1 Introduction to Morbid F orensic Medicine F o r ensic medicine is a branch of medical science (other branches, e.g. anatomy , physiology , biochemistry , pathology , medicine, pediatrics, surgery , etc.) which deals with application of medical knowledge to assist law for the administration of justice. So its all about justice the gr eatest e x p r ession of love and humanity . When we stand as a witness before the honorable judge we proceed with oath I swear by the almighty God, that in this evidence I shall tell the truth, the whole truth and nothing but the truth. W e can understand from the oath itself that this is all about truth and not merely about the findings which we have r ecorded while practicing medicine. T ruth is something which is beyond our findings. It may be an opinion which is drawn from the findings based on our knowledge and e xperience. Hence to assist law for administration of justice we must have tools of knowledge and e xperience.

6 / FORENSIC MEDICINE 2 Identification Identification of the deceased is the sole r esponsibility of the investigating agency . However on receipt of the dead body and r equisite papers from investigating agency , identity of ever y dead body must be verified by the autopsy conducting medical practitioner befor e beginning the autopsy . It has many advantages, like, it confirms that the autopsy of the body being conducted is the same as the one mentioned in the papers. It also gives us a chance to interact with the investigating agency and the available close r elatives or friends. A sympathetic talk with the r elatives not only builds a bond of confidence and faith on the postmor tem conducting medical practitioner and for ensic medicine but also supply impor tant infor mation about deceased. An autopsy conducting officer must not forget that he is a doctor .

2 0 / FORENSIC MEDICINE 3 Cloths, Ar ticles and Body Surface Meticulous e xamination of ar ticles, cloths and body sur face gives clue of contact of the deceased with e xternal objects, atmosphere and much mor e . EXAMINATION OF CLOTHES (FIGS 3.1 TO 3.9) Clothes of the deceased must be e xamined with respect to damages occur r ed (cuts, tears, broken buttons, tor n button holes, open stitch lines, scor ching, bur ns, etc.), stains (mud, semen, urine, feces, blood, saliva, ink, paint, decomposition fluid, poisons, etc.), foreign bodies (hair , fiber , ear t h par ticles, glass par ticles, etc.), peculiar smell or any other peculiarity .

4 0 / FORENSIC MEDICINE 4 Changes After Death Knowledge of changes after death is ver y much essential to deter mine the time since death and accuracy of interpr etation of injuries. F ollowing death the changes depends on intrinsic factors like physical health of body , disease, infection or injury by which the victim died, se x and age of deceased, body temperatur e at the time of death, etc. and e xtrinsic factors like clothing, atmospheric temperatur e, humidity , media in which the body kept, air cur r ents etc. Hence all the factors must be consider ed to evaluate time since death. Now , many mor tuaries have cold storage to pr eserve dead bodies. However they cr eate difficulties in calculating time since death as their low temperatur e delays the changes occur ring in the dead body .

7 2 / FORENSIC MEDICINE 5 Mechanical Injur y INTRODUCTIONINJURY Simplest possible definition of injur y is Br each or br eakage in the continuity of the tissue. Ther e ar e two types of injuries possible viz. natural and unnatural. Natural injur y includes injuries like ulcers, carcinomas, etc. As they don t have any medicolegal significance they ar e outside the r ealm of this subject. However it is r ecommended that the medical practitioner must be able to differ entiate between natural injuries and diseases from un - natural injuries. Un - natural injuries can be fur ther classified according to their causative agent , e.g. when they ar e caused by for ce or when physics is involved in their causation or when they a r e caused by some weapon or object they ar e mechanical injuries, when they ar e caused by heat they ar e bur n s , etc. Mechanical Injuries These ar e injuries caused by for ce or mechanics, i.e. physics is involved in causation of these injuries.

INJURIES BY THE FIRE AND ELECTRICITY / 1 3 3 6 Injuries by the F ire and Electricity BURNS (FIGS 6.1 TO 6.22) Bur ns and scalds ar e the thermal injuries caused by dr y and moist heat r espectively . The severity of the ther mal injuries depends on the intensity of heat applied, time period of its application and the body par ts involved. Bur n s can be seen as mer e r edness of skin or mucosa to complete consumption of the body par t.

1 6 8 / FORENSIC MEDICINE 7 Mechanical Asphyxia and Drowning Asphyxia means complete or par tial lack of o xygen supply . It can be classified as mechanical asphyxia when it is caused due to mechanical blockage of r espiratory tract, e.g. smothering, hanging, traumatic asphyxia, etc. and non - mechanical asphyxia when it is caused by causes other than mechanical asphyxia, e.g. poisoning, lung disease, etc.

STARVATION / 2 1 5 8 Star vation T otal deprivation of food causes star vation. The intake of food may be stopped suddenly or in a decr easing manner . Star vation is usually associated with neglect. The dead body of a star ved victim usually emits a disagr eeable odor . The clothes ar e absent or if pr esent they are dir ty . GENERAL FINDINGS (FIGS 8.1 TO 8.7) FIGURE 8.1: Insects like lice may be found in and around scalp hair.

FETUS / 2 2 5 9 F etus A baby from the eighth week of gestation till bir th is called a fetus. In the e xamination of a fetus following questions ar e to be answered. 1. What is the intrauterine age of the fetus 2. Whether the fetus was viable or not 3. Whether there is any sign of survival 4.

2 3 2 / FORENSIC MEDICINE 10 P oisoning It is death caused by local and/or systemic action of poison introduced in the body . The local action of poison depends on its chemical proper ty . It may be mild to sever e ir ritant or mild to sever e cor rosive. The systemic action of the poison depend on its components which gets absorbed in the body without change or after cer tain chemical changes. F or instance sulfuric acid gives local reaction depending on its concentration. If it is concentrated (mor e than 80%) then it gives fumes. So if the acid is consumed, the victim will r eceive cor rosions to gastrointestinal tract as well as to the r espirator y tract by the fumes. The absorbed sulfuric acid gets dissociated into H + and SO 4 ions. Both ions have no systemic action. H + is normal component of blood and SO 4 is nor mally used as a base in many medicines and it has no systemic r eaction. However if the consumed sulfuric acid is in dilute for m it causes cor rosion of gastrointestinal tract and do not cause any damages to r espirator y tract unless and until it is aspirated in it.

2 4 6 / FORENSIC MEDICINE 11 Death in P regnancy Medicolegal autopsies on pr egnant victims ar e usually car ried out when the deceased is brought as a case of sudden death, death followed by deliver y or abor tion. The questions which ar e supposed to be answer ed ar e : 1. Is she pr egnant 2. What is the period of pr egnancy 3.

SUDDEN DEATH / 2 5 9 12 Sudden Death Sudden death is death due to une xpected and undiag- nosed disease or condition. They ar e either pathological or physiological conditions. However , after conducting autopsy , befor e concluding the opinion as a natural death, chemical and to xicological analysis is advisable. Some other special investigations, cir cumstantial evidences and histor y of past illness should be consider ed before opining about the cause of death. Many cases of sudden death ar e either due to the system or multi-system involvement. Cardiovascular , nervous or r espirator y system diseases ar e common causes of sudden deaths.

INJURIES IN SEXUAL VIOLENCE / 2 7 5 13 Injuries in Sexual V iolence The usual target ar ea in se xual violence is br east and vagina. However complete body e xamination is essential. Neck, lips, mouth and anus can be the targeted ar eas of violence. Evidences and samples should be collected from all these sites. Examination of clothes for damage, stains and foreign bodies is vital par t in deaths associated with se xual violence. They should be air dried and, packed in paper bag followed by plastic bag with small holes to avoid decomposition and destruction of biological material on the clothes. Pubic hair should be e xamined for matting and combed for for eign hair . They should be collected by cutting with scissors. Swabs should be collected from perineum, vagina, c e r vix, anus, mouth and nipples. A smear on clean glass slide should be pr epar ed from each swab. One should tr y to avoid contamination of site e xamined and sample by gloves.

ARTIFACTS / 2 8 1 14 Ar tifacts These ar e the damages caused to the victim or deceased which may be misunderstood and misinterpr eted. Understanding ar tifacts is of ver y much impor tance to avoid disastrous problems. ARTIFACTS DUE TO RESUSCITATION (FIGS 14.1 TO 14.3) Incr ease in the numbers of hospitals and use of machines in medical science brought in differ ent types of injuries.

15 Introduction to Clinical F orensic Medicine CLINICAL FORENSIC MEDICINE This branch deals with clinical e xamination of the victims and/or accused. Usually a clinician is involved in these e xaminations. The histor y , consent, tr eatment, investigation and pr eser vation of samples play a most critical role in this medicolegal investigation. Examination of the injur e d including injuries by physical abuse involving victims like women and childr en ar e very impor tant and r equir e knowledge and e xperience of for ensic medicine. Ther e are many disciplines in law wher e the age is very significant while implementing any section or act or rule, e.g. consent, contract, rape, mar riage, judicial punishment, human trafficking, etc. Examination of accused and victim of se xual offence is a very impor tant piece of infor mation for the r espective cases. Examination of into xicated persons is again ver y impor tant in cases of vehicular accidents and cases of abuse.

16 Deter mination of Age Cer tifying age of the person is necessar y when it is at dispute. In Indian laws and Acts, age in years 7, 12, 15, 16, 18, 21, etc. has importance in some or other context. Medical e xamination for deter mining age consist of thr ee par ts: 1. Clinical e xamination 2. Odontological e xamination 3 . Radiological examination. CLINICAL EXAMINATION This examination determines physical development and secondar y se xual character development. Height, weight, chest gir th at the level of nipple and abdominal gir th at the level of navel should be taken into consideration to deter mine physical development.

17 Examination of Physically Abused or Injured A clinician may deal with e xamination of a once physically abused victim or r epeatedly physically abused victim. Once physically abused victims are usually the persons involved in scuffles, fights or interpersonal violence. However r epeatedly abused persons ar e close r elatives of the accused, e.g. wife, child, old aged parents or a weak person in the family . History and explanation of causation of injury is very important and it should be noted in the report. It must be opined that the explanation and time of occurrence of injuries supplied are consistent with that of the findings rather than opining the age of injury in days and hours. History of consumption of medicines like aspirin, anticoagulants or steroids should be ruled out as they are known to cause changes in the healing process of wound, thus affecting the calculation of age of any injur y . Age, sex, complexion, nutritional status and any disorder , allergies, bleeding disorders, etc must be consider ed befor e opining on the injur y .

3 4 4 / FORENSIC MEDICINE 18 Examination of W eapons A weapon is a device designed to injure or kill. There are two types of weapons which a doctor could come across. The first one is a weapon which fits exactly in the definition of weapon (Fig. 18.1) i.e. it has no other use than to injur e or kill, e.g. sword, pistol, dagger , etc. While others are the tools or objects used as a weapon of offence (Fig. 18.7) e.g. kitchen knife, shaving blade, axe, etc. Receiving the weapon of offence with requisition and queries is a frequent activity after autopsy or examination of abused or injured. Before accepting any article from the investigating authority it must be verified that whether it is properly packed, labeled and sealed. The seal on the packet must be verified by tallying it with a sample of seal on the r equisition or quer y letter . If any discrepancy is found then it should be brought to the notice and returned to the police personnel who brought it. If everything is found correct then such note should be made along with the receipt of the requisition or query and the article.

3 5 6 / FORENSIC MEDICINE 19 Examination in Sexual Offences Thr ee types of patients can be e xamined under this topic: 1. F emale victim of se xual offence 2. Male victim of se xual offence and 3. Male accused of se xual offence. The questions to be answer ed after e xamination ar e : 1. Is ther e any finding suggestive of se xual inter course 2. Is ther e any sign of struggle 3. A r e the clinical findings compatible with the histor y of incident r ecorded 4. What is the co-r elation of r epor ts of pr eser ved samples from for ensic science laborator y with clinical findings Medical e xamination should be car ried out without any delay . Sympathetic behavior should be maintained. Unnecessar y verbal and written comments should be avoided. Ther e ar e many myths about se xual offences. The e xamination should be conducted in a well lighted room.

3 6 2 / FORENSIC MEDICINE 20 Examination of Dr unk enness Alcohol consumption is popularly r efer r ed to consumption of countr y or for eign branded liquor which contains ethyl alcohol in differ ent concentration. However methyl alcohol is usually used in adulterated liquor . Histor y is a ver y impor tant par t to be consider ed befor e opining. Histor y of drinking time, quantity of alcohol consumed, illness, medicine; diabetes; mouth wash; injury ; any other into xicant.

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