DNC or sharp curettage) are that it is safer, more comfortable to the
client, and less risks of injury to the cervix and uterus.
DILATATION AND CURETTAGE
It is suitable in early pregnancy. Sometimes there may be excessive hemorrhage.
INTRODUCTION OF IRRITANT PASTE INTO THE CERVIX
Several compounds have been used, some being proprietary substances

manufactured expressly for this purpose, such as” utuspaste “.
They are introduced into the cervical canal by means of a special sterilized
applicator. Either by local toxic action on the fetus or by local necrosis and
separation of the chorioendometrial junction, the products of the gestation is
expelled.
ABDOMINAL HYSTERECTOMY
This is done only in complicated cases and is a safe method.
INSUFFLATION OF THE UTERUS
The use of the Higginson syringe to pump fluid under pressure into the cervical
canal is probably the most common method of effective abortion. Frequently this
method is employed by the woman herself by using water, soap solution or dilute
disinfectant. Though effective method but carries the high risk of a fatal outcome
from air embolism.
DILATATION OF CERVIX AND OXYTOCIN INFUSION
This is also a common method employed for procuring therapeutic abortion in

hospitals.
AMNIOTIC FLUID REPLACEMENT BY HYPERTONIC GLUCOSE OR SALINE

SOLUTION
This is also sometimes preferred by some practitioners but is not fully safe and can
result in several complications.
191
23 ABORTION
CAUSES OF DEATH IN CRIMINAL ABORTION

Immediate cause of death
1. Hemorrhage
2. Perforation
3. Vagal shock
Delayed cause of death
1. Fat and Air embolism
2. Peritonitis
3. Septicemia
4. Pyemia
5. Tetanus
EVIDENCE OF ABORTION
In abortion during the first 2 or 3 months of the pregnancy, the signs are ill- defined and
consist of bleeding, dilatation of external os.
During the abortion, occurring in late months of pregnancy, the hemorrhage is more marked
and the internal os may admit a finger. The genital organs are much softened and the
injuries to the genital tract can be viewed with a speculum.
The vaginal canal may show fissures or lacerations or marks of forceps. The other signs of
injury to the abdomen or on the body may be noted.
Material and liquid from the vagina, uterine cavity and blood should be collected for
chemical and bacteriological examination. In case of recent abortion, there may be
discharge of milk or colostrums on squeezing of the breast and there may be tenderness of
the abdominal wall. The uterus may not be palpable per abdomen, if it was not a case of
advanced pregnancy. On local examination, the undergarments may show some staining
with blood and occasionally, with liquid abortifacient agent, used locally.
Materials from alleged abortion that should be collected are the viscera, the uterus with its
appendages are preserved in aturated solution of common salt for chemical examination.
For histological examination some portion of uterus, ovaries and vagina are preserved in
formalin saline.
The product of conception may be examined and reported. While examining such an
aborted fetus, it’s important that the age of the fetus, is determined by employing Hasse’s
rule.
192
ABORTION 23
MEDICAL TERMINATION OF PREGNANCY

In England the Abortion act came into force on April 27th, 1968 and under its provisions, a
doctor will not be guilty of criminal offence in terminating a pregnancy if:
a. The termination is performed by a registered medical practitioner
b. Two registered medical practitioners are of the opinion, formed in good faith that:
c. Continuance of the pregnancy would endanger the life of the pregnant
woman, or
d. Would injure her physical or mental health, or
e. Would involve injury to the physical or mental health of any existing children of
the pregnant woman’s family, or
f. There is a substantial risk that if the child were born, it would suffer from such
physical or mental abnormalities as to be seriously handicapped.
There are several other conditions attached to the above grounds:
1. The termination of pregnancy must be carried out in a hospital administered by the
National Health Service.
2. Where termination is immediately necessary to save the life or to prevent grave
permanent injury to the physical or mental health of the woman, it may be carried out
anywhere and in such urgent circumstances; no second medical opinion is required.
In India the medical termination of pregnancy act was enforced in 1971 and is
performed under the following conditions:
1. When the continuance of pregnancy endangers the life of woman or may cause grave
injury to her physical or mental health.
2. When there is risk of the child being born with serious physical or mental handicaps
3. When pregnancy has been caused by rape
4. Pregnancy resulting from failure of contraceptive methods in a married woman which
is likely to cause grave injury to her mental health or when social or economic
environment can injure the mother’s health
5. Only a qualified registered medical practitioner having prescribed experience can
terminate pregnancy.
6. Obtain consent of the woman. If the period of pregnancy is below 12 weeks, it can be
terminated on the opinion of a single doctor. If the period of pregnancy is between 12
to 20 weeks 2 doctors must concur that there is an indication. Once the opinion is
formed the termination can be done by any one doctor. The doctor has to maintain
professional secrecy. He must treat her to the best of his ability and consultation be
made from a professional colleague preferably a specialist. If the woman’s condition
is serious, he must arrange to record the dying declaration. If the woman dies the
doctor should inform the police.
193
Chapter
24
OTHER ISSUES IN MARITAL LIFE
Divorce And Nullity 196

Impotence And Sterility 196
Causes Of Impotence And Sterility In The Male 197
Causes Of Impotence And Sterility In Females 198
Sterilizaon And Arficial Inseminaon 198
Legimacy 199
Paternity 200
195
24 OTHER ISSUES IN MARITAL LIFE
DIVORCE AND NULLITY

Divorce involves the dissolution of a previously valid marriage, but in certain circumstances,
a marriage may be annulled, i.e. declared never to have existed in law. The marriage may
be annulled and considered null and void, where the marriage has not been consummated
due either to impotence or willful refusal.
Though these are virtually pure legal matters, the medical officer should be aware of
divorce law because husband or wife frequently brought or turn to the doctor for their
enquiries about possible grounds for divorce.
The role of a medical officer is usually confined to proof or rebuttal of evidence of

impotence, adultery, cruelty and the fact that one party to a marriage is incurably of
unsound mind. Also, a wife has grounds for divorce if her husband has been found guilty of
rape, sodomy or bestiality.
In adultery, medical evidence may be called to show that pregnancy occurred during a
period when the husband could not possibly have had access to wife. The length of
pregnancy may be an important factor.
Medically, it can be proved to the satisfaction of the court to show that the child could not be
the offspring of the disputed father by blood grouping or DNA fests.
Cruelty may be shown both by evidence of physically assaults and of mental trauma.
An opinion regarding potency should be given in negative form if the male genitals appear
normal unless there is marked deviation from normal. In case of the female, it has to be
clearly shown that the anatomical defect of the vagina is incurable, even from surgery, and
consummation of marriage is impossible.
IMPOTENCE AND STERILITY

Impotence is the inability of a person to perform sexual intercourse where as sterility means
inability to procreate children. An impotent person need not be sterile but both may exist in
one person.
Frigidity is a term, which is used in female when she is unable to initiate or maintain the
sexual consummation.
The question of impotence and sterility may arise in number of cases viz.
1. Nullity of marriage
2. Divorce
3. Adultery
4. Contested paternity
196
OTHER ISSUES IN MARITAL LIFE 24
5. Legitimacy
6. Adoption
7. Compensation for damages where loss of sexual function is pleaded as the result of
an assault or accident
8. Rape and unnatural sexual offenses
Causes of impotence and sterility in the male
Age
Performance of sexual act by a small boy or very elderly person is very uncommon.
However there are cases on record when boys even below ten years were not only potent
but capable of procuring child. These usually occur in gonad or adrenal tumors.
In advanced age, the power of erection and sexual performance may diminish or disappear,
but there is no specific age at which such loss of power occurs.
Developmental abnormalities
Absence or non-development of penis may prevent the sexual act. Hypospadias and
epispadias may prevent intercourse and the seminal fluid may not reach the vagina. Double
penis and the penis adherent to the scrotum may pose difficulty in sexual intercourse which
can be corrected from surgery. Absence of testicles will produce sterility. Cryptorchidsm
invariably cause sterility but sexual performance is not always affected.
Local Disease
Phimosis, paraphimosis, adherent prepuce, hernia or elephantiasis and other local

diseases may cause temporary impotence.
General Disease
Diabetes, pulmonary tuberculosis and much other illness can cause temporary impotence
and sterility.
Psychological causes
Most of the cases of impotence are psychological. Fears of successful ability to complete
the act or apprehension of impotence are common causes of temporary impotence.
Feelings of guilty, depression, anxiety are other temporary causes of impotence. There are
some individuals who may be impotent with one particular woman but not with others. They
are named as “Cold”.
197
Causes of impotence and sterility in females
AGE
Age has no bearing for sexual intercourse as the woman is the passive agent. Even in old
age the sexual desire is not lost. A woman can usually beget child from the period of
ovulation which begins from menarche and lasts till menopause. However unusual causes
have been reported when a girl of six and half years, delivering full term baby and a sixty
three year female delivering her twenty second child.
Developmental Anomalies
Absence of vagina and chromosomal defect makes a female impotent and sterile.
Acquired Abnormalities
Vaginal injury or severe infection may lead to stricture or narrowing of the vagina.
Local Causes
Adhesions of the labia, imperforate hymen, and total occlusion of the vagina may cause
temporary impotence and sterility and can be cured by surgery. Other local causes viz.
prolapses of uterus, tumors or diseases of the ovaries etc. may produce temporary sterility
and can be corrected by surgery.
Psychological Causes
Psychic factors may lead to impotence as in males. Vaginismus is an example of

psychosomatic illness. Since the females are passive agents most of the factors do not
cause impotence.
STERILIZATION AND ARTIFICIAL INSEMINATION

In the case of a married patient, the consent of both the husband and wife should be
obtained before the sterilization of either party is undertaken. If sterilization, especially in
the female, is necessary on definite medical grounds, rather than as a method of birth
control, the refusal of the other party to give consent does not form any restriction.
Artificial insemination is a procedure for bringing about conception in the female by artificial
introduction of semen into the vagina, cervix or uterus.
There are two types of artificial insemination.

1. Artificial Insemination by Husband
2. Artificial Insemination by Donor
198
ARTIFICIAL INSEMINATION BY HUSBAND (A.I.H.)
Here the semen of the husband is used when the husband is impotent but not sterile.
ARTIFICIAL INSEMINATION DONOR (A.I.D.)
This procedure is employed where the husband is irreversibly sterile, yet a pregnancy is
desired. Here the semen of some person other than husband is used. Full consent must be
obtained from both partners.
There are several legal problems which include:
The legitimacy of the child is even disputed in A.I.H. since it does not constitute evidence of
proper consummation of marriage. But it is justifiable and unobjectionable since the child is
actually the biological product of both husband and wife.
The legal aspects of A.I.D. are numerous viz. adultery, legitimacy, nullity of marriage and
divorce but the charges becomes futile if consent of both the husband and wife has been
taken. Further, adoption of such child will provide the status of the natural born child. If the
parents do not declare artificial insemination, the child remains to be a natural child for all
purposes.
Strict precautions must be taken if A.I.D. is under taken. The donor should be of below 40
years of age, healthy and not related of either partner. The donor’s race and other
characteristics should resemble as closely as possible of the husband of the woman to be
inseminated. The necessary blood investigations viz. HIV, blood grouping, Rh testing,
VDRL etc. should be done and must be ideal for insemination. The identity of the donor
must be kept secret. The donor should not know to whom the semen is donated and the
result of insemination. It is better and wise to use pooled semen. Pooled semen is
composed of donor semen to which semen from the husband has been added.
LEGITIMACY
The legitimacy of a child is in doubt when a child is born, in marriage, if it can be proved
that the husband could not possibly be the father of child because of the following reasons:
1. Husband had not access to his wife during the time that the child was begotten,
2. Husband was physically incapable to beget children due either to impotence or willful
refusal.
3. The blood groups of the alleged father and the child is incompatible
4. Where the woman was pregnant by another man at the time of marriage and
5. Where husband was under the age of 16 years
6. Average duration of pregnancy- the normal period is 40 weeks or 280 days, though
this average period may be shortened or lengthened by several week. This issue
arises occasionally in cases of legitimacy on the grounds that pregnancy has
occurred in the absence of the husband.
199
The question of legitimacy arises in:
1. Maintenance suit: A man who resists an affiliation order for the maintenance of a
child, and denies being the father of the child
2. A woman may file a case in the court for fixing paternity on a certain person to
support the child.
3. Suppositions child: A woman may feign pregnancy and later produce a living child of
some one else for the purpose of claiming property.
4. Atavism: The child resembles his/her grand parents and not the parents.
PATERNITY
The actual testing and interpretation is performed by persons skilled in serology, but any
doctor may be requested to obtain the samples and forward them for examination.
Blood is to be taken from the mother, the child and the putative father or fathers.
Blood tests are purely an exclusory procedure and can never indicate that a given man is
the father of a given child. The child inherits one gene of each blood group from each
parent.
D.N.A. test can only indicate that a given man is the father of a given child.
The following group systems were used in past for ascertaining paternity; ABO, MNS, Rh,
Kell, P, Lutheran, Duffy and Kidd. These do not reveal the authenticity of parenthood and in
modern days DNA testing is the only reliable and authentic procedure.
Superfetation
This is fertilization of another ovum which is liberated in a subsequent cycle during the
continuation of earlier pregnancy. This is a type of twin pregnancy where one fetus always
remains more matured and developed than the other. Medicolegally, it becomes important
when fertilization of these two ova takes places from two separate sexual coitus with two
different persons. There may be gross variations between the complexion and other
features in appearance of the two babies leaving to the doubt of adultery and infidelity.
There may be suit for legitimacy and the paternity of either or both the babies.
Superfecundation
In superfecundation, ova of the same period of ovulation fertilized by two separate acts of
coitus. There may be law suit as in case of superfetation suspecting adultery and infidelity
and the paternity of either or both the babies may be disputed.
200
Surrogate birth
This is artificial insemination of a woman who accepts to have pregnancy with the sperm of
barren woman’s husband. This is a contract amongst the couple and another woman. After
surrogate birth the baby is handed over to its biological father and his wife. It is now also
possible to remove mature healthy ovum from the wife and fertilize with the husband’s
sperm in vitro in the specialized laboratory and re-implant this fertilized ovum/embryo (test
tube baby) in the hired woman’s womb. There may be series of medico legal issues
attached to surrogate birth viz. the surrogate mother may not hand over the baby to the
parents as per contract and legally her relationship with the child cannot be denied.
201
Chapter
25
ISSUES IN INFANTS AND CHILDREN
Infancide 204
Was The Child Sll Born? 205
Was The Child Dead Born? 205
Was The Child Viable And Born Alive? 206
Signs Of Livebirth 208
How Long Did The Child Survive AJer Birth? 209
Cause Of Death 210
Ba<ered Baby Syndrome 211
Cot Death (SIDS) 212
203
25 ISSUES IN INFANTS AND CHILDREN
INFANTICIDE
Infanticide means killing of an infant within one year of age. This differs from the charge of
murder in a sense that the law presumes that the infant was born dead and the prosecution
has to prove that the infant was alive and killed. Though deliberate killing of a new born
infant either by an act of commission or omission, is as much a homicide as the murder of
an adult, in England the infanticide acts of 1922 and 1938 regularized the position by
providing the new offense of infanticide within the following description.
“Where a women by any willful act or omission, causes death of her child, being a child
under the age of 12 months, but at the time the balance of her mind was disturbed by
reason of her not having fully recovered from the effects of giving birth to the child, or by
reason of the effect of lactation consequent upon the birth of the child”.
Giving consideration to the act, if the mother kills her baby she will be charged for
manslaughter with lesser punishment. When the mother commits the crime it becomes
difficult to be proved in the law courts as there is much scope for the defense of taking the
plea ranging from natural, accidental or other causes of death of the child to escape from
the charges. There is an additional advantage for the mother to get the benefit of doubt
when the charge is not fully proved beyond all doubts.
As such the charge of infanticide usually drops out. In case the charge of infanticide fails,
the court may order for the trial of concealment of birth or secret burial of the child or for
some other offense related to the death of the child.
In India, infanticide refers to the murder of the child if ingredients of murder are there and
the punishment is the same as in the murder of an adult.
In Nepal, infanticide is treated the same as killing of an adult and the punishment may be
life imprisonment depending upon various factors with confiscation of whole property of the
culprit. As usual, in Nepal also, the mothers are mainly involved in infanticide and the
punishment is awarded to her as well as to the person or persons assisting her in the
commission of the crime. The punishment may be life imprisonment. Life imprisonment if
awarded, in case of infanticide, may be reduced by supreme court to ten years or even less
depending upon the other conditions compelling the commission of the crime. In Muluki Ain
Section 18 when a newly born infant after it is born alive is exposed in any place with the
intention of abandoning it and death does not supervene, the parent of person responsible
for the care of such infant is guilty and may be punished imprisonment of four years. If the
infant dies, the offender may be tried for murder and will be punished as per the condition of
the case viz. life imprisonment, 10 years imprisonment or 2 years imprisonment.
Since the law presumes that the child was born dead, the medical officer holding autopsy
may have to reply the following queries:
1. Whether the fetus was stillborn or dead born
2. Whether the fetus was of viable age
204
ISSUES IN INFANTS AND CHILDREN 25
3. Whether the child was born alive
4. Whether the child had separate existence when born alive
5. If born alive, how long the child survived
6. What was the cause of death?
As per definition of infanticide the child must be less then one year of age but in practice
these deaths almost invariably occur within minutes or hours of birth.
WAS THE CHILD STILL BORN?

A stillborn fetus is one which is born after 28th week of pregnancy and does not show any
sign of life. This essentially includes birth where death occurs during the passage of fetus
from mother’s womb and that it was alive in the uterus.
WAS THE CHILD DEAD BORN?

A child born that has died in the uterus and may show one of the signs of
1. Maceration
2. Putrefaction
3. Mummification
Maceration
This occurs when the dead child remains in the uterus for some time and is surrounded by
liqor amnii. The body of macerated fetus is soft, flaccid and emits some sweetish
disagreeable odor. The skin is red or purple tint with blebs (blisters or vesicles). The blebs
are filled with serous fluid. The epidermis can be peeled off easily. The tissues are
edematous. The sutures of the skull bones may be separated and can glide over each
other. This is known as Spalding’s sign. The separation of the sutures can be demonstrated
by radiological examination. The brain substance is converted into grayish pulpy mass. The
viscera become infiltrated and lose the anatomical structures. The umbilical cord appears
red, soft, thickened and is easily lacerable. This is a sterile process and occurs if infant
remains dead in the uterus for few hours. There is no access of bacteria in the uterus since
the membrane is not ruptured.
Putrefaction
This occurs when the membrane is ruptured with entry of air in the uterine cavity. This
carries microorganisms with them and results in decomposition changes. Consequently the
child shows greenish discoloration and emits offensive odor.
Mummification
This condition results when the child dies in the uterus with little or no liqor amnii without
rupture of the membranes. The child becomes small, dehydrated and acquires the features
of mummification.
205
WAS THE CHILD VIABLE AND BORN ALIVE?

Live birth means a child completely born external to the mother and showing the signs of
life. There are some variations about the definition of live birth in various parts of the world.
Some say that a child be treated as live born even if any part of living child comes out of the
mother’s womb. This means that if the hand is out of the mother’s uterus and pulsation can
be felt it should be regarded as live born and destruction of such child is regarded as
infanticide or murder. Whatever may be the difference of the definition of live birth, the
material fact remains the same and the law covers almost all the aspects when the child is
killed after complete expulsion or partial expulsion or even when is capable of being born
alive.
To establish the charge of infanticide the medical jurist i.e. required to ascertain the
following points:
1. Viability of the child
2. Live birth
3. Separate existence
The first two issues are solved without much difficulty if the person is a trained medical
jurist. The third issue is difficult to prove unless a doctor, midwife or some other personnel
has witnessed the delivery. Consequently most of charges are futile, but the charge of child
destruction stands in the law court.
Viability of the child
Viability of the child does not mean it is live born but only that the fetus has attained the age
of viability. This is after 28th week of gestation. Normally an infant born 210 days or rarely
180 days after gestation can survive with the help of modern techniques. Viability can be
known by observing the following points.
1. General Appearance
The general condition of the infant, its plumpness and absence of any congenital deformity
and disease has to be noted and may be of some value.
The lanugo (fine, soft, downy hair) is seen only on the shoulders. The skin is covered with
vernix caseosa which is readily seen on the flexors of the joints and neck folds. It is a dirty
white cheesy substance, made up of sebaceous secretions and epithelial cells.
2. Weight of the child
It has been established that there is a close relationship between the age of infant and the
weight.
206
Period of Gestation and approximate weight
Age Weight
28th week 2.5-3 lbs
32nd week 3.5-4 lbs
36th week 5-6 lbs
40th week 6-8 lbs or more
It should be kept in mind that the female child is about 3 ounces less that a male child. The
individual weight of a twin is less than that of a singleton infant.
3. Height (Crown heel length= Rule of Hasse)
This is indeed the best criterion to establish the viability. This is easy and only needs skill in
taking the measurement from crown to the heel. This is known as Rule of Hasse, from the
name of Hasse, who did it in 1895.
The square root of the height of the fetus in centimeters gives the age up to 5 months.
Example: - a fetus of 16 cm length is of 4 months of age.
After 5 months, the length in centimeter divided by 5 gives the age in months. If the length
is taken in inches, it should be divided by 2, which would give the age in months. Example:
a fetus of 30 cm= 6 months of age or a fetus of 12 inches=6 months of age.
This is done by an osteometric board which is scaled in centimeters and in inches. The
measurement taken should be from heel to head.
4. Centers of ossification
At 28th week of gestation, the center of ossification centers appears on the lower end of
thigh bone and upper end of tibia. This can be demonstrated by making coronal slicing of
the thigh bone at the lower end, which shows dark centers in the middle.
Live Birth
Live birth does not necessarily mean separate existence of fetus as its death might have
occurred during the course of delivery.
Live birth in India means that the fetus was alive after complete expulsion from the mother’s
womb or when at least one living part of its body comes out and baby shows sign of life.
There is no mention of such aspect in Nepal for asserting live birth viz. complete expulsion
or partial expulsion.
207
In England, for a charge of infanticide to succeed it must be shown that the infant lived, and
this is where most charges of infanticide failed. Unless the autopsy surgeon can provide
adequate proof that separate existence occurred, there is no case.
SIGNS OF LIVEBIRTH
Signs of Livebirth includes at least one of the following:
1. Crying
2. Movement of the limbs
3. Yawning or sneezing
There are occasions when a child may cry when the head is inside the vagina and then
known as vagitus vaginalis, it may even cry inside the uterus, which is know as vagitus
uterinus. This occurs due to entrance of air in the uterine cavity.
In criminal cases, autopsy has to confirm live birth by examining the following points:
1. The shape of the chest
2. The position of the diaphragm
3. The change in the lungs
4. The changes in the stomach and intestine
1. Shape of the chest
It becomes expanded with the onset of respiration and becomes arch or drum shaped. In
absence of respiration, it is flat.
2. Position of the diaphragm:-
In unrespired lungs it lies at the level of 4th or 5th rib. When the respiration is established, it
descends down and occupies the level of 6th or 7th rib.
3. Change in the lungs:-
With the onset of respiration, the lungs expand and occupy the whole thoracic cavity and its
margin becomes well rounded. The unrespired lung is dense, firm, non crepitant and liver
like. After respiration has established, the lungs feel spongy in texture with patches of rose
color in appearance. The expansion of lungs in all the lobes occupying the thoracic cavity is
diagnostic of live birth. There is edema of the lungs when the respiration has been
established.
In doubtful cases, the demonstration of presence of alveolar duct membrane confirms the
diagnosis of live birth. There may be atelectasis of lungs due to obstruction by the alveolar
duct membrane. Alveolar duct membrane is not present in stillborn child.
208
Hydrostatic test
This test was once thought to be an important test for ascertaining live birth but be-
cause of fallacies it loses its validity. It is based on the fact that the specific gravity of
the unrespired lung varies from 1.04 to 1.05 and that of respired lung is 0.94, and as
such the unrespired lung sinks but the respired lung floats in a vessel of water.
For this test, the whole lung with the heart and thymus are taken out from the thoracic
cavity and placed in a bucket, which is half filled of distilled water. The vessel should be
of such a size that it should admit the lungs comfortably and still should have some
space to allow the viscera to float or sink. If it floats it would mean that the child had
respired. If it sinks, it would indicate otherwise. Further to this the lungs are cut into
pieces and put into the vessel. If it again floats it would suggest live birth. Again the
pieces of lungs are placed between the cardboard and squeezed gently and are placed
in the water. If it floats again, it may mean live birth. This is done to exclude the tidal air
from the lungs. But a respired lung may sink because of disease and unrespired lung
may float because of presence of putrefactive gases.
Hydrostatic test is not done in cases when the fetus is born before 180-days, is a mon-
ster, shows signs of maceration or mummification, umbilical cord has separated and
umbilicus has cicatrized and the stomach contains milk.
4. Changes in the stomach and intestine
When the infant first respires, air is ingested in to the stomach. This can be demonstrated if
the stomach and the intestine are taken out with ligature at both ends and dissected in
water, air bubbles can be seen over the surface of water.
However, the most important criterion of live birth is the demonstration of food matter or
milk in the stomach and intestine. This would not only suggest live birth but would also
indicate that the infant survived for some time. Bacterial laden meconium is another sign of
live birth which can be demonstrated. The separation of the stump cord with inflammatory
ring or epithelialization is also diagnostic of live birth. Meconium is a green viscid substance
made up of bile and mucus. It is generally expelled in a day or two after delivery.
HOW LONG DID THE CHILD SURVIVE AFTER BIRTH?

This is difficult problem to solve and only a guess can be given. Three points to be noted
are:
1. Stump of the cord
2. Skin
3. Caput succedaneum, if present
209
1. Umbilical cord
Clotting of blood occurs from the cut end in about 2 hours. The cord attached to the child
starts drying in about one day time. A zone of redness appears around the cord in two days
time. The umbilical cord dries up in 5-6 days and drops off leaving a suppurating ulcer
which heals in about tens days.
2. Skin
Soon after delivery, the skin color is red and is covered with vernix caseosa. Vernix
caseosa is thick sticky material adherent to axillary and inguinal folds of the infant. This
lasts for 2-3 days and assumes normal color in a week’s time.
The changes in fetal circulation may also be looked for ascertaining the age. The umbilical
vessels, ductus arteriosus, ductus venosus close by 10-15 days. Foramen ovale closes by
3rd month. Rarely, it may not close and gives rise to a condition called Morbus Cerulus
showing cyanosis of face and other parts.
CAUSE OF DEATH
1. Natural
2. Accidental
3. Criminal
1. Natural Causes
Immaturity, debility, congenital diseases, malformation, erythroblastosis fetalis etc
2. Accidental causes
Prolapsed cord, prolonged labor, strangulation of cord, born under caul (when the child is
surrounded by a membrane that covers its face) etc
Rarely, the child dies from precipitate labor which is condition where delivery occurs without
knowledge of the mother and the child receives fatal injuries. It usually occurs among
multipara having roomy birth canal and a small fetus. However, this may not necessarily kill
the child as the cord protects violent fall of the child.
Quite often, the mother in criminal cases advances precipitate labor as a plea as an excuse
to save herself from punishment if she was involved in infanticide. A medical officer
attending such a case should be vigilant and weigh all the pros and cons to provide full
justice while giving the report. In case there are multiple fractures of skull bones or some
other severe injuries on the body of the child, a suspicion of foul play arises as the child
cannot be expelled from the womb like a bullet because the cord would prevent violent falls.
210
3. Criminal causes
These could be by acts of commission or omission.
Acts of commission could be from different ways ranging from smothering, throttling,
strangulation, choking or bashing the child against hard or even inflicting injuries from lethal
weapons or cutting throat etc. Even poisoning by opium or some other poisons are resorted
to kill the infant.
Acts of omission include killing a child without inflicting any injury on the body. This could be
from failure to ligate the cord, or when the infant is left unattended for the things which are
essential to carry on life. This could be exposure to heat and cold and many other aspects
necessary for the survival of the infant. Mother is obliged to call relatives, friends while in
labor pain to have a safe delivery and failure of this amount to act of omission.
BATTERED BABY SYNDROME

Cruelty to children is not recent. In 1946, Caffey, a radiologist, published his observations
on the occurrence of “Multiple fractures of the long bones of infants suffering from chronic
subdural hematoma”. These results of deliberate injury to children, and other ill effects due
to same cause, have come to be known as the Battered Baby Syndrome. The indication of
the battered child syndrome is repetition of injury to different sites at different times,
produce lesions, demonstrating varying degrees of healing. The most reliable x-ray features
in battered children are observed most often in the bones of their arms and legs. These
injuries on the children are inflicted from an adult generally a parent, foster parent or
guardian. Battered Child syndrome must be considered in any child where the degree and
type of injury does not match the history advanced, and where the injuries of different
stages of healing are found and when there is purposeful delay in seeking medical
attention.
The postmortem should be very thorough and supported by photographs, x-rays,

microscopic sections all pertinent lesions and toxicological analysis.
Skull fractures must be noted with special reference to their location, shape and extent. Any
hemorrhage e.g., extradural, subdural or subarachnoid should be noted and carefully
described as regards to position in relation to fractures, amount, color, and adhesiveness.
An autopsy surgeon should always ascertain contrecoup lesions and coup lesions to
determine if the injury resulted from a moving head striking a fixed object or moving object
striking a fixed head.
The special attention should be paid to identify the fractures of ribs and their ages and
whether all are of same age or of different ages.
Rupture of viscera due to blunt injuries is common in cases of Battered Baby.
211
COT DEATH (SIDS)

Cot death in America is known as crib deaths. The modern nomenclature of this type of
death is inclined towards “Sudden Infant Death Syndrome” (S.I.D.S.) which exhibits a
pattern of symptoms and circumstances, even though the actual cause appears to be
obscured. S.I.D.S. is also sometimes known as S.U.D. or sudden unexplained death.
Whatever the names may be but the fact lies that an apparently healthy child, usually
between three weeks and one year of age, is put to bed in the night after a normal feed
without any apprehension that some tragedy is going to take place. The child may had little
running of nose or some mild respiratory infections even mild diarrhea. Quite frequently
these minor indispositions rarely warrant the call of any doctor by the parents or the
relatives. Some time later the child is found dead in the morning.
There has been possibly no sound, no crying of the child and neither much sign of struggle
and further the tragedy is made worse by its utter unexpectedness. It has been noticed that
many children had face down which earlier gave an erroneous impression of asphyxia.
While this may be true for a very small group of cases but there is no foundation for these
assumption in all such deaths which only confuse the real issue and would prevent the
gravity of the situation and research. A few cases may reveal some definite disease such
as pneumonia but then they are not the true cot deaths, though the mode of death may be
similar. Cot death almost always occurs during sleep, usually in the morning, very rapidly
and peaceful, the suffering left for the parents.
The actual cause is still unknown although the blame has been attributed to so many
causes ranging form allergy to cow’s milk, respiratory infection, vitamin deficiency,
hypothermia and all sorts of reasons form the possible to the frankly fantastic. Some
suggest that breast feeding may prevent cot deaths but such deaths have been occurring
throughout the ages when breast feeding was universal although the breast feeding is
certainly beneficial for other reasons, there is no evidence that it prevents cot deaths.
It is now clear that it is a common end result of a group of factors coming together in an
infant and is triggered by slight infection such as cold etc. Possibly if all these unknown
factors do not assemble in an infant suffering form some mild disorder the sudden
unexpected death may not occur.
During autopsy examination on such deaths the thymus gland is of normal size with
multiple petechiael hemorrhages often described as “FLEA BITTEN”. The dissection of the
gland shows hemorrhages. The pleural surface of the lungs show few petechiael
hemorrhages with large purple zone of collapses. The out surfaces of the lungs show
congestion. These all merely suggest the features of central respiratory failure and not
necessarily mechanical asphyxia as thought to be. Occasionally the respiratory tract may
contain milk or some other food matter which is the agonal phenomenon of terminal death
and not always the primary cause of death due to choking.
212
Virological and bacteriological studies are in progress but nothing authentic had yet
advanced.
Recent epidemiological surveys carried out in various parts of the world suggest the season
and low socioeconomic class of infants. Studies carried out at Sheffield have given some
clue about the reduced incidence of cot deaths in a particular area which received special
antenatal, prenatal and postnatal care.
The basic facts to remember about Sudden Infant Death Syndrome may be summarized as
follows.
1. This is a natural disease causing sudden death amongst the infant after the first week
of life the commonest period being 4th month of life during the fourth month of the
calendar year.
2. They are healthy children except the few having some mild cough or running nose or
little diarrhea.
3. They are taken to bed in the night apparently in healthy condition and found dead in
the morning.
4. They do not affect the newly born children and is rare after twelve months.
5. They are not infectious in the usual sense.
6. The actual cause is still unknown and appears to be due to number of factors
assembling together in an infant having some mild infection.
7. Cot death is the most single cause of death of small infants after the first week in
developed countries.
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Chapter
26
SEXUAL OFFENSES AND PERVERSIONS
Sexual Offenses 216

Natural Sexual Offenses 216
Rape (As Per Muluki Ain, Nepal 1999) 216
Examinaon Of The Vicm In Cases Of Rape 219
Examinaon Of Genitalia Of Rape Vicms 220
Examinaon Of The Alleged Assailant In Sexual Assault 221
Unnatural Sexual Offenses 222
Sodomy 222
Buccal Coitus 223
Besality 223
Sexual Perversions 224
Sadism 224
Masochism 224
Fechism 224
Peeping Tom 224
Troilism 224
Exhibionism 224
Scoptophilia 225
Voyeurism/Undinism 225
Fro<eurism 225
Nymphomania 225
Lebsian Love 225
215
26 SEXUAL OFFENSES AND PERVERSIONS
SEXUAL OFFENSES
Classification of sexual offenses
1. Natural Offenses
a. Rape
b. Incest
c. Adultery
2. Unnatural offenses
a. Sodomy
b. Tribadism
c. Bestiality
d. Buccal coitus
3. Sexual perversions
a. Sadism
b. Masochism
c. Fetichism
d. Peeping Tom
e. Troilism
f. Exhibitionism
g. Scoptophilia
h. Voyeurism/Undinism
i. Frotteurism
j. Nymphomania
k. Lesbian Love
NATURAL SEXUAL OFFENSES

Rape (As per Muluki Ain, Nepal 1999)
A rape is defined as having sexual intercourse with a woman under circumstances falling
under any of the following descriptions
1. Sexual intercourse with a woman with or without her consent if she has not attained
the age of 16 years
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SEXUAL OFFENSES AND PERVERSIONS 26
2. Sexual intercourse with a woman who has attained the age of 16 years but
a. Against her will
b. Without her consent
c. With her consent when her consent has been obtained by putting her in fear of
death or of hurt.
d. With her consent when she has been put under undue influence
The Nepalese law does not require penetration as a conclusive proof of rape.
This clause makes provision for the offense of Rape.
Punishment for Rape in Nepal
The offender shall be inflicted the punishment for rape as follows:

a. If the rape is of a woman below 14 years the imprisonment for the offense extends
from 6-10 years.
b. If the rape is of a woman who has attained the age of 14 years and above the
offender shall be imprisoned extending from 3 years to 5 years
c. If the offense of rape is committed by a minor, the punishment awarded to such
minor shall be half than that to be awarded to the adult.
As per section 375 on Indian Penal Code, the definition of rape is as follows:
A man is said to commit rape that has sexual intercourse with a woman on the
circumstances falling under any of the following six descriptions
1. Against her will
2. Without her consent
3. With her consent, when her consent has been obtained by putting her or any person
in whom she is interested, in fear of death or of hurt
4. With her consent, when the man knows that he is not her husband and her consent is
given because she believes that he is another man to whom she is or believes herself
to be lawfully married
5. With her consent, when at the time of giving such consent by reason of unsoundness
of mind or intoxication or the administration by him personally or through another, of
any stupefying or unwholesome substance. She is unable to understand the nature
and consequences of that to which she gives consent
6. With or without her consent, when she is under sixteen years of age and by a man
with his own wife below fifteen years of age
217
Punishment for rape in India
Imprisonment of either description for a term which shall not be less than 7 years, but which
may be for life or for a term which may extend to 10 years and shall be liable to fine unless
the woman raped is his own wife and not under 12 years of age in which case he shall be
punished with imprisonment of either description for a term which may extend to two years
or fine or both.
When a police officer or some other government official takes advantage of his position,
and commits rape on a woman, he shall be punished with rigorous imprisonment for a term
which shall not be less than 10 years, but which may be for life and shall also be liable to a
fine.
The sentence may for adequate and special reasons to be mentioned in the judgment
impose a sentence of imprisonment of either description for a term of less than 10 years.
When rape is committed on a woman by a gang or more than one person the similar
punishment is awarded.
In England, under sexual offense act 1956, rape is defined as unlawful sexual
intercourse without her consent by fear, force, or fraud, or when she is below sixteen years
of age.
Punishment for rape in England
In England, the punishment of rape is anything up to life imprisonment.
General considerations of Rape
There is no age limit either for the victim of rape or for the accused. Rape can be committed
with an elderly woman. Regarding the age of the accused the court takes appropriate
decision as to whether a young accused can be considered as sexually potent and capable
of performing sexual intercourse or not. Old age is not a bar for a man to be capable to
perform sexual intercourse.
In England, the law presumes that the boy below 14 years of age is sexually impotent and
therefore incapable of committing rape. Intercourse with a girl less than 16 years of age is
always unlawful, consent being immaterial. For a charge of rape to lie, there must be a
degree of penetration of female by the male organ.
Even in India, the same law applies. The degree of penetration is immaterial so long as the
tip of the penis passes between the labia. Full introduction or the emission of semen is
irrelevant so long, as at least partial penetration has occurred. It is therefore quite possible
to commit legally the offense of rape without producing any injury to the genitalia or leaving
any seminal stains. In such cases, the medical officer should mention the negative facts in
his report, but should not give his opinion that no rape has been committed.
218
The ingredients which are essential for proving a charge of rape are accomplishment of the
act with force, or resistance.
EXAMINATION OF THE VICTIM IN CASES OF RAPE

Examination should be undertaken as early as possible so that the spermatozoa if present
in the vagina should not disintegrate. A requisition for examination for examination of the
victim should come either from a police officer of that area or court. An authorized person
should be there to identify the victim before the doctor.
It is essential for the doctor to obtain consent from the woman concerned, if over 12 years,
from the parents or guardians if below this age. Consent for examination is a must for a
doctor; otherwise there may be charge of indecent assault initiated against the doctor. The
doctor should first speak to the alleged victim and her female companion. If the girl is of a
particular tender age, she should not be subjected by long question about the
circumstances, but is obtained from the adult present. With a more mature woman, careful
questioning should be made to ascertain her version of the events, as well as general
details of her health, menstrual history etc.
A full record must be kept, this being equally as important as in other medico legal matters.
Apart from usual details, the exact time of examination and person requesting examination
should be carefully and legibly recorded. A lady attendant should always be there during
examination.
The general appearance of the alleged victim, clothing, and hair, status of agitation or
emotion should be noted.
Doctor is the only person with the opportunity to observe more gross disorders of clothing. If
the girl has alleged that she was partly stripped, the clothes may have been replaced in the
wrong order or inside out or backwards. The detailed examination of the clothing is the
concern of the doctor and scientists of Forensic Science Laboratory. Tears, mud, blood and
seminal stains should be carefully noted. Grass or other vegetable matters adherent should
be carefully noted. Attempt at undressing the woman should never be made; she should be
requested to undress herself. Usually seminal stains are on the front of clothes and those of
the blood are on the back. But largely depends on the position of the victim and accused
during the commitment of the offence. Blood and seminal stains and the clothing if present
should be dried, carefully packed in either polythene bag or clean brown paper for
transmission to the laboratory.
A general physical examination should be conducted. The whole body should be examined
for injuries, mud, blood, or seminal stains, with particular attention to the back of the upper
arms, shoulder blades, buttocks, thighs, neck, face, and breasts. Teeth marks or suction
impressions from the assailant’s mouth may be found on the neck, breast or even
abdomen. There may be lacerations of the nipples from the teeth. Bruising of the lips may
be found due to rough kissing and suction. Photographs of the impression should be taken.
219
Any suspicious seminal stains on the thighs or other parts of the body should be collected
by a moistened swab, if on the skin surface.
The gait of the victim is observed and if painful, should be noted in the report.
EXAMINATION OF GENITALIA OF RAPE VICTIMS

It should be performed under good light and lithotomic position is preferable. Bruises,
scratches and stains of the thighs and buttocks should be looked for. The pubic hair should
be examined and matted stains or foreign materials cut away and preserved. The pubic hair
should be combed out as non matching male pubic hair may be present. All samples should
be carefully retained, packed and labeled.
The vulva should be inspected for scratches, swelling, bruises or other traumatic lesions.
Vaginal swabs and aspiration of fluid with a pipette should be made before digital
examination. Unless laboratory examination is immediately available, smear should be
made on microscopic slides and air dried.
Hymen as a result of sexual intercourse is usually lacerated, having one or more radiate
tears and edges of which are red, swollen, tender, and may bleed on touching if examined
within a day or two after the act.
The fourchette and posterior commissure are not usually injured in case of rape, but they
may be torn if the violence used is very great. The extent of the injury of the genitalia
depends upon the degree of disproportion between the genital organs of both parties and
the force used.
In small children, the hymen is not usually ruptured as they are situated high up and there is
often bruising of the labia and laceration of perineum and fourchette.
The hymen may be conveniently examined by inserting a glass globe which is then partially
withdrawn so that the hymen is spread around its circumference.
The presence of gonococcal infection may be kept in mind if the alleged assailant suffers
from the disease. If there is mucopurulent or purulent discharge, a thin film from the
discharge should be made from two or three glass slides and stained by Gram’s Method
and examined under high power microscope for the presence of Gonococci, which are
kidney or bean shaped, intracellular, gram negative, diplococci. In the case of negative
result, the films from the discharge are examined on at least three successive occasions
with intervals of one week. A negative result on the first examination of the smear and when
a subsequent smear after few days shows positive result is of great value. The period of
incubation of Gonorrhea varies usually from two to eight days and of Syphilis varies from
two to eight weeks. If the accused is suffering from a venereal disease and if the story of
rape is true, the victim is likely to suffer from the same disease within its period of
incubation.
220
Other precautions include the taking of finger scrapings in case the victim has managed to
scratch her assailant and thus have fragments of skin beneath her nails which may be
blood grouped. A venous blood sample may be required from the victim for comparison
studies with the culprit.
DNA test may be performed in the specialized laboratory from the tissues or trace elements
so collected for authenticating the assailant.
The report should be made immediately, after examination and should be comprehensive
containing negative and positive findings. The medical officer is not in a position to say that
rape has occurred but only that recent intercourse has or has not taken place and that
various injuries are or are not present on the genitalia or general body surface. His job is to
record such findings and injuries and interpret them to the court at the time of trial not to
prejudge the issue on medical grounds alone.
It should be kept in mind that rape is legal term and not a medical diagnosis.
EXAMINATION OF THE ALLEGED ASSAILANT IN SEXUAL

ASSAULT
The examination of the alleged assailant is undertaken when requested by the police. The
same formalities have to be observed and same line of examination should be followed.
Consent should be asked for after telling the accused the object of examination. Presence
of attendant is not necessary. His version of the case is recorded. Marks of identification
should be noted, general examination should be made looking especially for finger nail
scratches on the face or arms, groins, buttocks and loins. The genitals should be examined
with note of penile size which may be relevant where serious injury has been inflicted on
the woman. The glans and the prepuce may appear moist due to vaginal fluid if examined
soon after the occurrence. A swab should be taken and preserved.
Glans penis and the frenulum may be examined carefully for swellings, tenderness, and
injuries and also for the presence of smegma. Absence of smegma may indicate absence
of sexual intercourse with full penetration particularly in uncircumcised penis. Foreign
materials such as blood, mud stains or vegetable matter on the knees, buttocks, and pubic
hair should be looked for. Samples of the pubic hair should be taken and kept in the brown
envelope with proper label for further examination.
The presence of active venereal disease should be looked for.
A blood sample should be taken for grouping. Examination of the clothing for seminal stains
is primarily the job of the forensic science laboratory. Photograph of the scene, injuries, and
pattern of teeth if the victim had teeth bite are essential.
Sometimes, DNA test may be required for authenticating the crime and the involvement of
the assailant in the suspected case.
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UNNATURAL SEXUAL OFFENSES

SODOMY
Sodomy is the commonest unnatural sexual offenses and comprises anal intercourse.
Sodomy may be homosexual (man to man) or may be heterosexual (one male and one
female). In any case, a male is the active agent and either another male or a female acts as
a passive agent. Sodomy is also called buggery. When the passive agent is a young child,
it is called Pederasty. When the passive agent is an old person, it is called Gerontophilia.
Penetration however little should be strictly proved.
Anal intercourse is punishable and in case the passive agent consents he is also punished
as per law. The defense in the law court that the passive agent is the wife is not acceptable
as per law as marriage is taken as an implied consent for normal intercourse and not for
anal intercourse. If the wife consented, both are guilty and if she did not give consent, the
husband is guilty.
Various forms of homosexuality including anal intercourse are now lawful in England and
Wales between consenting adults of the age of 21 years or above and when practiced in
private place (Sexual offense act, 1967).
According to the Old Testament, sodomy used to be practiced in the town of Sodom. Thus
it acquired the name, Sodomy.
Examination of the passive partner may reveal seminal stains on the surrounding skin and
hair and evidence of recent penetration of the anus. Swelling, tenderness, bleeding fissures
and tears, acute dilatation and possibly fecal soiling may all provide corroborative evidence
of recent forceful penetration. Rectal swabs may reveal emissions of semen.
Before taking up the examination the doctor must obtain the consent and then undertake
the brief general examination, examination of wearing apparels particularly the
undergarments. Finally the examination of anorectal region is undertaken in a well lit place
in a special clinical examination room.
In the case of chronic passive homosexual, the sphincter may be destroyed with permanent
dilatation of the anus. These may be funnel shaped depression the anus be thickened,
possibly fissured, keratinized skin around the margin, with loss of the normal
mucocutaneous junction. The normal corrugations at the anal margin may be lost as the
muscle atrophies.
In either the acute or chronic case, lubricants such as vaseline or hair cream may be
present, and should be sampled by means of a swab.
In case of a female passive agent, the presence of a female attendant while examining is
necessary.
222
Examination of an active agent will also include:
1. General Examination
2. Examination of clothing
3. Examination of genitals
If the examination is undertaken soon after the crime, the glans and length of the penis will
have moist appearance due to staining by mixture of semen, fecal matter and lubricant if
used. There may be fecal odor. There may be tear of frenum and presence of anal hair of
the passive agent on the glans or prepuce.
The general examination may reveal nail scratches inflicted by the passive agent or teeth
bite in course of struggle to avert the act. The penis may bear such injury marks.
BUCCAL COITUS
Buccal or oral coitus is punishable under unnatural sexual offense. This offense has been
mentioned in the Bible and was practiced in the town of Gomorrah. Hence it is also known
as sin of Gomorrah.
When the male organ is sucked by a female or another male, it is called fellatio. When
female sex organs including clitoris is sucked by a male or another female, it is called
cunnilingus.
There may not be any injury on the face or oral cavity of the victim. The penis may show
abrasions, caused by the teeth and may have stains of saliva.
BESTIALITY
This is an unnatural sexual offense practiced with the help of lower animals.
It is more common in males and the animals chosen include she-goat, or a hen. It is very
uncommon in the females and a pet dog is the choice.
An accused may show his penis stained with a mixture of semen and the animal dung.
Animal hair is the common finding on the body of accused with the typical odor of the
animal. Commonly, the shepherds engaged in grazing their sheep or goat may commit this
offense. On examination of the animal done by a vet, human semen may be seen present
in the vagina or anus of the animal or the cloacae as in the case of hen. Human hair may
be present on the animal.
223
SEXUAL PERVERSIONS
SADISM
In sadism, the sexual gratification is achieved by torturing sex partner by beating, biting and
humiliation. A French writer de Sade was the first person to describe it, hence the name
Sadism. It may be practiced by either sex, but is seen more commonly in males. In extreme
cases, the sadist may achieve sexual orgasm by murdering a female. Such a murder is
known as Lust Murder. Rarely a sadist after murdering a female, cuts open the body, tears
out the genitals, and devours the flesh to obtain sexual pleasure. This is known as
Necrophagia. Sometimes, he may perform sexual intercourse with a corpse, which is
called Necrophilia.
MASOCHISM
This is the opposite of sadism. It is generally found in males, but it may occur in female who
may invite their lovers to inflicting injuries on their body for achieving sexual orgasm.
Masochistic asphyxia is also an example of Masochism. In masochistic asphyxia, death
accidentally occurs when a pervert creates a state of hypoxia for achieving orgasm and the
mechanism fails resulting in sustained constriction of the neck.
FETICHISM
This condition is commonly seen in males. The pervert derives sexual gratification by
seeing or touching the female body parts, dress, particularly the undergarments or some
articles of feminine use. Some fetishist may steal small articles used by females for
masturbation and orgasm.
PEEPING TOM
A peeping tom gets sexual gratification by observing the sex performance by others
followed by masturbation.
TROILISM
Here the pervert gets sexual gratification by inducing his wife for sexual intercourse with
another man and observing the act.
EXHIBITIONISM
It is the exposure of the genitalia in a public place to derive sexual pleasure. It is common in
male perverts and rare in females to expose themselves in public. It is an obscene act and
punishable in Nepal and many other countries.
224
SCOPTOPHILIA
Deriving pleasure by seeing a nude woman in bathroom, while dressing or undressing at

the sexual organs The act of observation results at masturbation. It is rare in females.
VOYEURISM/UNDINISM
It is the severe form of Scoptophilia, when the pervert gets gratification by seeing a woman
micturiting. In some cases the prevent gets sexual pleasure when urination is made on his/
her body by the loved one.
FROTTEURISM
It is usually practiced by male when they derive sexual pleasure by rubbing their private
part against a female body in crowd.
NYMPHOMANIA
Excessive sexual desire in a woman This is sexual perversion and is not a punishable
offence.
LEBSIAN LOVE
This is also known as Tribadism. This is female homosexuality practiced between two
females to derive sexual pleasure. Sexual pleasure is obtained amongst themselves by lip
kissing, manual manipulation of breasts and genitalia and genital friction and use of clitoris
as organ of passion. Sometimes such lesbians use artificial penis or phallus alternately to
achieve orgasm. The lesbians usually suffer from nymphomania and are indifferent towards
male. Sometimes, if one of the lesbians is rejected by another homosexual partner may,
commit homicide or suicide.
225
Chapter
21
FORENSIC PSYCHIATRY
Insanity 228
Classificaon Of Mental Illness 229
Terms In Forensic Psychiatry 229
McNaughten Rule 232
Diagnosis Of Mental Unsoundness 233
Testamentary Capacity 234
227
27 FORENSIC PSYCHIATRY
INSANITY
Forensic Psychiatrist has to certify mental capacity and soundness of mind of a person in
relation to criminal and civil cases.
In criminal case
1. When a defense is sought on the ground that an act committed by a person is in a
state of unsoundness of mind and such an act which is otherwise considered as a
crime may be dealt in that light.
2. When the pleader of the accused person expresses the inability of the person to
plead his defense during a trial.
3. When after being convicted in a court of law, petition is field before the court, to defer
the execution in jail or sending him/her to mental asylum.
4. When a plea is advanced that a person has attempted suicide due to unsoundness of
mind.
5. In case of criminal breach of trust or fraud committed against an insane in business or
property matter.
6. In case of abetment of suicide of an insane person.
7. In case of rape of an insane women.
In civil cases
1. Capacity to make a valid will (testamentary capacity)
2. Continuance or dissolution of a business contact on the ground of mental abnormality
of either partner
3. In connection with the nullity of marriage or divorce cases
4. Competence of witness
5. Validity of consent given by an insane person
Causes of insanity
1. Genetic
a. Chromosomal abnormalities
b. Biochemical
c. Genes
2. Constitutional
a. Psyche of object
b. Personality
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FORENSIC PSYCHIATRY 27
c. Temperament
d. Autonomic reactivity
3. Extrinsic factors
a. Head injury
b. Drugs
c. Infection and others
d. Mental Conflict
e. Personal or family loss and psychological stress
CLASSIFICATION OF MENTAL ILLNESS

1. Organic disorder
2. Acute-Delirium, confusional states, Korsakoff’s syndrome
3. Chronic- Degenerative, epileptic, traumatic, demyelinating etc
4. Affect Disorders involving the mood primarily- mania, melancholy, anxiety states and
phobias
5. Psychosomatic illness- conditions which aggravate somatic disorders
6. Compulsive conditions- Obsessions, impulse, psychopathic disorders
7. Others- Schizophrenia, hysteria
TERMS IN FORENSIC PSYCHIATRY

In case of insanity the following terms are often used and the medical jurists should be well
acquainted with them:-
1. Illusion
2. Delusion- grandeur, persecution, infidelity etc
3. Hallucination
4. Impulse- Kleptomania, dipsomania, mutilomania, run amok (homicidal)
5. Delirium (due to mental unsoundness, high fever, Datura and alcohol)
6. Obsession
7. Somnambulism
8. Somnolentia
9. Lucid interval
10. Euphoria
229
ILLUSION
It is a false interpretation of some object which has a real existence. For example a man
may mistake a rope for snake, or may mistake a tree in dark to be that of a ghost. A sane
person is capable of correcting the false impressions. An insane person cannot do so.
DELUSION
Delusion is a false or erroneous belief in something which is not a fact, and which persists
even after this has been explained or demonstrated. A normal person will correct this by his
reasoning power, past experience or when explained to him by others. Delusion is a
symptom of insanity and is found in schizophrenia, paranoid states and other atypical forms
of insanity. Delusions may be of grandeur or exaltation, persecution, of infidelity and other
forms.
In delusions of grandeur a person may imagine himself to be very rich or even king.
Simultaneously, there may be sign of persecution, and he may imagine that his enemies
are conspiring to kill him or ruin him financially. The delusions of grandeur and persecution
often exist together in the same person. Medicolegally the delusions are very important as
this may lead to commit suicide, murder or some other crime.
DELIRIUM
It is a disturbance of consciousness in which orientation is impaired, the critical faculty is

blunted or lost and thought content becomes irrational, irrelevant or incoherent. Delirium
may occur in some cases of high fevers, poisoning viz. datura intoxications or by
psychological factors.
HALLUCINATION
Hallucination is a false sensory perception without any objective stimulus to produce it.
They are purely imaginary and any form of sensation may be involved viz. visual, auditory,
tactile, and olfactory. The hallucinations of hearing and sight are the most common. In
visual hallucination a person imagine a tiger attacking on him when no tiger exists.
In auditory hallucination a person hears voices of a person threatening him to death when
no such person is present.
In tactile hallucination a person may imagine that bugs or rats crawling into his bed or may
imagine that grains of sand were lying under the skin or some small insects were creeping
on the skin giving rise to itching sensation.
IMPULSE
This is a sudden and irresistible force compelling a person to do some action without motive
or forethought. Normally a sane person when intends to do any act, he thinks the
230
consequences and then performs it. An insane person may do things on impulse as they
lack the reasoning power and judgment.
Sometimes the sudden impulse to do some action exists in normal person as seen in cases
of Kleptomania where there is an irresistible desire to steal articles of little value.
The other types of impulse are

1. Pyromania: An irresistible impulse to set fire to things.
2. Mutilomania: An irresistible impulse to kill animals
3. Dipsomania: An irresistible impulse to drink alcohol more and more
OBSESSION
An obsession is a persistent and irresistible thought, an idea or emotion constantly

entertained by a person which he recognizes as irrational but persists in spite of all efforts
to drive it out from his mind. For example, a person goes to his bed at night after securing
bolts of the door of his room but goes on rechecking the bolts number of times and he is
aware of the irrationality of his obsessive checks. This are usually signs of Psycho-neurosis
and is termed as obsessive compulsive neurosis.
SOMNABULISM
It means walking during sleep. Such a person has generally no recollection of the events
occurring during the period of somnambulism. In most of cases some element of psychiatric
problem exists.
Sometimes he may commit suicide, homicide or meet with an accident. Such a person is
not criminally responsible for his acts.
SOMNOLENTIA
This is also called sleep drunkenness. This condition is mostly seen in cases immediately
after an epileptic fit. This is half way between sleep and awake. In some cases when a
person is suddenly aroused from deep sleep he may unconsciously commit some horrible
action for which he is not criminally responsible for such a deed
LUCID INTERVAL
This is a period occurring in the course of insanity during which there is complete absence
of the signs and symptoms of mental disease. During this period the person is fully
responsible of his civil and criminal actions.
EUPHORIA
This is a state in which there is an increased sense of well being increased mental activity
and freedom from anxiety. There may be hallucinations and sometimes maniacal condition
231
may be seen. Euphoria is commonly seen amongst opiate addicts and after consuming
tranquilizers.
PSYCOPATH
This is a person who is neither insane nor mentally defective, but fails to conform to normal
standard of behavior.
Psychopaths have abnormal personality, persistently behave in an antisocial or disruptive

manner, and do not repent on their actions.
DELIRIUM TREMENS
Dealt in Chapter 37, Alcohol
KORSAKOFF’S PSYCHOSIS
Dealt in Chapter 37, Alcohol
WANDERING LUNATIC
Medical Officer can arrest a wandering lunatic and will forward to a magistrate for
admission in hospital since his behavior is dangerous for himself and others.
No civil or criminal responsibility can be attributed to a lunatic.
PHOBIA
An excessive or irrational fear of a particular object or situation

1. Fear of enclosed places —claustrophobia
2. Fear of open spaces - Agrophobia
3. Fear from Dark
4. Fear from Crowd
McNAUGHTEN RULE
“Nothing is an offense where a person commits a crime that by reason of unsoundness of
mind is unable to understand the nature and consequences of his act at that moment”. This
is the legal test of insanity. In 1843, Mr. Edward Drummond, the private secretary of the
then Prime Minister Of England, Sir Robert Peel was shot dead by one Daniel McNaughten
who suffered from delusion of persecution and thought his life was in danger from the then
Prime Minister of England Sir Robert Peel and this only could be stopped by shooting Sir
Robert peel. He attempted to do so, but by mistake shot and killed Edward Drummond.
McNaughten was acquitted as a result of evidence which showed him to be suffering from
schizophrenia.
232
Points True Insanity Feigned Insanity
Onset Gradual Abrupt
Signs and symptoms Shows some signs of insani- Not any particular type
Motive None Some motive may be
Sleep May pass sleepless nights No control over sleep
Habit Filthy in habit Maintains reasonable clean-
Physical examination Minimum even with continu- Gets exhausted like a nor-
Skin and lips Dry, dirty, cracked, coated Not so
Tongue Coated Clean
Appearance Agitated or vacant Not so
Mood May be violent, abusive, de- May overact to show abnor-
Food May overeat or show signs Normal, not filthy while eat-
Table 27.1. Difference between true and feigned insanity

DIAGNOSIS OF MENTAL UNSOUNDNESS
Mental Unsoundness is diagnosed by history taking, physical Examination and examination
of mental state.
Special Investigations are usually not required. However, gene analysis may be done to
identify if the insanity is genetic or acquired.
MANAGEMENT OF INSANE CASES

Restraint of a dangerous Lunatic (Immediate Restraint)
A dangerous lunatic can be restrained immediately for short term till arrangement for his
treatment and admission to a hospital is made. Immediate restraint under the personal care
of attendants is done by the consent of lawful guardian of the insane person or even
233
without his consent if the time is short and there is immediate danger of life of the insane
person or other persons. The restraint must last so long as the danger exists. Immediate
restraint can also be imposed on persons suffering from delirium due to disease, or from
delirium tremens. Such restraint must cease with the recovery of the person.
Immediate restraint is done under the personal case of attendants e.g., by safely locking up
in a room. The consent of the lawful guardian of the insane person has to be taken, but if
there is no time to take the consent and the insane person is dangerous to himself or to
others, he can be immediately restrained.
Admission after voluntary approach
A person can be admitted to a mental asylum on voluntary request for relevant

examinations and treatment. The in charge of a mental hospital on a written application
form the intending boarder with the consent of two witnesses can admit in the hospital.
Such a person should not be detained for more than 24 hours after he has given notice to
leave hospital.
Reception on application
A relative of an insane person applies to the medical officer-in-charge of a mental hospital

for admission and treatment. A medical certificate is required for such admission. In
absence of such certificate, the doctor of mental asylum will arrange examination of such
persons by two medical officers.
Reception order on application
The doctor of I/C of mental Hospital can make an application to the magistrate judge in
case of a mentally ill person who is undergoing his treatment under a temporary treatments
order that
1. The Treatment is required for more than six months.
2. The further treatment is required in the interest of his or others safety.
The husband or wife or any other relative can make an application.
Two medical certificates should be submitted who must have examined separately within
ten days of the presentation of the application.
The doctors must have certified that the alleged person is suffering from mental disorder or
such degree tat warrants admission in mental asylum.
TESTAMENTARY CAPACITY
Testamentary Capacity is the ability of a person to make a valid will. It consists of
1. An understanding of the nature of the will
234
2. A knowledge of the assets to be disposed and
3. An ability to recognize those who have moral claims on the property
The Will is invalidated if it is proved that the testator, at the time of making his will, was not
of a “sound and disposing mind” and had not sufficient mental capacity to understand the
nature and consequences of his act, and if it is satisfied that he disposed of his property in
a way which he would not have done under normal conditions.
If a medical practitioner is called upon to witness the execution of the will of a sick person
he should elicit the mental condition, any disease and should ensure that the person is in
sound and of disposing mind. Thorough questions to be put up to the testator of his social
contacts, family, friends, business partners, hobbies etc. His awareness should be property
tested.
235
Chapter
28
TOXICOLOGY
Routes Of Administraon Of Poisons 238

Eliminaon Of Poisons 238
Effects Of Poisons 238
Factors Influencing The Acons Of A Poison 239
Classificaon Of Poisons 239
Miscellaneous Poisons 240
237
28 TOXICOLOGY
Toxicology is the science of poisons. A toxicologist is one who has learned about their
mature, sources, properties, effects, detection and quantification. He is thus a ‘poison
expert’.
A poison may be defined as a substance which exerts a deleterious effect and ultimately
may cause death by virtue of its chemical action. This can occur even, when it is
administered in relatively in small quantities. Thus, allergic or atypical responses which
occasionally follow administration of many drugs viz. adverse reactions are not true
“poisoning”. A man trained in Forensic Medicine should have sound knowledge of the
common poisons so as to give opinion about the cause of death, manner of death and
other relevant points raised in a poisoning case.
There is no strict demarcation between a medicine and a poison because a medicine in a

toxic dose is a poison and a poison in small dose may act like a medicine. In legal terms,
the real difference between a medicine and a poison is the intent with which it is given. If
the substance is given to provide some relief of the ailment, it is medicine but if it is given
with the intension to cause harm it is a poison. Further, it must be remembered that some
individuals, in a medicinal dose can exhibit serious poisoning effects due to idiosyncrasy or
allergy or when suffering from some other disease which is not compatible with the given
medicine. However an addicted or habituated person can tolerate much larger dose of that
drug as compared to a non-addicted person.
Routes of Administration of poisons

1. Oral (Commonest)
2. Parental- Intramuscular, intra-venous, Subcutaneous.
3. Natural orifices- Rectal, vaginal, urethral and nasal
Like medicines, Poisons are also absorbed rapidly by inhalation, sublingual, intravenous,
intramuscular, subcutaneous routes or when administered from natural orifices.
Elimination of poisons
Unabsorbed poisons are excreted through feces and vomitus. After absorption they are
mostly excreted through urine, breath, sweat and saliva. A part of the absorbed poison is
secreted in the intestinal mucosae and the excreted through the feces.
Effects of poisons
Local acting poisons- mineral acids and alkalis.
Remote acting poisons- opium, barbiturates, digitalis, sedatives, tranquilizers, carbon-

monoxide poisoning etc.
Poisons having both local and remote actions- Arsenic, Organophosphorous compounds,
carbolic acid, oxalic acid, phosphorous, snake bite etc.
238
TOXICOLOGY 28
Factors influencing the actions of a poison
1. Quantity
Heavy dose of a poison acts rapidly and often resulting in death. However, a high dose of
poison may be vomited out without exhibiting any toxic action e.g. white arsenic or opium.
2. Form
Poisons in gaseous form are quickly absorbed and are thus most rapidly effective. Liquid
form of poison is readily absorbed than a solid poison and the effect is quicker.
3. Chemical Form
Pure metallic and mercury are not poisonous because they are insoluble and can not be
absorbed.
4. Condition of the stomach
a. Fatty food usually delays the absorption.
b. Food stuff in the stomach acts as diluents of the poison and delays the toxic
effect.
c. Disease of the stomach and intestine affects the absorption of poisons and
may delay its poisoning effect.
d. In case of achlorhydric subjects the effect of KCN or NaCN is ineffective as
hydrochloric acid in the stomach is required for conversion of KCN and NaCN
to HCN before absorption.
CLASSIFICATION OF POISONS
According to the site and mode of action
Local acting poisons Irritants Systemic
Strong acids and • Non-metallic inorganic irritants- • Affecting the brain (cerebral)-
alkalis. Phosphorus, chlorine, Bromine and
Iodine • Somniferous- Opium and its alkaloids, Barbiturate
• Metallic inorganic irritants- Arsenic, • Inebriant- Alcohol, Ether, chloroform

Mercury, Copper, Lead etc • Deliriant- Datura, Belladonna, cannabis
• Organic vegetable poisons- Castor • Affecting the spinal cord (spinal)-Nux Vomica
oil seeds, Croton oil seeds Calotro-
pis etc. • Affecting the peripheral nerves- Curare, Conium
• Animal poisons- Snakes, canthari- • Affecting the heart (cardiac) and blood vessels (vascular) -
des and insect bites Aconite, Digitalis, Oleander, Tobacco, and Hydrocyanic acid
• Mechanical poisons- Diamond dust, • Affecting the lungs (Asphyxiants) - Poisonous non-respirable
powdered glass. gases e.g., CO2, CO, Coal gas etc.
According to motive or nature of use

Homicidal poisons Suicidal poisons Accidental Poisons
Aconite, arsenic • Opium, Barbiturate, Organophosphorous com- • Aspirin, Carbon-monoxide, CO2, H2S, Barbi-
pounds, CuSO4, Aluminum Phosphides, Car- turates etc.
239
28 TOXICOLOGY
IDEAL SUICIDAL POISONS Should be
1. Cheap
2. Easily available
3. Should have no bad taste
4. Should not cause much pain or suffering
OPIUM OR ITS ALKALOIDS-BARBITURATES, Organophosphorous compounds,
Aluminum Phosphide are some of the known common suicidal poisons.
IDEAL HOMICIDAL POISONS should be

1. Cheap
2. Easily available
3. Free from bad taste or odor
4. Certain in its action
5. Should resemble some disease.
Arsenic and aconite were used to be considered as homicidal poisons. Combination of
alcohol and barbiturates administered without knowledge of consumer are also common
homicidal poisons.
MISCELLANEOUS POISONS
For full discussion see chapters 46-49, 52-55
A variety of plants belonging to unrelated families and genus contain certain chemical com-
pounds that can cause serious ill-effects in human beings and animals. These substances
are known as toxins and the source and chemical nature of each one is so varied that it is
impossible to place them under a single category.
Sometimes they are placed under a general heading of miscellaneous poisons because
they may include bacterial and fungal toxins, toxic plants, snake venoms, bees and even
spiders.
These naturally occurring toxic compounds belong to certain chemical groups e.g. alka-
loids, glycosides, triterpenoids and steroids, proteins and polypeptides, alcohols and phe-
nols etc.
240
TOXICOLOGY 28
Some important poisonous plants and their toxins are as follows:-
1. Beladona Alkaloids
2. Datura
3. Castor Seed (Ricinus Communis)
4. Croton Seeds (Croton Tiglium)
5. Abrus Precatorious
6. Oleander
7. Aconite
8. Digitalis
9. Nicotine
10. Strychine
11. Ergot
12. Calotropis
13. Hemlock
14. Argemone Mxicana (Food Poison)
241
Chapter
29
TREATMENT OF POISONING CASES
General Principles Of Treatment 244

Removal Of The Paent From Exposure 244
Removal Of The Unabsorbed Poison 244
Method Of Using Stomach Tube 244
Use Of Andotes 245
Dues Of Medical Praconer In Case Of Suspected Poisoning 248
Diagnosis Of Poisoning In The Living 248
243
29 TREATMENT OF POISONING CASES
GENERAL PRINCIPLES OF TREATMENT

The general principles of treatment of poisoning cases include the following aims:
1. Removal of the patient from the source of exposure.
2. Removal of the unabsorbed poison.
3. Elimination of the absorbed poison.
4. Use of antidotes.
5. Symptomatic treatment.
Removal of the patient from exposure
Remove the patient from the poisonous environment immediately in case of exposure to
volatile or poisonous gas. Artificial respiration may be life saving. Hospitalization may be
required.
Removal of the unabsorbed poison:
Removal of the clothes and washing of the body will be necessary in case of contact of the
poison with the external body surface as in cases with organophosphorous compounds or
acids. When the poison has been taken orally the unabsorbed part of the poison should be
taken out by use of stomach tube, if indicated or by inducing emeses. Gastric wash should
be avoided in cases of poisoning from corrosives because of the danger of perforation of
stomach. It should also be avoided in case of poisons which cause convulsion i.e. in
strychnine poisoning. In comatose patients, washing may lead to aspiration pneumonia and
can only be attempted after proper intubation. In infants and young children Ryle’s tube
may be used for gastric wash, if, indicated and with great caution.
Emesis is better than stomach wash in early stage of poisoning and can be achieved by
adopting the following methods:
a. Stimulating the fauces by finger.
b. Administering one tablespoonful of salt in a glass of lukewarm water.
c. Administering one tablespoonful of mustard powder in a glass of water.
d. Apomorphine hydrochloride- 1-2 ml of 3mg/ml concentration administered by intra-
muscular injection. It should be avoided as far as possible because the vomiting may
continue for a longer period and results in fall of blood pressure, tremor, collapse,
shock and unconsciousness. Emesis should not be attempted in comatose patients,
corrosives, convulsive and volatile poisons.
Stomach wash is indicated when emesis cannot be effective or when quick removal of the
unabsorbed poison is necessary. Stomach tube is 1.5 meter long and 1.5cm in diameter. At
one end of the tube there is a rubber or glass funnel. The other end is smooth with one
central opening and few lateral openings. At about the mid part of the tube there may be a
244
TREATMENT OF POISONING CASES 29
suction bulb, used to pump out the stomach content. There is provision of mouth gag with a
hole at its midpoint to allow the passage of tube through it.
Method of using stomach tube
The mouth gag is placed in between the teeth of the jaws, with the patient lying in one
side with low head. The smooth end of the tube is lubricated with olive oil or liquid paraf-
fin and pushed slowly through the hole up to 50 cm mark so as to reach the stomach
cavity. Care should be taken that it does not enter the air passage. When the tube end
is inside the stomach, 300 ml. of lukewarm water is poured through the funnel end of
the tube and the stomach content and water is pumped out by syphoning action. The
first wash with plain lukewarm water is preserved for chemical action. Subsequent
washes are made with suitable antidote or neutralizing agent. The wash is continued till
the poison is eliminated. In most cases, about 250 ml. of the neutralizing agent is left in
the stomach to neutralize the remaining poison. In case of opium poisoning the washing
is made of KMno4 solution till the normal pink color of KMno4 solution appears from the
stomach wash. About 250ml. of KMno4 solution is also left in the stomach after last
wash, because a part of the poison is resecreted in the stomach.
Sometimes, purgatives or high colonic lavage may be initiated to clear off the poison
from the lower part of the intestine. Bulky bland food is useful in preventing the damage
of gastric mucosae and delaying its absorption. Fatty food delays the processes of ab-
sorption but incase of white phosphorus poisoning it promotes absorption and is more
poisonous. The poison in the stomach can be diluted by giving water to drink.
In case of snake bite a ligature is placed, proximal to the site of injection and the poison
is then squeezed out or sucked out and pressure bandage is applied.
The absorbed poison is eliminated by forced diuresis,

dialysis and by use of chelating agents for heavy metals.
Chelating agents are the substances which act on the
absorbed metallic poisons and promote excretion through
kidney.
USE OF ANTIDOTES
Antidotes are substances which counteract the effect of

poisons.
According to their modes of action, they are divided into:

Fig. 29.1. Stomach Tube
a. Mechanical or Physical antidote
b. Chemical antidote
c. Physiological antidote
d. Chelating agents
245
MECHANICAL OR PHYSICAL ANTIDOTES
It prevents the action of the poison mechanically. For example- Egg albumin, oils prevent
the action of the poison by forming a coating on mucous membrane of the stomach.
However fats and oils should not be used for oil soluble poisons like kerosene, phosphorus,
Organophosphorous compounds, Phenols etc. Bulky food like banana acts as a mechanical
antidote to glass as it prevents its action by imprisoning its particles within its meshes.
Adsorbents viz. finely powdered activated charcoal has the capacity to adsorb poisons in
the pores so that the poison cannot come in contact with the wall of the stomach, thus,
preventing its toxic effects.
CHEMICAL ANTIDOTES
These are substances which inactivate poisons by undergoing chemical reaction with them
by forming harmless or insoluble compounds. The examples are weak acids for alkalis. In
case of poisoning with strong corrosive alkalis weak vegetable acids like citric acid, vinegar
etc. is administered as they neutralize the alkalis.
Potassium permanganate is an ideal chemical antidote in cases of opium poisoning since it

oxidizes the opium.
Freshly prepared ferric oxide in case of arsenic poisoning is also a chemical antidote since
it forms ferric arsenate which is not absorbed.
PHYSIOLOGICAL ANTIDOTE
These are the substances which act on the tissues of the body and produce symptoms
exactly opposite to those caused by the poison.
Examples: - Neostigmine for Datura or hyoscine group of poison. Naloxone for morphine
(opium) poisoning, Barbiturate for strychnine poisoning
A specific receptor antagonist blocks the action of the drug or the poison at its target
receptors in the body. Atropine is an example as a physiological antidote of morphine but is
not administered because it can cause death by paralyzing the motor and sensory nerves
just like morphine. Atropine and physostigmine are two real specific antagonists and
produces opposite effects.
UNIVERSAL ANTIDOTE
Universal antidote is administered when the exact nature of the poison is not known. This is
combination of physical and chemical antidotes.
Composition of universal antidote
Activated charcoal —-2 parts
Magnesium oxide ——1part
Tannic acid —————1 part
246
Activated charcoal acts mechanically by absorbing the poisons within its pores. Magnesium
oxide neutralizes the acids. Tannic acid precipitates most of the alkaloid poisons. The dose
is about 15 grams in a glass of water. The dose may be repeated once or twice.
CHELATING AGENTS
These are the substances which act on the absorbed metallic poisons. They form chelate
with metallic poisons those are freely available in the circulation and promote excretion
through kidney. They do not produce signs and symptoms opposite to those produced by
the metallic poisons and hence are not physiological antidotes.
The following chelating agents in use are:
British Anti Lewisite (Dimercaptopropanol or Dimercaprol)
It is a drug of choice in case of arsenic or mercury poisoning. It acts on the tissue cells of
body, and dislodges the metals from its combination with the Sulfhydryl radicals in the
tissue enzymes and carries it to the tissue fluids and promotes excretion through kidney.
Dose- 3-4 mg/kg of body weight, as a preparation of 10% B.A.L. with 20% Benzyl Benzoate
in ground nut oil, given deep I.M., 4 hourly for the first two days, followed by twice daily for
10 days or until recovery. To combat toxic manifestations like restlessness, salivation,
vomiting, convulsion or coma ephedrine sulfate 25mg is administered immediately. B.A.L.
can also be administered in poisoning from gold, bismuth and other heavy metals.
E.D.T.A. (Ethylene diamine tetra-acetic acid)
It is a specific chelating agent antidote for lead poisoning. When the salt combines with
calcium forms a stable chelate known as disodium calcium disodium edetate. When this
preparation is introduced into the circulation it does not cause hypocalcemia. It removes
blood lead and helps to get relief from the toxic manifestations of lead poisoning.
Dose: 1g twice a day by slow I.V. drip mixed with 5% glucose for about 5 days.
Penicillamine
It is a degraded product of penicillin and has a stable SH radical in it, which helps it to
combine with the free metal in circulation. It is a good chelating agent for copper sulfate
poisoning as well as in cases of lead, gold and mercury poisoning.
Dose: 30mg/kg of Body weight per day, given orally in 4 divided doses for 7 days.
DESFERRIOXAMINE
It is a specific antidote for iron. Dose orally 8-12 g in divided doses. For absorbed part of
the poison, 2g dose is given I.V. with 50% Levulose solution.
247
DUTIES OF MEDICAL PRACTITIONER IN CASE OF SUSPECTED

POISONING
A doctor has to undertake the care and treatment of the patient, and help the authorities to
arrive at a correct interpretation of the case.
In case of suspected homicidal poisoning, the doctor must confirm his suspicion before
expressing an opinion.
Any suspected articles of food and excreta should be preserved. Full or empty bottles,
capsules, paper packets, or liquids lying about should be collected and preserved.
If a private practitioner is convinced that the patient is suffering from suicidal poisoning, he
is not bound to inform the police. If the practitioner is summoned by the investigating police
officer, he is bound to give all information regarding the case that has come to his notice.
A government doctor is required to report to police all cases of suspected poisoning,

whether accidental, suicidal or attempted suicidal cases in the hospital.
If a case of suspected poisoning dies death certificate should not be issued but death
should be communicated to the nearest police officer for arranging post-mortem
examination.
Diagnosis of Poisoning in the living
1. The symptoms appear suddenly in a healthy person.
2. The symptoms appear immediately or within a short period after food or drink.
3. The symptoms are uniform in character and rapidly increase in severity.
4. When several persons are exposed at the same time in the same source of poison,
all suffer from similar symptoms at or about the same time.
5. The discovery of poison in food taken, in the vomit or in the excreta is strong proof of
poisoning.
Collect:
• Stomach wash
• 10 ml. of blood
• Urine and
• Feces
248
10 mg of Sodium fluoride for 10 ml of blood acts both as a preservative and as an
anticoagulant.
249
Chapter
30
MINERAL ACIDS
Sulfuric Acid 252

Nitric Acid 253
Hydrochloric Acid 254
251
30 MINERAL ACIDS
Certain chemicals, notably concentrated Sulfuric, Nitric and hydrochloric acids, and alkalis,
can cause extensive destruction of the tissues and even momentary contact may produce
an injury which is slow to heal and its repair may call for treatment by plastic surgery.
Concentrated Sulfuric acid is probably the most dangerous. Mineral acids produce
coagulation necrosis. They are local acting and have no remote action.
SULFURIC ACID
Sulfuric acid can produce severe burns of the skin and clothing. Injuries produced by
Sulfuric acid will leave dirty red stains on dark fabrics. The skin and mucosa are at first
whitened but soon becomes brownish and later black and the affected tissue e.g. that of the
stomach, becomes a blackened mass.
The lips are usually swollen and excoriated and dark brown streaks may be seen extending
from the angles of the mouth to the sides of the chin and adjoining areas due to flow of the
acid. On ingestion, the victim feels burning pain in the mouth, throat, and food pipe and
epigastric region. Vomiting may occur which is usually dark brown and strongly acidic. The
vomitus usually contains shreds of mucous membrane. There is intense thirst. Teeth are
chalky white in color. Tongue becomes swollen, shapeless with continuous salivation.
Circulatory collapse may cause immediate death or death can occur from asphyxia due to
edema of glottis. If person recovers he may develop esophageal or pyloric stenosis.
There may be severe constipation. The pupils usually dilated and mental faculties are
normal till death.
Fatal Dose: 5 to 10 ml.
Fatal Period: 12 to 24 hrs.
Treatment:-
Immediate dilution and neutralization of the acid is imperative. Water or milk mixed with four
tablespoonfuls of calcium or magnesium oxide, aluminum hydroxide gel should be
administered slowly. Side by side demulcents such as olive oil, egg whites, butter or ghee
should be given. To combat shock administer corticosteroids which will also prevent
development of esophageal stricture.
Sodium carbonate or bicarbonate should not be administered orally as this will cause
enormous production of CO2 gas in the stomach leading to perforation.
Do not pass stomach tube to wash the stomach.
Do not induce vomiting by any medicine which will be disastrous for the patient.
252
MINERAL ACIDS 30
Skin injuries should be treated by the application of magnesium oxide or carbonate in
powder or paste. Eye injury calls for prompt and thorough irrigation with a solution of
sodium bicarbonate.
Post mortem appearances
The mucosa of the upper digestive tract shows erosion and coagulation with scar formation.
The stomach is usually converted into a soft black mass which readily disintegrates during
examination.
Perforation may occur with escape of its contents into the peritoneal cavity. Erosion or
severe inflammation of the larynx and trachea may be present. If the victim survives for few
days its toxic effects are visible in the liver and kidney which then is swollen.
Medico-legal Aspect
Accidental poisoning results due to ingestion of the acid presuming it to be some medicine.
Accidental burn may occur when the bottle containing acid falls and breaks on the body.
Most cases are suicidal.
It is not used for homicidal purpose because of its acid taste. However, throwing of Sulfuric
acid to disfigure and harm individuals out of jealousy or enmity is a common practice. This
is known as VITRIOLAGE (vitriol throwing). Blindness may occur if the eyes are involved.
Precaution during autopsy
Autopsy surgeon should wear proper gloving to protect from the acidic effect on their hands
and body.
The viscera should be retained in supersaturated solution of common salt for sending to
forensic science laboratory.
The test for acid may be under taken in the post mortem room if the facility exists.
NITRIC ACID
The signs and symptoms are similar to those of poisoning by Sulfuric acid. Nitric acid is
fuming heavy liquid. The inhalation of the fumes of nitric acid is highly dangerous because
even short exposure to these fumes may cause severe inflammation of the air passage and
bronchopneumonia. Those who have to deal with the accidents from nitric acid must take
suitable precautions and should guard their mouths and noses and must not remain in
direct contact with the fumes for more than a few seconds. Prompt dilution or neutralization
253
30 MINERAL ACIDS
of the acid is imperative. Nitric acid produces yellow discoloration of the tissue due to the
production of picric acid via xanthoproteic reaction.
Treatment:-
Same as of Sulfuric acid poisoning
Fatal Dose - 10 to 15 ml
Fatal Period - 12 to 24 hrs
Postmortem Appearances
These are similar to Sulfuric acids, but the tissues, teeth are stained yellow.
The mucosa of the esophagus and stomach may not show yellow discoloration and may
appear brown or black due to formation of acid hematin. Perforation of the stomach is
uncommon.
Medico-legal Aspects
• Mostly accidental poisoning
• Suicide from nitric acid is uncommon.
• Homicidal from nitric acid is rare.
HYDROCHLORIC ACID
Hydrochloric acid is mildest of all the corrosives
It is less corrosive in action than Sulfuric acid. Perforation of the stomach is rare.
Signs and symptoms and treatment are similar to Sulfuric acid poisoning.
Postmortem appearances
These resemble Sulfuric acid poisoning
he mucosa is at first gray later becomes black, due to the formation of acid hematin.
The inhalation of the fumes of hydrochloric acid may cause inflammation of the air
passages with symptoms of suffocation, dyspnea and coughing.
254
MINERAL ACIDS 30
Fatal Dose - 15 to 20 ml
Fatal Period - 18 to 36 hours
• Mostly accidental
• Sometimes suicidal
• Homicidal is rare.
255
Chapter
31
ORGANIC ACIDS
Carbolic Acid (Phenol) 258

Oxalic Acid 259
Aspirin (Acetyl Salicylic Acid) 261
257
31 ORGANIC ACIDS
CARBOLIC ACID (PHENOL)

In pure form, the acid consist of colorless, needle like crystals, having
phenolic smell (lifebuoy soap odor) and a burning sweet taste. On exposure
to air the crystals liquefies to deep pink or brownish pink liquid. It is soluble in
alcohol, glycerin, and fats. It is slightly soluble in water. It is used as an
antiseptic, disinfectant, preservative and in industries. The commercial
carbolic acid has severe impurities, chiefly cresol. Lysol is a 50% solution of
cresol. Dettol is a chlorinated carbolic acid with turpineol.
Action:
On application to skin it causes numbness, tingling leading to anesthesia of the skin due to
destruction of he nerve endings of the skin. The effected part looks red which is followed by
necrosis.
In concentrated form, when it comes into contact of the mucous membrane, produces white
patch and thickening of the mucosae. Locally, it is corrosive in action and after absorption it
behaves like a narcotic poison.
Signs and Symptoms
On swallowing of the acid there is burning pain in mouth, throat, and chest and extending
down to stomach. The lips, mouth and tongue become white and hardened. There may be
nausea and vomiting.
The systemic effects comprise, fall of blood pressure, contraction of pupil and
unconsciousness. There is a strong odor of phenol in breath.
Carbolic acid is converted into hydroquinone and pyrocatechol in the body before being
excreted in the urine. On keeping the urine exposed to air the metabolic products undergo
oxidation and the color of the urine changes to olive green known as CARBOLURIA.
Carbolic acid is a nephrotoxic agent causing oliguria and albuminuria.
Fatal Dose - Approximately 2 grams.
Fatal Period - Death may occur within 3 to 4 hours due to respiratory or circulatory failure or
in few days due to hepatic or renal failure.
Treatment
If phenol falls on the body, the area should be washed with soap and water. Olive oil or
some vegetable oil should be applied on the affected area and again it should be washed
with soap water.
258
ORGANIC ACIDS 31
When ingested the stomach should be washed carefully with plenty of lukewarm water
containing animal charcoal, vegetable oil, magnesium sulfate. Stomach wash made from
lime solution is advantageous as phenol combines and forms harmless products. Washing
should be continued until the washings are clear and odorless.
Demulcent drinks like milk, egg albumin should be given.
Saline containing 5-7grams of sodium bicarbonate per liter is given intravenously to combat
circulatory depression and enhancing the excretion of carbolic acid by producing diuresis.
Post-mortem Appearance
Externally - There will be corrosion of the skin which may appear grayish or reddish. The
mucous membrane of the lips and mouth is corrugated, sodden, white or ash gray and may
be detached with small tiny submucosal hemorrhages.
Internal - The mucosa of the esophagus and stomach is hardened and may appear white
or gray, corrugated and arranged in longitudinal folds with tiny hemorrhages. The stomach
looks like a leather bag. The stomach contains a reddish fluid mixed with mucus and shreds
of epithelium. There will be smell of phenol. The liver and spleen will show white patches.
Kidneys are enlarged and may show signs of hemorrhagic nephritis.
Medicolegal Aspects
Accidental poisoning may occur when it is taken by mistake for some other liquid or when
taken by a child, as it is readily available in house.
Suicidal poisoning is very uncommon.
Homicidal use is not possible ordinarily due to its typical odor.
Rarely, diluted phenol mixed with some other agent is pushed inside the uterus to produce
abortion.
OXALIC ACID
Oxalic acid is colorless, transparent prismatic crystals and closely
resembles in appearance of the crystals of magnesium and zinc
sulfate.
It is extensively used as metal cleaning agent and stain remover. It is

also used in leather industry, in calico-printing and book binding centers.
It has a burning sour taste.
259
31 ORGANIC ACIDS
ACTION
It has local and remote action. Locally, it corrodes the skin and mucus membrane. Large
doses cause rapid death from shock. Hypocalcemia develops, because it readily combines
with the calcium ion in the body tissues forming calcium oxalates. Hypocalcemia causes
tingling and numbness of fingers and limbs In acute poisoning there is muscular
tenderness, irritation and tetanic convulsion. Respiratory depression is common feature and
ventricular fibrillation may lead to death.
On ingestion, vomit is the usual feature and the Vomitus contains altered blood and mucus
and has a “coffee ground” appearance.
If death is delayed there may be signs of toxic nephritis viz. oliguria, hematuria, and
oxaluria.
Fatal Dose- 5-15 grams
Treatment
Stomach tube may be passed cautiously for removing the unabsorbed poison. The stomach
wash should be done with calcium lactate or calcium gluconate, two teaspoonfuls in each
lavage. This will form calcium oxalate in the stomach which is insoluble and should be
taken out by stomach wash. It should be kept in mind that any preparation of calcium which
converts the poison into insoluble calcium oxalate is life saving antidote in oxalic acid
poisoning. If these are not available in hand a suspension of ordinary chalk mixed in water
or milk will neutralize oxalic acid.
Demulcent drinks should be given to protect the mucus membrane of the stomach from the
corrosive action of the acid. Side by side 10% calcium gluconate should be given by slow
I.V. injection which will combine with the oxalic acid in the circulation and blood calcium will
be spared. This will prevent hypocalcemia. Enema may be useful to remove the
unabsorbed poison.
Maintain blood pressure, respiration and electrolyte balance.
Post-mortem Appearances
Oxalic acid usually does not produce corrosive effect on the skin and the lips.
The mucus membranes of the mouth, tongue and esophagus are usually whitened and
show longitudinal erosion. The stomach mucosa is eroded and appears brownish in color
which is mixed with altered blood. The upper part of intestine also shows signs of erosion.
Kidneys are congested and swollen. On microscopic examination the tubules are loaded of
calcium oxalates.
Viscera should be preserved for onward transmission to forensic science laboratory.
260
ORGANIC ACIDS 31
Medico-legal aspects:-
Accidental poisoning is common amongst children. It can also occur when it is taken by
mistake for magnesium sulfate.
Suicidal poisoning is less common
Homicidal poisoning is rare because of its sour taste.
Oxalic Acid Magnesium Sulfate
Taste Sour and acid Bitter
Reaction Strongly acid Neutral
With Sodium Carbonate Produces effervescence Absent
Ink Stain Disappear No affect
Table 31.1. Differences between oxalic acid and magnesium sulfate
ASPIRIN (ACETYL SALICYLIC ACID)

It is extensively used as an antipyretic analgesic
and as prophylactic in many cases of coronary
artery disease. It is a popular self medicating
agent.
Signs and Symptoms
Aspirin overdose commonly produce nausea, vomiting, tinnitus and deafness. Profuse
sweating occurs in moderately severe poisoning. There may be pain abdomen. The
respiration is at first fast and deep and then depressed. Scanty urine with more uric acid
excretion There may be hematemesis, hematuria and purpura like hemorrhage.
Petechiae and subconjunctival hemorrhage can occur due to reduced platelet aggregation.
Signs of serious aspirin poisoning include metabolic acidosis, renal failure and CNS effects
such as agitation, confusion, coma and fits.
Death can occur as a consequence of CNS depression and cardiovascular collapse.
Fatal Dose - 5-15 grams. In persons idiosyncratic to aspirin, therapeutic dose can be fatal.
261
31 ORGANIC ACIDS
Treatment
Stomach wash with 5% sodium bicarbonate is effective up to 6 hours of ingestion.
Intravenous sodium bicarbonate (8.4%) is life saving.
Urinary Alkalinization is indicated.
Hemodialysis is very effective
Patients are often very dehydrated, and it is important to replace fluid loss from vomiting
and sweating.
Medico-Legal Aspect:-
Commonly accidental poisoning in children
Suicidal poisoning is very rare.
They are not used for homicide.
262
Chapter
32
LEAD POISONING
Metabolism 264
Distribuon In The Body 264
Mode Of Acon 264
Clinical Picture 264
Treatment 266
Post Mortem Findings 266
Diagnosis 267
Medicolegal Aspects 267
263
32 LEAD POISONING
Lead is used widely in a variety of industries. All Lead compounds like Lead Arsenate, Lead
Oxide and Lead Carbonate are highly dangerous whereas Lead Sulfide is the least toxic.
Lead has been used in industry and in household products for centuries.
People are exposed to lead chiefly via paints, Plumbing fixtures, cans, and leaded petrol.
Many other environmental sources of exposure exist, such as leafy vegetables grown in
lead contaminated soil, improperly glazed ceramics. Many industries, such as battery
manufacturing, painting and paint removal, persons engaged in printing press and the
plumbers continue to pose a significant risk of lead exposure. In chronic poisoning the
clinical manifestations of which are termed Plumbism have been known since ancient
times.
Metabolism
Elemental lead and inorganic lead compounds are absorbed through ingestion or
inhalation. Tetraethyl lead (organic lead) is absorbed to a significant degree through the
skin as well. Lead absorbed into blood plasma accumulates in soft and hand tissues. The
bulk of absorbed lead is stored into the skeleton. Lead is excreted mainly in the urine and in
the feces.
Lead poisoning may occur in three ways:

1. Inhalation
2. Ingestion
3. Through Skin. This occurs only in organic compounds, especially tetraethyl lead.
Inorganic compounds are not absorbed through skin
Distribution in the body
Nearly 90% of ingested Lead is excreted in feces. Lead absorbed from the gut enters the
erythrocyte. It is then carried to the liver and kidney and finally transported to the bones.
Mode of action
Lead exerts its toxic action by combining with essential SH groups of certain enzymes,
particularly amongst those involved in carbohydrate metabolism.
Fatal Dose - Lead acetate 20g; Lead Carbonate 40g
Fatal Period - One to two days.
Clinical Picture
The clinical picture of Plumbism is different in organic and inorganic lead exposures.
264
LEAD POISONING 32
The toxic effects of inorganic Lead exposure are:
1. Abdominal Colic
2. Obstinate constipation
3. Loss of appetite
4. Blue line on gums
5. Stippling of red cells
6. Anemia
7. Wrist and foot drop
The toxic effects of organic Lead compounds are mostly on CNS and shows
1. Mental confusion
2. Headache
3. Insomnia
4. Convulsion
5. Delirium
Inorganic compounds of lead show
1. Lead Colic- Involving both small and large intestines, spasmodic pain which relieves
on pressure
2. Lead Line (Burtonian Line) - Blue line on gums.
3. Basophilic Stippling of Red Cells
4. Anemia
5. Retinal Stippling - grayish glistening Lead particles
6. Lead Encephalopathy - changes in personality, restlessness
7. Cardio-Renal Manifestation - High BP, Atherosclerotic changes
8. Reproductive - Sterility, Abortions, Loss of libido
9. Optic Atrophy
10. Osteopathy
11. Lead Palsy like wrist and foot drop.
In adults symptomatic lead poisoning usually develops when blood lead levels exceed 80
µg/dl for a period of weeks, and is characterized by abdominal pain, headache, irritability,
joint pain, fatigue, and anemia. There is inability to concentrate and then may be short term
memory loss. Lead encephalopathy is rare.
265
32 LEAD POISONING
A lead line sometimes appears at the gingival tooth border after prolonged high level
exposure. Chronic lead poisoning is associated with increase in blood pressure and serum
creatinine. Elevation of the blood lead level appears to be a risk factor for anemia. The red
blood cells show marked punctate basophilia, there is presence of dark blue colored
pinhead sized spots in the cytoplasm of red cells, due to toxic action of lead on porphyrin
metabolism.
Rarely, paralysis affecting the extensor muscles of the fingers and wrist occurs causing
wrist drop, and brachioradialis usually escape from paralysis. Paralysis may spread to the
extensors of the foot, resulting in foot drop and the tibialis anterior muscles usually escape.
Diagnosis is made on a thorough clinical examinations based on the type of work done and
the quantitative estimation of the lead content of urine and blood.
Treatment
It is absolutely essential to prevent further exposure of affected individuals to lead.

Pharmacologic treatment for lead toxicity entails the use of chelating agents, principally
calcium disodium edetate (Calcium EDTA). Calcium EDTA in the dose of 1g is dissolved in
500 ml 5% normal saline or dextrose is given intravenously, over one hour. Chelation is
recommended for the treatment of all children whose blood lead levels are >2.7 µmol/L,
with the addition of B.A.L if lead encephalopathy is found. The chelation is recommended
for adults if blood lead level exceeds 80µg/dl.
In acute lead poisoning besides administering calcium EDTA calcium gluconate - 2g I.V. is
given which relieves abdominal colic and also enhances the deposition of lead in the bones
and thus averts the acute crisis.
Sodium iodide or potassium iodide or ammonium chloride 1-2 g, thrice a day helps removal
of lead from bones. Restriction of calcium diet and vitamins D helps quick mobilization of
lead from its accumulation in the bones. Care must be taken that acute lead poisoning may
not occur during removal of level of lead from bones and in such case EDTA is
administered to prevent acute poisoning. In case of crisis due to high level of lead in blood
due to rapid mobilization from the bones or otherwise administration of calcium gluconate,
milk help to shift lead from blood to the bones. Removal of lead from bone may be
undertaken slowly at a later date, keeping in mind the recurrence of acute poisoning.
Post mortem findings

1. A blue line may be seen on the gums.
2. The body will be emaciated.
3. Liver may show degenerative changes.
4. Kidneys may show signs of interstitial nephritis and are usually contracted.
266
LEAD POISONING 32
Circumstances of poisoning
1. It is not used for suicide.
2. Diachylon paste (lead oleate) was used in past for procuring abortion.
3. Accidental chronic poisoning of lead occurs in workers exposed to lead chiefly via paints,
plumbing, fixtures etc.
Diagnosis
Diagnosis is based on history, clinical features and laboratory test. Raised blood lead
concentration between 0.1 to 0.6 mg/dl is practically diagnostic. Basophilic stippling of red
blood corpuscles is also diagnostic.
Medicolegal Aspects
Chronic lead poisoning is common and regarded as an industrial disease. This is accidental
among factory workers when they are exposed in the factory in an ill ventilated condition
and when proper personal hygiene and periodical medical examination is inadequate.
Accidental poisoning may occur among children when they ingest paints or similar
substances containing lead.
Diachylon paste containing lead oleate which can be used to procure criminal abortion can
cause lead poisoning.
Homicidal poisoning is rare.
267
Chapter
33
MERCURY
Mercury Poisoning 270

Laboratory Findings 271
Treatment 271
Post Mortem Appearances 271
269
33 MERCURY
The soluble salts of mercury inactivate sulfhydryl enzymes and thus interfere with cellular
metabolism. Metallic mercury is not toxic.
Mercurous mercury and mercuric mercury can be combined with other chemicals such as
carbon, chlorine or oxygen, to form inorganic or organic mercury compounds.
Metallic mercury is used in thermometers, dental amalgams, and some batteries.
Inhalation of metallic mercury vapor causes cough, dyspnea and tightness or burning pain
in the chest. This may cause respiratory distress, pulmonary edema, lobar pneumonia,
fibrosis, and in severe case have sometimes led to death.
Acute high dose ingestion of inorganic mercury causes severe gastrointestinal corrosion
with nausea, vomiting, hematemesis and abdominal pain.
The lethal dose of inorganic mercury is estimated to be in the range of 10 to 42 mg/kg.
In mild dose it causes gingivitis, loosening of teeth, high B.P, tachycardia and nephrotic
syndrome. Ingestion of organic mercury compounds is followed by diarrhea, tenesmus and
blisters of the upper gastro-intestinal tract.
The fatal dose of organic mercury is 10 to 60 mg/kg.
Chronic exposure to metallic mercury produces a characteristic intention tremor and

mercurial erythrism comprising of memory loss, insomnia, timidity and sometimes delirium.
Tremor is one of the most characteristic manifestations of chronic mercury poisoning and
the advanced condition is referred to as Hatter’s shake because it was common amongst
workers engaged in the hat manufacturing industry.
The neurotoxicity resulting from organic mercury exposure is characterized by paresthesia,

impaired peripheral vision, hearing and smell. This may be associated with unsteadiness of
gait, memory loss and muscular weakness. Such symptoms begin at doses above 1.7 mg/
kg.
Post mortem findings exhibit lesions in the basal ganglion and gray matter of the cortex and
cerebellum.
Organic mercury exposure is primarily through the ingestion of grain treated with mercuric
fungicides or of contaminated fish. This is also associated with an increased risk of fetal
toxicity.
After the 1955 mercury poisoning out break in Japan, exposed mothers to mercury vapors
gave birth to infants with mental retardation, dysarthria etc.
Exposure of children to mercury in any of its forms can cause a particular syndrome known
as acrodynia, or pink disease. The classical signs are flushing, itching, swelling, salivation,
raised blood pressure etc. The fever is associated with pink colored rashes.
270
MERCURY 33
Laboratory findings
Symptoms may develop when blood and urine mercury level exceeds 20 µg/dl.
In chronic exposure to mercury vapors, the worker may suffer from mercurialentis which is
deposition of grains of mercury on the anterior lens of the eyes.
Treatment:
In acute poisoning emesis or gastric lavage be initiated. British anti lewisite and
Penicillamine are chelating agents of choice. B.A.L. at a dose of 100mg 4 hourly for 2 days
is given deep IM. Penicillamine in a dose of 30mg/kg per day in divided dose is useful.
I.V. injection of 5 to 10% solution of glucose in normal saline should be given freely to
produce diuresis.
Symptomatic treatment should be undertaken as and when required. Hemodialysis is useful

if kidney is involved.
On ingestion of the poison in concentrated form the mucous membrane of lips, mouth and
pharynx presents grayish white appearance. The stomach is softened and contains
coagulated albumen mixed with mucous and liquid blood. The gastric mucosae are
inflamed and contain grayish deposit of mercury. The intestine becomes ulcerated and
gangrenous. The liver and spleen becomes congested. The liver shows signs of cloudy
swelling.
The kidneys are swollen with necrosis of the tubules. In chronic poisoning of mercury the
liver shows fatty degeneration. The kidneys show tubular necrosis. The basal ganglion,
gray matter of the cortex and cerebellum exhibit definite changes viz. swollen and softened
Medicolegal aspects
Homicidal and suicidal poisoning is rare.
Accidental cases of poisoning by mercuric chloride can occur when concentrated solution is
used in washing abscess cavity or irrigating the vagina, uterus or rectum.
Mercurous chloride (calomel) is a safe medicine but in large doses it acts as an irritant
poison.
271
Chapter
34
ARSENIC
Clinical Features 274

Acute Arsenic Poisoning 274
Chronic Arsenic Poisoning 274
Diagnosis 275
Treatment 275
273
34 ARSENIC
Arsenious oxide or arsenic trioxide is the common form of arsenic used. This is known as
white arsenic. It is tasteless, odorless and heavy powder. When the powder is added to
water it floats in the surface of water although it is three and half times heavier than water.
Occupational exposure to arsenic is common in the smelting industry.
Low level arsenic exposure continues to take place in the general population through the
commercial use of inorganic arsenic compounds in common products such as pesticides,
paints etc. Arsenic is a natural contaminant of some deep water wells.
In general, inorganic arsenic is more toxic than organic arsenic.
After absorption, inorganic arsenic accumulates in the liver, spleen, kidneys, lungs and
gastrointestinal tract. It is also accumulated in keratin rich tissues such as skin, hair, nails,
soft tissues, and bones. Arsenic inhibits sulfhydryl enzyme system.
Metallic arsenic is not poisonous. It oxidizes in air and then becomes poisonous.
It is largely used in preparing wall papers artificial flower, paste for killing rats etc.
Clinical Features:
All arsenicals inhibit the SH enzyme system which are necessary for cellular metabolism. It
is a strong capillary poison. The long standing effects of acute arsenic poisoning are bone
marrow aplasia with basophilic stippling of RBC and immature white and red blood
corpuscles in peripheral circulation.
There may be development of white streaks at the growing parts of the nails called Mee’s
lines. Vomiting, Diarrhea, Blood stained urine, Oliguria, Dehydration are the common signs
and symptoms.
Depression of myocardium and prolonged Q-T intervals and abnormal T waves are
invariable seen in arsenic poisoning.
ACUTE ARSENIC POISONING

This result from ingestion of arsenic which induces inflammation and necrosis of the
intestinal mucosae These changes manifest as diarrhea, vomiting, fluid
loss and hypotension. The stool is often blood stained and so is the
Vomitus. Abdominal pain is a common feature.
Lethal Dose: - 120 to 200 mg in adults and 2mg/kg in children
CHRONIC ARSENIC POISONING

The onset of symptoms comes at 2 to 8 weeks. Fig. 34.1. Arsenic
Hand
274
ARSENIC 34
Typical findings are skin and nail changes, such as hyperkeratosis, hyperpigmentation and
transverse white striae of the fingernails known as Mee’s lines.
Diagnosis
An X-ray of the abdomen may reveal ingested arsenic, which is radio-opaque. The serum
arsenic level may exceed 7µg/dl. Electrocardiogram may include QRS complex broadening,
QT prolongation and T wave flattening.
Arsenic may be detected in the hair and nails for months after exposure.
Fatal Dose - 0.1 to 0.2 g
Fatal Period - One to two days.
TREATMENT
Syrup ipecac can be given to induce vomiting. The stomach should be washed thoroughly
by the stomach tube with large amount of water and milk. A freshly prepared hydrated ferric
oxide precipitate is administered in tablespoonful dose at short intervals for 2 to 3 days.
This converts the arsenic into ferric arsenite which retards absorption of arsenic. This is
prepared by mixing 45 ml of tincture ferric perchloride with 5g magnesium oxide or
potassium carbonate in a glass of water. It is strained by a muslin cloth and the precipitate
is administered.
I.V. fluid and electrolytes replacement in an intensive care setting may be life saving. B.A.L.
is the chelating agent of choice and is administered I.M. at an initial dosing of 3-5 mg/kg
every 4 hrs for 2 days every 6 hrs on the 3rd day and every 12 hrs there after for 10 days.
In case of renal failure, doses should be adjusted carefully and hemodialysis may be
needed to remove the chelating agent.
MEDICOLEGAL ASPECTS
Arsenic is the most popular homicidal poison because it is colorless and tasteless. A very
small quantity can cause death and the signs and symptoms resemble from hemorrhagic
gastro-enteritis. It can be easily administered with food or drink.
However, if arsenic poisoning is suspected it can be detected even in completely

decomposed bodies and also can be found in bones, hairs and nails for several years after
burial. It can also be detected in burnt bones or ashes. Suicide is rare because it causes lot
of sufferings before death.
The viscera, bones, hairs and nails are retained. Stomach in acute poisoning shows
submucosal hemorrhage, fatty degeneration of liver and nephritis
275
34 ARSENIC
Some people take arsenic daily for rejuvenation or as an aphrodisiac. They develop
tolerance of arsenic and can take arsenic 0.3 g or more in one dose. Such persons are
labeled as arseninophagists.
Accidental death may occur from its improper medicinal use or due to admixture with
articles of food.
Traits Arsenic Poisoning Cholera
Diarrhea Follows vomiting Precedes Vomiting
Stool Bloody diarrhea Rice water
Pain abdomen Present Absent or may be slight
Conjunctiva Inflamed Not inflamed
Stool exam Will show arsenic Cholera vibrio

Table 35.1. Difference between arsenic poisoning and cholera
276
Chapter
35
PHOSPHORUS (INORGANIC -NON METALLIC)
Yellow Phosphorus 278

Red Phosphorus 278
Acute Poisoning 278
Symptoms 278
Treatment 278
Chronic Poisoning 279
277
35 PHOSPHORUS (INORGANIC -NON METALLIC)
Phosphorus is an inorganic non metallic Irritant poison which sets up inflammation in the
G.I. canal.
There are two varieties - a) White or yellow, which is highly poisonous and b) red, which
is non poisonous.
YELLOW PHOSPHORUS
It is highly poisonous and occurs as a white, waxy and translucent soft cylinder. On
exposure to the air it becomes yellow. Insoluble in water somewhat soluble in alcohol or
ether and rapidly soluble in carbon disulphide On exposure to air it emits white fumes which
have garlicky odor.
At 30°C it ignites in the air, burning with greenish white flame in the dark and thus is kept in
water and taken out with forceps.
It is used in chemical industry, fertilizer manufacture and as rodenticides and in fireworks

and gunpowder.
RED PHOSPHORUS
It is non poisonous obtained from heating white phosphorous 240°C in an atmosphere of
CO2 or N2 It is not luminous in the dark and it has no garlicky odor. Safety Matchbox side
contains Red phosphorous and powdered glass. Match sticks Contains KCL and antimony
Sulfide.
ACUTE POISONING
Symptoms
Stage I - May appear after 1-6 hours of ingestion. Sometimes symptoms may appear soon
after swallowing poison. There is burning pain and local irritation of the throat followed by
nausea, vomiting and diarrhea.
Stage-II - G.I. Symptoms are prominent. There is garlicky taste, burning pain in throat
followed by vomiting. Vomitus is of garlicky odor and luminous in dark. Breath is also
garlicky in odor and may be luminous in the dark. Diarrhea is not a constant feature but if
occurs are dark, offensive in odor and sometimes phosphorescent.
In rapidly fatal cases these symptoms become severe, peripheral circulatory collapse sets
in and the patient passes into a state of delirium, convulsion and coma showing sign of
acute yellow atrophy of liver. Large Dose of 1 to 2 grams may cause death in about 12 to
24 hrs.
Stage III - Latent Period - No symptom for 2-4 days.
Stage IV - Signs of liver failure, resembling acute viral hepatitis with jaundice and pruritus
may be present. Liver and spleen are enlarged, abdomen is usually distended. Vomiting
278
PHOSPHORUS (INORGANIC -NON METALLIC) 35
and purging contains blood. Bleeding from mouth, nose, urethra, vagina and uterus are
common features.
Phosphorus is a Protoplasmic poison. Normal metabolism is disturbed, cellular oxidation is
affected and extensive fatty degeneration is found. In contact with skin, yellow phosphorous
causes burns and blisters.
Fatal Dose - 60-120 mg
Fatal Period- 2-8 Days
Treatment
Washing the stomach from KMnO4 solution converts phosphorus into phosphoric acid and
phosphates and itself changes to manganese dioxide. The stomach may be washed with
0.1% CuSo4 solution which converts phosphorus into phosphide of cupper. The bowel is
evacuated. Liver is protected by administering low fat, high protein and high carbohydrate
diet. Dextrose oral and -5% glucose I.V. drip may be required.
There may be garlicky smell from stomach, gastric mucosa will show yellow petechiael
hemorrhages, mucous membranes are inflamed and liver is enlarged or atrophied showing
the signs of acute atrophy of liver. Jaundice is almost always present.
CHRONIC POISONING
It occurs due to inhalation of yellow phosphorus fumes. The industrial workers who are
exposed to vapors may suffer from swelling and necrosis of jaw bone. This particularly
occurs when there is dental caries. The vapor makes entrance in the jaw bone from caries
and excites the Haversian canal of the bone resulting in increased bone formation. This
additional formation of bone causes decreased blood supply in the bone. Consequently,
there is necrosis of the jaw bone. On X-ray examination there is sequestration of jaw bone.
This is known as PHOSSY JAW.
Besides this, there are signs of liver failure. The liver will show signs of fatty degeneration
which gradually diminishes in size presenting as acute atrophy of liver. There is emaciation
of the body, loss of appetite. The gums are inflamed and there is fetid odor from the breath.
MEDICOLEGAL ASPECTS
Accidental poisoning may occur amongst children due to ingestion of fireworks or rat
poisons. Homicidal poison is rare.
Chronic poisoning may occur amongst industrial workers working in an ill ventilated
atmosphere with poor oral hygiene.
White phosphorus is used for arson purposes. It is thrown on huts which may catch fire.
279
Chapter
36
ORGANOPHOSPHOROUS POISONS
Signs and Symptoms 282

Diagnosis 283
Treatment 283
Medico-Legal Aspect 283
Aluminum Phosphide 284
Treatment 284
Medico-Legal Aspect 284
Post Mortem Appearance 285
281
36 ORGANOPHOSPHOROUS POISONS3
These compounds are extensively used as pesticides in agriculture.
They are obtained from phosphoric acid and occur in alkyl phosphates and aryl phosphates
compounds. Alkyl phosphates include (1) Malathion, (2) Hexaethyltetraphosphates etc.
where as aryl phosphate include (1) Parathion (Follidol), Diazinon (Tik 20) etc.
These compounds inhibit acetylcholinesterase and cause accumulation of acetylcholine at

muscarinic and nicotinic synapses and in the CNS.
Carbamates such as the insecticides aldicarb, Baygon, Sevin and bendiocarb (Ficam)
reversibly inhibit this enzyme.
Organophosphorous compounds such as the insecticides- Diazinon, Malathion and

parathion and the chemical warfare “nerve gases” such as sarin irreversibly inhibit
acetylcholinesterase and cause accumulation of acetylcholine at muscarinic and nicotinic
synapses.
Organophosphates are absorbed through the skin, lungs and gastro-intestinal and widely
distributed in tissues.
Sign and Symptoms
Muscarinic effects include

1. Nausea and vomiting
2. Abdominal cramps
3. Increased bronchial secretions
4. Cough, wheezing and dyspnea
5. Salivation
6. Pupillary constriction
7. Blurred vision
8. Lacrimation
9. In severe poisoning there may be bradycardia, fall of blood pressure and pulmonary
edema.
Nicotinic signs include
1. Twitching
2. Fasciculations
3. Tachycardia and hypertension
4. In severe poisoning paralysis and respiratory failure may occur.
5. CNS effects include: Anxiety, Restlessness, Confusion, Seizures and Coma
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ORGANOPHOSPHOROUS POISONS 36
Toxicity due to carbamates (Baygon) is usually less severe then due to the
organophosphates.
Diagnosis
Diagnosis depends mainly on the clinical signs and history, since cholinesterase assays are
not routinely or rapidly available.
A reduction of cholinesterase activity in plasma and red blood cells to < 50% of normal
confirms the diagnosis.
Treatment
The contaminated clothing should be removed and the body should be washed thoroughly
with soap and water.
When the poison is ingested, it should be washed out by using activated charcoal. Charcoal
is effective within 4 hours of ingestion.
Atropine, a muscarinic receptor antagonist should be administered for muscarinic effects. A

dose of 2 mg is pushed I.V. every 10-15 minutes until pupils are dilated, bronchial
secretions have dried. A total dose may be up to 40 mg.
Cholinesterase reactivators viz. Pralidoxime (2-PAM) is indicated for nicotinic symptoms

due to organophosphate poisoning. A dose of 1 to 2 g is given I.V. over 5-30 minutes. It can
be repeated in 30 minutes, if the response is incomplete.
Supportive measures include oxygen administration and treatment of seizures with

benzodiazepines.
Fatal dose - Malathion and Diazinon 1g orally Parathion 175 mg orally.
The fatal dose of the most of the organophosphate ranges from 100mg to 350mg orally.
Post mortem Appearances
Asphyxial signs viz. cyanosis, congestion and petechiael hemorrhages are found. There
may be smell of kerosene. Blood stained froth is seen at the mouth and nose. Viscera are
congested. The air passage is congested and contains frothy hemorrhagic exudates. The
cholinesterase in red blood corpuscles and at myoneural junction is below normal.
Medico-legal Aspect
Their easy availability and quick action is the reason for their popularity for suicidal
purposes.
Homicide is rare because of its typical kerosene smell and bitter taste.
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36 ORGANOPHOSPHOROUS POISONS3
Accidental poisoning may occur amongst the person who are engaged in the manufacture
and packing of the compounds and those who use these compounds as sprays in the open
as insecticides.
ALUMUNIUM PHOSPHIDE
Aluminum Phosphide is mainly used to control insects and rodents in food grains and fields.
It is available as white tablets of Celphos, Quickphos, Alphosh etc. each weighing 3gms
and has the capacity to liberate one gram of phosphine. Aluminum phosphide has garlicky
odor. Phosphine is liberated after ingestion of Aluminum phosphide tablets. Phosphine is
absorbed from the gastro-intestinal tract by simple diffusion. It is also absorbed from lungs
after inhalation. After ingestion some aluminum phosphide is metabolized in liver and
phosphine is liberated which causes damage to the internal organs, the phosphine acts as
a respiratory poison.
Fatal Dose - 0.15 to 0.5 g
Fatal Period- 1 to 3 days
Signs and Symptoms
1. Acute respiratory distress
2. Easy Fatigue
3. Nausea and vomiting
4. Jaundice
5. Cardiac arrhythmia
6. Pulmonary edema and coma.
Treatment
Gastric lavage with KMNO4 should be immediately done. Give activated charcoal 100gm
orally to absorb phosphine. There is no specific antidote. Symptomatic treatment is given.
Medico-legal Aspect
Organophosphorous compounds are very common suicidal poison
Accidental poisoning is common. Homicidal poisoning rare because of garlicky odor.
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ORGANOPHOSPHOROUS POISONS 36
Post mortem Appearance
Garlic- like odor organ inflamed and swollen mucus membrane of the lower part of the
gastrointestinal tract is inflamed and swollen.
285
Chapter
37
ALCOHOL
Absorpon, Detoxificaon And Excreon 288

Pharmacological Acon 289
Acute Alcoholic Intoxicaon 289
Signs And Symptoms 289
Treatment 290
Medico-Legal Aspects 292
Diagnosis Of Drunkenness 292
Clinical Examinaon 292
Chronic Alcoholism 293
Delirium Tremems 293
Acute Confusional Insanity 294
Korsakoff’s Psychosis 294
Alcoholic Demena 294
Methyl Alcohol 294
Ethylene Glycol 295
287
37 ALCOHOL
Commonly, the word alcohol refers to ethyl alcohol. This is obtained from distillation of
fermented carbohydrate. Pure ethyl alcohol is colorless, transparent having an aromatic
smell and burning taste. This is extensively used in modern medicine.
The concentration of alcohol varies, in different forms of alcoholic beverages. The

concentration of alcohol, in different drinks, may approximately be present as noted below:-
Type of Alcoholic Beverage Concentration of alcohol
Rum 50-60 percent
Whisky, gin and brandy 40 to 50 percent
Port, sherry and Champagne 15 to 20 percent
Wines 10 to 15 percent
Liquors 30 to 35 percent
Beer 4 to 10 percent
Proof spirit is an old term to define alcohol which when poured on the gunpowder causes
burning and the water content of alcohol is unable to prevent it. Alcohol content is 57.10
percent and water remains to be 42.90 percent.
Absolutely alcohol contains 99 percent of pure alcohol; where as rectified spirit contains 90
percent of alcohol.
Absorption, Detoxification and excretion
Absorption of alcohol is very rapid by a simple process of diffusion. Ethyl alcohol being a
small hydrophilic molecule is also rapidly absorbed from the alveoli. Eighty percent is
absorbed from small intestine and twenty percent from the stomach. About ninety percent
of alcohol is detoxified in the liver. During the process of metabolism, it is converted to
acetaldehyde, acetic acid and finally to carbon dioxide and water. About ten percent of the
alcohol is excreted as such from urine, breath, saliva and sweat. The peak concentration of
alcohol in the blood reaches in about one to one and half an hour time after ingestion. The
absorption of alcohol is delayed, if it is consumed after food and more if a fatty meal has
been consumed. The milk also retards the absorption. The rate of destruction is reasonably
constant in standard conditions which are fifteen grams of alcohol per hour. It is possible to
know the alcohol blood concentration of individual, in suspected crime, related with alcohol
ingestion. In other words it is possible to calculate, how long after a given dose the body will
be alcohol free and estimation can be made of blood concentration few hours before an
analysis was made.
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ALCOHOL 37
Pharmacological Action
Alcohol depresses the higher centers, which control the judgment and behavior.
Subsequently, it depresses the motor centers and medulla. The initial effect of exhilaration
and excitation is due to released inhibitory effect of the lower centers from the control of
higher centers. In smaller doses, it stimulates the gustatory nerves, and so the appetite is
increased Alcohol has no nutritional value but provides calories. Each gram of alcohol
yields seven calories in the body.
ACUTE ALCOHOLIC INTOXICATION

This occurs due to ingestion of large quantity of alcohol either in one big dose or at short
intervals.
Signs and symptoms
The signs and symptoms of alcohol intoxication can be conveniently grouped in three
stages depending upon the concentration of alcohol in the blood.
1) STAGE OF EXCITEMENT
This stage commences when the concentration of alcohol ranges between 0.05% to 0.2%
The person feels well and talks well. The behavior may be altered and the person laughs
easily and may become angry on petty matters. Gradually, he talks vulgar and acts in an
obscene manner. He becomes argumentative which may be even on wrong paints. There
may be smell of alcohol from the breath. In this stage some person retains remarkable
mental alertness in spite of intoxication.
2) STAGE OF INCO-ORDINATION
There is incoordination of thought, speech and action. Incoordination of thought leads to

mental confusion and hence sometimes called as state of confusion. The memory of recent
events is impaired. Incoordination of speech leads to slurred and incoherent voice. There is
difficulty in pronouncing consonants. Incoordination of muscles leads to staggering gait.
The reaction time is increased. The person may commit traffic accidents. There is delay in
applying brakes. Driving on twisted roads becomes faulty. There is tendency of overtaking
other vehicles on the road. The eyes appear congested and there is strong smell of alcohol
from the breath. The pupils are dilated. There may be hiccups. The person may vomit at
this stage following sleep and recovery. There will be hangover due to edema of brain. The
person may be happy or sad or irritable depending on his inherent emotion. The blood
alcohol concentration varies from 0.2 to 0.4%.
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37 ALCOHOL
3) STAGE of narcosis
The blood concentration of alcohol is beyond 0.4%. The person goes under deep and do
not respond to strong stimuli. Gradually, he enters in coma. The pulse is rapid, temperature
may be subnormal and the pupils may be contracted at this stage. However, while pinching
the body, there may be dilatation of the pupils. The dilatation of pupils on pinching the neck
or facial muscles is known as MacEwan’s Sign. The respiration gradually diminishes and
the reflexes are abolished. Side by side the medulla is affected and the pupils are dilated.
Fine lateral nystagmus is seen in this state. The MacEwan’s sign is an important sign in
differentiating alcoholic coma from other causes of coma. If this condition persists for about
12 hours death may result from respiratory paralysis.
Treatment
At first the stomach should be washed with plain water and the same sent to chemical
examiner. Subsequent wash should be undertaken with sodium bicarbonate solution for
preventing acidosis. The intravenous administration of vitamin B6 is useful in dosage of 50
to 100 mg. This improves the metabolism of alcohol. Coramine or other analeptics should
be administered. Administration of oxygen may be necessary. Oral and intravenous glucose
is recommended. The body heat should be maintained with blankets and hot water bags.
The rest of treatment is symptomatic.
Rigor mortise usually lasts for a longer period. Externally, there may be injuries on the body
on account of intoxication. The clothing may be soiled with dirt or torn. Internally, when the
body cavities are opened, smell of alcohol will be experienced. The smell of alcohol may
also occur, when the cranial cavity is opened. The gastric mucosae will be eroded. The
lungs are edematous and congested. The viscera should be retained in saturated solution
of common salt for chemical examination.
POST MORTEM BLOOD ALCOHOL
The blood for estimation of alcohol should be better collected from the veins at a distance
from heart. Axiliary veins or femoral veins are most suited. Collecting blood from heart
should be avoided as far as possible since the alcohol diffuses from stomach to heart,
which may show spurious concentration. Blood should be collected in 1% sodium fluoride
tube as preservative, which prevents loss of blood alcohol level by glycolysis and bacterial
action and also acts as an anticoagulant. Occasionally, the question is raised in courts that
the blood alcohol level, as reported by the chemist be lower, than it was at the moment of
death because some alcohol evaporated or was reduced when death occurred at the time
of autopsy, when the sample was obtained. The answer is simple that with stoppage of vital
functions of circulation, respiration, metabolism, and urine formation, no alcohol can be lost
after death. There is no loss of alcohol from blood by evaporation or any other means once
death has occurred. However, with the onset of decomposition alcohol is destroyed.
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ALCOHOL 37
Urine Alcohol
Analysis of two urine samples is required. The first specimen should be collected soon after
the incident. The second sample should be collected half an hour later and the time interval
between the two specimens should be accurately noted. The alcohol concentration in the
second sample of urine corresponds the blood alcohol level during the inter specimen
interval. The difference of alcohol content in the two samples of urine suggests either the
absorptive phase at its peak or in the eliminative phase. The blood and urine alcohol ratio
1:1.35. Accordingly, multiplication of the alcohol concentration in the second sample of
urine by 0.75 furnishes a value, which closely approximates the blood level during the time
that this specimen was secreted.
Fatal Dose - Variable. However 300 to 400 ml of absolute alcohol may cause death.
Fatal Period - May be regarded as one to two days but the death may be prolonged, when it
may occur due to complications.
The assailant may have been more easily provoked to violence because his elevated blood
alcohol eroded his emotional stability and judgment. Motor accidental deaths are mainly
result of drunken driver or drunken pedestrian. Accordingly, the blood alcohol is to be
ascertained in both the cases during investigation of the case.
Alcohol diminishes the driving efficiency in the following ways

1. It increases reaction time. The ability to depress his foot brake pedal or swing his
wheels in an emergency situation is lost.
2. It creates false confidence. A small quantity of alcohol makes him drive worse and
simultaneously giving him the impression that his driving is better.
3. Alcohol impairs concentration, lowers judgment and muscular co-ordination. Alcohol
makes drivers talk more, and their attention can be easily diverted.
4. It depresses visual and auditory acuity.
Most of the crimes are committed under the influence of alcohol. These include murder,
sexual offences, manslaughter, traffic accidents etc.
Drunkenness is a condition which results from excessive ingestion of alcohol and the
concerned person is so much under its influence that he:-
1. Loses control over his mental faculties.
2. Is unable to perform the duties on which he is particularly engaged at a particular
time.
3. He may be source of danger to others.
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37 ALCOHOL
In places, where there is prohibition enforced, Drinking in itself is crime and illicit distillation
of alcohol is prohibited. Therefore some persons do illicit distillation, increasing the work
load of police. There may be adulteration in alcohol, resulting some serious sickness or
even death to the consumers. Occasionally, methyl alcohol is consumed as a substitute to
ethyl alcohol causing blindness or death. In case where there is prohibition, acute alcoholic
intoxication plays a very considerable part in day-to-day work of the police department. In
places where there is no prohibition, drunkenness in such place is not a crime unless it is
accompanied by acts of omissions or commissions involving danger to life or property of
person or persons or himself. Thus, a person may be charged of being drunk or disorderly
or drunk and in charge of a vehicle. A doctor may be charged for attending a person or
operating a person or delivering a baby when intoxicated.
Diagnosis of Drunkenness
This is based on estimation of alcohol from blood, urine, saliva and clinical examination.
Blood in living cases should be collected with caution. Spirit or ether should not be used for
cleaning the skin. Skin should be cleaned with soap water. Sodium fluoride or potassium
oxalate may be used as preservative in the blood sample. In dead bodies the blood should
be collected from periphery to avoid any percolation from the stomach.
Urine sample is collected in the usual manner to which 30 mg of phenyl mercuric nitrate is
used as preservative for every 10ml of urine.
Breath is collected in a rubber balloon. The person is asked to blow the balloon. The
breathalyzer, alcometer, intoxmeter or drunkometer analyzes this. The amount of alcohol in
2100ml of alveolar air is the same as that in 1cc. of blood at 31 degree centigrade.
Alternatively, the person is asked to chew paraffin square and the saliva is collected to
measuring the alcohol concentration. This is seldom practiced.
Clinical Examination
Besides these tests the clinical examination may also be required. The person may be
asked to walk on a straight line. During intoxication there is no coordination of the gate.
Finger nose test should also be performed. However, the general examination of clothing,
speech and smell of alcohol from mouth is sufficient to infer consumption of alcohol. Eyes
become suffused. Extrinsic eye muscles may show the presence of fine lateral nystagmus,
which is an important sign of alcoholic intoxication. There is excessive salivation but
occasionally dry or furred tongue can be noticed. There are unusual actions of hiccups,
belching, vomiting and fighting. a
Different countries where there is no prohibition have fixed a safe level of alcohol in blood
for purposes of driving a vehicle. In Britain, the safe limit of alcohol for a driving a car is
0.08%.
However, the suspected person should be carefully watched for any head injury or other
drug ingestion that may give similar findings. Very frequently, head injury occurs following
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ALCOHOL 37
intoxication and the person must be retained in the hospital for close observation and CT
scan and X-ray of skull should be undertaken to exclude internal injuries in the head and
fracture of skull bone.
CHRONIC ALCOHOLISM
This result from continued use of alcohol and is characterized by physical, moral and
mental degeneration. The physical degeneration is characterized by poor hygiene, loss of
appetite, wasting, chronic gastro-enteritis, impotency and fatty changes in the heart and the
liver.
Four types of alcoholic insanities have been known which exhibits moral and mental
changes viz.
1. DELIRIUM TREMEMS.
2. ACUTE CONFUSIONAL INSANITY
3. KORSAKOFF’S PSYCHOSIS
4. CHRONIC DEMENTIA
1) DELIRIUM TREMENS
In delirium tremens the person becomes restless and irritable. His symptoms are worst at
night and consists largely the disorders of perception associated with tremor. The person
becomes hallucinated. He hears voices threatening him with death or some horrible fate.
He may feel the sensation of serpents, rats, mice and insects crawling over the skins. He
mistakes identities and losses all sense of his surroundings. He may become violent and
homicidal. At times the hallucinations are so worst that they may commit suicide to escape
from them. Delirium tremens is frequently seen amongst chronic alcoholics during the
following condition.
1. Acute infection
2. Shock from fracture of bones
3. Exposure to cold
4. Excessive ingestion of alcohol after some lapse of time when he had no drink.
Treatment
Delirium needs immediate treatment, chlorpromazine in a dose of 100mgm 4 times a day

and paraldehyde 10 to 20 ml are indicated. The person should be hospitalized.
Administering lipotropic factors and vitamin-B-complex may help protect liver. Convulsion
should be controlled by giving dilantin in a dose of 100 mg, 3 times a day.
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37 ALCOHOL
2) Acute confusional Insanity
In these condition hallucinations do appear but are less terrifying. Frequently the person
becomes over active and violent.
3) Korsakoff’s Psychosis
This is a type of alcoholic insanity associated with peripheral neuritis. In this disease there
is loss of memory of recent events and extreme disassociation. The treatment includes high
dosage of vi.-B1 and other symptomatic management.
4) Alcoholic dementia
All forms of alcoholic insanities tend to end in alcoholic dementia. This any occur without
being preceded by any other form of alcoholic insanity to such a mark degree that it may
need treatment. The most prominent feature of this dementia is loss of memory and the
habit of supplying blanks in the memory by fabrication of events, which have not occurred.
Chronic alcoholism is the commonest cause of sexual featured crimes especially those of
homicidal in nature. Stages leading to such crimes are fairly constant. The person becomes
irritable and the sexual desire shoots up. He becomes suspicious regarding the chastity of
his wife. Hallucinations then appear and several past incidents are interpreted to support
his delusional belief. Then comes the threat of violence, if the wife does not confess. Then
after repeated quarrels they may commit murder to his wife. It is worth nothing that it is
usually the wife and not the girlfriend whom he kills. Alcoholic women usually do not kill
their husband but often mutilate them or even commit suicide.
The person suffering from alcoholic insanities are not liable for any criminal action. They are
detained in mental asylum for treatment.
METHYL ALCOHOL
This is also known as wood alcohol or wood naphtha. This is obtained by destructive
distillation of wood or molasses. It has an action similar to that of ethyl alcohol. During the
process of metabolism, it is converted to formaldehyde and formic acid. It is slowly excreted
and hence acts as a cumulative poison. The poisonous effect is mainly due to metabolites.
The most remarkable effect is optic neuritis, which leads to total or partial blindness.
The other toxic effects are: - Dizziness, weakness, nausea, vomiting, abdominal pain and
fixed and dilated pupils.
Fatal Dose: - Approximately 60 to 300 ml. However, even much less dose has caused
blindness.
Fatal Period:-May be about 1 day, which may be prolonged to 3 to 4 days.
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ALCOHOL 37
Treatment
Stomach wash with 5% sodium bicarbonate Paraldehyde should be administered for

controlling the convulsion. Giving sodium bicarbonate either through oral route or intra-
venous channel will prevent acidosis. Ethyl alcohol may be administered which retards the
oxidation of methyl alcohol since they have common oxidation pathway.
Post mortem Appearance
The viscera are congested with inflammation of the gastric mucosae. Kidney show tubular
degeneration.
ETHYLENE GLYCOL
It is an anti freeze agent. The symptoms are similar to meningoencephalitis. Kidneys are
affected and this is converted to oxalic acid in the body. There is oxaluria and oxalic acid is
raised in the blood.
Treatment
Stomach should be washed. Calcium gluconate should be given to prevent hypocalcemia.

Ethyl alcohol may be administered which is the enzymatic inhibitor of the oxidation of
ethylene glycol.
Fatal Dose: - May be 100 to 400 ml.
Medicollegal Aspects
Accidental poisoning, when it is taken in place of ethyl alcohol, can occur. Rarely it has
been used as a suicidal poison.
295
Chapter
38
BARBITURATES

Complicaons 300
Treatment 300
Medicolegal Aspect 301
297
38 BARBITURATES
Barbiturates are hypnotics. These are largely used in modern
medicine, mostly to induce sleep or as an anticonvulsant and
occasionally to relieve anxieties. It has been correctly alleged that the
medical practitioners have over prescribed this drug and also that this
drug is easily available in the market. The incidence of suicidal
deaths from barbiturate poisoning amongst common people is
declining because of the availability of other potent and effective
newer drugs. It is extensively used as an anti epileptic drug and
anesthesia. It is a common suicidal poison amongst medical and
paramedical personnel’s because it is readily available to them. Fig. 38.1. Barbiturate
Capsules
Barbiturates are rapidly absorbed from the gastro-intestinal tract and
are concentrated in the liver. Some are metabolized in the liver and
part of it excreted through urine. Depending upon its excretion and resultant duration of
action, it has been grouped into four categories.
1) LONG ACTING BARBITURATES
The duration of action is 8-16 hours. The following drugs are long acting barbiturates.
a) Barbitone - Therapeutic dose varies between 200 to 300 mg. The fatal concentration in
blood is about 6 mg% to 7mg%. It comes in white tablets.
b) Phenobarbitone - This drug is largely used in epilepsy and therapeutic dose varies from
30 to 120 mg. The fatal concentration in blood is the same as in Barbitone. It comes in
white tablets.
2) INTERMEDIATE ACTING BARBITURATES
The probable duration of action is from 4-8 hours. These are of following types and the
tablets and the capsules are of different colors. The color of barbiturate pills is of immense
medico-legal value because the doctor can identify most of them during post mortem
examination.
a) Allobarbitone (Dial): White Tablets: Therapeutic dose being 50 to 200 mg.
b) Amylobarbitone (Amytal): Blue Capsules: Therapeutic dose 100 to 200 mg.
c) Butobarbitone (Soneryl): Pink Tablets: Therapeutic dose being 100 to 200 mg.
d) Pentobarbitone (Nembutal): Yellow Capsules: Therapeutic dose 100 to 200mgm.
The fatal concentration in the blood is 1-2 mg% and in liver is 5-6mg%
3) SHORT ACTING BARBITURATES
Duration of action 3-6 hours
a) Cyclobarbitone: White tablet: Therapeutic dose 200 to 400 mg
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BARBITURATES 38
b) Hexabarbitone: White Tablet: Therapeutic dose 200 to 4000mg
c) Secobarbitone: (Seconal): Red Capsules: Therapeutic dose 75-150 mg
The fatal concentration in blood is 1-2 mg% and in liver is 4-6mg%.
4) ULTRA SHORT ACTING BARBITURATES
The duration of action is less than 1 hour. These are used in anesthesia.
Thiopentone B (Pentothal): Therapeutic dose is 100 to 500 mg. through intravenous route.
Barbiturates potentates the action of alcohol and as such a small dose can kill a person if
taken together.
Fatal Dose - Have enormous variation. Normally 10 to 15 times of the therapeutic dose may
kill a person but an addict would, normally need much higher than non-addicts.
Signs and Symptoms
In case of mild intoxication there is drowsiness followed by sleep and recovery occurs
without any complications except little hangover viz. headache in the morning. In poisoning
of moderate to severe degrees there may be series of events, which needs immediate
management of the case in a well equipped hospital. When the cases are managed in a
well staff equipped hospital, the death rate is markedly reduced.
The clinical features summarized bellow:-
1) Impaired consciousness
The degree of the involvement of the consciousness will largely depend upon the doses
and the period elapsed since ingestion of the drug. The severity of the involvement of the
consciousness may be put under four grades: -
a) Grade I- The person responds to vocal commands
b) Grade II- There is maximum response to minimal painful stimulation.
c) Grade III- Minimal response to maximal painful stimulation.
d) Grade IV- Total unresponsiveness
2) Abnormal reflexes
Both the superficial and deep reflexes are affected. There is sluggish response of reflexes
in moderate intoxication. In severe cases the reflexes may be completely absent.
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38 BARBITURATES
3) Hypotension
There is fall of blood pressure which is due to toxic action of barbiturate on the heart and
smooth muscles of the blood vessels.
4) Respiratory depression
Depression of respiration is not as mark as seen in opium poisoning.
5) Oliguria/ANURIA
This is mainly because of hypotension, anoxia and deleterious effect of barbiturate on renal
tubular cells.
6) Skin
Barbiturate causes in many cases the bullous lesions on the skin, which is commonly seen
in the pressure points. These skin blisters are commonly seen amongst persons, who have
been into coma for a longer time. These barbiturate blisters are important feature from
differentiating them from other causes of coma.
Besides the entire clinical feature, the blood level of barbiturate is naturally raised. The
higher barbiturate blood level are noticed from consumption of long acting barbiturates with
the toxicity similar from short acting barbiturates having lower blood concentration and as
such the blood concentration is not proper for assessing the severity of the condition. The
stress should be made more on the clinical features than on the barbiturate blood
concentration.
In Mandrax (Methaqualone + diphenhydramine) poisoning which is also a hypnotic, the

additional features are hyperreflexia, papilledema and acute pulmonary edema.
Complications
Severe shock, acute respiratory depression, hypo-static and aspiration pneumonia, anuria,
electrolyte imbalance and psychotic changes There may be attacks of fits following
recovery from over dosage.
Treatment
1. Removal of the unabsorbed poison from stomach tube with water mixed with
activated charcoal or tannic acid. This is useful only when the poison has been
ingested within 4 hours and the patient is not in severe shock.
2. Respiration should be maintained by administration of oxygen.
3. Giving saline or blood transfusion should support circulation. Hydrocortisone and
Noradrenalin can treat hypotension and shock. Coramine is a dose of 5 to 10 ml may
be administered every half an hour until reflexes are normal. Bemigride and
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BARBITURATES 38
amiphenazole were once used as specific antidotes but it has been proved beyond
doubts that hey do more harm than good and hence has been discarded.
During recent days forced diuresis, alkalinization of urine, peritoneal dialysis and
hemodialysis are advocated. They are useful when kidneys and heart are involved. This
leads to excretion of the poison from the body. Suitable antibiotics may be administered to
prevent from secondary complications. Management of coma is carried out in the usual
manner.
Externally, the face and nails may show cyanosis. Little froth may occur on the mouth and
the nostrils. Internally, there may be general visceral congestion, edema of the lungs and
the brain. The important feature is the discoloration of the esophageal and stomach
mucosae produced by the different types of barbiturate pills. The pink mucosa may be seen
in cases of Seconal or Soneryl, yellow in cases of Nembutal and blue discoloration from
Amytal capsules ingestion. Moreover, the demonstration of the drug from stomach with their
capsule covering will be very helpful in proper diagnosis of the drug. The barbiturates are
irritants in nature and hence the mucosae are eroded. There may be barbiturate blisters on
the pressure points. The viscera, blood and urine are retained for chemical examination.
Medico- legal Aspect
The evaluation of the circumstances of the death, in most of the cases would determine the
manner of death. A suicidal note or the remaining of the container of the drug may suggest
intentional over dosage. Accidental poisoning may occur amongst children.
In some cases the barbiturates may cause mental confusion and a person may go on
ingesting the drug without realizing that he has already taken the drug. The phenomenon is
known as “Barbiturate automatism”.
The possibility of a combined ingestion may also be kept in mind when alcohol is mixed
with Barbiturate.
301
Chapter
39
OPIUM POISONING
Acons 304
Heroin 304
Morphine 305
Stages Of Opium Poisoning 305
Confirmaon Of Opium Poisoning 305
Treatment 306
Post-Mortem Appearances 306
Differenal Diagnosis Of Opium Poisoning (From Other Causes Of Coma) 306
Medico-Legal Points 307
303
39 OPIUM POISONING
Opium is obtained from Papaver sominiferum poppy capsule. Unripe white capsule is
taken, vertical incision is made and the milk yielded is collected, dried in air.
The dried milk turns black after drying and

the residue is then powered to give Opium
Active Principles
The active principles of Opium are alkaloids

belonging to two structural groups
Phenathrene derivatives
Morphine, Codeine, Thebain
Benzylisoquinoline derivative
Papaverine, Narcotine, Narceine
Actions
The signs and symptoms of opioid toxicity

particularly of Morphine, heroin, methadone
and pethidine are the same but vary in
intensity.
Fig. 39.1 Papaver Somniferum plant
They depress, respiration, cerebral cortex
and stimulates vomiting center, vagus nerve, spinal cord. They suppress cough centre.
HEROIN
This is a synthetic analog of Morphine. Heroin is more potent then

morphine. There is no stimulation of vomiting center. Taken
orally, intravenously or by inhalation, heroin gives rapid, intensely
pleasurable experience often sexual arousal. Physical
dependence occurs within a few weeks of regular high dose
injection. As a result the addict’s life becomes increasingly
centered on obtaining and taking the drug. Accidental overdose is
common.
Fig. 39.2. Heroin
Heroin is a synthetic product derived from opium. Unusually
potent heroin laced with a powerful painkiller has killed many
hundreds of people. The culprit in many of the cases appears to be heroin mixed with
fentanyl, a potent form of synthetic morphine that is used to treat extreme pain.
Veterinarians use own formulation of it to immobilize large animals.
304
OPIUM POISONING 39
Heroin sold illegally in many countries typically is diluted, or ‘cut’, with common substances
such as sugar, flour, quinine or starch. Such fillers help traffickers boosts profits.
Distributors may dilute a kilogram of heroin once or twice before sending it to street-level
dealers and a local dealer may cut it again before making individual doses.
MORPHINE
Morphine is named after Morpheus - The Greek god of dream. The poisonous properties of
opium are chiefly due to presence of morphine. Morphine hydrochloride and morphine
sulfate are pharmacological life saving medicine. The therapeutic dose may vary from 8 to
20 mg. Morphine is 5 to 8 times more powerful than the opium from which it is derived.
Symptoms
1. Euphoria
2. Drowsiness/ Vomiting
3. Narcosis
Signs
The chief signs are:-

1. Pupils (pinpoint) constricted
2. Respiration depressed and
3. Coma
Stages of Opium Poisoning
1. Stage of euphoria
Sense of well being, flushing of face, hallucination, violent convulsions/ excitement in

children.
2. Stage of drowsiness
Drowsiness, vomiting, giddiness, lethargy, papillary constriction, cold clammy skin, cyanosis
of face/nail beds and fall of blood pressure. The respiratory rate diminished.
3. Stage of unconsciousness
Initially there is uncontrollable desire to sleep, from which the patient may be roused by
inflicting wet towels or pinching the body part. This is follow by severe respiratory
depression, pinpoint pupil, Fall of BP, unconsciousness, cyanosis, decreased or absent
deep tendon reflexes.
305
39 OPIUM POISONING
Confirmation of Opium poisoning
Naloxone injection is given IV, and pupil dilatation if observed will confirm the diagnosis of
morphine or opium poisoning.
Fatal Dose - Opium -2g, Morphine 0.2g. Addicts will need higher dose.
Fatal Period - 1/2 - 1 Day approximately.
Treatment
Immediate stomach wash with 1: 5000 KMnO4 solutions should be performed.
The pink color of KMnO4on ingestion turns to black due to oxidation of opium by KMnO4.
Even if morphine was injected, the washing should continue because opium is secreted in
the gut.
Washing is done until the color of solution is unchanged. The treatment of pethidine, heroin
and methadone poisoning is the same.
The Naloxone 0.5 mg injection is given I.V. in adults. It should be given every two minutes
as necessary until the level of consciousness and respiratory rate increase and pupillary
dilation occurs. A total dose of 10 mg may be required in some cases. Steps should be
taken to ensure a clear airway and provide respiratory support. Administration of N-allyl
morphine is best avoided as it causes depression of respiration. Other symptomatic
measures are taken as per signs and symptoms.
There may be signs of asphyxia viz. cyanosis, congestion. There may be froth around
mouth and nose.
Smell of opium from mouth if recently ingested. Pooling of blood in great veins.
Retain viscera for chemical analysis. The addicts addicted to intravenous injections would
show linear needle tract scars overlying the veins of the elbow, forearms, back of the hands
and lower limbs. The vein may show recent or old thrombosis. If the addict uses heroin
snuff the nasal mucosa will be congested and discolored. In such cases nasal swabs are
collected to identify heroin, snuffed by the addict.
Differential diagnosis of opium poisoning (From other causes of coma)

1. Diabetic coma
Urine and blood exam will reveal the elevated sugar in urine and blood. History of diabetes,
flushes face, deep respiration and smell of acetone in the expired air.
306
OPIUM POISONING 39
2. Alcoholic coma
MacEwan’s sign is positive. The contracted pupil, while pinching the neck or facial muscles
dilates. This is known as MacEwan’s sign. There is smell or alcohol from breath and cold
clammy skin.
3. Head injury Coma
There may be variety of injuries present on the head viz. be scalp injury, fracture of skull
bones and or intracranial hemorrhage. Bleeding from mouth, nose and ears.
4. Apoplexy
The patient affected is usually an elderly person. There may be paralysis. Pupils are dilated
except in case of pontine hemorrhage.
5. Pontine hemorrhage
In pontine hemorrhage there is constriction of pupil, raised blood pressure and body
temperature.
6. Uremic coma
Urine may show albumin, hyaline castes and there may be anasarca.
7. Epileptic coma
Tongue usually bitten by teeth, pupil may be dilated and patient gradually improves.
Presence of froth around the mouth, eyes pushed upwards are the usual signs of epilepsy.
8. Hysteric coma
Usually common amongst young girls. No organic lesion can be demonstrated.
9. Barbiturate coma
Pupils dilated and respiration not very depressed. Blood barbiturate level will be raised.
10. Carbolic acid
Carbolic acid also produces constriction of pupil and unconsciousness but there is strong
phenolic odor from breath with the signs of corrosion on the lips and on the body.
Medico-legal Points
Opium is the common drug for committing suicides. Suicide by pethidine and morphine is
common amongst the medical professionals as they are easily available and cause
peaceful, painless death in sleep.
Opium is rarely used as a homicidal poison for adults because of its bitter taste and smell.
Accidental poisoning may occur amongst infants and children due to swallowing of opium
meant for their elders.
In older days the opium had been used for committing infanticide.
307
39 OPIUM POISONING
An addict may commit any crime to procure the drug.
It is said to be an aphrodisiac but its chronic use taken away the sexual performance.
308
Chapter
40
FOOD POISONING
Salmonella group is the commonest type of the organism which causes infectious type of
food poisoning. Other organisms like Streptococci, Proteus, Coli group and Shigella are
also involved. The toxic type of food poisoning is due to the ingestion of preformed toxins in
prepared food viz. canned or preserved food. The toxins of Staphylococci and Botulinum
toxin produce intoxication.
It may occur as isolated cases or small out breaks.
Diagnosis is made on the basis of history, clinical features and isolation of organism from
the suspected food, vomitus, stool, urine, blood etc.
Post mortem Features
The mucous membrane of stomach and intestine are swollen, congested and there may be
minute ulcers. Kidneys are congested and the liver show fatty change. Viscera should be
retained.
309
Chapter
41
CARBON MONOXIDE
Pharmacological Acon 312

Treatment 313
311
41 CARBON MONOXIDE
Carbon monoxide is produced whenever carbon containing material is incompletely
oxidized during combustion. The important source are fires involving coal, wood, paper, or
charcoal, and incomplete combustion of natural gas in heaters, hot water heaters, gas
refrigerators and even as constituents of exhaust from automobiles and other gasoline and
oil burning internal combustion engines.
Natural gas is almost pure methane and contains no CO when it reaches the consumer’s
gas appliance. However, if it is incompletely burned, CO is produced.
Pharmacological Action
CO is not a direct cellular poison. Its harm, results from the affinity with which hemoglobin
enters into a reversible combination with it in preference to combining with oxygen. The
affinity of hemoglobin for CO is more than two hundred times greater than for oxygen.
Carbon monoxide is absorbed rapidly through the lungs forming carboxyhemoglobin. This
combination decreases its oxygen carrying capacity, inhibiting cellular respiration.
The combination of Carbon monoxide with hemoglobin produces Cherry Red

carboxyhemoglobin. The reduction in oxygen carrying capacity of blood in CO poisoning is
proportional to the amount of carboxyhemoglobin.
Signs and Symptoms
The signs and symptoms of Carbon monoxide poisoning depend upon the percentage of
the gas present in the hemoglobin.
At 10 to 20% there is slight headache or no symptoms. Amongst heavy smoker there may
be 5% saturation of carbon-mono-oxide in blood. Bigger cities having heavy traffic may lead
to a saturation of about 20% in blood. Saturation from 20 to 30% may cause headache,
malaise, giddiness, nausea, vomiting, and sense of weakness, faintness, impaired reaction
time, poor judgment and rapid pulse rate.
30 to 40% of concentration of CO in blood will cause loss of coordination, staggering gait,

fall of blood pressure, dimness of vision and fast pulse rate.
In 40 to 50% concentration of CO in blood will produce signs and symptoms similar to

drunken condition viz. slurred speech, mental confusion, severely congested eyes and semi
consciousness.
50 to 60% of concentration of CO in blood produces convulsion and coma.
Over to 60% there is deepening coma and death.
Presence of CO in the blood, together with soot in the air passage which is usually acutely
engorged constitutes proof that the victim was alive at the time of the fire. An elevated
carboxyhemoglobin confirms exposure and the assessment should be done with the time
elapsed from exposure to sampling and is suggested by a cherry red color of the skin.
312
CARBON MONOXIDE 41
Treatment
This consists of removing the victim from exposure of the gas and assisting the respiration.
In severe cases inject 0.5 to 1.00 ml of adrenalin and 5 ml of Coramine. Repeat if
necessary. Mannitol may be administered to remove the cerebral edema. Exchange
transfusion may be required in severe cases. Antibiotic may be needed for preventing the
secondary complications. Other supportive treatment may be necessary.
The fair complexioned people show cherry red colored postmortem hypostasis. Frothy
blood from mouth nostrils is invariably present. There may be bullous skin lesions. Muscles
and blood may be cherry red in color. Lungs are highly congested with frothy blood in the
bronchial tree. A normal color of Postmortem staining does not exclude CO poisoning,
especially in anemic persons and analysis of blood sample is the only sure way of
confirming or eliminating Co poisoning. There may be evidence of bronchopneumonia.
There may be necrosis of the papillary muscles of the myocardium. In severe cases there
may be bilateral softening of the Globus Pallidus of the brain. Kidneys are also affected
showing acute tubular necrosis.
Carbon monoxide poisoning should always be suspected when a person is dead in a tightly
closed room which contains some evidence of fire. This usually occurs in winter season.
Accidental deaths commonly occur due to gas leaking from defective appliances. The
persons more liable from the accidental deaths are decrepit, diseased, drunk and drugged.
There is usually suicidal note in suicidal cases. The exhaust pipe of the automobiles
contains carbon monoxide when the car is started. As such the defective pipes can lead to
the accumulation of carbon monoxide gas inside the car and can cause poisoning to the
occupants. Suicides are being committed by connecting tube from the exhaust outlet of the
motor vehicle and inhaling the gas while the vehicle is kept started. Deaths have occurred
usually in this fashion in garage of the car. Alcoholics who retire to bed smoking a cigarette
are at special risk. Tragically, people are more at risk from house fire and many die from
CO poisoning. Homicidal deaths seldom occur from carbon-mono-oxide poisoning and are
only possible when coal gas is used for heating or cooking purposes. Blood should be
retained for spectroscopic examination. Viscera should also be retained for excluding the
possibilities of ingestion of other poisons. Combination of other poisons in suicidal cases is
seen in most deaths.
Sometimes when there is leakage of exhaust pipe of the car the gas is accumulated in the
car compartment and occupant during long drive may suffer from CO poisoning resembling
alcoholic intoxication and because of wrong driving due to intoxication the car may be
detained by the police for interrogation. By the time the driver is taken to the police station
he will inhale the oxygen from the atmosphere eliminating CO poisoning and naturally no
charges of alcoholic intoxication will stand.
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Chapter
42
PETROL/KEROSENE/PARAFFIN
This is an oily liquid found under the ground in several parts in the world. This crude oil
contains inflammable and explosive products which are removed by distillation and
purification. The refined oil, which boils 150 to 300 ° Centigrade, is known as kerosene oil.
Accidental poisoning amongst children quite frequently occurs due to its ingestion by
mistake. The other product, which boils at much less temperature, is known as gasoline
which contains petrol, octane, naphtha etc. The heavier portion is the paraffin which boils at
much higher temperature and extensively used for heating the rooms. This is also
responsible for the accidental deaths to children.
Signs and Symptoms
Petrol is moderately toxic when ingested. Inhalation of gases causes series of signs and
symptoms from apparent drunkenness to coma and death depending upon its
concentration. They cause vomiting, convulsion but the principle danger is the involvement
of respiratory tract. Because of its low surface tension, it spreads over the mucosa of the air
passage and causes collapse of the alveolar tissues In the event of the recovery; it leads to
widespread pulmonary fibrosis. Dyspnea, cyanosis and bronchopneumonia are invariably
present. Radiological examination may show opacities in the lung fields.
Treatment
No stomach wash is attempted since they may lead to soiling of the upper respiratory tract.
Oxygen, antibiotics, cortisone and supportive therapy have to be undertaken as early as
possible.
315
Chapter
43
HYDROCYANIC ACID
Pharmacological Acons 318

Sign And Symptoms 318
Treatment 318
Postmortem Appearances 319
317
43 HYDROCYANIC ACID
Hydrocyanic acid is also called prussic acid.
This is obtained by distilling potassium cyanide or ferrocyanide with Sulfuric acid. It has
characteristic odor of bitter almonds. Hydrocyanic acid is widely distributed in nature. It is
present in the kernels of various fruits such as peaches, plums, bitter almonds and in the
leaves of cherry laurels. Hydrocyanic acid gas is used to fumigate the ships, buildings and
citrus trees. Hydrocyanic acid forms cyanides with metals of these. Potassium cyanide is
used in photography and in industrial processes. Liquid Hydrocyanic acid (Prussic Acid) is
used in veterinary science and is an ingredient of several medicines.
Pharmacological Actions
It is a protoplasmic poison and inhibits the oxidizing enzyme i.e. cytochrome oxidase and
prevents the uptake of oxygen by the cells. As a result of this the blood remains fully
oxygenated and both arterial and venous blood have a uniform bright red color.
Sign and symptoms
Inhalation of hydro cyanic acid gas or swallowing of large doses of prussic acid may cause
sudden death as if struck by lighting. The victim may not even utter a cry. Occasionally, the
person may survive for a minute or two in which he may perform some voluntary acts like
throwing of bottles or walking a little distance. If death is delayed for a few minutes; there
will be agonizing dyspnea, convulsions and dilated pupils. With still smaller dose the person
first experiences headache, confusion, giddiness, nausea and loss of muscular power.
There will be typical smell of bitter almonds. A small quantity of froth may be present on
mouth. The diagnosis is based on history, physical examination and on clinical findings.
On ingestion of the salt such as potassium or sodium cyanide the signs appear later since it
is acted upon by the hydrochloric acid of the stomach and only then hydro cyanic acid is
formed which becomes poisonous. In persons suffering from achlorhydria there will not be
any poisoning effect. Majority of people have complained severe epigastric pain. Death
usually occurs from respiratory paralysis. Potassium cyanide or sodium cyanide behave like
corrosive poison and cause corrosive effect.
Fatal Dose - A dose of 200 mg of Potassium or sodium cyanide is lethal. 50 mg of

hydrocyanic acid is potentially lethal.
Treatment
There is hardly any time for treating a person if a massive dose has been ingested or
inhaled. The basic aim should be to dissociate the cytochrome cyanide combination. As
such the hemoglobin should be converted to methemoglobin, which would combine with
cyanide to form cyanmethemogblobin.
One ampule of 0.2ml of amyl nitrite be crushed in the handkerchief and the victim is asked
to inhale for thirty seconds. Side-By -Side an intravenous injection of 3 percent amyl nitrite
318
HYDROCYANIC ACID 43
10.ml is given very slowly. This should be followed by the administration of sodium
thiosulfate solution in a dose of 50 ml of 25% solution.
This would convert the hydro cyanic acid to thiocyanate, which is an inert compound. An
aqueous solution of methylene blue in a dose of 50ml of 1% solution is also regarded as an
antidote. It also forms methemoglobin and it must be remembered that the available drug at
that time, should be administered without losing time. Cobalt acetate in a dose of 100mgm
forms inert stable complexes and may be tried as well.
In case of potassium cyanide the stomach should be washed with 5-10% solution of sodium
thiosulfate followed by administration of solution of ferrous sulfate with potassium
carbonate, which forms inert Prussian blue. In case of inhalation of hydro cyanic gas the
person should be immediately removed to fresh air and respiration should be added in the
treatment.
There will be smell of bitter almonds. Froth round the mouth and nostrils are a common
feature. Post mortem hypostasis is invariably pink in color. The mucous membrane of the
stomach appears cherry red in color. The brain and meninges are hyperemic. Petechiael
hemorrhages are usually seen on the pleura and pericardium. Poisoning from potassium
cyanide shows corrosion of the mucosae of the gastro-intestinal tract.
The brain, lungs and blood in addition to other viscera are retained for chemical
examination. The spectroscopic examinations of blood will show the characteristics of
absorption bands.
The autopsy surgeon should be careful while conducting autopsy; otherwise he may
develop hydro cyanic acid poisoning. They should be properly clothed, masked and ensure
that the gloves are not torn.
Medico- Legal- aspects
This is a common suicidal poison as it is available to commercial photographers and

scientists. Usually the photographers keep potassium cyanide for their use. Accidental
poisoning in the docks while spraying the drug has also been reported. Homicidal poisoning
is rare because of typical bitter almond smell and taste. Hydro cyanic is also used as a
cattle poison. In some countries HCN gas is used for legal execution.
Individuals involved in anti state activities carry cyanide capsules and when they are
captured, prefer to commit suicide by consuming the cyanide capsule for avoiding the
torture and confessional statement.
319
Chapter
44
HALLUCINOGENS
LSD (Lysergic Acid Diethylamide) 322

Mescaline And Peyote 323
Cannabis Sava 323
Cocaine 324
321
44 HALLUCINOGENS
Hallucinogens are the drugs which when used cause the state of unreality in the
consciousness of the individual.
The important hallucinogens are:-

1. LSD (LYSERGIC ACID DIETHYLAMIDE)
2. MESCALINE
3. PEYOTE
4. CANNABIS
5. COCAINE
LSD (LYSERGIC ACID DIETHYLAMIDE)

LSD is a semisynthetic compound a portion of the molecule is obtained from the Ergot
fungus. It is colorless, tasteless and odorless. This is the strongest amongst all the known
hallucinogens. It has a very powerful effect even in minute dosage. This property makes it
possible for illegal trade for its transport on sugar cubes or even socked in paper etc. This is
habit forming and not addictive.
Formerly, it was used for research and religious purposes. Nowadays, this is largely abused
by the young generation of the developed countries for inducing hallucinogenic effect and
also to remove the boredom.
ACTION
It causes varied hallucinations. The person has no control over his actions. The feeling of
being able to fly under the influence of lysergic acid diethylamide can lead to users to jump
out of the window. The hallucination may lead to murder. In a case, described by
Ungerleider and Fisher, a young man who ingested this drug for the first time in his life was
convinced that he had to offer a human sacrifice. He was about to throw his girlfriend off the
roof of a Hollywood hotel but was prevented from doing so.
The most harassing aspect of the effect of LSD is the reappearance of hallucinations days,
weeks, or even months after ingestion of a dose. No biochemical or physiological
explanation is available for this action. On account of this property a person may commit
suicide or even murder to escape from the recurrence of these symptoms. The person
inters into a dreamy state. It is a strong antagonist of serotonin, which means it mimics the
action of this neurotransmitter in the brain. There are more than a dozen serotonin
receptors in the brain that regulate different functions, viz. our mood and how we interpret
what our senses tell us. When the specific serotonin receptor 5-HT2A is the target of LSD it
appears that our senses are in a jumble. In such a situation even unreal images that are
never likely to be true appear to be real. In a small percentage of the population
322
HALLUCINOGENS 44
synaesthesia is a normal condition in which the person’s senses get mixed up so that he
smells color and tastes sound. A similar condition can also be manifested by LSD.
Fatal Dose: - Usually not fatal but a dose of 14mg may be regarded as a fatal dose.
Hallucinogenic dose: - About 100 micrograms of the LSD.
Death due to LSD over dosage is rare. The varied hallucinations may lead to accident,
suicide and homicide. The person after ingestion enters into a state of fantasies. The
hallucinations are of sight, auditory and tactile. Hepatitis may occur with frequent ingestion
of LSD. Chromosomal defect due to LSD is disputed. The drug is usually taken in groups.
Treatment
There is no specific treatment. Tranquilizers may be administering to reduce the

hallucinations. Psychotherapy may be helpful.
MESCALINE AND PEYOTE

These are obtained from cactus plant, which grows under the ground. Button shaped
growth appears on the surface. These buttons, when taken in capsule or boiled with tea,
produces mild hallucinations
CANNABIS SATIVA
This is commonly known as Hashish, in south
and central part of Africa it is called “Dagge”
and “Hemp” or “Bhang” in India. It is also
called Marijuana which is a Mexican term and
means ‘Pleasurable’ feeling. It is consumed
in several ways viz. smoked, drunk or eaten.
Commonly it is smoked either rolled in cigarette or in pipes.
The resinous exudates of the plant is mixed with tobacco and
rolled as cigarette, which then known as “Reefers or weed”.
The active principle is not an alkaloid, but fat-soluble oleoresin

known as Cannabinol. The poison is rapidly absorbed from the
respiratory or gastro-intestinal tract.
Siddhi or Bhang leaves contain minimum amount of

Cannabinol less than 2 percent and used as drinking purpose.
Ganja or Hashish contains about 5-10% of Cannabinol, which Fig. 44.1. Marijuana
is obtained from the flowering tops of female plants. Reefer or Plant
323
44 HALLUCINOGENS
weeds are smoked in solvents and contains 20-50%Cannabinol. Liquid Hashish or charas
is dark green fluid and contains the resinous extract in a solvent which contains 10-50%
Cannabinol .
Sign and Symptoms
These resembles very much of alcoholic intoxication causing excitement first and then
paralysis. The patient is pleased with him, tends to become talkative and feels superior. His
appetite is increased and he eats food with great relish. He is the subject of hallucination.
The hallucinations are those of sexual in character. He sees nude women dancing or
playing some music before him. The person with excitable nature may become violent, if
disturbed. This stage is followed by narcosis, when the person becomes sleepy with dilated
pupils. The most striking feature is tingling and numbness of the extremities. Fatal cases
are unusual. The person wakes up in the morning without depression and nausea.
In chronic poisoning the person may develop a peculiar type of insanity and develops
homicidal tendency he first commits the murder of the individual with whom he has some
real enmity or imaginary enmity followed by murder of others, who comes on the way. This
sort of killing of the persons lasts till the homicidal tendency. The person then may commit
suicide or surrender to police. This state of affair is known as “Run Amok”.
Fatal Dose: - 10 Minims of active principle may be regarded as the fatal dose for the non-
addicts. The addicts may need much higher dose to die.
Treatment
Commonly the treatment comprises of washing the stomach, injecting strychnine/Coramine

and administering strong tea or coffee.
Post- Mortem Appearances
Nothing specific. There may be signs of general congestion. The leaves, seeds or stem can
be isolated if they have been ingested in the form. The viscera and the remnants of the
plants may be retained for chemical examination.
COCAINE
This is obtained from dried leaves of plant Erythroxylon coca. This is bitter in taste. They
have been largely used in ophthalmic practice. Novocain, nupercain etc are synthetic
substitutes. It is CNS stimulant and local anesthetic.
Signs and symptoms
Initially the person is excited with a sense of well-being. The sexual desire is increased.
Tingling and numbness of the extremities are experienced. The pupils are widely dilated.
324
HALLUCINOGENS 44
Subsequently, the person is depressed with feeble respirations, convulsions and coma.
Death occurs from respiratory paralysis or cardiac arrest.
Fatal Dose: - may be regarded as 1.5 gm if taken from mouth 1gm parenterally
Treatment
If it has been taken orally the stomach should be washed with a solution of potassium
permanganate. Injecting barbiturates controls convulsions. Respiratory depression may be
corrected by administering oxygen. To control restlessness and convulsions 8 ml of
paraldehyde or 0.25 gm of Thiopentone sodium through IV route beneficial. To control
cardiac irritability acetylcholine Hydrochloride in a dose of 1 mg or carbachol 0.25 mg or
Neostigmine Hydro bromide 1mg is useful.
Nothing particularly except some signs of asphyxia
Medicolegal Aspects
Cocaine rapidly deteriorates in the body and as such it is difficult to detect from viscera.
Initially, the cocaine is taken as an aphrodisiac (Sex Stimulation), which ultimately leads to
habituation. On continued consumption the person becomes impotent with physical, mental
and moral degeneration. There is desire of homosexuality. Performance of the sexual act is
diminished although the desire for having sex is increased. Cocaine is used either by
needle, mouth or through snuff. The tongue amongst the chronic users appears to be jet
black in color. There has been loss of appetite, dilated pupils, emaciation and varied
hallucinations. An important feature of chronic poisoning is Magnun’s symptom. This is a
sort of tactile hallucination where the person feels as grains of sands are lying under skin
and of feeling of bed bugs moving under the skin.
325
Chapter
45
ANIMAL POISONS
Snakes (Ophidia) 328

Scorpion 329
Black Spider 330
327
45 ANIMAL POISONS
SNAKES (OPHIDIA)
Type of Snakes Genus Types Species
Poisonous Colubride Land Snakes Cobra, King Cobra,

common Krait, The
• Lay egg (Round tail ) banded Krait and the
• Head is about the Vipers
same width of the
neck
Sea Snakes
• pupils are circular
(Flat tail and very
poisonous)
Viperidae Pit Vipers

• narrow neck
• broad heads Pitless Vipers Russell’s Viper
• short tail
• pupils are vertical
Saw Scale Viper
slits
Non Poisonous MOST OF THE

SNAKES
Snake venoms, whether colubrine or Viperidae has hemolytic as well as neurotoxin

properties. Cobra venom is mostly neurotoxin and viper venom is mostly hemotoxic. The
pupils of cobra are circular, where as the pupils of viper are vertical, slit like. Poisonous
snake inject venom in the tissues, at the site of bite. Venom, during the process of bite is
squeezed from the gland which is near the upper jaw of snake and transmitted in the tissue
through the grooves or channels of the fangs. Due to bite there are two fangs impression
are present on the site of the body. There may be paralysis of the muscles with signs of
collapse. There is bleeding from nose and mouth particularly in viper bite. Local reaction
with more local pain and oozing is seen in viper bite.
Treatment
20cc of polyvalent anti snake venom serum I.V. if not available antivenin may be given.
Symptomatic Treatment
Wash with cold water and KMnO4 solution. Apply pressure bandage
Saline Infusion
328
ANIMAL POISONS 45
Give anti allergic/ Steroids
Pain reliever
Adrenaline S.O.S.
Give antibiotic- if infection suspected
A.T.S./ Tetvac as prophylaxis
Positive assurance to combat shock
Krait
Cobra
Cobra Viper
Fig. 45.1. Snakes
SCORPION
The poison of the scorpion is stored in the gland at
the end part of the tail. During bite the scorpion
presses its sting on the body injecting the venom.
The venom is hemotoxic and neurotoxin in action.
Action
Locally there is acute pain and swelling. Pulse is

slow and irregular. Muscular fasciculation and
convulsion are the usual signs. There may cardiac
Fig. 45.2. Scorpion arrhythmia and ischemia of the myocardium.
329
45 ANIMAL POISONS
Treatment
Wash the affected part thoroughly. The broken sting is taken out if seen at the site of bite.
Pressure bandage is useful. Treat the shock and specific antivenin is injected at the site of
bite and also by intravenous route. Other symptomatic treatment is resorted.
BLACK SPIDER
This is also called black widow spider and its bite causes pain,
cramps at the site of bite followed by nausea, vomiting and raised
blood pressure. It has action on nervous system and at the nerve
endings of the diaphragm causing respiratory depression.
Female Black widow spiders are poisonous. They are larger than the
males and are black colored with a red hourglass on the dorsal
surface of their abdomen.
Treatment
Administer calcium intravenously, Neostigmine, atropine and

Fig. 45.3. Black analgesics.
widow spider
330
Chapter
46
BELLADONA ALKALOID INTOXICATION
(DELIRIANT POISONS)
Treatment 333
331
46 BELLADONA ALKALOID INTOXICATION(DELIRIANT POISONS)
Alkaloids are complex nitrogenous
compounds present in various plants. Some
medicinally important alkaloids are morphine,
atropine, physostigmine, quinine, aconitine
etc. All alkaloids are poisonous at different
dose levels and most of them act on some
portion of the central nervous system.
Belladona is the common name of the plant
Atropa belladona or deadly nightshade and is
a member of the potato family. A special
group of chemical substances present in this
plant are, in general known as belladona
alkaloids which are present in many other
plants viz. Datura fastuosa, Datura niger,
Datura stramonium, Atropa belladonna,
Hyoscyamus niger etc.
Datura alba (white flowers) and Datura niger

(blue flowers) are two varieties of the plant
that grow abundantly in waste lands all over
India and Nepal. Datura stramonium grows at Fig. 46.1. Atropa belladonna
high altitudes of the Himalayas. Datura plant
has bell shaped flowers and has spherical fruits that are covered with
sharp projections and contain yellowish brown seeds.
Datura and Hyoscyamus Niger contain the physiologically active

alkaloids hyoscine, hyoscyamine and traces of atropine. All parts of
the plant contain these active principles but the seeds are more
poisonous. Atropa belladonna also grows abundantly in India and
Nepal. All parts of Atropa belladona viz. leaves, berries and roots are
poisonous and contain the alkaloids atropine, hyosciamine and
hyoscine. These alkaloids are widely used as drugs in abdominal
colic, ophthalmic and urinary diseases but at higher doses they are Fig. 46.2. Datura
extremely poisonous.
Hyoscine (Scopolamine) has been tried as a hypnotic (Truth serum)

for extorting confession from persons suspected to have committed
some crime.
Sign and Symptoms
Signs and symptoms of all these deliriant poisons are the same.
The first symptom to appear is oral dryness. The toxic symptoms of Fig. 46.3. Datura Fruit
alkaloid over dose include dry hot skin, dysarthria, dilated pupils,
dysphasia and delirium. Other toxic effects include muscular inco-ordination, confusion,
hallucinations and photophobia. The person becomes delirious. He moves his lips due to
332
BELLADONA ALKALOID INTOXICATION(DELIRIANT POISONS) 46
dryness of the mouth and the speech becomes indistinct. He picks up bed-clothes and pulls
imaginary threads. Death results from medullary depression and ultimate exhaustion. The
behavior of the patient can be compared as in the old saying "Red as beet, dry as a bone,
mad as a wet hen and hot as a hare”.
Fatal Dose: Uncertain. However one fruit if pound and taken orally may show signs of
poisoning and even death.
Treatment
Stomach should be washed out with plain water.
Physostigmine by intramuscular route in doses 0.5 mg at regular intervals will combat most
of the toxic manifestations. Morphine should not be administered as it would further depress
the respiratory center. Short acting barbiturates may be given to control the convulsions
and delirium. Mechanical cold sponging may control hyperthermia.
No characteristic post mortem appearance; but efforts should be made to detect the seeds
or other fragments in the stomach and intestine in cases of over dosage by ingestion.
Viscera should be retained for chemical examination.
Medico-Legal Aspects
Accidental over dosage may result in fatal intoxication. Children are specially susceptible
and occasionally even therapeutic dose may lead to death. Eating raw fruits by the children
or by adults by mistake may also produce toxic effects. Datura is also used for criminal
purposes. The seeds are mixed in hot curry or some other sweet drink or alcohol and used
to stupefy travelers for theft. Hyoscine has been tried as a truth serum amongst the
suspected criminals.
The seeds of Datura and capsicum resemble each other and the broad differentiating
features are as follows:
333
Chapter
Datura Seeds Capsicum seeds
Shape Kidney shaped Small and thin
Color Dark brown Yellow
Margin Double edged at the convex border The convex border has one
Taste Bitter Pungent
47
On section Embryo is curved outward at the hilum Embryo is curved inwards
CASTOR SEED (RICINUS COMMUNIS)

Ricinus communis (castor or arandi) is widely present in India and Nepal. The castor beans
are expressed to obtain castor oil which has purgative action.. The waste left over from
processing the beans contains a poisonous principle Ricin. It is a glycoprotein and is
composed of two polypeptide chains that are disulfide bonded. It produces agglutination of
red cells and some hemolysis and its action resembles that of bacterial toxins. A very small
amount of Ricin is fatal if injected but a greater amount is needed if swallowed. The toxic
effects are diarrhea, vomiting, pain abdomen, prostration and collapse. The powder of
seeds causes conjunctivitis when applied to the eyes.
Fatal Dose: Approximately 8 to 10 seeds may be fatal when taken in crushed from.
Depending on the route of administration (inhalation or Injection) as little as 500 µg of pure
Ricin can kill an adult.
Treatment
The treatment is symptomatic. Dehydration has to be prevented by giving suitable infusion.

Electrolyte balance has to be maintained. The abdominal pain may be corrected by
administering Morphine or some other antispasmodic.
Medico-Legal Importance:
1. Criminal Abortion
2. Accidental poisoning amongst children.
3. Occasionally suicidal
335
47 CASTOR SEED (RICINUS COMMUNIS)
Nothing specific. Signs of inflammation in the gastro-intestinal tract may be seen. Ricin
produces hemorrhagic inflammation of the G. I. T even if it is given subcutaneously.
However, no reliable test exists to confirm that a person has been exposed to Ricin.
Fragments of the seeds may be found in the stomach or intestines. The victim appears
dehydrated. Heart may be dilated, hemorrhage in the pleura and edema of liver, kidneys,
spleen and lungs may be seen. Viscera, viz. stomach with it contents, a portion of small
intestine, about one pound of liver and half of each kidney or one full kidney should be
retained for chemical examination.
Fig. 47.1. Ricinus communis
336
Chapter
Tests for environmental samples can be done by two methods but require special
equipment.
Fluorescence immunoassay can be performed. An antibody is used to bind the Ricin

present in the sample and is then detected by fluorescence immunoassay.
Polymerase chain reaction (PCR):- A new method involving location and making copies of
parts of the DNA contained in the castor bean plant. The method looks for the DNA of the
gene that produces the Ricin protein.
Fig. 48.1. Croton tiglium
Fig. 48.2. Croton seeds
337
Chapter
48
CROTON SEEDS (CROTON TIGLIUM)
Active principal is Crotein. This is also

vegetable irritant poison.
Fatal Dose: Approximately 4 to 8 seeds.
Signs, symptoms, treatment, postmortem

appearances and medicolegal significance
are the same as seen in castor seeds
poisoning.
49
ABRUS
PRECATORIOUS
All parts of the plant Abrus precatorius are
Fig 49.1. Abrus precatorius poisonous but the seeds contain the
maximum concentration of the toxin known
as abrin. The seeds are red in color with a black spot at one end.
Abrin is a toxalbumin whose physiological actions are very much similar to those of viper
snake venom. The other toxin present in the seeds is abric
acid both of which produce severe gastrointestinal signs like
vomiting, diarrhea and abdominal pain. This progresses to
weakness, shock and death within a short period. If one seed
is chewed it can kill an adult human being. Abrin is a ribosome
-inactivating protein (blocks protein synthesis) and is one of
the most deadly plant toxins known. When used for criminal
purposes the seeds are crushed and mixed with onion, Datura,
Opium, and then dried in the air and shaped to pointed Fig. 49.2. Abrus seeds
needles. Such needles become very hard and when
introduced in the skin of cattle can cause necrosis of the area. The signs and symptoms
closely resemble those of snakebite.
339
Chapter
Treatment
The principle treatment is injecting the victim of anti- Abrin. Antiabrin is prepared in the
same process as antivenom for snakebite.
Oleander 342
Aconite 343
Digitalis 343
Nicone 344
341
50 CARDIAC POISONS
Medico- legal Significance
1. Cattle poison
2. Arrows poison
3. Occasionally Homicidal
50
CARDIAC POISONS
OLEANDER
There are two varieties of the oleander plant a white or
pink flowered variety known as Nerium odorum and a
yellow flowered variety known as Cerbera thevetia or
Thevetia peruviana. Both plants grow in temperate
climate throughout the world. Nerium odorum is widely
Fig. 50.1. Cerbera thevetia present in India and Nepal.
Both plants are very toxic and the milky juice contains
the cardiac glycosides Nerin and Oleandrin. The pharmacological actions of these
glycosides resemble the actions of the heart drug digoxin. Both species can be toxic when
taken by mouth and several reports of death by oleander have been documented. Yellow
oleander (Cerbera thevetia) yields several glycosides such as thevetin, thevetoxin, cerebrin
and others. The seeds of the plants contain the poison in large quantity.
Fatal Dose: Uncertain and a small dose can kill a person.
Signs and symptoms
Ingestion of the poison causes difficulty in swallowing and speech, abdominal pain,
vomiting and diarrhea. There may be profuse frothy salivation. First the pulse is slow which
later becomes rapid and weak accompanied with fall in blood pressure. Pupils are dilated,
muscular twitching, tetanic spasms, drowsiness, coma, respiratory paralysis causing death.
Nothing specific. There may be leaves or flowers in the stomach and organs may be
congested.
342
CARDIAC POISONS 50
Medico- legal Significance
The plant is grown all over the world because of

its beautiful flowers. Accidental ingestion of the
milky juice or the seeds of the Cerbera thevetia
may lead to poisoning and death. The juice or the
stem of the plant is also used for procuring
criminal abortion. They produce ulceration and
inflammation of the genitalia.
ACONITE
Aconite is the dried root of the plant Aconitum
napellus. There are several other varieties and all
parts of all the varieties are poisonous the root is
most potent containing the active alkaloids
aconitine, pseudo-aconitine, aconine,
picraconitine, etc.
The main toxic manifestations are alternate

dilatation and contraction of pupils, tingling of
mouth and throat, anesthesia of the skin, fall in
blood pressure, cardiac arrhythmia and death Fig. 50.2. Aconitum napellus
resulting from ventricular fibrillation. It first
stimulates, and then paralyzes the peripheral terminations of the
sensory and secretary nerves, the CNS, myocardium, skeletal
and smooth nerves but it dose not seem to affect the higher
centers of the brain because the mind remains clear till the end.
In India it is also called Bish, Teliyabish or Bachnag and is
extensively used externally by Hakeems and Vaidyas for
muscular pain, rheumatism, myalgia and paralysis. Fig. 50.3. Root of Aconite
Fatal Dose: Approximately 1 g of the root or 2mgm of the active

principle aconitine.
Treatment
This includes gastric lavage with warm water. Administration of atropine 1 mg and artificial
respiration is beneficial. 50 ml of 0.1% Novocain a given IV slowly prevents cardiac
arrhythmia.
Medico-Legal Importance
The roots of the plant have been sometimes used in homicide because of its sweet taste
making it easy for administration in bread or some drinks. Further this is rapidly destroyed
343
50 CARDIAC POISONS
after death and is difficult to be isolated. This is also used
in medicine and accidental poisoning may occur. It has
also been used as an arrow poison for killing animals.
DIGITALIS
The plant Digitalis purpurea contains a large number of
glycosides, collectively known as cardiac glycosides due
to their action on the heart. The important glycosides are
digitoxin and digitonin. They increase the myocardial
contractility and thus promote the efficiency of the heart.
In view of this beneficial effect digitalis has been
extensively used in modern medicine and hence
accidental poisoning is common. The signs and
symptoms very much resemble those of oleander
poisoning.
The main toxic effects are anorexia, nausea, ectopic

beats, atrial and ventricular fibrillation, paroxysmal atrial
tachycardia and occasionally complete heart block.
Fig. 50.4. Digitalis purpurea
Fatal Dose: - 15 to 30 mg of digitalis, 4mg of digitoxin.
Fatal period: - One to 24hrs.
Treatment
Stomach wash with tannic acid solution is

recommended. 100 mg lignocaine IV is the
antidote for digitalis induced cardiac arrythmias.
0.6mg atropine IV may be given to treat
bradycardia which may be continued for 4 days.
Not specific except the existing disease of the

heart. Viscera retained as usual for chemical
examination.
NICOTINE
Fig. 50.5. Nicotiana tabacum Nicotine is the alkaloid present in Nicotiana
tabacum (tobacco). All parts of the plant are
poisonous except the seeds. The dried leaves
(tambakhu) are used for chewing or smoking or as snuff. Other alkaloids present in
344
CARDIAC POISONS 50
tobacco are anabasine and nor-nicotine. They are widely used in agriculture as insecticide
and worm killer and for fumigation.
Acute poisoning symptoms are excessive salivation and a burning sensation in the throat
and stomach, nausea, vomiting. Pupils are contracted and later on they are dilated. Cardiac
arrythmias may occur. Respiration is rapid which becomes slow later. Death may occur
from respiratory failure.
Symptoms of chronic poisoning are cough, wheezing, anorexia, anaemia, tremors,

irregularity of heart beat and sometimes angina like pain may be encountered.
Fatal Dose - 60 mg nicotine. Rapid death resembles death from cyanide poisoning.
Ingestion of 15 to 30 g crude tobacco may be fatal.
Fatal time - 5 to 15 minutes.
345
Chapter
Treatment
Stomach wash with warm water and tannic acid solution is performed.
Purgatives are given and colon wash is done.
Signs of Asphyxia are seen. Stomach may

contain tobacco leaves and have the peculiar
smell of tobacco.
Medico-legal points
Excessive smoking, ingestion and application

of leaves on wounds are common causes of
accidental poisoning. Suicidal and homicidal
poisoning is uncommon.
51
STRYCHNINE
POISONING
Strychnos nux vomica is a spinal poison.
Strychnine is obtained from the seeds of Fig. 51.1 Strychnos nux vomica
Strychnos nux vomica. It has intense bitter
taste. Seeds are flat, circular discs, slightly concave on one side and convex on the other
side. The diameter is around 2 to 2.5cm and around 0.5cm in thickness. Seeds are ash
gray in color. They yield two principal alkaloids, strychnine and brucine.
Strychnine is very stable and resists putrefaction and can be detected in a dead body, even
some years after death.
Pharmacologically it is a respiratory stimulant. It is used as vermin killers.
347
51 STRYCHNINE POISONING
Signs and Symptoms
It resembles that of tetanus. In strychnine poisoning the onset of poisoning is sudden soon
after ingestion and there may not be any history of injury. It gives an intensely bitter taste
and produces convulsions affecting all the muscles at a time. Convulsions are due to direct
action on the reflex centre of spinal cord. During the intervals of the convulsions the
muscles are relaxed.
Convulsions are at first clonic, but eventually becomes tonic. The person bears an anxious
look with the prominent staring eyes and the pupils are dilated. This feature is known as
Risus Sardonicus. The body is arched in hyperextension and the victim may acquire a
position of Opisthiotonus viz. resting on heel and occiput. Sometimes the posture may be of
forward bending due to contraction of diaphragm and then called Empresthotonus. Very
rarely the person may bend sideward and then called Pleurosthotonus. The mind usually
remains clear. The convulsions become great if there is noise or even on touch.
Death may be occurring from Asphyxia.
Fatal Dose - For an adult are 50 to 100 mg. One seed if chewed and ingested could be
fatal.
Fatal Period - 1 to 2 hours but may be delayed.
Treatment
Barbiturates should immediately be administrated intravenously. If convulsion is controlled,

stomach wash may be attempted.
Other treatment is symptomatic.
348
Chapter
Postmortem appearance
Rigor mortis sets in early and lasts for a longer time. There may be livid patches on the
skin. Viscera are congested and the mucous membrane of the stomach is eroded with
hemorrhagic patches.
Medico-legal points
1. Accidental poisoning from over
dosage.
2. Suicidal and homicidal cases
are rare.
3. Nux vomica seeds are
sometimes used for destroying
cattle.
4. In older days it was used as
arrow poison.
52
ERGOT
The ergot alkaloids ergotamine,
ergotoxine, ergometrine etc. are some
of the important toxins present in the
dried sclerotia of the fungus Claviceps
purpura which grows on cereals like
rye, barley, wheat etc. The black Fig. 52.1. Ergot
fungal mass has a peculiar odor and
disagreeable taste. These are also known as mycotoxins. Chronic poisoning with ergot is
known as Ergotism.
Signs and Symptoms
Acute poisoning is only a problem in overdosage while poisoning due to eating is rarely
seen these days. Overdosage too is rare and usually occurs from use in large quantities as
349
52 ERGOT
an abortifacient. The symptoms are vomiting, diarrhea, intense thirst, a tingling, itchy and
cold skin, a rapid weak pulse, confusion and unconsciousness. Death may occur due to
coma.
Chronic poisoning or ergotism may result from continuous use in patients with severe
infection (such as purpueral fever), liver disease or hyperthyroidism. Circulatory
disturbances are the usual early symptoms that appear as coldness of skin, severe
muscular pain, vascular stasis resulting in dry peripheral gangrene of the fingers, toes,
ears, nose etc.
Fatal dose - 1 - 2g
350
Chapter
Fatal period: - One to several days.
Treatment
Stomach wash should be given followed by administering purgatives. Vasodilators like

nitrites may also be given.
Post-mortem appearances
These are not characteristic. The internal organs

are congested. Degeneration of intima of smaller
arterioles may be seen and there may be
thrombus formation.
53
CALOTROPIS
Calotropis is a wild shrub that grows all over India
and Nepal. Two species that are commonly seen Fig. 53.1 Calotropis gigantea
in the wild are C. gigantia (purple flowers) and C.
procera (white flowers). The toxic glycosides
present in the plant are calotropin, calotoxin, uscharin and calactin. These are also present
in the thick acrid juice that comes out if an incision is given to the stem or leaf stalk.
Signs and Symptoms
It causes redness and vesication if applied to the skin. Ingestion of the juice produces an
acrid bitter taste and burning pain in the throat and stomach, salivation, vomiting, diarrhea,
dilated pupils, convulsions, collapse and death. The juice is known to cause heart paralysis.
Fatal dose - Not certain
Fatal period - about 12 hours
Treatment
Treatment is mainly symptomatic. A stomach wash and use of demulcents is

recommended.
351
Chapter
Dilated pupils, stomatitis, froth at the nostrils and inflammation of gastro-intestinal tract is
seen. The brain and viscera are congested.
Medico-legal aspects
Toxicity due to overdosage is possible since the flowers,

leaves, root and juice of Calotropis is used as medicine in the
Ayurvedic system. Commonly it is used as an abortifacient. It
is rarely used for suicide or homicide but is sometimes used
for infanticide.
54
HEMLOCK
Hemlock or Conium maculatum is native to most parts of
Europe and USA. The plant belongs to the same family as
carrot and parsley. Its tap root resembles carrot and its leaves
resemble those of parsley. Most common cause of accidental
hemlock poisoning is its close resemblance to these edible Fig. 54.1. Conium
plants. The seeds contain highest concentration of poison. maculatum
Conium maculatum contains the alkaloid coniine and seven
other closely related compounds which are generally called conium alkaloids. The structure
of coniine is similar to that of nicotine with similar physiological actions. It activates the
nicotinic receptor and therefore, stimulates the central nervous system.
353
Chapter
Signs and Symptoms
At this stage the symptoms include headache, unsteadiness (ataxia), salivation, profuse
sweating and tachycardia. At a later stage the stimulation stage is followed by slow heart
rate (bradycardia), motor paralysis, CNS depression, ultimately respiratory paralysis leading
to death.
55
ARGEMONE MEXICANA
(FOOD POISON)
Fig. 55.1. Argemone mexicana The plant Argemone mexicana is commonly found in
the wild. Sometimes the oil from the seeds of
argemone is used as an adulterant of mustard oil. The seeds are
dark brown in color and resemble mustard seeds. Argemone
seeds are covered with small regular projections that give them a
rough and wrinkled surface whereas mustard seeds have a
regular and smooth surface. When argemone seeds are pressed
they burst with a popping sound but mustard seeds break
silently.
The oil contains the alkaloids sanguinarine and

dihydrosanguinarine that are responsible for the toxic effects of
the oil. Consumption of oil adulterated with argemone oil causes
epidemic dropsy in which there is swelling of the body and the
condition is known as “beri beri”.
Signs and Symptoms

Fig. 55.2. Argemone
mexicana with seeds There is gradual loss of appetite, gastrointestinal disturbances
causing diarrhea and there is edema of the legs. In some cases
blood pressure becomes low and pulse is feeble. There is myocardial damage and heart
gets dilated. There could be tenderness and enlargement of the liver. In about 10% cases
there could be dimness of vision due to glaucoma. The calf muscles feel tender and there
355
55 ARGEMONE MEXICANA
may be tingling feeling on the skin. At a later stage the heart gets severely damaged that
Nitric acid test Ferric chloride test.

Reagent- pure nitric acid
Reagents-
Procedure-
Concentrated hydrochloric acid.
To about 5ml of oil add equal
amount of pure nitric acid. Ferric chloride reagent: - prepared from ferric nitrate and HCl.
Shake for 1 minute to mix the oil Procedure-

and acid layers. Add about 2ml conc. HCl to each tube and shake well.
Allow the layers to separate. Warm in a boiling water bath for 4-5 minutes with constant shaking.
The acid layer showing yellow to Take out the tube and add 1 ml of ferric chloride reagent to each tube.
orange color indicates presence of
argemone oil. Rotate the tube between the palms to mix but not to disturb the upper
oil layer.
This is a preliminary spot test but a
confirmatory test is recommended if A distinct reddish brown precipitate appears on heating the tube again
nitric acid test is positive. for 10 minutes which confirms presence of argemone oil as low as
0.25%.
leads to death. Further confirmatory test is carried out by thin layer chromatography.
That can detect 0.001% in all oils and fats.
Treatment
There is no specific treatment except a good diet and a supportive treatment for the heart.
Laboratory tests for detection of Argemone adulteration in mustard oil
356
INDEX
of blood 139 Administration 2, 27, 175, 217,

A of fluid blood 74, 113, 146 238, 266, 306, 319, 335, 343
Accuracy 65, 133 Admission 30, 232-234
Abdomen 60, 67, 72, 79, 111, Accused person 52, 228 Adoptions 10, 197, 199
114, 143, 153, 175, 183, 184, suspected 42 Adultery 24, 196, 199, 200, 216
192, 219, 275, 278, 330 Acetylcholine, accumulation of Adults 22, 61, 80, 164, 204, 211,
Abdominal 282 217, 219, 266, 274, 306, 307,
colic 265, 266, 332 Acid 244, 247, 252-254, 258, 260 333, 335, 339, 348
pain 265, 270, 274, 294, 335, hematin 254 symptomatic 265
339, 342 hydro cyanic 318, 319 Age 20, 31, 56, 73, 81, 86-89, 91-
Abortifacient 349, 351 Hydrocyanic 239, 317, 318 96, 109, 143, 144, 147, 197-
Abortion 10, 24, 36, 50, 51, 185, lactic 77, 83 199, 204, 206, 207, 210-212,
186, 188-190, 192, 259, 265 nitric 253, 254 216-219
comprehensive 187 phosphoric 279, 282 estimation of 89, 92, 94
first trimester 189, 190 prussic 318 statutory 20, 21
natural 188 Sulfuric 252-254, 318 years
procuring 188, 267 Aconite 239-241, 342, 343 minimum 96
services 187 Act 6, 7, 10, 11, 13, 20-22, 24, 27, of 205, 217, 218
safe 186 50, 96, 204, 219, 220, 223- Agency 6, 174
unsafe 186 225, 228, 230-232, 245-247, Agent 24, 37, 109, 245, 259
Abortion-related death 186 289, 290 active 222, 223
Abraded of coitus 178, 200 chelating 245, 247, 266, 275
collar 136, 137 of commission 26, 204, 211 passive 198, 222, 223
skin 137 of omissions 211, 292 Air 80, 82, 112, 139, 144, 164,
Abrasions 75, 80, 108-110, 118, of sexual intercourse 178 170, 205, 208, 209, 220, 258,
126, 138, 159, 161, 165, 167, Actin 77 274, 278, 304, 339
223 Action 26, 30, 32, 78, 79, 111, embolism 191, 192
Abrin 339 230-232, 239, 240, 246, 254, passage 144, 145, 158, 161,
Absorbed 258, 260, 283, 322, 329, 330, 165, 170-172, 245, 253, 254,
metallic poisons 245, 247 342, 343 283, 312, 315
poison 238, 244, 245 duration of 298, 299 Albumin 145, 307
Absorption 171, 189, 238, 239, Activated charcoal 246, 283, Alcohol 37, 156, 164, 229, 232,
245, 258, 274, 275, 288 284, 300 240, 258, 278, 287-293, 299,
of alcohol 288 Acute 301, 307, 333
Abuse 21, 35-37, 70 arsenic poisoning 274 absorption of 288
Accidental deaths 53, 86, 146, poisoning symptoms 344 blood concentration 288
165, 174, 276, 313, 315 Addicted persons 36 concentration of 288, 289, 291,
motor 291 Addicts 36, 299, 304, 306, 308, 292
Accidents 6, 50, 53, 57, 64, 73, 324 estimation of 290, 292
122, 128, 197, 231, 253, 323 Adherent 59, 219 ethyl 288, 292, 294, 295
traffic 109, 289, 291 Adhesions 60, 61, 198 excessive ingestion of 291, 293
Accreditation 39 Adipocere 81 methyl 292, 294, 295
Accumulation formation 72, 78, 80, 81 poisoning death 62
of acetylcholine 282 smell of 289, 290, 292
357
Index
Alcoholic court 12 Atropine 72, 246, 283, 330, 332,
dementia 294 courts conduct initial trial 12 343, 344
insanities 293, 294 Appetite 265, 279, 289, 293, 324, Attendants 34, 221, 234
intoxication 292, 313, 324 325, 355 Authenticating 221
Alkalis 238, 239, 246, 252 Application 2, 38, 92, 102, 108, Authority 11-13, 25, 53, 248
Alkaloids 239, 240, 304, 323, 142, 159, 162, 234, 253, 258, designated court 70
332, 344, 347 345 Autolysis 77, 78
Alkyl phosphates 282 Arachnoidmater 129, 130 Automatic pistols 132, 134
Allegations of negligence 26, 27 Arborescent Automobile Injuries 121
Alleged negligent treatment 50 marks 153 Autonomous regulatory body 30
Aluminum Phosphides 239, 240, skin pattern 79 Autopsy 3, 43, 53, 56, 68, 70,
284 Arch 103, 208 130, 146, 173, 204, 208, 253,
Alveolar duct membrane 208 Areola 179, 183, 184 290, 319
Ammunition 10, 132, 134 Argemone examination 42, 43, 72, 127, 212
Amperes 150 mexicana 355 Medicolegal 55, 56
Amyl nitrite 318 oil 355 surgeon 135, 136, 208, 211,
Anal intercourse 222 seeds 355 253, 319
Anemia 265, 266 Arms 7, 22, 79, 101, 102, 123, Avulsion 113
Anemic persons 313 150, 211, 221
Anesthetic deaths 21 Arrest 11, 15, 42, 43, 66, 232
Angle 93, 105, 108, 109, 161, 252 Arrow poison 343, 348 B
right 93, 97 Arsenic 88, 189, 239, 240, 247,
Animal hair 88, 223 273-276 Babies 14, 175, 188, 200, 201,
Animals 223, 231, 240 inorganic 274 204, 207, 292
Anorexia 343, 344 poisoning 88, 246, 274-276 Backwards 57, 58, 159, 219
Answer 14, 16, 17, 45, 46, 48, acute 274 Balls 132, 133
290 Arterial blood flow 158 Bands 104
Ante mortem Arteries 59, 60, 67 Barbitone 298
burn injuries 145 carotid 160, 161, 163, 167 Barbiturate
burns 144 middle meningeal 129 blisters 300, 301
death 144 pulmonary 59, 139 blood
Antemortem 110, 112, 144 Artificial insemination 198, 199, concentration 300
Ante-mortem injuries 172 201 level 300
Antemortem thrombi 57, 59 Asphyxia 66, 152, 156-158, 161, Barbiturates 64, 156, 238-240,
Antibiotics 301, 313, 315, 329 166, 212, 252, 348 246, 297, 298, 300, 301, 333,
Antidotes 244, 245, 247, 284, deaths 152 348
301, 319, 344 masochistic 160, 224 Barium nitrate 134
Physical 245, 246 mechanical 74, 155, 156, 212 BARR BODIES 100
physiological 245-247 signs Barrel 132-135, 139
universal 246 of 152, 157, 159, 160, 165, Barristers 52
Antimony sulfide 134 325, 345 Basal ganglion 270, 271
Antivenin 328, 330 viz 163 Base 58, 101, 128, 130, 134, 179
Anus 222, 223 Traumatic 156, 164-166 of skull 126, 128, 129
Aortic Asphyxial Basophilic stippling 265, 267,
stenosis 68 deaths 73, 156, 163, 165 274
valve 60, 68 signs 158 Battered
Apex court 12 viz 283 Baby Syndrome 22, 211
Appeals 12, 13, 38, 52 Aspirin 239, 261 Child 211
court of 52 Assailant 6, 56, 109, 114, 116, child syndrome 6, 22, 211
Appearance 43, 77, 79, 86, 95, 118, 160, 162, 163, 219, 221, children 22, 211
110, 115, 137, 138, 145, 146, 291 syndrome 22
159, 173, 175, 178, 200, 259, alleged 116, 220, 221 Baygon 282, 283
260 Assault 42, 47, 82, 86, 116, 163, Bed 57, 69, 83, 212, 213, 230,
Chronological 90 196, 197 231
Post-mortem 3, 161, 259, 260, Atheroma 60, 67 Beget
306, 345, 350, 351 Atropa belladonna 332 child 198
Appellate Atrophy, acute 279 children 199
358
Index
Behavior 20, 37, 44, 50, 232, 289, investigations viz 199 Bone
333 level 291, 300 injuries 151
personal 37 pigment 79 marrow 22, 173
Benefit 21, 22, 35, 204 plasma 264 Bones 22, 70, 82, 92, 93, 96, 99,
Beveled margin 138 pressure 170, 171, 175, 244, 105, 108, 112, 117, 127, 128,
Bhadra 13 258, 260, 266, 282, 300, 305, 142, 143, 266, 274, 275, 279
Bhang 323 312, 342, 343 carpal 94
Bigger blood vessels 110 raised 69, 126, 270, 307, 330 jaw 279
Bilirubin 111, 112 Raised 267 thigh 207
Birth 14, 204, 205, 209, 270 sample 62, 221, 292, 313 Bonnet 122
Certificate 13, 14 venous 221 Bony union 92, 93
surrogate 201 seeps 68 Boxers 78, 126
Bite 328-330 stained Boxing injuries 126
Bitter almonds 318, 319 froth 159, 283 Boys 197, 218
Black urine 274 Brain 58, 64, 66, 80, 115, 126-
eye 110, 129 stains 118 130, 139, 146, 152, 158, 161,
widow spiders 330 stream infection 139 175, 239, 319, 322
Blackening 134, 135, 137, 138, sugar 175 blood flow studies 21
142 tests 200 criteria 21
Bladder 61, 83 traces 162 death 21, 64-66
urinary 61, 72, 83 tracks 68 total 21
Blebs 205 transfusion 300 stem injuries 126
Blisters 142, 144, 205, 270, 279 venous 318 Brainstem death 65
Blood 62, 74-76, 82, 83, 109, 110, vessels 58, 74, 75, 112, 113, Branches 129, 130, 154
118, 129, 130, 135, 136, 144, 145, 239, 300 Breast feeding 212
145, 156, 219, 265, 266, 288- bigger 110 Breasts 109, 110, 117, 163, 179,
292, 298, 299, 312, 313, 318, ruptured 113 183, 184, 192, 219, 225
319 volume 144, 170 Bride burning death 146
accumulation of 139 Bloodstains 165 Bronchi 59, 67
acts 249 Blue 37, 87, 112, 157, 265 Bronchopneumonia 144, 253,
alcohol 291 green discoloration 79 313, 315
concentration 289 Blunt Brown 83, 110-112, 254
elevated 291 impact injuries 108 Bruises 59, 75, 108-113, 138, 220
level 290, 291 injuries 112, 130, 211 blood disorders 111
altered 260 Body 7, 42, 43, 56-59, 70, 72-83, young children 111
barbiturate level 307 92, 93, 108-110, 115-118, 134 Bruising 59, 110, 111, 114-116,
calcium 260 -139, 142-147, 150, 151, 159- 126, 159, 161-163, 165, 167,
concentration 288, 290, 300 165, 170-173, 223-225, 288- 219, 220
lower 300 290 Bullet 128, 133, 134, 136-139,
corpuscles, white 145 cavities 67, 114, 290 210
decreased 279 cell 100 tandem 139
diluted 171 emits 79 Bullous skin lesions 313
discharge 183 fat 78 Buried dead body 70
disorders bruise 111 fluids 83 Burn injuries 142, 143, 146, 154
elements 75 heat 290 ante mortem 145
exam 306 Shallow Thick 93 inflicted 146
external 139 skin 111 males withstand 143
extravasation of 75, 110, 112, surface 108, 114, 143, 221 postmortem 145
113, 129 burnt 143 Burning 137, 138, 142, 144-146,
flow 69, 157 external 244 151, 153, 278, 288
frothy 79, 163, 313 temperature 72, 73, 83, 307 pain 252, 258, 270, 278, 351
gravitates 74 normal 72, 74 Burns 141-145, 151, 252, 279
grouping 88, 196, 199 tissues 64, 65, 260 ante mortem 144
groups 199, 200 weight 247 Deep 143
hemoglobin content 74 Boils 315 Joule 151, 152
hemolyzed 79 Bombay 42, 43 Burnt areas 144, 145
infiltrated 112 Bonafide treatment 36 Burst 68, 79, 80, 134, 355
359
Index
Buttocks 74, 126, 128, 219-221 Cementum 92 procuring 197
Centers 69, 94, 207, 289, 343 stillborn 208
Centimeters 89, 183, 207 Suppositions 200
C Centuries 20, 264 young 222
Cephalic index 88, 89 Childbirth 186
Cables 151, 157 Cerbera thevetia 342 Children 6, 20-22, 61, 73, 77,
Cadaveric Cerebellum 58, 270, 271 143, 160, 193, 203, 211, 212,
spasm 78, 118, 172 Cerebral blood flow studies 22 220, 261, 262, 266, 267, 315,
Spasm 78, 172 Certificate 14, 23, 47, 234 333
Calcium Certificates 47 Age 94
EDTA 266 Certiorari 12, 13 beget 199
gluconate 260, 266, 295 Cervical born 213
oxalates 260 canal 191 healthy 213
Calculi 60, 61 vertebrate 158 mature 22
Calories 289 Cervix 67, 183, 184, 189, 191, procreate 196
Calotropis 111, 189, 241, 351 198 young 111
Canals, cervical 191 Chairman 30 Chinese 86, 87, 89, 101
Canines 90, 92 registered doctors 30 Chloride content 170, 171
Cannabinol 323, 324 Chambers 132, 133, 171 Chlorides 144, 145
Cap, percussion 134 Charge 27, 35, 44, 47, 53, 116, Choke 132, 133, 135
Capacity 23, 184, 228, 246, 284, 134, 135, 199, 204, 206, 219, half 132, 135
312 234, 292, 313 Choking 156, 164-166, 211, 212
testamentary 228, 234 of infanticide 204, 206, 208 death 165
Capillaries 74, 130, 156 of medical negligence 26 Chromosomes 100, 104
Capsules 60, 248, 298, 301, 323 propellant 133, 134 Chronic
cyanide 319 of rape 218, 219 exposure 270, 271
Carbamates 282, 283 Charring 137, 145, 151 poisoning 271, 279, 325, 344,
Carbolic acid 238, 258, 259, 307 Cheeks 109, 163, 175 349
Carbon Chelating agents 245, 247, 266, subdural hematoma 22, 130,
monoxide 135, 145, 156, 311- 275 211
313 Chelation 266 Chronological appearances 90
poisoning 73, 144, 145, 312, Chemical Cigarette 313, 323
313 antidotes 245, 246 Circulation 65, 66, 171, 173, 247,
death 62 examination 151, 192, 290, 301, 260
soot 59, 145 319, 324, 333, 335, 344 Civil cases 10, 16, 45, 52, 86, 228
Carboxyhemoglobin 138, 144, stimulation 64 Clammy skin 307
312 Cherry red 74, 145, 312, 313, 319 cold 126, 305
Cardiac Chest 58, 74, 79, 109, 115, 123, Classification 67, 102, 104, 132,
arrest 6, 68, 154, 158, 171, 173, 143, 146, 150, 156, 157, 164, 142, 143, 216, 229, 239
325 165, 208, 258, 270 Clients 46, 179, 190, 191
reflex 161, 163, 173 muscles 167 Clinical
arrhythmia 284, 329, 343 Chief 44, 53 examination 266, 292
Cardinal signs 127, 156 District Officer 11 features 267, 274, 299, 300, 309
Carotid arteries 160, 161, 163, Judicial Magistrate 43, 44 medicine 20
167 justice 12, 43 methods, ordinary 64
Carpal bones 94 of India 43 picture 126, 264
Carrot 353 Child 21, 22, 96, 160, 178, 184, signs 283
Cartridge 132-134, 136 193, 196, 198-201, 204-206, Clinician 20
Cases blood pressure 355 208-212, 259 Clitoris 178, 179, 223, 225
Castor 335 beget 198 Close range shot 138
Cavity 59, 60, 139, 184, 190 dead 205 Clot, postmortem blood 59
thoracic 139, 208, 209 destruction 206 Clothes 73, 87, 145, 154, 219,
uterine 190, 192, 205, 208 female 207 244
Cc 62, 292 healthy 22, 212 Clothing 70, 73, 82, 86, 88, 116,
Cells 64, 65, 88, 100, 104, 318 living 200, 206 134, 135, 137, 142, 145, 152,
red blood 266, 283 male 207 219, 221, 223, 252
Cellular death 64 natural 199 CO 239, 312
360
Index
concentration of 312 Consciousness 230, 299, 306, Court 2, 8, 10-17, 24, 25, 38, 42-
poisoning 312, 313 322 48, 51, 52, 96, 182, 196, 200,
CO2 79, 239, 278 Consent 7, 11, 21, 25, 27, 34, 46, 204, 218, 219, 221, 228
Cobra 328, 329 66, 96, 187, 193, 198, 199, apex 12
Cocaine 61, 322, 324, 325 216-219, 221, 222, 234 of appeals 52
Code 20, 30, 31 informed 7, 20, 21 appellate 12
of ethics 30, 31 valid 20, 21 authorized 70
Coitus 178, 200 Constitution 12, 13 contempt of 44, 51
Cold clammy skin 126, 305 Constricting 157, 158 County 52
Collar, abraded 136, 137 Constriction 74, 146, 161 crown 50-52
Colleagues 23, 32, 35 point 163 district 12
professional 24, 31, 35 of pupils 69, 307 District 10-12
Colleges 39 Consultation 33, 35, 43, 193 fee 10
Color 59, 60, 72, 75, 79, 81, 87, Contact 70, 74, 75, 122, 123, 134- Fee Act 10
111-113, 145, 156, 157, 179, 137, 142, 151, 162, 179, 244, high 43, 44, 52
183, 208, 211, 298, 319 246, 258, 279 highest 43
changes 79, 111-113 direct 151, 152, 253 of India 43
Coloring materials 101 Contamination 25, 27, 173 Juvenile 44
Colorless 258, 259, 275, 288, 322 Contempt of court 44, 51 of law 2, 3, 7, 16, 24, 42, 44, 47,
Coma 66, 69, 261, 278, 282, 284, Contents 204, 206, 222
290, 300, 301, 305, 306, 312, blood hemoglobin 74 level of 12
315, 325, 342, 349 chloride 170, 171 Magistrate 52
Comatose patients 244 Continuance 193, 228 procedures 2
Commencement 114 Contract 10, 33, 201 question 11
Comminuted fracture 127, 128 Contracture 142 of record 12, 43
Commission 6, 25, 33, 204, 292 Contravention 12, 13, 24 session 44
act of 26, 204, 211 Control 16, 45, 190, 233, 289, of sessions 43, 44
Committals 52 291, 322, 333 superior 12
Committee 37, 38 Contusion 75, 108, 110, 118, Supreme 12, 13, 43, 204
Complexion 86, 87, 200 126, 130, 136-138, 167 ultimate 52
Compounds 191, 264, 265, 282, Convection 72, 73 Court-martial 12
284, 353 Convex border 60, 333 Courts discretion 44
organic mercury 270 Convict 3 Cresol 258
Organophosphorous 238-240, Convicted physician 38 Crib deaths 212
244, 246, 282, 284 Conviction 3, 24, 35, 38, 50, 52 Cries 163, 208, 318
Compression 74, 128, 146, 156, Convulsions 69, 244, 247, 265, Crime 7, 15, 25, 44, 47, 52, 70,
157, 164, 165, 172 278, 293, 295, 312, 315, 318, 76, 88, 160, 163, 204, 221,
Computer 104 325, 329, 333, 347, 348, 351 223, 291, 292
Concentration Cooling 64, 72, 73 Criminal 6, 10, 11, 50, 52, 86,
of alcohol 288, 289, 291, 292 rate of 73 144, 210, 211, 228
blood alcohol 289 Cord 58, 209-211 abortion 188, 192, 335
of CO 312 umbilical 205, 209, 210 cases 10-12, 16, 38, 45, 52, 86,
Conception, products of 61, 190, Coronary 208, 228
192 arteries 60, 67, 68 court proceedings 86
Conduct 11, 30, 38 artery disease 47, 67, 68, 261 death 50
money 16, 45 Coroner 42, 43, 50, 51, 53 homicides 6
Professional 23, 30, 35-38 system 50, 53 Crockery 113
Conduction 72, 73 Corrosives 142, 244, 254 Cross-examination 11, 17, 45,
Confidentiality 20, 25, 33 Cortex 270, 271 46, 51
Confirmatory 21, 22, 139 Cot death 51, 212, 213 Crown court 50-52
Congestion 61, 156, 158, 162, COT DEATH 212 Crystals 189, 258, 259
163, 165, 212, 283, 306 Council 12, 32, 38, 39 Cure 26, 32, 33
signs of 163, 324 judicial 12 Curettage 191
venous 158, 161 Countries 12, 33, 36, 42, 70, 108, Custody 50, 51
Conium maculatum 353 153, 213, 224, 292, 305, 322 Cuticular scales 88
Conjunctiva 156, 159, 172, 276 County Court 52 Cyanide capsules 319
Coup injury 127 Cyanides, sodium 318
361
Index
Cyanosis 152, 156, 157, 162-165, hours 290 Dementia, alcoholic 294
210, 283, 301, 305, 306, 315 immediate 139, 152, 171, 252 Demonstration 208, 209, 301
Cylinder 133, 135 indicate 109 Demulcent drinks 259, 260
Infant 51 Dental doctors 30
instantaneous 68, 69, 158 Dentine tissue 92
D lightning 73 Dentition 89, 91
mechanism of 66, 158, 171 mixed 90
Dactylography 102, 103 Miscellaneous 50 Denuded skin 108
Dagger 114 modes of 66, 68, 118, 212 Deposit 137
Damage 26, 27, 82, 126, 127, molecular 64, 65 Deposition 11, 13, 16, 17, 45, 46,
134, 197, 245, 284 natural 50, 67, 69, 164 48, 67, 68, 92, 142, 145, 266,
Danger 6, 21, 25, 36, 116, 189, normal till 252 271
232, 234, 244, 292 Operation 51 Depressed fractures 127
Dark 79, 87, 135, 156, 179, 183, painless 307 Depth 114, 115, 133, 134, 170
184, 230, 232, 278 poisoning 61 Designated court authorities 70
Datura 229, 241, 246, 332, 333, rapid 260, 344 Destruction 6, 117, 143, 151,
339 rate 299 206, 252, 258, 288
niger 332 results 77, 333 Detach 59, 113
stramonium 332 scene 56 Detention 44
Days 22, 23, 79-82, 108-110, 112, sentence 43, 44 Development 26, 64, 66, 75, 77,
144, 175, 183, 206, 209, 210, signs of 64, 72 79, 100, 104, 130, 186, 252,
220, 247, 271, 275, 293, 294, somatic 64, 65 274
348-350 suicidal 78, 146, 298 of rigor mortis 76, 77
modern 156 suspicious 43 Diachylon paste 267
smokeless powder 133 terminal 212 Diagnose unnatural death 67
Dead time of 72, 74, 82, 171 Diagnosis 3, 21, 26, 27, 66, 68,
body 7, 11, 13, 24, 43, 47, 70, unexpected 212 69, 152, 160, 190, 208, 233,
72-74, 81, 83, 86, 104, 144, unexplained 212 248, 266, 267, 275, 283, 292
147, 170 unintended 6 of death 64, 163, 164
buried 70 violent 78 Diagnostic 34, 113, 151, 157, 267
demands 3 viz 64, 146 of live birth 208, 209
child 205 Debilitated person 164 Diameter 88, 132, 133, 135-137,
person 56 Decedent 74, 80, 82 244, 347
Death 21-23, 42, 50, 51, 53, 56, Decision 12, 22, 52, 66, 218 Diaphragm 208, 330, 347
62-69, 72-83, 144-146, 156- Declarant 14, 48 Diarrhea 190, 213, 270, 274, 276,
161, 163-166, 170-175, 204, Declaration 14, 31, 48 278, 335, 339, 342, 349, 351,
205, 212, 213, 290-293, 342- of Geneva 20 355
344 Decomposition 75, 79, 80, 147, Diatoms 173, 174
abortion-related 186 172 Diazinon 282, 283
alcohol poisoning 62 Deducing time 82 Difference 73, 90, 110-113, 134,
anesthetic 21 Defense 13, 16, 17, 27, 45-47, 206, 233, 276, 291
ante mortem 144 116, 204, 222, 228 Diffusion 284, 288
asphyxial 73, 156, 163, 165 Defloration 178 Digitalis 238, 239, 241, 343, 344
brainstem 65 Degree 22, 26, 75, 92, 100, 112, Digitoxin 343, 344
bride burning 146 142, 143, 211, 220, 264, 299 Dilatation 189, 191, 192, 290, 343
carbon monoxide poisoning 62 of Dupuytren 143 Dilated pupils 21, 294, 318, 324,
cellular 64 master 30 325, 332, 351
certificates 13, 14, 47, 248 of penetration 218 Diluted blood 171
choking 165 Delays 22, 47, 211, 239, 289 Direction 65, 108, 114, 115, 118,
clutch 87 Deliriant poisons 331, 332 133, 137, 150, 162
Cot 51, 212, 213 Delirium 229, 230, 234, 265, 270, of impact 108
COT 212 278, 293, 332, 333 Dirty skin 139
crib 212 tremens 232, 234, 293 Disappearances 77
diagnosis of 64, 163, 164 Delivery 14, 178, 179, 181, 183, Discharge 132, 136, 153, 183,
of donor 65 184, 206, 207, 209, 210 192, 220
his/her impending 47 Delusions 230, 232 electrical 153, 154
Homicidal 173, 313 of grandeur 230 handgun 137
362
Index
Disciplinary proceedings 37 Driver 122, 123, 291, 313 England 50, 52, 53, 70, 193, 204,
Disclosure 25 Drowning 59, 64, 156, 169-173 208, 218, 222, 232
Discoloration 74, 151, 182, 301 fresh water 170, 171 Enquiry 21, 42, 53, 160, 196
of skin 74, 142 mechanism of 170 Enterotome 61
yellow 254 seawater 171 Entice patient 23
Disease 25, 27, 34, 47, 58, 66, 67, signs of 172 Entrance 61, 115, 135, 136, 138,
73, 164, 198, 206, 209, 220, Drowsiness 299, 305, 342 152, 164, 208, 279
234, 235, 238-240, 294 Drugs 10, 34, 37, 51, 61, 70, 164, marks 151
hypertensive heart 68 188-190, 229, 238, 246, 247, wound 115, 134, 137, 138, 152
infectious 25, 103 298, 299, 301, 319, 322, 323 Entry 61, 115, 135, 151, 205
Local 197 Drunk 20, 160, 292, 313, 323 wound 115, 136-138
transmitted 25 Drunkenness 291, 292, 315 Epidermal 143
Dislocations 59, 108, 117 Dry 110, 150, 151, 159, 175, 292, Epidermis 152, 205
Dismembered body 89 332, 333 Epiphysis unites, Lower 93
Displacement 127, 128, 189 heat 142 Epithelialization 144, 209
Disposing mind 235 skin 150 Erasure 38
Disputed person 104 Dupuytren 143 of name 38
Disruption of tissues 134, 151, Dura 57, 58 Ergot 241, 349
152 Duramater 57, 58, 129, 130, 146 Ergotism 349
Distance 110, 122, 128, 134, 135, Duration 47, 159 Erosion 59, 253, 260
161, 170, 290, 318 of action 298, 299 Errors 17, 26, 27, 45
Distillation, illicit 292 of exposure 143 Eruption 90, 92
District 12, 44 DUTIES of physician 33, 35 Erythema 142, 143
Court 10-12 Duty 6, 13, 23, 25-27, 31, 32, 35,Escape 79, 110, 123, 139, 204,
courts 12 36, 42, 43, 53, 116, 291 253, 266, 293, 322
judges 12 professional 31, 35-37 Esophagus 59, 60, 166, 254, 259,
Police Office 11 Dying declaration 14, 47, 48, 193 260
Divorce 178, 196, 199 Establishment 65, 82, 86
Divulge 46 Estimation
DNA 104, 336 E of age 89, 92, 94
finger printing, modern days 104 of alcohol 290, 292
fingerprinting 104 Ears 117, 136, 163, 165, 307, 349 Ethics 19, 20, 31
modern days 200 Earthing 150 code of 30, 31
test 221 Ecchymosis 110 Ethyl alcohol 288, 292, 294, 295
Doctor 2, 3, 14, 23, 25-27, 30, 31, Eclampsia 69 Ethylene glycol 62, 295
42, 45-48, 50, 51, 70, 72, 182, Edema 58, 60, 175, 208, 289, Euphoria 229, 231, 232, 305
193, 219, 234, 248 301, 335, 355 Euthanasia 8, 22
owes 23 Edges 75, 114, 115, 138, 180, types 8
professes 26 220, 333 ethics regarding 22
single 193 Education 30 EVA 190
Doctors profession 30 medical 30, 38 Evidence 7, 8, 11, 16, 17, 20, 23,
Documents 7, 16, 24, 36, 44, 45 Electric mark 151, 152 24, 42, 45-48, 51, 52, 58, 59,
Doll 65 Electrical discharge 153, 154 65, 72, 86-88, 108, 196, 313
Donor 22, 65, 66, 198, 199 Electricity 151, 153 Examination 11, 16, 17, 22, 23,
death of 65 Electrocution 152 30, 43, 45-48, 57, 59-61, 70,
Dosage 64, 290, 300, 301, 322, injuries 151 86, 87, 89, 105, 152, 219-223,
323, 333, 348 Elevated blood alcohol 291 233, 234
Dose 238, 247, 266, 270, 271, Emaciated persons 77 chemical 151, 192, 290, 301,
275, 276, 283, 288, 289, 293, Emasculation 117 319, 324, 333, 335, 344
294, 299, 300, 305, 306, 318, Embryo 182, 183 clinical 266, 292
319, 322-325, 332, 333, 342, Emergencies 21, 26, 33-35 general 221-223, 292
343 Emergency treatment 24 of witness 16, 45
divided 247, 271 Emesis 244 Excessive ingestion of alcohol
high 170, 188, 189, 239 Emotional 36 291, 293
lethal 270, 274 Emphysema aquosum 173 Excreta 248
Dowry deaths viz 42 Encephalopathy 265, 266 Excretion 245, 247, 259, 288,
Drinks, Demulcent 259, 260 298, 301
363
Index
Excusable homicide 6 Fatalities 150, 153 Food 6, 25, 59, 60, 82, 165, 175,
Exhaust pipe 313 Father 20, 104, 199, 200 209, 212, 233, 248, 275, 276,
Exhumation 42, 70 Fatty degeneration 271, 275, 279 288, 324
Existence, separate 205-208 Features poisoning 309
Exit 115, 134, 135, 138, 154 clinical 267, 274, 299, 300, 309 Foot 77, 86, 161, 189, 265, 266
Mark 151, 152 common 260, 274, 279, 319 Foramen magnum 128, 129
wound 114, 115, 134, 136-138, Feces 79, 238, 248, 264 Foreign
152 Fee 16, 24, 33, 34, 45 body 115, 165, 178, 179
Expenses 16, 24, 45, 114 Feet 126, 128, 134, 135, 137, 146, Inhaled 166
Expert 3, 8, 13, 15, 53, 238 154, 157, 172 doctors 30
opinion 11 Fellow physicians 37 materials 165, 220, 221
physician 187 Female Forensic
witnesses 11, 24, 48 body 225 doctor 72
Exposure 6, 35, 82, 92, 142, 150, child 207 Medicine 2, 3, 5, 56, 238
171, 211, 224, 244, 258, 264- pseudohermaphrodite 101 pathologist 48, 67, 86
266, 270, 278, 312, 313 Skull 98 Psychiatry 227, 229
chronic 270, 271 Frontal 99 Formation 81, 130, 134, 254, 279
duration of 143 Male Skull 98 scab 110
organic mercury 270 Females 61, 80, 93, 96, 97, 99, Formula 74
of tissues 142, 143 100, 110, 111, 143, 146, 163, Foul 13, 42, 43, 47
Expulsion, complete 206, 207 164, 182, 196, 198, 218, 222- Fourchette 184, 220
Extensive lacerated injuries 116 225, 330 Fractures 27, 57-59, 70, 109, 117,
External body surface 244 Femur 89, 93, 95, 96, 98 122, 123, 126, 128, 129, 163,
Extortion 10 forms 93, 97 165, 167, 211
Extradural hemorrhage 57, 129, Fertilization 200 of base of skull 128, 129
146 Fetus 36, 182, 191, 192, 200, 204 Comminuted 127, 128
Extravasation 110 -207, 209, 210 fissured 127
of blood 75, 110, 112, 113, 129 Fevers, high 77, 229, 230 Linear 127
Extremities 160, 324 Fibers 77, 87, 114, 137, 162 Multiple 22, 128, 210, 211
Exudation 109, 110, 144 Fibrillation, ventricular 68, 152, of skull 126-128, 211
Eyelids 77, 79, 110, 156, 175 260, 343 bones 293, 307
Eyewitnesses 11 Fingerprints 103, 104 Fragments 105, 113, 115, 137,
Fingers 13, 48, 56, 58, 77, 81, 86, 221, 333, 335
102, 103, 105, 136, 151, 161- Fresh water drowning 170, 171
F 163, 179, 180, 192, 244 Friction 92, 108, 109
FIREARM INJURIES 139 Front 57, 109, 118, 122, 123, 143,
Fabricated wounds 116 RIFLED 136 219
Fabricator 116 Firearms 108, 132, 133, 135 passengers 123
Factors, associated 72 RIFLED 133, 134 Frontal, life time 105
Failure 6, 21, 25-27, 66, 171, 193, Firing 132, 133 Froth 172, 173, 301, 306, 307,
211 First trimester abortion 189, 190 318, 319, 351
Fair skin 79 Fissured fractures 127 blood stained 159, 283
Faith 21, 193 Fixation of lividity 74 Frothy blood 79, 163, 313
Fallacies 173, 209 Flaccid 77, 205 Fumes 253, 254
Fat 78, 81, 82, 110, 111, 170, 175, Flame 134, 136, 142 Functions 30, 53, 64, 66, 100,
192, 246, 258 Flap-like skin 113 142, 170, 322
Fatal 118, 261, 323, 335, 344, 348 Flash 151, 152 Fuses 92, 95
concentration 298, 299 Flattened skin 151
Dose 252, 254, 255, 258, 260, Floats 209, 274
261, 264, 270, 275, 279, 283, submerged dead body 82, 170 G
284, 291, 294, 295, 299, 323- Flotation 78, 81, 170
325, 342-344, 348, 349 time 81, 82, 170 Gagging 146, 165
injuries 210 Fluid 130, 142, 144, 145, 151, Gall bladder 60, 61, 175
Period 252, 254, 255, 258, 264, 170, 197, 220, 275 Garlicky odor 278, 284
275, 279, 284, 291, 294, 306, blood 74, 113, 146 Garroting 161
344, 348, 350, 351 Fluorescence immunoassay 336 Gases 75, 79-81, 132, 134, 137,
time 344 Fontanels 115 151, 170, 172, 312, 313, 315
364
Index
natural 312 singeing of 134, 137, 142, 145 163, 166, 172, 189, 192, 211,
Gastric wash 244 Hallucinations 229-231, 293, 212
Gastrointestinal signs 339 294, 305, 322-324, 332 Petichiael 152, 156
Gastro-intestinal tract 284, 298, days 322 pontine 69, 73, 126, 307
319, 323, 335, 351 varied 322, 323, 325 spontaneous 126, 130
GENERAL SIGNS 156 Hallucinogens 321, 322 Hemotoidin 111, 112
Geneva 20 Halt 126 Hemotoxic 328, 329
Genitalia 60, 178, 218, 220, 221, Hammer 113, 127, 128 Hen 223
224, 225, 342 Handed person Heroin 304-306
Genitals 163, 221, 223, 224 left 162 High tension injuries 151
Gestation 187, 191, 206, 207 right 118 Hippocratic Oath 20
Girl 179, 180, 198, 218, 219 Handgun discharge 137 His/her 14, 34, 35
Gland 212, 328, 329 Hands 21, 27, 72, 75, 78, 89, 102, impending death 47
Glans 221, 223 105, 109, 116-118, 122, 136, patients 35, 36
Glass 103, 113, 244, 246 162, 165, 172 History of hypertension 68
of water 244, 247, 275 Hanging 156-158, 160, 166, 167 Hole 135, 138, 245
Glycosides 240, 342, 343 Harm 20-22, 238, 301, 312 Homicidal 56, 114, 160, 164, 165,
Gm 156, 325 Hashish 323 167, 173, 175, 229, 254, 255,
Gold 247 Hasse 192, 207 259, 271, 293, 294, 339
Gomorrah 223 Head 38, 57, 65, 69, 76, 77, 82, burning 146
Government 10, 11, 13, 14, 30, 117, 118, 126-128, 130, 137, deaths 173, 313
42, 70, 187, 218 138, 146, 157-159, 170, 171, Homicide 6, 7, 10, 11, 51, 53, 56,
Case Act 10 207, 208, 328 66, 70, 116, 146, 160, 162,
criminal cases 10, 11 injury 82, 122, 125, 128, 130, 204, 225, 231, 262
doctor 43, 248 229, 292 excusable 6
Govt 30 moving 126, 127, 211 justifiable 6
Grains 270, 271 Headache 265, 299, 312, 353 Honor 31, 34
Gram 220, 284, 289 Heal 108, 109, 116, 142, 210, 252 Hospital 14, 30, 50, 86, 191, 193,
Grandeur 230 Healing 22, 32, 142, 211 232-234, 248, 293, 299
Grass 83, 172, 219 Health 22, 23, 30, 31, 190, 193, mental 234
Grave 219 Hostile witness 48
injury 193 Committee 35, 37, 38 Hour time 288
intra-abdominal injuries 189 mental 187, 193 Hours 11, 17, 22, 45, 65, 72-74,
Gravid uterus 80 service providers 186, 187 76, 77, 79, 81-83, 144, 170,
Gravity 34, 35, 82, 139, 170, 175, Heart 59, 62, 65-67, 77, 80, 139, 183, 205, 288, 298-300
209, 212 150, 153, 170, 171, 209, 239, death 290
Gray 58, 87, 254, 259, 270, 271 290, 300, 301, 343, 344, 355 of death 72, 79, 112
Green 75, 101, 112, 113, 183 Heat 72, 73, 78, 142, 143, 145, of ingestion 262, 278, 283
discoloration 79 146, 151, 154, 211 House 52, 56, 57, 83, 146, 165,
Grievous hurt 116, 117 regulation 73 166, 259
Grooves 133, 139, 328 ruptures 145 Hrs 252, 254, 275, 278
Gross thermal injuries 152 Heel 122, 207, 347 Human hair 88, 223
Guardians 20-22, 34, 211, 219 Height 89, 99, 109, 122, 126-128, Humanity 31, 32
lawful 234 207 Humerus 89, 93
Guilty 3, 10, 193, 196, 197, 204, Helps 78, 122, 247, 266 Hunger pain 175
222 Hematoma 110 Hurt 116, 117, 217
Gums 92, 265, 266, 279 chronic subdural 22, 130, 211 grievous 116, 117
Gun 113, 136, 139 Hematuria 260, 261 Husband 20, 25, 182, 196, 198,
Hemodialysis 262, 271, 275, 301 199, 201, 217, 222, 234, 294
Hemodilution 170, 171 Hydro cyanic acid 318, 319
H Hemoglobin 79, 111, 112, 170, Hydrochloric acid 239, 252, 254,
312, 318 318
Habeas corpus 12, 13 Hemolysis 74, 75, 78, 111, 170, Hydrocyanic acid 239, 317, 318
Habituated person 238 171, 335 Hydrostatic test 209
Hair 70, 80, 87, 88, 127, 142, 175, Hemolyzed blood 79 Hygiene, personal 267
219, 222, 274, 275 Hemorrhage 57, 58, 61, 69, 73, Hymen 178-180, 184, 220
human 88, 223 126, 129, 130, 139, 157, 159, intact 179, 180
365
Index
Hymenal tissue 178 India 42, 43, 70, 81, 87, 146, 170, acute 130
Hyoscine 332, 333 193, 204, 207, 218, 323, 332, Automobile 121
Hypertension 69, 130, 282 335, 342, 343, 351 blunt 112, 130, 211
history of 68 chief justice of 43 impact 108
Hypertensive heart disease 68 Indians 86, 87, 99 bone 151
Hyperthermia 69, 70 Indicate 75, 82, 101, 108, 114, Boxing 126
Hypertrophy of left ventricle 68 134, 136, 173, 200, 209 brain stem 126
Hypervolemia 170, 171 death 109 contrecoup 126
Hypocalcemia 247, 260, 295 Industries 258, 264 Contre-Coup 127
Hypostasis 74, 113 Inebriated doctor killing 6 coup 127
Hypotension 274, 300 Infant dangerous 116
Hypothermia 64, 212 death syndrome 70, 164, 212, deceleration 127
213 deliberate 22, 211
Deaths 51 electrical 151, 153
I Infanticide 50, 164, 182, 204-206, external 146
210, 351 eye 253
Identification 42, 81, 85-87, 93, charge of 204, 206, 208 fatal 210
101-105, 122, 147, 221 Infants 21, 22, 61, 111, 115, 164, gun shot 136
Identity 56, 70, 86, 87, 105, 147, 203-206, 208-213, 244, 270, grave 193
199 307 intra-abdominal 189
Ilium 95, 97 born 20, 56, 88, 204 high tension 151
Ill 112, 192, 267, 279 Infarcts 68 inflicting 211, 224
health 47 Infection 139, 144, 186, 189, 198, mechanical 107, 108
person 234 212, 213, 229, 329, 349 moist heat 142, 145
Illicit distillation 292 blood stream 139 multiple 165
Illness 25, 34, 35, 47, 82, 197 Infectious disease 25, 103 stab 66
Immediate stomach wash 306 Inferences 8, 46, 48 multiples 57
Immersion 67, 81, 170, 171, 173 Infidelity 200, 229, 230 obscure 57
Impact 109, 110, 112, 113, 122, Infiltrated blood 112 Penetrating 119
123, 126, 127, 133 Inflammation 58, 59, 61, 253, pericardial 139
direction of 108 254, 274, 278, 295, 342, 351 permanent 193
primary 122 signs of 75, 335 post-mortem 172
Impaired reaction time 312 Inflicted burn injuries 146 primary 122
Impairing, permanent 117 Inflicting injuries 211, 224 impact 122
Impersonation 86 Information 7, 10, 11, 15, 25, 33, repetition of 22, 211
Impotence 196-199 34, 36, 42, 43, 48, 53, 75, 81, Secondary 122
temporary 197, 198 248 impact 122
Impotent 197, 199, 218, 325 Ingestion 82, 252, 253, 260, 264, sever 123
person 196 270, 271, 274, 279, 284, 288, shot gun 136
Impression 56, 102, 103, 109, 289, 299, 309, 313, 315, 322, shotgun 134, 136
136, 162, 219, 291 323, 344, 345 signs of 146, 160, 173, 192
Imprisonment 10, 16, 44, 45, hours of 262, 278, 283 sustain 116, 123
117, 217, 218 Inhalation 144, 156, 165, 170, whiplash 123
Improper pressure 36 171, 238, 253, 254, 264, 270, throat 114, 118
Impulse 229-231 279, 284, 304, 315, 318, 319, tissue 142
irresistible 231 335 underneath 116
Inability 196, 228, 265 Inhaled Foreign Body 166 vaginal 198
Inches 132-135, 207 Inhibits 282, 318 whip lash 58
Incised wounds 72, 108, 114, Initiating prosecutions 53 Innocent person 3
116, 118, 126, 136, 145, 146 Injured body 57 Inorganic 264, 265, 277, 278
Incision 57, 58, 72, 75, 113, 118, Injures 116, 122, 193 arsenic 274
351 Injuries 13, 14, 22, 57-60, 66, compounds 78, 264, 265
longitudinal 59, 60 108, 109, 114, 116, 117, 122, mercury 270
Incisors 90, 92 123, 126-128, 139, 142-145, Inquest 42, 43, 50, 53
Incoordination 289 165, 191-193, 210, 211, 218- report 43
Incubation 220 221 Insane person 164, 228, 230,
Acceleration 127 231, 234
366
Index
Insanity 47, 228-233, 324 Kidneys 22, 60, 61, 65, 80, 139, Level 11, 75, 99, 116, 161, 163,
Insemination 199 220, 245, 247, 253, 259, 260, 190, 208, 265, 266, 306
artificial 198, 199, 201 264, 266, 271, 295, 335 blood
Inspector of police 13, 43 Killing 6, 7, 164, 204, 211, 324 alcohol 290, 291
Instantaneous death 68, 69, 158 inebriated doctor 6 barbiturate 307
Institutions 12, 32 King 12, 20, 230 of court 12
Instruments 67, 113, 114, 189 KMno4 solution 245 Life 21, 31, 35, 36, 47, 50, 64, 66,
Intact hymen 179, 180 Knees 95, 109, 122, 161, 221 72, 77, 78, 95, 116, 117, 193,
Intercourse, anal 222 Knife 59, 114, 116 205-207, 213, 218
International code of MEDICAL Knot 159, 161, 167 imprisonment 204, 218
ETHICS 20, 23 Knowledge 2, 3, 17, 20, 23, 26, time
Internship Training 30 27, 31, 33, 45, 64, 187, 210, frontal 105
Intestine 61, 79, 80, 175, 208, 235, 240 photograph 105
209, 239, 245, 260, 271, 288, Korsakoff 229, 232, 293, 294 Ligature 60, 157-162, 209, 245
309, 333, 335 groove 162
large 61, 83, 265 impressions 161, 162
Intima 67, 68, 160, 163, 350
L mark 109, 159-161, 167
Intoxication 217, 289, 290, 292, material 157, 159, 160, 162
Labia
293, 299, 309, 313 Lighter 90, 98, 99
majora 179, 180
Investigation 11, 13, 15, 33, 42, Lightning death 73
minora 179, 180 Linea albicans 183, 184
53, 68, 291
Lacerated
of government criminal cases 10, Linear fracture 127
injuries 113
11 Lines 87, 274, 275
Extensive 116
officer 11 silvery 183, 184
wounds 108, 112, 145, 146, 154
Involuntary muscles 77 Lining endothelium 59
Lacerations 58, 59, 102, 109,
Iron 112, 153, 247 Lips 79, 81, 110, 156, 165, 219,
112, 113, 122, 123, 126, 130,
Irresistible impulse 231 252, 258-260, 271, 307, 332
160, 163, 165, 167, 192, 219,
IRs 44 Liqor amnii 182, 205
220
Issuance 23, 24 Liquid blood 271
Lactic acid 77, 83
Listens 7, 25
Lady 180, 182, 184
Live
J Lands 3, 10, 17, 31, 46, 133, 139
birth 206-209
Larynx 59, 67, 80, 173, 253
diagnostic of 208, 209
Jaundice 278, 279, 284 Lasts 77, 78, 183, 210, 290, 348
person 65
Jaw bone 279 Law 2, 3, 6-8, 10-13, 16, 21, 24-
wire 153
Jaws 77, 90, 245 26, 31, 33, 36, 42-45, 47, 187,
Livebirth 208
Job 25, 221 204, 218, 222
Liver 60, 61, 65, 72, 79, 80, 111,
Joints 76, 77, 108, 206 Lawful guardian 234
139, 208, 253, 259, 271, 274,
Joule burn 151, 152 Lawyer 16, 17, 45-48
275, 278, 279, 293, 298, 299,
Judges 12, 17, 42, 46, 51, 52 Lead Carbonate 264
335
Judicial Left ventricle, hypertrophy of 68
failure 278, 279
council 12 Legal, Medico- 319, 339, 342
Lividity 74-76
magistrate 44 Legitimacy 197, 199, 200
fixation of 74
Chief 43, 44 Legs 22, 77, 79, 117, 119, 122,
Postmortem 74, 76
Second class 43, 44 123, 211, 355
Living
Juice 342, 351 Length 58, 61, 89, 92, 97, 105,
child 200, 206
milky 342 114, 115, 150, 196, 207, 223
person 86
Jurisdiction 12, 13, 52 of skull 89
Livor 74
Justice 2, 12, 52, 210 Length-0 89
Mortis 72, 74
Justifiable homicide 6 Lengthx1 89
Local Disease 197
Juvenile Court 44 Lengthx2 89
Lochia rubra 183
Lengthx3 89
Longitudinal incisions 59, 60
Lesbians 225
K Lesions, bullous skin 313
Loop 103
Lord Chancellor 52
Lethal 318
KCN 239 Lords 52
dose 270, 274
Keratinized skin 222 Losing time 319
Kerosene 145, 146, 246, 283
367
Index
Loss 65, 138, 175, 178, 197, 222, Masturbation 178, 179, 224, 225 Medico-legal Aspect 136, 253,
229, 265, 290, 293, 312, 318 Maternal pulse 182, 183 262, 283, 284
of memory 270, 294 Mature 21, 201, 238 Medicolegal
terminal blood 74 Meals 82 Autopsy 55, 56
Lower blood concentration 300 protein 82 interest 188
LSD 322, 323 Measurement 47, 89, 207 Medico-legal points 307, 345,
Lubricants 222, 223 Mechanical 348
Lukewarm water 244, 245, 259 asphyxia 74, 155, 156, 212 Medicolegal Reports 11, 13, 14
Luminous 278 injuries 107, 108 Medium 80, 82, 89, 164
Lunatic, wandering 232 Mechanism 127, 139, 158-160, Medulla 64, 88, 289, 290
Lungs 59, 60, 66, 69, 80, 152, 224 Mee 274, 275
164, 167, 170, 172, 173, 208, of death 66, 158, 171 Members 30, 32, 35, 36, 66, 117,
209, 212, 239, 274, 282, 312, of drowning 170 332
313 of heat regulation 73 Membrane 180, 205, 210
Lysergic acid diethylamide 322 Media 37, 68 alveolar duct 208
Medical Memory 104, 289, 294
certificates 13, 14, 24, 36, 234 Meninges 128, 152, 163, 164, 319
M colleges 30, 38 Mental
doctors 13, 30 asylum 228, 234, 294
Maceration 205, 209
education 30, 38 health 187, 193
MacEwan 290, 307
MEDICAL ETHICS 20, 32, 35 hospital 234
Machine 66
international code of 20, 23 unsoundness 229, 233
Maggots 79
Medical Mercury 134, 188, 239, 269-271
Magistrate 42, 43, 48, 52, 70, 232
Evidences 3, 13, 14, 47, 196 metallic 270
Courts 52
examiner 53, 56 poisoning 247, 270
Magistrates 43, 52
Jurisprudence 2 vapors 270, 271
Magnesium
MEDICAL METHODS 189, 190 Mescaline 322, 323
oxide 246, 247, 252, 253, 275
Medical Metabolism 264, 288, 290, 294
sulfate 189, 259, 261
negligence 6, 26, 27 Metallic
Magnifying lens 102, 113, 114
charge of 26 mercury 270
Maintenance 92, 200
officer 13, 42, 196, 204, 210, poisons 247
Majesty 12, 13
218, 221, 232, 234 absorbed 245, 247
Malathion 282, 283
person 14 Metals 150, 152, 247, 259, 318
Male
personnel 36 heavy 188, 245, 247
child 207 Meters 135, 244
practice 2, 19, 26, 27, 30, 32
pseudohermaphrodite 101
practitioner 11, 13, 20, 186, 235, Methods, common 164, 190, 191
Males 80, 93, 96-100, 111, 197,
248, 298 Methyl alcohol 292, 294, 295
198, 222-225, 330 Metopic Suture 95
registered 24, 26, 31, 48, 193
Management 36, 233, 299, 301
profession 31-34, 37 Mg/kg 247, 270, 274, 275
Mandamus 12, 13
register 38 Middle
Marbling 79
science 3, 30, 32 cranial fossa 129
Margins 111-115, 127, 137, 146,
termination of pregnancy 190, meningeal artery 129
159, 184, 208, 222 Milk 183, 192, 209, 212, 252, 259,
193
beveled 138
treatment 50 260, 275, 288, 304
upper 99
MEDICAL WITNESS 46 Milky juice 342
Marijuana 323
Medicine 2, 3, 20, 21, 25, 64, 238, Minutes 65, 66, 72, 82, 205, 283,
Marriage 42, 86, 96, 178, 182,
252, 253, 318, 343, 351 306, 318, 344
196, 199, 222
clinical 20 Mirror 118
nullity of 178, 196, 199, 228
Forensic 2, 3, 5, 56, 238 Miscellaneous
Married patient 198
Indian 20 deaths 50
Marry 25
Medico- legal 339, 342 poisons 240
Masochism 216, 224
Medico Legal Importance 153, Misconduct, professional 24, 35,
Masochistic
154 37, 38
asphyxia 160, 224 Medico-legal 47, 146, 254, 255, Mishaps Wrong Patient 27
practice 160 Mistake 26, 56, 64, 230, 259, 261,
261, 291, 294, 313, 323, 351
Mass 134, 135
Medico-Legal 47, 333, 335, 343 315, 333
Master degree 30
Mixed dentition 90
368
Index
Mixture MVA 190, 191 Neurotoxin 328, 329
of semen 223 Myocardium 59, 60, 68, 274, 313, Neutralization 252, 253
of tetrazene 134 329, 343 Nicotiana tabacum 344
Ml 244, 245, 248, 249, 252, 254, Nicotine 241, 344, 353
255, 266, 275, 291, 293-295, Nicotinic
300, 313, 318, 319, 325, 343
N signs 282
Modern days DNA 200 symptoms 283
NaCN 239
finger printing 104 synapses 282
Nails 70, 80, 108, 142, 162, 165,
Modes of death 66, 68, 118, 212 Nitric acid 253, 254
Moist heat injuries 142, 145 221, 274, 275, 301 NMC 30, 32, 35, 38
Naked body 73
Molecular death 64, 65 Nominated 30
Name 14, 24, 31, 37, 38, 101,
Money 23, 36, 116 Nepal Dental Doctor Association
Montgomery 183 207, 212, 222
30
Mood 233, 322 erasure of 38 Non-addicted person 238
Narrowing 60, 132, 198
Morning hours 70 Normal
Natural
Morphine 61, 246, 304-307, 332, body temperature 72, 74
abortions 188
333, 335 till death 252
Mother 14, 104, 188, 193, 200, born child 199 Nose 74, 79, 81, 117, 129, 157,
child 199
204-207, 210, 211 165, 212, 253, 279, 283, 306,
deaths 50, 67, 69, 164
Motive 8, 23, 48, 182, 230, 233, 307, 328, 349
gas 312 Nostrils 109, 156, 159, 163, 164,
239
Nausea 190, 258, 261, 270, 278,
Motor accidental deaths 291 172, 301, 319, 351
282, 284, 294, 312, 318, 324,
Motorcyclists 122 Nuclear sexing 100, 101
330, 343, 344
Mouth 59, 79, 105, 129, 136, 146, Null 12, 13, 196
Neck 58, 59, 77, 79, 90, 93, 97,
159, 163-165, 172, 252, 253, Nullity of marriage 178, 196, 199,
109, 115, 118, 119, 129, 146,
258-260, 306, 307, 318, 319, 228
157, 159-164, 167, 219
325, 342, 343 Numbness 258, 260, 324
bones 59
gag 245 Nymphomania 216, 225
folds 206
indicate death 109
Mucosa 252-254, 259, 315 muscles 163
Mucous membrane 60, 80, 100,
narrow 328 O
structures 59, 159, 163
178, 246, 252, 258, 259, 271,
Neckwear 159 Oath 16, 42, 45, 47, 48, 51
279, 309, 319, 348
Necrosis 258, 271, 274, 279, 313, Object 16, 17, 45, 46, 74, 78, 108,
Mucus 170, 209, 259, 260
339 109, 113, 115, 153, 160, 165,
membrane 61, 260
Needles 27, 101, 114, 115, 258, 221, 228, 230, 232
Mud 59, 109, 164, 219
325, 339 Obscure injuries 57
Multiple stab injuries 66
Negative result 220 Obsession 229, 231
Multiples injuries 57
Neglect 36, 50 Obstruction 123, 158, 164, 170,
Muluki Ain 7, 10, 13, 187, 216
Negligence 26, 27, 53, 182 208
Mummification 72, 78, 81, 205,
allegations of 26, 27 Obtuse angle 93, 97
209
Negligent Doctor 27 Occasions 64, 88, 144, 146, 208,
Mummified body 81
Negroes 87, 89, 99 220
Murder 6, 47, 50, 56, 65, 86, 128,
Nepal 7, 9, 12, 30, 38, 39, 42, 81, Occlusion 67, 68
173, 204, 206, 224, 230, 291,
87, 117, 170, 187, 204, 207, Occupants 122, 313
322, 324
216, 217, 332 Odor 240, 278, 349
Murdered person 57
Murdering 224 Dental Doctor Association Nomi- garlicky 278, 284
nated 30 Offended persons 11
Muscarinic 282
Medical Council 14, 29-31, 33, Offender 52, 117, 204, 217
effects 282, 283
35, 38, 39 Offense 7, 10, 24, 37, 43, 52, 165,
Muscle proteins 76-78
Muscles 58, 73, 76-78, 81, 142, Act 30, 31, 35 204, 217, 223, 232
Nepalese 86, 87, 99 of rape 217, 218
143, 289, 313, 328, 347
Criminal Justice System 15 Offspring 104, 196
involuntary 77
doctors 30 Oil 189, 246, 355
uterine 188
Nerium odorum 342 argemone 355
voluntary 77, 78
Nerves 58, 142, 145 mustard 355
Mustard oil 355
Nervous system 330, 332, 353 vegetable 258, 259
Muzzle 132, 134, 136
369
Index
Oleander 239, 241, 342 stomach tube 252 impotent 196
Oleate 267 Passengers 123 inhales water 173
Oliguria 175, 258, 260, 274 Passing vehicle 122, 123 inters 322
Omissions 6, 17, 26, 45, 56, 204, Passive agent 198, 222, 223 laughs 289
211, 292 Paste, Diachylon 267 live 65
Operation Death 51 Patches 74, 208 living 86
Opinion 3, 11, 13, 35, 47, 83, 159, white 258, 259 missing 86, 103, 105
193, 196, 218, 238, 248 Paternity 104, 200 murdered 57
Opium 64, 211, 239, 240, 245, Pathological conditions 58, 60, non-addicted 238
246, 304-307, 339 61 normal 230, 231, 233
poisoning 69, 126, 246, 300, Pathologies 60 resource 39
303, 305, 306 Patient 7, 21-27, 31-37, 46-48, 64, respective 65
Organic 264, 265 66, 144, 244, 245, 248, 252, right-handed 162
mercury 262, 278, 300, 305, 307 robust 160
compounds 270 rights 20 sane 230
exposure 270 Payment 23, 33 sick 235
Organisms 139, 309 Pedestrian 122 single 160
Organophosphates 282, 283 Pediatricians 22 suspected 165, 292
Organophosphorous compounds Peeping tom 216, 224 unqualified 24
238-240, 244, 246, 282, 284 Pellets 132-135 untrained 186
Organs 11, 24, 27, 60, 65, 66, 78, Pelvis 95, 96, 123 upright 32
80, 81, 112, 116, 117, 139, Penetrate 108, 112, 138, 139 wakes 324
146, 175, 189, 225, 284 Penetrating 108, 115 young 21
Orgasm 224, 225 Injuries 119 Personal
Orifices 83, 167, 178, 180 Penetration 133, 137, 217, 221, behavior 37
Ova 200 222 Behaviour 36
Ovaries 100, 183, 184, 192, 198 degree of 218 case 234
Overdosage 349, 351 Penicillamine 247, 271 effects 70
Oxalic acid 62, 238, 259-261, 295 Penis 79, 100, 197, 218, 223 gains 24
Oxidation 258, 295, 306 Percussion cap 134 hygiene 267
Oxygen 156, 270, 312, 313, 315, Perforating 108, 115, 137 Personality 228, 265
318, 325 wound 114, 115 abnormal 232
Perforation 192, 244, 252-254 Personnel 206
Pericardium 60, 152, 163, 164, medical 36
P 167, 319 paramedical 298
Period Persons
Pain
of incubation 220 idiosyncratic 261
abdominal 265, 270, 274, 294,
of pregnancy 193 lasts till 324
335, 339, 342 Permanent teeth 90, 91 Pervert 224, 225
hunger 175
Peroxide 134 Petechiael hemorrhages 156,
Painless death 307
Persecution 229, 230, 232 157, 159, 162-165, 172, 212,
Paints 264, 267, 274, 289
Person 6-8, 14, 25-27, 47, 48, 86, 283, 319
Pair 59, 89, 95, 100
101-104, 159-161, 170, 199, Pethidine 304, 306, 307
Pale 74, 151, 159, 162, 173, 183
200, 230-232, 234, 235, 289- Petichiael hemorrhage 152, 156
Palms 105, 111, 161, 163
294, 299-301, 318, 319, 322- Petrol 145, 146, 315
Paralysis 27, 153, 266, 307, 324,
325 PEYOTE 322, 323
328, 343 Pharmacologic treatment 266
addicted 36
Paramedical personnel 298
alleged 234 Phases 15
Parathion 282, 283
anemic 313 Phenols 240, 246, 258, 259
Parents 21, 22, 104, 199-201,
authorized 219 Phosphates, alkyl 282
204, 211, 212, 219 Phosphine 284
dead 56
Parietal head injuries 123
debilitated 164 Phosphoric acid 279, 282
Parsley 353
disputed 104 Phosphorus 83, 189, 246, 277-
Partners 199, 228
emaciated 77 279
Pass
habituated 238 Photographs 37, 105, 211, 219,
death sentence 43
healthy 248 221
imprisonment 44
ill 234 life time 105
370
Index
Physician 20, 21, 32-38, 65 Poroscopy 105 Private patients 26
absent 35 Post Privation 117
convicted 38 Mortem Appearances 151, 159, Permanent 117
expert 187 164, 165, 283, 285, 295, 325, Privileges 20, 35
fellow 37 333, 335 professional 35, 36
registered 38 mortem Probation 38
Physicians viz 22 blood alcohol 290 Proceedings, criminal court 86
Physiological antidote 245-247 examinations 13, 42, 298 Procreate children 196
Physostigmine 246, 332, 333 signs 144 Procurator 53
Piamater 129, 130 Posterior cranial fossa 129 Procurator-fiscal 53
Picture, clinical 126, 264 Post-mortem Appearance 3, 161, Procure patients 24
Pieces 127, 209 259, 260, 306, 345, 350, 351 Procuring
Pin point pupils 126 Postmortem abortion 188, 267
Pinching 290, 305, 307 Appearances 254, 319, 337, child 197
Pistol 134, 136 342, 348 patients 37
Plaintiff 10 blood clot 59 Products of conception 61, 190,
Plants 240, 323, 324, 332, 342- burn injuries 145 192
344, 351, 353 burning 144 Profession 20, 24-26, 32, 34, 35
Plastic cannula 190 hypostasis 72, 75, 82, 145, 171 medical 31-34, 37
Pleura 163, 167, 172, 319, 335 Post-mortem injuries 172 Professional
Poisoning 3, 47, 58, 146, 160, Postmortem Lividity 74, 76 abortionist 188, 189
238, 244, 246-248, 253, 261, Post-mortem signs 165, 171 colleagues 24, 31, 35
263-267, 271, 282, 299, 300, Potassium 83, 170, 318 Conduct 23, 30, 35-38
313 cyanide 318, 319 courtesy 35
accidental 254, 259, 261, 262, oxalate 62, 292 duties 31, 35-37
267, 279, 284, 295, 301, 307, Pound 132, 333, 335 misconduct 24, 35, 37, 38
315, 319, 335, 343, 345, 348 Powder 104, 134, 136, 253, 274, privileges 35, 36
acute 260, 266, 275, 278, 349 335 services 33, 35, 37
cases 238, 243, 244 grains 137, 138 Prognosis 34, 36, 143
deaths 61 unburnt 134, 135 Prohibition 12, 13, 292
effects 238, 239, 318 Power 31, 37, 43, 44, 50-53, 76, Projectile 136, 137
Poisonous 239, 245, 274, 278, 117, 133, 153, 197 Propellant charge 133, 134
318, 328, 330, 332, 339, 342, reasoning 230, 231 Property 204, 228, 235, 238, 292,
344 Practice 322
Poisons 61, 170, 211, 238, 239, masochistic 160 Prosecutor, public 11, 15, 53
244-248, 260, 271, 283, 300, medical 2, 19, 26, 27, 30, 32 Prostate 80, 147
301, 313, 323, 329, 342, 353 Precautions 21, 47, 221, 253 Protein
absorbed 238, 244, 245 Precipitate labor 210 meal 82
arrow 343, 348 Preferences 21, 22, 312 nitrogen 83
deliriant 331, 332 Pregnancy 36, 179, 181, 182, 186 Proteins, muscle 76-78
miscellaneous 240 -193, 196, 199-201, 205 Provisions 10, 12, 13, 39, 187,
unabsorbed 244, 260, 300 dose 190 193, 217, 245
Police 10, 11, 14, 15, 21, 42, 43, medical termination of 190, 193 Prussic acid 318
50, 53, 193, 221, 248, 292, period of 193 Psychosis 232, 293, 294
313, 324 termination 186 Puberty 96, 100
inquest 42, 43 Pregnant Pubic
inspector of 13, 43 living woman 183 hair 220, 221
office 11 woman 183, 187, 193 symphysis 89, 97, 183
District 11 Prescribe 24, 34, 36 Pugilistic attitude 78, 145
officer 11, 14, 16, 43, 45, 218, Pressure 57, 67, 74, 75, 109, 111, Pulmonary
219, 248 114, 123, 158, 161-163, 173, artery 59, 139
personnel 11 191, 265 edema 60, 171, 172, 270, 282,
Pons 58, 64, 126 abrasion 109 284
Pontine hemorrhage 69, 73, 126, improper 36 embolism 59, 69
307 points 74, 300, 301 Pulse, maternal 182, 183
Pooled semen 199 Primary impact injuries 122 Punctured wound 114, 115
Pores 105, 246, 247 Prime Minister 232
371
Index
Punishment 10, 15, 117, 204, Red 59, 103, 112, 142, 145, 159, Responsibilities 10, 11, 20, 22,
210, 217, 218 183, 205, 210, 220, 258, 278, 26, 32, 34, 36, 136
Pupils 65, 252, 283, 289, 290, 333, 339 Restoration 22, 38
305, 307, 324, 328, 342, 344, blood of registration 38
347 cells 266, 283 Restraint 233, 234
constriction of 69, 307 corpuscles 170, 267, 274, 283 Immediate 233, 234
dilated 21, 294, 318, 324, 325, cells 265, 266, 335 Revolvers 132-134
332, 351 cherry 74, 145, 312, 313, 319 Rh 199, 200
pin point 126 Reddish 79, 109, 110, 259 Ribs 167, 173, 208, 211
Purgatives 245, 345, 350 Redness 142, 144, 210, 351 Ricin 335, 336
Putrefaction 64, 72, 75, 78-81, Reefers 323 Ricinus communis 335, 336
83, 87, 113, 170, 172, 205, Reflex cardiac arrest 161, 163, Ridges 90, 102, 103, 105, 133,
347 173 151
Putrefied Body 80 Reflexes 21, 65, 290, 299, 300 RIFLED
Putrefy 80 Reformatories 44 FIREARM INJURIES 136
Pylorus 82 Refusal 7, 24, 34, 196, 198, 199 FIREARMS 133, 134
Reg 31 Rifled weapons 108, 132, 134
Regions 75 Rifles 132, 134, 136
Q Register, medical 38 Rifling 133
Registered Right-handed person 162
Qualification 24, 30, 37
doctors 30 Rigor 77
Questions, leading 14, 16, 17, 45,
Chairman 30 mortis 64, 72, 76, 77, 82, 145
46, 48
medical development of 76, 77
Quo warranto 12, 13
doctor 30 Risk 25, 151, 191, 193, 264, 313
practitioner 24, 26, 31, 48, 193 Robbery 10, 163
R physician 38 Room 160, 231, 234, 315
Registration 30, 31, 38, 39 Root 92, 163, 332, 342, 343, 351
Race 86-89, 99, 199 restoration of 38 transparency of 92
Radiation 72, 73, 142 Regulation 20, 24, 33, 35 Rs 117
Radius 89, 94 Relatives 11, 56, 70, 188, 211, Rupture 61, 68, 69, 110, 111,
Raised blood pressure 69, 126, 212 129, 130, 146, 156, 157, 159,
270, 307, 330 Relaxation 76, 77, 160, 182 167, 178, 189, 205, 211
Range 72, 132, 133, 135, 137, Remote delivery, signs of 183, skin 110
270 184 Ruptured blood vessels 113
Rape 10, 11, 47, 86, 88, 96, 163, Reparative process 144
178, 187, 193, 196, 197, 216- Repeated sexual intercourse S
221, 228 178, 180
charge of 218, 219 Repetition of injuries 22, 211
Sacrum 58, 93, 96
offense of 217, 218 Report 11, 13, 14, 24, 33, 35, 43,
Sadism 216, 224
RAPE VICTIMS 220 47, 210, 218, 220, 221, 248
Sadist 224
Rate 72-74, 80, 288 of conduct 38
Safe abortion services 186
of cooling 73 Request 35, 47, 187
Saliva 159-161, 223, 238, 288,
Ray 94, 95 Res Ipsa Loquitor 27
292
of wrist 94 Resistance 110, 146, 150, 151,
Salivation 247, 270, 282, 351,
Reaction time, impaired 312 153, 160, 219
Resource persons 39 353
Reactions 21, 79, 80, 172, 175,
Samples 70, 200, 220, 221, 290,
238 Respective persons 65
291, 336
Rear passengers 123 Respiration 21, 64, 66, 67, 208,
of urine 291, 292
Reasoning power 230, 231 260, 261, 290, 300, 304-307,
Sane person 230
Recommendation 12, 30, 38, 52 313, 319, 344
Saturation 312
Record 11, 12, 43, 130, 193, 197, Respiratory
Scab formation 110
219, 221 depression 260, 300, 305, 325,
Scalds 142
Recovery 103, 143, 234, 247, 330
Scalp 57, 76, 112, 126, 134, 137
289, 299, 300, 315 infections 212
Scarring 142, 144
Rectum 72, 80, 271 passage 163-165
Scene death 56
rate 305, 306
Science 3, 23, 132, 238
Respired lung 209
372
Index
medical 3, 30, 32 Shock 21, 64, 82, 144, 244, 260, abraded 137
Scoptophilia 216, 225 293, 300, 330, 339 attachment 79
Scorpion 329 Shot 134-136, 232 blisters 300
Scratches 220 close 137 changes 64
Seawater drowning 171 Close range 138 cold 349
Second class Judicial Magistrate gun 132 color 210
43, 44 Shotgun 108, 132-134 denuded 108
Secondary impact injuries 122 injuries 134, 136 dirty 139
Secrets 25, 31, 46, 199 Siblings 22 discoloration of 74, 142
Section frothy blood 173 Sick person 235 dry 167
Seeds 189, 324, 332, 333, 335, Signature 14, 31, 47, 48, 152, 162 fair 79
337, 339, 342, 344, 347, 353, Signs 14, 48, 129, 130, 163-165, flap-like 113
355 172, 173, 178-180, 182-184, flattened 151
argemone 355 230, 231, 233, 258-261, 278, hot 332
Croton 241, 337 279, 289, 290, 304-307, 312, injuries 253
Seizures 282, 283 332, 333 keratinized 222
Semen 11, 198, 199 Absolute 179, 182 open 79
mixture of 223 of asphyxia 152, 157, 159, 160, receptors 171
pooled 199 165, 325, 345 splits 145
Senses 322, 323 viz 162, 306 subcutaneous tissue 59
Sentence 43, 44, 52, 218 asphyxial 158 surface 101, 108, 220
Service providers, Health 186, cardinal 127, 156 surrounding 142, 222
187 chief 305 tags 108
Services 23, 31-35, 187 classical 270 thickness of 56, 113
professional 33, 35, 37 clear 27 Wet 150
of SUMMONS 16, 45 clinical 283 wound 137
time of 16, 45 common 274 Skull 57, 58, 80, 88, 96, 105, 126-
Session court 44 of congestion 163, 324 129, 134, 137, 146, 293
Sessions 43, 44 of death 64, 72 bones 57, 126, 127, 138, 146,
judge 43 of drowning 172 147, 205, 210, 293, 307
Sever injuries 123 external 159, 161, 162, 164, Female 98
Severity 37, 110, 127, 143, 248, 165, 171 Skull Male 98
299, 300 gastrointestinal 339 length of 89
Sex 31, 56, 81, 86, 88, 96, 99, GENERAL 156 Sleep 57, 212, 231, 233, 289, 298,
100, 143, 147, 170, 224, 325 important 159, 161 299, 305, 307
chromatin 88, 100 of inflammation 75, 335 Sloughs 144
chromosomes 100 of injuries 146, 160, 173, 192 Smear 220
Sexual 198, 294, 324 of life 205-207 Smegma 221
act 197, 325 of Livebirth 208 Smell 117, 259, 270, 283, 306,
assault 163, 164, 167, 221 of liver failure 278, 279 307, 319, 345
gratification 224 Nicotinic 282 of alcohol 289, 290, 292
intercourse 96, 178, 179, 196- post-mortem 165, 171 Smoke 134, 135, 137
198, 216-218, 220, 221, 224 recognition 101 deposits 137, 138
act of 178 of remote delivery 183, 184 Smothering 6, 109, 156, 164,
repeated 178, 180 of struggle 118, 212 165, 211
offenses 42, 215, 216 useful 144 accidental 164
orgasm 224 warning 69 Snake 230, 328, 329
performance 197, 308 Silica coatings 173 Snakebite 339
pleasure 160, 224, 225 Silvery lines 183, 184 Sockets 79, 80
relationship 36 Singeing of hair 134, 137, 142, Sodium
Shaft 93, 95, 97 145 bicarbonate 253, 259, 262, 295
metacarpals 94 Sinks 209 cyanide 318
Shake 270 Skills 26, 32, 36, 187, 207 Sodomy 88, 196, 216, 222
Sharp 108, 114-116 Skin 58, 59, 72, 74, 75, 79, 108, Soft tissues 79, 80, 105, 112,
edge 113, 114 109, 111-115, 134, 136-138, 113, 151, 274
margin 138 142-146, 150-152, 154, 162, Solapith 179
S/he 32-35, 37, 38 258-260, 264, 292, 293 Soluble 152, 258, 278
373
Index
Solution 253, 258, 271, 306, 319, Stops 66 transplantation 65
325 Strangulation 67, 109, 156, 161, Surgical
KMno4 245 162, 164, 166, 167, 172, 210, methods 190
tannic acid 344, 345 211 treatment 33
Somatic death 64, 65 Strength 150, 163 Surrogate birth 201
Soot 137, 138, 142, 145, 312 Strikes 109, 127, 128, 138 Surroundings 43, 73, 293
carbon 59, 145 Struggle 109, 118, 165, 212, 223 Suspected
Source 101, 147, 238, 240, 244, injuries 173 accused person 42
248, 312 Strychnine 189, 347 person 165, 292
Spasm, Cadaveric 78, 118, 172 poisoning 73, 244, 246, 347 poisoning 70, 248
Specialty 24, 25, 37 Strychnos nux vomica 347 Suspended animation 64
Specimens 11, 291 Subarachnoid hemorrhage 57, Suspension 159-161, 260
Speech 86, 117, 126, 289, 292, 69, 130 Suspicious 42, 53, 60, 86, 220,
333, 342 Subconjunctival hemorrhages 294
Sperm 201 112, 161, 163, 165, 261 deaths 43
Sphere 97 Subcutaneous tissues 110, 112, Sustain
Spiders, Black widow 330 113, 142, 146, 159, 167 injuries 116, 123
Spine 58, 123, 128, 159 Subdural hemorrhage 57, 129, whiplash injuries 123
Spiral 133 130 Sutures 80, 205
Spleen 61, 80, 111, 259, 271, Subjects 17, 46, 47, 92, 100, 130, Svensson 136-138
274, 278, 335 324 Swabs 27, 221, 222
Stains, seminal 218-222 Submerged Swollen 79, 162, 220, 252, 253,
Starvation 175 body 81, 170 260, 271, 285, 309
State 10, 14, 43, 53, 60, 64, 67, dead body floats 82, 170 Sword 114
78, 89, 224, 228, 231, 278, Submersion 170 Symptomatic 290, 335, 348, 351
289, 290, 322-324 Subpoena witnesses 51 management 294
Statement 7, 11, 14, 47, 48 Substances 27, 126, 129, 145, measures 306
Stature 86, 89 189, 238, 240, 245-247, 267 treatment 244, 271, 284, 328,
Statutory age 20, 21 Sudden death 50, 51, 67-70, 213, 330
Sterile 100, 196, 198, 199 318 Symptoms 69, 230, 231, 246-248,
Sterility 25, 196-198, 265 Suffocation 59, 156, 164, 166, 253, 254, 270, 271, 274, 278,
Sterilization 198 254 289, 304-306, 312, 315, 324,
Sternum 89, 92, 93, 99, 123, 167 Suggilation 72, 74 325, 332, 342-344, 349
Stick 127, 128, 142, 161, 179 Suicidal 50, 56, 57, 114, 118, resemble 275
Stiffening 76, 78 160, 164, 167, 173-175, 248, Syncope 66
Stillborn child 208 253, 255, 301, 313, 335, 345 Syndrome
Stimulation, chemical 64 cases 313 Battered Baby 22, 211
Stomach 60, 61, 80, 82, 173, 175, deaths 78, 146, 298 battered child 6, 22, 211
208, 209, 239, 244-246, 252- poisoning 248, 259, 261, 262, Battered children 22
254, 258-260, 275, 279, 290, 271 infant death 70, 164, 212, 213
318, 319, 324, 325 Suicide 7, 50, 51, 53, 66, 128, Klinefelter 100
acts 239 136, 146, 151, 159, 182, 225, Syringe 190
cavity 245 228, 230, 231, 293, 294, 322- System 23, 42, 52, 53, 102, 104,
content 245 324 189
mucosa 260 Sulfuric acid 252-254, 318 nervous 330, 332, 353
mucosae 301 poisoning 254 VICTIM JUSTICE 15
tube 244, 245, 260, 275, 300 Summer 79-82, 170
wall 80 Superfecundation 200
wash 244, 245, 248, 259, 260, Superfetation 200
T
262, 295, 315, 344, 345, 348, Superimposition technique 105
Table 30, 88-90, 93, 96-99, 103,
350, 351 Supportive treatment 313, 355
110-113, 135, 167, 233, 261,
Immediate 306 Suppositions child 200
276
Stomatitis 351 Suprasternal notch 58, 59, 89
Stones 113 Surface 57, 60, 74, 75, 79, 81, 92, inner 128, 129, 138
Tablet, White 284, 298, 299
Stool Bloody 276 99, 103, 108-110, 113, 133,
Tailing 114
Stoppage 65-67, 74 137, 144, 170, 212
Tails 118, 328, 329
of functions 66, 290 Surgery 2, 21, 102, 196-198
374
Index
Tales 7 injuries 114, 118 Trauma 58, 66, 69, 126, 136, 139,
Tandem bullets 139 Thrombosis 67, 69, 306 160, 164, 166
Tannic acid solution 344, 345 Thrombus 59, 67, 69 Traumatic asphyxia 156, 164-
Tardius spots 58, 156 Throttling 67, 159, 161-163, 166, 166
Taste, bad 240 211 Treatment 22, 23, 26, 27, 34-36,
Tasteless 274, 275, 322 Thumb 101, 102, 122, 151, 162 233, 234, 252, 254, 266, 283,
Tattoo Thyroid cartilage 118, 159-161, 284, 290, 293-295, 306, 318,
designs 101 163 319, 323-325, 343-345, 350,
marks 86, 101, 102, 138 Tibia 89, 93, 95, 207 351
Tattooing 101, 134, 135, 137, Till, persons lasts 324 Alleged negligent 50
138, 146 Time 14, 31, 33, 34, 72-74, 77, 79 bonafide 36
Tattoos 101, 102 -83, 122, 145, 146, 199, 204, emergency 24
Technique 104, 190, 191 205, 209, 210, 234, 235, 248, medical 50
Superimposition 105 290, 291, 312, 313 Pharmacologic 266
Teeth 80, 86, 89, 90, 92, 99, 145, bracket 72 of poisoning cases 243, 244
147, 159, 219, 221, 223, 245, day 210 principle 339
252, 254, 270 of death 72, 74, 82, 171 recommended 34
bite 59, 221, 223 estimating 83 s/he 34
Temperature 65, 72-74, 80, 81, exact 219 supportive 313, 355
142, 143, 170, 290, 315 fatal 344 surgical 33
Temple 57, 134, 136, 138 hour 288 Symptomatic 244, 271, 284,
Temporary limitation 11 328, 330
impotence 197, 198 long 87, 88 Trial 42, 43, 204, 221, 228
teeth 90-92 losing 319 Appellate courts conduct initial
Tenderness 192, 221, 222, 355 officers 53 12
Tension 160 of services 16, 45 Trimester 186, 190
Terminal short 110 Trunk 74, 76, 77, 82, 109, 170
blood loss 74 Tingling 258, 260, 324, 343, 349 Truth 8, 16, 20, 45, 47, 48
death 212 Tip 81, 89, 218 serum 332, 333
Termination 36, 187, 190, 193 Tissues 57, 64, 65, 74, 75, 78, 79, Tube 69, 244, 245, 313
Testamentary capacity 228, 234 81, 110, 113, 134, 135, 137, Tubercles 183
Testator 235 142, 145, 156, 252, 254, 328 Tumors 58, 60, 198
Testicles 100, 197 disruption of 134, 151, 152 Typhanet 134
Tests 16, 45, 64, 65, 173, 182, exposure of 142, 143
200, 201, 209, 253, 292, 336 hymenal 178
Hydrostatic 209 Tobacco 239, 323, 344, 345
U
Tetraethyl 264 Tongue 59, 117, 145, 158, 159,
Ulcers 142, 144, 309
Tetrazene, mixture of 134 163, 165, 252, 258, 260, 307,
Ulna 94
Theft 10, 37, 151, 333 325
Ultimate court 52
Therapeutic dose 261, 298, 299, Total brain death 21
Ultra violet rays 142
305, 333 Town 222, 223
Umbilical cord 205, 209, 210
Thermal injuries 147, 154 Toxic 189, 264, 270, 274, 315,
Unabsorbed poison 244, 260,
gross 152 342
300
Thick 179, 180 action 239, 264, 266, 300
Unburnt powder 134, 135
Thickness 57, 58, 80, 105, 108, effects 239, 246, 253, 265, 294,
Unconscious patients 34
112, 127, 128, 142, 144, 347 332, 333, 335, 343, 355
Unconsciousness 160, 244, 258,
burning 142, 143 symptoms 332
305, 307, 349
of skin 56, 113 Toxicology 2, 3, 237, 238
Undergarments 192, 222, 224
Thigh bone 207 Toxins 51, 240, 241, 309, 339,
Undergraduate 30, 38
Thighs 74, 101, 175, 219, 220 349
Unethical 32, 33
Thoracic Trachea 59, 80, 173, 253
conduct 35
cavity 139, 208, 209 Track 115, 136, 138
Unexpected death 212
vertebrae 99 Traffic accidents 109, 289, 291
Unexplained death 212
Thorax 58, 59, 96, 114 Tragedy 212
Unintended death 6
Thousandths 132 Transmitted disease 25
Unnatural 14, 42, 43, 56, 66
Throat 56, 78, 118, 211, 252, 258, Transparency of root 92
deaths 13, 42
278, 343, 344, 351 Transplantation surgery 65
375
Index
diagnose 67 Victim 3, 15, 42, 48, 114-116, Weight 61, 90, 157, 158, 161,
sexual offenses 197, 222, 223 118, 122, 135, 136, 144-146, 175, 206, 207
Unqualified person 24 159-166, 170-173, 218-221, Wendel 136-138
Unrespired lung 208, 209 252, 253, 312, 313, 318 Wet skin 150
Unsafe abortion 186 alleged 219 Wheels 122, 123, 291
Unsoundness 217, 228, 232 ate 82 Whorl 103
mental 229, 233 VICTIM JUSTICE SYSTEM 15 Wife 25, 96, 196, 198, 199, 201,
Untrained person 186 Victim viz 139 217, 218, 222, 224, 234, 294
Upper epiphysis unites 93 Victims sustain 126 Wild 351, 355
Upright Person 32 Violence 11, 37, 50, 110, 111, Windscreen 122, 123
Urinary bladder 61, 72, 83 145, 163, 220, 291, 294 pillars 122, 123
Urine 3, 61, 79, 83, 175, 238, 248, Violent 53, 210, 233, 293, 294, Winter 81, 82, 170
258, 264, 266, 288, 292, 298, 324 Witness 3, 8, 13, 14, 16, 17, 31,
301, 306, 307 asphyxial deaths 73 42-46, 48, 182, 228, 234, 235
blood stained 274 deaths 78 box 17, 45, 51
samples of 291, 292 Viper 328, 329 Common 48
Uterine bite 328 examination of 16, 45
cavity 190, 192, 205, 208 Viperidae 328 expert 11, 24, 48
muscle 188 Virgin 178-180 hostile 48
Uterus 61, 67, 147, 182-184, 189, False 179, 180 MEDICAL 46
191, 192, 198, 205, 206, 208, woman 178, 179 subpoena 51
259, 271, 279 Virginity 177-179 Woman 20, 119, 178, 180, 188,
Viscera 3, 61, 70, 152, 160, 163, 191, 193, 197-201, 216-219,
164, 173, 192, 205, 209, 211, 221, 225
V 253, 260, 275, 324, 325 Womb 201, 205-207, 210
Volts 150, 153 Women 117, 186, 190, 204
Vacuum 190
Vomiting 190, 244, 247, 252, 258, Workers 267, 270, 271
Vagina 72, 178-180, 182-184,
261, 262, 270, 274-276, 278, industrial 279
189, 192, 196-198, 208, 219,
282, 284, 292, 294, 305, 312 World 103, 186, 189, 206, 213,
223, 271, 279 Vomitus 145, 238, 252, 260, 274, 315, 342
Vapors 279
278, 309 Wound 77, 81, 86, 112-116, 118,
Varied hallucinations 322, 323,
126, 134, 136-139, 143, 144,
325
146, 345
Varieties 67, 100, 278, 332, 342 W Fabricated 116
Vegetable oil 258, 259
lacerated 108, 112, 145, 146,
Vehicle 25, 122, 123, 165, 289, Wad 133-135
154
292, 313 Wall 68, 69, 128, 137, 184, 246
perforating 114, 115
passing 122, 123 Wandering lunatic 232
punctured 114, 115
Veins 74, 145, 290, 306 Ward 116
Wrist 78, 94, 116, 118, 123, 265,
Velocity 138 Warning signs 69
266
Venom 328, 329 Warrant 26, 42, 43, 212
ray of 94
Venous Wash 245, 252, 290, 328, 330
Writ 12
blood 318 gastric 244
of habeas corpus 12, 13
sample 221 Washing 244, 245, 259, 279, 306,
congestion 158, 161 324
Ventricular fibrillation 68, 152, Water 78, 81, 82, 170-173, 175, X
260, 343 179, 191, 209, 245, 252, 258,
Verdict 15, 42, 50 260, 274, 275, 278, 283, 288 Xiphoid process unites 92, 93
Vernix caseosa 206, 210 cold 67, 171, 172, 328 X-ray 94, 95, 275, 293
Vertebrae, thoracic 99 glass of 244, 247, 275 X-rays 142, 211
Vertebral column 58 warm 343, 345 XY 100, 101
Vesication 142, 143, 145, 351 Weapon 75, 78, 87, 103, 108,
Vesicles 111, 142, 145, 205 111, 113-116, 118, 128, 133,
Vessels 59, 60, 69, 75, 79, 110, 137
Y
114, 145, 209 Rifled 108, 132, 134
Yards 132, 135
Vestibule 179, 180 Weeds 81, 170, 172, 324
Years
Viability 206, 207
of age 205, 217, 218
376
Index
experience 30
imprisonment 117, 204
minimum age 96
standing 52
Young children
bruise 111
377

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Prof.

First Edition 2006

Medical knowledge is constantly changing. As

I owe gratitude to all of them.

We are glad to be associated with the following persons:

He started his teaching career at AIIMS, New Delhi and

He was conferred the title of Visiting Professor at the Uni-

His was also the Chairman of Department of Forensic

He has also been a consultant to the Government of Del-

He was examiner of MBBS, MD, and PhD of various uni-

His qualifications were sought by the Medical Council of

He was awarded the coveted Chikitsa Ratna Award dur-

He has two sons, both in Australia and a daughter who is

In Nepal, number of medical colleges grew phenomenally in the last decade

I am sure Fundamentals of Forensic Medicine and Toxicology will help the

We, on behalf of Kathmandu University, thank Professor Sharma for taking

Prof Dr. Sitaram Adhikary

My sincere congratulations to him.

Prof. Dr. Ram K. M. Shrestha, MD

Fig. 1.1 Forensic Medicine is connected

Purpose of Forensic Medicine

Act e.g. smothering

Failure to perform an act

E.g. Omission to provide food to children – failure to

An inebriated doctor killing a person when operating

Fig 2.1. Causation of a homicide

Criminal homicides are legally classified as (a) murder or (b) manslaughter.

A homicide is excusable when accident or mishap results in an unanticipated and

A. First, an unlawful lethal act was performed and

EUTHANASIA (MERCY KILLING)

Euthanasia can also be:

Cases such as partitions, transactions, land related cases, contracts, donations,

1. Government case Civil

INVESTIGATION OF GOVERNMENT CRIMINAL CASE

MEDICOLEGAL ROLE OF DOCTORS

• The Appellate Court

The District Court

THE PROVISION FOR INVESTIGATION REGARDING POST

Certification of Post mortem Act 2031, applied from 2032.1.1 is as follows:

MEDICAL EVIDENCES PROVIDED BY MEDICAL PRACTITIONER

PHASE OF NEPALESE CRIMINAL JUSTICE SYSTEM AND ROLE OF

Unable to pay fine condition

Prison/ Reforms House Third Phase

Fig. 3.4. Phases of Nepalese Criminal Justice System

PROCESS OF APPEARING IN A COURT OF LAW

It is a document compelling the attendance of a witness in a court of law under penalty. It is

If he is an atheist he may give evidence on solemn affirmation quoting “I solemnly affirm

Clinical ethics is a practical discipline that provides a structured approach to assist

One of the oldest codes of medical ethics is the Hippocratic Oath.

The oldest written code of medical Ethics written by Hammurabi, King

Susruta Samhita was composed in between 200-300A.D. Susruta, as father of Indian

ETHICS REGARDING CONSENT

ETHICS REGARDING DETERMINATION OF DEATH

Nowadays, brain death describes certain clinical characteristics of a nonfunctioning brain

ETHICAL PROBLEMS IN PEDIATRICS

ETHICS REGARDING EUTHANASIA

INTERNATIONAL CODE OF MEDICAL ETHICS

RIGHTS AND PRIVILEGES ENJOYED BY A REGISTERED MEDICAL

INFAMOUS CONDUCT (PROFESSIONAL MISCONDUCT)

List of professional misconducts:

“The omission to do something which a reasonable man would do or doing something

To constitute a charge of medical negligence there must be:

A doctor, merely because he is registered medical practitioner, is under no legal obligation

A doctor must be well informed of newer developments in medical practice. Ignorance of

Medical Jurisprudence & Forensic Science (Royal Law College, Arifwala)

Medical Jurisprudence & Forensic Science (Royal Law College, Arifwala)