Forensic Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Part 13)

Forensic Medicine Review
A Free Booklet Series by Dr. Aryan

Preface:
• This is the study material designed by Dr. Aryan with creation and compilation of the best
of the best and the most finest slides on the subject. I would like to offer a billion heartily
thanks for everyone who contributed directly or indirectly to the creation of the material
through creation and dissemination of the scientific information.
• Covering everything in one study material is next to impossible. Hence, refer to gold
standard textbooks for building solid concepts or in case of any doubt. Textbooks are
acknowledged at the end of the presentation. If any source has been missed to
acknowledge, it doesn’t lessen their impact and contribution in any way.
• Don’t keep searching for pattern between the consecutive slides. You won’t find many.
Rather to boost your recall and review, I have constructed many slides and are deliberately
placed with no much relation between the preceding and the succeeding ones.
• The main rule of a review material is that it must make you recall or learn maximum
amount of information in minimum amount of time and space.
• Motivational quotes and articles are included within the slides. Always remember that
every good idea, nice piece of information and everything else is literally and absolutely
worthless unless you execute.
• If you know everything in the slides in much detail, you probably wouldn’t need this
material.
Best of luck WORK & SUCCESS! Dr. Aryan
(Anish Dhakal)

Prerequisites of Brain Death
• Clinical or neuroimaging evidence of an acute CNS catastrophe that is
compatible with the clinical diagnosis of brain death
• Exclusion of the confounding medical condition that may confound
clinical assessment
• No drug intoxication or poisoning
• Core temperature greater than 32 degree Celsius (92 degree
Fahrenheit)
Dr. Aryan (Anish Dhakal)

• Legal definition of injury:
Any harm, whatever illegally, caused to any person in body, mind,
reputation or property is referred to as an injury.
• Medical definition of injury/wound:
It is defined as damage to any part of the body due to the application
of mechanical force.

CLASSIFICATION of Injuries:
• Etiological classification
• Depending upon severity of injury
• Depending upon the moment of death
• Medico legal classification

Grievous Injury
• Muluki Ain (2020 B.S.)
1) Loss of eyesight or blindness
2) Deprivation of smelling capacity of the nose
3) Making deaf upon damaging the hearing capacity of the ear
4) Damage to the speaking capacity of the tongue
5) Making useless upon cutting the breast of a woman
6) Making female and male sterile
7) Making fracture and dislocation of joints of spine, hands, legs
leading to disability.

Abrasion: It is the removal of superficial epithelial layer of the skin,
usually the epidermis and papillary dermis, by friction against rough
surface.
 Types:
i. Scratch/linear abrasion
ii. Graze abrasion
iii. Pressure abrasion
iv. Imprint abrasion

Age of abrasion
DURATION FEATURES
Fresh , less than 24 hours Bright red oozing of serum and some blood. Exudation dries to form a
reddish scab, comprising blood, lymph& epithelial cells infiltrate.
2-3 days Reddish brown scab, less tender
4-5 days Scab is dark brown in color
5-7 days Scab is brownish black & starts falling off from the margins. Epithelium
grows & covers defect under the scab.
7-12 days Scab dries, shrinks & falls off, leaving depigmented are underneath. It
gradually gets pigmented in due course of time.
>12 days Epithelium becomes thinner & atrophic. New collagen fibers are
prominent. Basement membrane is present and vascularity of the
dermis decreases.

Contusion:
It is the extravasation of blood in the subcutaneous/subepithelial tissues due to
rupture of blood vessels, usually capillaries as a result of blunt force injury.

Age of Contusion
Color Time since injury
Bright red Freshly produce
Bluish (deoxygenated Hb) Few hours to 3 days
Bluish black/brown (hemosiderin) 4-5 days
Greenish (biliverdin) 5-6 days
Yellowish(bilirubin) 7-12 days
Normal 2 weeks

Laceration: It is the tearing or splitting of skin, mucous membrane,
muscles or internal organs caused by either a shearing or a
crushing force, produced by application of a blunt force to a broad
area of the body.
• Types:
i)Split laceration - perpendicular impact causing crushing
ii)Stretch laceration - stretching of the skin, beyond its elasticity
iii)Avulsions - impact of heavy grinding force being tangential to the body part so
that flap of uniform thickness is raised

Laceration:

STAB WOUND:
Penetrating injury where the depth is greater than the
length unlike incised wound, where the force applied is
perpendicular to the surface.

Chop wounds: Chop wounds are sharp force injuries
produced by a sharp, heavy weapon resulting in a sharp
penetrating injury caused by the sharp edge combined
with crushing injuries caused by the heavy weapon.
• Medico legal importance:
Most of the injuries are homicidal
Few are accidental
Rarely suicidal
Causative weapon

Chop wounds (a type of sharp injury)

Parts of knife

Cadaveric spasm: molecular death not yet occurred, cannot be produced by any
methods after death. Indicates manner of death better.

1. Virchow’s method Individual organ one by one & dissection of the organ
2. In-situ dissection Dissection of the organ in situ with very little evisceration
3. En masse Removing most of the internal organs in one swoop
4. En- bloc removal Removing organs block wise e.g. thoracic en bloc

Cause of death in burn
Immediate
• Primary / Neurogenic shock
• Asphyxia d/t CO, CO2, cyanide gases
• Laryngospasm
• Indirect trauma
Delayed
• Hypovolemic shock  1st 48 hours
• Toxemia Up to 3-4 days
• Infections and sepsis  After 4-5 days
• Inhalation injury
• Organ failure
• Thromboembolism, Fat embolism

Pugilistic/Boxing/Defence attitude
• Heat stiffening caused by protein
coagulation (albumin)
• Unlike rigor mortis is permanent and
doesn’t pass off until decomposition
• Indicates exposure to great heat & seen
in both antemortem and postmortem
burning & thus no medicolegal
significance
• Flexor muscles being bulkier, leads to
flexion attitude

Is the burn antemortem or postmortem?
Antemortem Burn Postmortem Burn
Vital reactions present Vital reactions absent
True blisters (vesicles) with albumin & chloride Has only air & thin clear fluid
Line of redness present No line of redness
Enzymatic activity is increased (histamine, serotonin) No enzymatic activity
Soot particles in URT & respiratory passage injury
present
No smoke in air passage or respiratory injury
Curling ulcer present No ulcers
Blood CO level elevated usually more than 10%.
Cherry red discoloration of blood
Blood CO level normal
Infection, healing & granulation present No such findings

Exposure to Heat
• Heat cramps: Minor’s cramps, stoker’s cramps, fireman’s
cramps (strenuous physical activity in high temperature
where profuse sweating causes dehydration)
• Heat prostration: Heat exhaustion, heat syncope, heat
collapse (excessive fluid loss leading to circulatory collapse
without rise in body temperature)
• Heat hyperpyrexia: Heat stroke, sun stroke (failure of heat
loss mechanisms)
• Autopsy findings:
-P.M. caloricity
-R.M. appears early, passes off early
-Decomposition starts early
-organs congested Dr. Aryan (Anish Dhakal)

• Ventricular fibrillation (commonest)
• Cardiac asystole
• Respiratory muscle paralysis
• Respiratory center paralysis
• Secondary mechanical injuries
• Burn injuries and complications
Manner of death
Accidental > Suicidal > Homicidal
Cause of death in Electrical injury:

Lightening burns:
Linear burns: moist skin creases & skin folds
Dendritic burns (Arborescent or Filigree burns/
Lichtenberg’s phenomenon): superficial, thin,
multiple, irregular tortuous tree or fern like pattern;
are pathognomonic of lightening
Surface burn: beneath metallic objects worn

Joule burn/ Electric mark:
• Entry point of current
• Electricity produces heat in the body unlike flash burn casusing
exogenous application of heat
• Oval shallow craters

Definition
• It is expulsion or extraction of products of conception before fetal
viability i.e. before 28 weeks of gestation or < 500 grams
• Legally, The premature expulsion of the products of conception from
the womb, at any time before the period of gestation is completed.

Abortion Law in Nepal
No one shall cause abortion upon causing coercion, threat, lure
or offer (Pralovan) to a pregnant woman. In cases where a
person causes abortion in that manner, the person shall be
liable to the following punishment:
1) Imprisonment for a term of one year in case the fetus is
up to Twelve weeks
2) Imprisonment for a term of three years in case the fetus is
up to Twenty Five weeks
3) Imprisonment for a term of Five years in case the fetus is
above than Twenty Five weeks
Commits abortion or causes abortion by doing any act with intention or knowingly or with sufficient reasons
to believe that such an act is likely to cause an abortion

Signs of Abortion In dead:
• Undergarments may show blood clots and POC fragments.
• Congestion of labia and injury to the posterior commissure.
• Perforations of Uterus, pelvic and peritoneal organs
• Presence of chemicals and instrumentation marks in uterus and
cervix.
• Intrauterine infection

Paradoxical / Reciprocal undressing
• Seen in hypothermia related deaths
• Persons found naked and dead
• Usually in old age
• Severe & long term exposure to cold
May be d/t deranged thermoregulatory mechanism (failure of vasoconstriction) 
↑ blood flow to skin  feeling of warmth despite contrary (exaggerated sense of
warmth)  opens clothes  die out of hypothermia
• In addition there may be disorientation and confusion d/t hypothermia
• Suspicion of sexual offence related death
• Other one is “Hide & Die syndrome”

Hypothermia
• Core temperature < 35 ºC
35ºC - 32ºC  feeling cold, shivering
32ºC - 27ºC  no shivering, lethargic, muscles
stiffen, RR / BP / Pulse / Metabolism ↓
< 27 ºC  coma, unconsciousness, death
• Death is due to asystole, ventricular fibrillation,
anoxic failure of vital centers

Spark burn (Crocodile skin)

• Due to close range electric
flash
• Cataract
• Chorio-retinitis
• Optic atrophy
• Burning of eyelashes
• 1st degree burns over
face
Arch eye

PRESERVATION OF VISCERA AND OTHER MATERIALS
In all cases of poisoning
1. Stomach with its full contents.
2. Half of Liver or 500 grams whichever
is more.
3. A loop of small intestine.
4. Half of each kidney.
5. Some portion of spleen
In some particular poisons:
1. Blood 100ml: in cases of absorbed poisons.
2. Urine 100ml in all cases where blood is preserved.
3. Part of both lungs in cases of volatile poisons.
4. Heart in case of cardiac poisons.
5. Brain in cerebral poisons.
6. Spinal in spinal poisons.
7. Bones in arsenic and lead.
8. Hair in arsenic and copper.
9. Nails in arsenic.
Skin-scrap from areas stained with a suspected poison.
Stained areas of dress, suspected packet of poison, strips of
tablets recovered from pocket.

Signs of Asphyxia (Asphyxial stigmatas)
Cyanosis of skin and face
Congestion of organs
Petechial hemorrhages (skin of face & lining of eyelids)
Pulmonary edema
Fluidity of blood (persistent liquidity due to release of catecholamine
& fibrinolysins)
Dilatation of right chamber of heart

HANGING
• It is a form of violent death produced by suspending
the body with a ligature round the neck, the
constricting force being the weight of the body or a
part of body weight.

Strangulation

• Adelson (1974) criteria for a 'valid diagnosis' of manual
strangulation
1. Bilateral skin trauma
2. Subjacent soft tissue haemorrhage
3. Laryngeal/hyoid injuries
• Without trustworthy features of cervical squeezing, facial and ocular
petechiae carry no specific diagnostic weight

DROWNING
• It is a form of asphyxial death
where air entry into lungs is
prevented due to submersion of
mouth and nostrils into water or
any fluid medium.
• After 48 to 72 hours or more, the
skin of the palms and the soles
becomes bleached, wrinkled, and
soddened. This is called
washerwoman's hands and feet.
The epidermis separates from the
dermis in glove and stocking
fashion, from the hands and feet.

Postmortem signs of drowning:
Specific signs (Pathognomonic signs of
drowning)
Non specific signs
Fine copious persistent white leathery froth, increases
on chest compression (differentials also include OP,
opioids, barbiturates & other poisoning)
Emphysema aquosum (hyperinflated lungs crossing
midline & obscuring pericardial sac)
Weeds, grass or mud tightly clenched in hand due to
cadaveric spasm
Sub pleural hemorrhages (Paultauf’s spots)
Pleural fluid accumulation Cutis anserine or goose skin
Huge amount of water in stomach, intestine & middle
ear
Washer woman’s hand & feet
Diatoms in brain and bone marrow Additional signs like blood strontium level, brain
swollen, middle ear congestion & hemorrhage,
engorgement of solid organs, etc.
Fresh water: VF & Sea water: cardiac arrest Dr. Aryan (Anish Dhakal)

Laboratory findings in drowning
• Microscopy: alveoli are distended and contain fluid with aquatic
vegetations.
• Biochemical:
Gettler test (> 25% difference in chloride content significatent
between left & right chambers of heart)
Strontium test (as blood chloride content of very little utility)
• Diatom testing: unicellular algae (in brain, marrow, kidney, liver; have
silica so even greater value in putrefied body)

Examination findings of sexual assault in a
virgin victim
Vulva: labial edema, scratches, bleeding, bruises, tear
Hymen
 Fresh: Bleeding, swollen margins, reddish, tender, inflamed & enlarged.
Contusion and laceration mostly at 6 o’clock position (5-7: front
insertion; 9-11: insertion from back). Stellete lacerations at 3, 6 and 9
o’clock positions.
After 2-3 days: Swollen margins and congestion present. Healing starts
at a week but do not unite. Lateral adhesion, scarring and
revascularization is reported
Vagina: foreign particles, discharges, bleeding, bruises, tear
In deflorated victim, semen in fornices, vulva, garments, vagina & evidence of struggle is more important

Puncturing wounds: weapon enter other parts other than viscus

Firearm: Any instrument that discharges a missile by the expansive force of
gases produced by burning of an explosive substance.

Rifled firearm injuries:
Contact shot Close range (5 to 8 cm) Near range Distant range
Over bony region like
cranial vault, stellate (star)
or cruciform shaped,
everted margins. Circular on
thin bone with collar
abrasion.
Body in range of flame
(thus burning & singeing),
smoke (thus blackening) &
powder blast (thus powder
tattooing by grains)
Entry wound same size as
bullet with lacerated and
inverted edges
Circular wound
Little or no evidence of
burning, singeing,
blackening or tattooing but
hair might get burnt
Collar abrasion present.
Grease collar present.
Collar abrasion may be
present but no evidence of
burning, singeing or
tattooing is reported
Collar abrasion may be
present. No blackening, no
tattooing
Cherry red muscles of track
due to CO
Cherry red muscles of track

Shotgun injuries (no rifling/smooth bore, pellets instead of bullets):
Contact shot Close range (up to 3
feet)
Near range (up to 7
feet)
Distant range
(beyond 7 feet)
Muzzle impression & skin
indentation in hard contact
Singeing, blackening,
tattooing of skin is seen
No burning or soot soiling.
Tattooing up to 3-4 feet
Separate pellets injury
Wound track cherry red No burning beyond 30 cm.
No blackening (soot soiling)
beyond 1-3 feet
Scalloped wound edge (rat
hole). On increasing
distance satellite wounds
around the main bolus
wound is seen
No central aperture
Wad present insitu. Though equally intense,
powder tattooing is less
dense compared to
handgun due to great barrel
length.
Beyond 4-5 feet the wads
strike below the main
wound with circular or oval
imprint
No blackening, no tattooing
Petal wound: abrasion due
to petals of shotgun
ammunition at 1 to 3 feet

Some peculiar effects
• Dum-dum bullet: A type of bullet designed to explode
on impact.
• Tandem bullet: Sometimes, when a firearm is
discharged , the bullet does not emerge. On pulling
the trigger again two bullets run at a time from
muzzle.
• Ricochet bullet: A bullet which before striking the
target, strikes some intervening object first and after
rebounding hits the target.
• Back spatter: in contact shot, the muzzle may suck
the blood and tissues from wound in to barrel.

Bumper injuries are patterned rectangular injuries mostly seen on the calf
region of the leg with imprints of the bumper of the vehicle (low bumper
injuries indicate braking).

Primary impact injury Secondary impact injury Secondary injury
Injury sustained by pedestrians
as a result of striking by the
offending vehicle for the first
time
as a result of second impact with
the offending vehicle once the
primary impact is over
as a result of striking the ground
or any object other than the
offending vehicle after being
knocked down
Imprint abrasion or patterned
bruise.
Pelvis fracture, cranio-cerebral
injuries, head of femur pushed
into acetabulum, etc.
Grazed abrasions, fracture of ribs
and extremities, cervical spine
injuries.
Body pivots so impact occurs on
buttocks and upper thigh
producing striae, stretch
laceration and avulsion of skin or
subcutaneous tissue. Also,
bumper injuries & whiplash
injuries.
At lower speed (about 50 kmph or
less), secondary injuries more on
sideways.

Waddle’ triad (injury in pedestrians)

CLASSIFICATION of Head injuries:
• Impact injuries
Injuries of scalp
Skull fracture
Cerebral contusions and lacerations
Epidural hemorrhages
Intra-cerebral hemorrhages
• Acceleration/deceleration injuries
Subdural hematomas
Diffuse axonal injury (DAI)

BLACK EYE/ Racoon Eye
(PERIORBITAL BRUISING)
It is caused by:
1.Direct blow in front of orbits, bruising
lids.
2.Injury to the forehead/anterior scalp,
the blood tracking down under the scalp
due to gravity.
3.Fracture in the anterior cranial fossa,
the blood leaking through cracked
orbital plates.

Types of Fractures of Skull (cranial vault fracture)
Fissured/Linear Most common, straight or curved fracture lines
Depressed Large kinetic energy, heavy object but smaller striking area (fracture a la
signature)
Mosaic (spider’s
web)
Comminuted depressed fractures with radiating fissures
Pond/Indented Infants & children (only dent is produced due to high elasticity just like ping
pong ball)
Gutter Part of thickness of bone is removed
Diastatic/Sutural Young adults, fracture along suture lines (mostly sagittal suture)
Perforating Weapon passes through both outer & inner table of skull
Blow-out Blunt trauma, fracture of floor & medial wall of orbit
Elevated One end of bone elevated while retrieving the weapon

Types of Fractures of Skull (basilar fracture)
Anterior cranial fossa Black eye
Middle cranial fossa Battle’s sign (Mastoid hemorrhage)
Posterior cranial fossa
Transverse (Hinge) fractures/
Motorcyclist fracture
Vault fracture extending through the skull base from
both sides meeting in the midline at pituitary fossa.
Produces complete fracture across the skull base
Ring fracture Around the foramen magnum (mechanism: ‘feet first’
or buttock first’ when kinetic energy transmitted up
the cervical spine
Longitudinal fracture of base of
skull

Brain injury definitions:
• Contusion: Cerebral cortical contusions are multi-focal punctate or
streak hemorrhages associated with foci of necrosis which tends to be
distributed along the crests or gyri. Over time merge to form wedge
shaped hemorrhages.
• Concussion: Concussion is the state of temporary unconsciousness
(due to partial or complete paralysis of brain function), due to head
injury occurring immediately after injury, always followed by amnesia
and tends to recover spontaneously.

COUP INJURY CONTRE COUP INJURY
• Occurs beneath the site of impact • Occurs opposite to site of impact
• D/t forward movement of brain against skull just under
impact site
• D/t bouncing back of brain against opposite side of
impact
• More when stationary head is struck by moving weapon
or stick
( Head can still move after the impact)
• More when head in motion strikes a stationary object or
ground
( If head is fixed then it can occur by a blow over head)
• E.g. Blows by stick, hammer • E.g. Fall injury landing on head, road traffic accidents
• Greater in frontal and temporal lobes due to rough
texture of ACF & MCF
when there is fall on occiput
• Results directly by impacting force • Results due to shearing strain and vacuum effect
• Medicolegal importance: Differentiate between fall and blows. Contrecoup very rare before 3 years. Intermediate
coup contusions may be confused with intracerebral hemorrhages.

Difference b/w Drunkenness and Concussion
FEATURES DRUNK CONCUSSION
Face Suffused, flushed, warm Pale, clammy
Pulse Fast, bounding Slow, feeble
Pupils
Contracted in coma,
dilate on external stimuli and
contract again,
reaction to light -sluggish
Contracted or unequal
Breathing Sighs, puffs, eructates Shallow, irregular, slow
Memory Confused
Retrograde amnesia
unrelieved by time.
Behavior
Uncooperative, abusive,
unresponsive, insolent, talkative
Cooperative quiet.
PUNCH DRUNK SYNDROME / DEMENTIA PUGILISTICA / CTE
Condition seen in boxers and alcoholics – repeated head trauma -
concussions – dementia, lower limb weakness, unsteady gait, hand
tremors, mental dullness and hesitancy of speech.

TYPES OF CONTUSION (independent of the status
of head)
1.Fracture contusion
2.Gliding contusion
3.Herniation contusion

Fingerprint

Temporary teeth eruption (months)
Tooth Mandibular Maxillary
Central incisor 6-7 7-8
Lateral incisor 8-9 9-10
First molar 10-11 11-12
Canine 19-20 21-22
Second molar 22-23 24-25

Permanent teeth eruption (years)
Teeth Mandibular Maxillary
1st molar 6-7 6-7
Central incisor 7-8 7-8
Lateral incisor 8-9 8-9
Canine 9-10 10-11
1st premolar 11-12 12-13
2nd premolar 13-14 14-15
2nd molar 14-16 16-17
3rd molar 17-21 17-21
@Momma is in campus…PPMM

Others are Boyde’s (counting incremental lines on histological section of dead infants) & Stack’s method (weight & height of
erupting teeth of child).

At 2-5 years, no permanent teeth and all 20 temporary teeth present
6th year: 1-4 PT & 20 TT
7th year: 4 PT & 20 TT
After that for each year till 12th year increase PT by 4 each time and
decrease TT by 4 each time
At or after 12 years, TT becomes nil & PT increases till it becomes 32
maximum at around 17-25 years

Key differences in pelvis for sex determination in skeletal remains
Male Female
Pelvis massive, stands higher & more erect Smooth, slender & less massive
Deep funnel shaped Flat bowl shaped
Subpubic angle is “V-shaped” acute (70-75 degrees) Subpubic angle is “U-shaped” obtuse (90-110 degrees)
Pelvic inlet is heart shaped & smaller Pelvic inlet circular, elliptical & larger
Obturator foramen is round/oval with base upward Triangular with apex forward
Greater sciatic notch is small, narrow, deep, < 90 degrees Greater sciatic notch is large, wide shallow, >90 degrees
Preauricular sulcus not frequent, narrow & shallow
without marked edges
More frequent, broad and deep
Acetabulum large, deep & directed laterally Acetabulum small & directed anteriorly
Sacrum longer, narrower, evenly distributed curvature
with 5 or more segments
Shorter, broader, marked curvature with 5 segments

Few differences in skull for sex determination in skeletal remains
Male Female
Larger, longer (robust) Smaller, rounder (gracile)
Rugged with prominent muscle attachment
markings
Smooth
Supraorbital ridge prominent & rounded Less prominent or absent, sharper if present
Orbits are square shaped with rounded borders Orbits rounded, set lower with sharp borders
Chin is square shaped Chin is rounded
Forehead sloping (steeper) & less round Vertical & more round
Capacity more (1500-1550 cc); > 200 cc more than
females
Capacity is less (1350-1400 cc)
Mandibular angle (Gonion) less obtuse (<125
degrees), prominent and everted
Mandibular angle (Gonion) more obtuse (>125
degrees), not prominent and inverted
Body height more at symphysis Lesser body height at symphysis

STATURE ESTIMATION
• 2 x (length of either arm) + 30 cm + 4 cm
• 2 x (length from vertex to symphysis pubis)
• 2 x (length from symphysis pubis to either heel)
• 3.3 x (length from sternal notch to symphysis pubis)
• 8 x (height of skull)
• 19/5 x (length of forearm)

Chronic Mercury Poisoning (Hydrargyrism) in
a Nutshell
Blue black line (as Burtonian lines in lead poisoning). Diphtheria
like membranous colitis & dysentery
Danbury tremors/ Hatter’s or glass-blower’s shake: moderately coarse tremors
involving hands first, then lips/tongue & finally arms & legs interspread by jerky
movements. Concussio mercuralis (Shaking palsy): Severe form where person can’t
even dress, write or walk
Erethism: personality
disturbance characterized
by excessive shyness,
irritability, tremors, loss of
memory and insomnia
Acrodynia (Pink disease): idiosyncratic
hypersensitivity reaction especially in children
with pinkish, puffy, painful, paraesthetic rash
with peeling of skin & shedding of teeth
Minimata
disease:
poisoned fish
eating in
Japan

Durham Rule (1954)
• “an accused person is not criminally responsible, if his unlawful act is the
product of mental disease or mental defect.”
Curren’s Rule (1961)
• “an accused person is not criminally responsible, if at the time of
committing the act, he did not have the capacity to regulate his conduct
to the requirements of the law, as a result of the mental disease or
defect.”
Doctrine of diminished responsibility

Was the baby born live?
HYDROSTATIC TEST (volume increases after birth so specific gravity
decreases). Control is a piece of liver. Sinking at any level implies no
respiration at birth
False positive – putrefaction, artificial respirators/ ressuscitation
False negative- Atelectasis, pneumonic consolidation, pulmonary edema
Test is worthless if <180 days, is mummified/macerated or stomach contains milk

Other old methods to determine if the baby
was born alive?
Fodere’s test & Ploucquet’s test: Weight 30-40 gm to double & ratio
lung to body 1/70 to double respectively
Breslau’s second life test/Stomach-bowel test
: live baby has respired and also swallowed some air
Wredin’s test: air replaces gelatinous substance in middle ear

Dead birth (fetus died in-utero)
• Rigor mortis: only after 7 months
• Mummification: deficient blood supply, scanty liquor amnii & no
air entered uterine cavity
• Maceration: aseptic autolysis as dead fetus not in contact with
air is surrounded by sterile amniotic fluid. IUD signs:
1. Skin slippage: first sign within 12 hours
2. Robert’s sign: gas in great vessels (aorta)
3. Spalding sign: radiological sign showing loss of alignment & over-riding of the
cranial vault
Putrefaction is very rare and develops due to rupture of membranes. Adipocere is almost never seen.

Cinderella syndrome: only a particular child (usually female) is chosen for battering

Skeletal injuries: Suspicion of Child Abuse!
Posterior rib fractures at costovertebral junction of multiple
ribs
Spiral fractures of lower limb in non ambulatory children
Metaphysical or epiphysis “chip or avulsion” fractures
Multiple fractures of difference Ages
Multiple, depressed & wide skull fracture in occipito-
parietal area
(@ parents should manage anger)

Professional secrecy: implied term of contract between doctor and patient in which
doctor is obliged to keep secret all that he comes to know concerning the patient in course
of his professional work. Its disclosure means failure of trust and confidentiality
Privileged communication: clear and genuine statement made by the doctor regarding
any subject matter in accordance with his duty to protect the interests of the community or
of the state. It should be made between doctor and the concerned authority
Medical negligence (Malpraxis): Absence of reasonable care or skill or willful
negligence of a medical practitioner in the treatment of the patient causing physical, mental
or financial injury to the patient
Professional misconduct: infamous conduct in professional respect which is an act or
behavior executed by a physician in pursuit of his profession which is regarded as disgraceful
or dishonorable by his professional colleagues of good repute and competence

All opiods except pethidine causes pin point pupils.

Factors affecting Rigor Mortis
Age (never occurs in fetus <7 months). Faster in children and old age
people
Physique of the person (in healthy person, onset is slower and duration
long)
Atmosphere temperature (increased temperature causes quicker
appearance and disappearance of rigor mortis). In water immersed bodies
it starts early and disappears late (very long duration)
Cause of death
 appears quickly and passes quickly in TB, cancer, strychnine poisoning, cut
throat, electrocution, etc.
 Early disappear in bacterial infection as in gas gangrene due to putrefaction
 Absent in person dying from septicemia

Age estimation from Elbow, Wrist & Pelvis
• CRITOE: 1 year to 11 years
• At 11 years all six ossification centers appears
• At 14-16 years, all those bones fuse
• No of carpel bones (up to 7 years) = Age in years roughly
• Lower end of radius: appear in 1-2 years, fuse in 17-19 years
• Pisiform: 9-12 years (if it ossified means age > 10 yrs.)
• Base of 1st metacarpal fuse: 15-17 years
• Ulna:
Upper end: appear in 8-9 yrs. Fusion in 15-17 years
Lower end: appear in 5-6 yrs. Fusion in 17-19 years

Iliac crest 15-16 years appear, fuse 19-21 years
Ischial tuberosity 16-17 years appear, fuse 20-22 years
Triradiate cartilage Fuse at 12-14 years
Greater trochanter 14 years appear, fuse at 14-15 years
Lesser trochanter 4 years appear, fuse at 15-17 years
@ If not fused or appeared: take upper limit i.e. less than upper limit. If fused or appeared take lower
limit i.e. more than lower limit

What exactly is a poison?
Poison is a substance (solid, liquid or gas), which if introduced in
the living body or brought into contact with any part there of,
will produce ill health or death by its constitutional or local
effects or both.
Have certain ideal characters example: Two important characters of
Ideal Homicidal Poison:
Signs & symptoms should resemble a natural disease
Least Postmortem changes and not to be detected by any chemical tests
e.g. Fluorine and Thallium, but commonly used are Arsenic and Aconite

CLASSIFICATION OF POISONS
(According to the site and mode of action)
Corrosive:
 Strong Acid:
Mineral acid and organic acid : sulphuric, nitric, hydrochloric
Organic acids: carbolic, oxalic, acetic, salicylic.
 Strong alkali:
hydrates and carbonates of sodium, potassium and ammonia
 Metallic:
Mercuric Chloride, zinc chloride, ferric chloride
Irritant:
 Agricultural
 Inorganic:
Non metallic: phosphorus, iodine, chlorine
Metallic: arsenic, copper, lead, mercury
Mechanical: Glass Powder, diamond dust, hair
 Organic:
Vegetable: abrus precatorius, castor, calotropis
Animal: snake and insect venom

CLASSIFICATION OF POISONS contd…
Systemic:
Cerebral:
CNS depressant:alcohol, GA, opoid analgesics, hypnotics, sedetives
CNS stimulants: cyclic antidepressant, amphetamine, Caffine
Deliriant: dhatura, belladonna, cannabis, cocaine
Spinal: Nux vomica, gelsemium
Peripheral: curare, conium
Cardiovascular: aconite, quinine, oleander, tobacco
Asphyxiants : CO, CO2, hydrogen sulphide
Miscellaneous: food poisoning, botulism

CLASSIFICATION OF POISON ACCORDING TO MOTIVE
OR NATURE OF USE (Manner of Death):
• Homicidal: Arsenic, Aconite, Digitalis, Abrus Precatorius, Strychnos nux
vomica.
• Suicidal: Opium, Barbiturate, Organophosphorus, carbolic acid, copper
sulphate.
• Accidental: Aspirin, organophosphorus, copper sulphate, snakes bite, Ergot,
CO, CO2, H2S.
• Abortifacient: Ergot, Quinine, Calotropis, Plumbago.
• Stupefying agent: Dhatura, cannabis, chloral hybrate.
• Agents used to cause bodily injury: Corrosive acids and alkalies.
• Cattle Poison: Abrus precatorius, Calotropis, plumbago.
• Used for malingering: semicarpus anacardium

Marsh test, method for the detection of arsenic , so sensitive that it can
be used to detect minute amounts of arsenic in foods (the residue of fruit
spray) or in stomach contents.
The sample is placed in a flask with arsenic-free zinc and sulfuric acid.
Arsine gas (also hydrogen) forms and is led through a drying tube to a hard
glass tube in which it is heated.
The arsenic is deposited as a mirror just beyond the heated area and on
any cold surface held in the burning gas emanating from the jet.
Tests for Arsenic

Reinsch’s test for Arsenic detection
• Put 1-2 strips of bright copper foils into suspected solution previously
acidulated with HCl
• Boil for 5-10 minutes
• Copper foil becomes coated with steel grey or black deposits of arsenic if
present
• Foil- washed in water, alcohol and ether
• Then heated will show white deposits of arsenious oxide (octahedral crystal
on microscopy)

Postmortem Findings in acute Arsenic
Poisoning:
External
• Body will be dehydrated and emaciated. Features of dehydration like sunken
eyeball, cyanosed skin, etc. are noticed.
• Delayed putrefaction due to antibacterial action of arsenic and dehydration
• Rigor mortis is observed to be unusually longer
• Blood, vomitus, fecal matter may be present on body surface or clothes

Internal PM findings in Arsenic Poisoning:
Stomach –
• Velvety red or brownish
• Patchy areas with small ulceration seen on mucosa
• Gastric contents emit garlicky odour
Heart –
• Shows subendocardial hemorrhage
Other viscera –
• May show fatty degeneration (liver, kidney and heart)
• Brain may show acute encephalitis with hemorrhagic spots

Chronic Arsenic Poisoning
1st stage (GI & Nutritional disturbances) Gradual emaciation. This is followed by anorexia,
nausea, vomiting & diarrhea
2nd catarrhal stage Features of common cold or inflammation of
respiratory tract and eye
3rd stage of skin rash Hyperkeratosis of palms and soles
Finely mottled & patchy brown raindrop like
skin hyperpigmentation of flexures, eyelids or
neck
White transverse streaks of Adrich-Mee’s lines
Falling of hair
4th stage of nervous disturbance Peripheral polyneuropathy causing tingling,
numbness & paresis

Cognisable offence: police may arrest the offender without a arrest warrant
Inquest: inquiry or investigation into the cause of death when death is sudden,
suspicious or unnatural
Subpoena/Summons: document commanding the attendance of a witness in a
court of law under a penalty (contempt of court if avoided without giving valid
reasons)
Conduct Money: payment to meet traveling and other expenses for a witness
from his/her residence to court
Perjury: giving willful false/fabricated evidence under oath or failure to state
what he knows or believes to be truth (Hostile witness: interest or motive behind
concealing the truth or a part of it or giving completely false evidence against the party
that has called him)

Dying declaration: recorded by doctor or legal officer in presence of two other witness.
Patient's own language and patient must sign it. Not valid if person survives but is of
corroborative value & the person is called to court for oral evidence.

Procedure in Court
Steps:
Oath: “To speak the truth, the whole truth and nothing but the truth”
A. Examination in chief: Questions by prosecution lawyer and may be other
lawyers from victim side
Only general descriptive types of questions are asked. Leading questions are not
allowed except for hostile witness
B. Cross Examination: Questions by defense lawyer
Any types of questions relating to the case. No time limit
C. Re-examination (prosecutor lawyer try to clarify cross examination)
D. Questions by the judge
Qualification, training and experiences can be asked at any step.

Witness: A person who has seen, heard, perceived or examined a fact or knows
about fact.
1. Common witness – testifies about what he has seen, heard or perceived in
relation to the case
2. Expert witness – who, on account of his/her professional qualification,
training and experience is capable of deducing opinion and inferences from
the facts observed by himself or noticed by others.
3. Hostile witness: Who falsifies or gives false evidence. Law of perjury is
applicable.
Doctor can be both common & expert witness; at the same setting as well. Apart from directly witnessing the
scene for example if he describes site, size and position of injury then he is acting as a common witness. If for
the same injury he gives medical opinion on whether it is antemortem or postmortem & the probable weapon
causing it then he is acting as expert witness.

Privileged Communication (An exception to
professional secrecy)
In court of law (Authority grants absolute privilege)
Infectious disease (e.g. cook or child nurse with cholera)
Specific diseases for employees (e.g. patient with epilepsy operating a heavy
machinery or is a bus driver)
Venereal diseases (e.g. marriage of a HIV patient)
Notifiable diseases (e.g. polio, neonatal tetanus, smallpox), death or birth
Right to know of descendants ( e.g. genetic diseases)
Moral or social duty (e.g. suspected child abuse, violent homicidal tendency)
Suspected crime
Insurance reports
Negligence suits

Some defense Points for a doctor against
Negligence:
No duty owned to the patient
Contributory negligence (e.g. patient not taking the medicine or
following proper instructions) for civil negligence
Reasonable error of judgment (a disease mayn’t be correctly diagnosed
at all times)
Therapeutic or diagnostic misadventure
Medical maloccurance (e.g. hypersensitivity to drugs)
Res judicata (question of negligence has already been decided by the court, then patient is not
allowed to contest the same questions in another proceeding between himself and the doctor)

Magnan's sign is a clinical sign in which people with cocaine addiction experience paresthesia which feels
like a constantly moving foreign body, such as fine sand or powder, under the skin.

Signs of decomposition in a Nutshell
a. Color change of skin (greenish discoloration of right iliac fossa above
cecum due to sulphmethemoglobin formation)
b. Marbling of skin (branches of tree: superficial veins of limbs, thighs,
abdomen, chest & neck stained greenish brown or purplish red)
c. Evolution of foul smelling gases like methane, hydrogen sulphide,
ammonia with pressure effects like gas stiffening, bloating,
putrefactive blisters, purging, swollen genitalia, etc.
d. Appearance of maggots (2-3 days of death maggots develop, are
voracious eaters: secrete protelolytic enzymes and rapid destruction of
body occurs)
These are all external signs of decomposition. Internal findings include greenish discoloration of undersurface of liver,
formation of foamy liver. Larynx and trachea decompose first while prostate and non gravid uterus decompose last.

Differences between poisonous & non poisonous
snakes:
Poisonous snakes Non-poisonous snakes
Head is triangular Head is spoon shaped & round
Head scales are smaller. If large may contain pits Larger head scales usually
Belly scales are large and cover the entire
breadth of belly
Belly scales are small like those on back and
don’t cover entire breadth
Fangs are long and canalized Short and solid fangs
Two fang marks as bite mark with or without
small marks of other teeth
Number of small teeth marks in a semicircular
set
Tail is compressed Tail is diamond shaped
Usually nocturnal Not so

Cannabis Preparation
Cannabis preparation
(fatal dose)
Source Tetrahydro
cannabinol
(THC)
content (%)
Potency as compared
to bhang
Hashish/Charas (2
g/kg)
Resin from leaves stem 8 – 14 10
Ganja (8g/kg) Flower top of female plant 1 - 2 2
Bhang (10 g/kg) Dried leaves, fruit shoot 1 1
Hash oil Cannabis concentrate 15 - 40 25

Acknowledgements:
Best of the best slides, pictures and information on the web. Special
thanks to all those brilliant minds for their act of creation and
compilation of scientific material without which this work would not
have been possible
Essentials of Forensic Medicine and Toxicology, Reddy
Textbook of Forensic Medicine and Toxicology, Rao
Review of Forensic Medicine and Toxicology, Biswas

5 Sure Shot Ways to Beat Procrastination
https://medium.com/@anishdhakal718/5-sure-shot-ways-
to-beat-procrastination-1de51bf159f1

Forensic Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Part 13)

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