Transcript
MEDICOLEGAL ASPECT OF INJURY
RADHIKA AGARWAL
(64)
TARANGGOEL (81)
INJURYbull Medico-legally-injury is defined as breach or
dissolution of natural continuity of any of the tissue of a living body by actual physical violence
bull Legally- trauma or injury may be defined as any harm whatsoever in nature caused illegally to the bodymindreputation or property ( Section 44 IPC)
INJURIESMEDICOLEGAL ASPECT
Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act
INTERPRETATION OF WOUNDS(1) Causative object or weapon
Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument
(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots
(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole
CLASSIFICATION
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
INJURYbull Medico-legally-injury is defined as breach or
dissolution of natural continuity of any of the tissue of a living body by actual physical violence
bull Legally- trauma or injury may be defined as any harm whatsoever in nature caused illegally to the bodymindreputation or property ( Section 44 IPC)
INJURIESMEDICOLEGAL ASPECT
Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act
INTERPRETATION OF WOUNDS(1) Causative object or weapon
Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument
(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots
(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole
CLASSIFICATION
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
INJURIESMEDICOLEGAL ASPECT
Some important terms in relation to lsquomedicolegal aspect of injury-bull ASSAULT- An assault is an lsquooffer of threatrsquo or an attempt to apply force to the body of another in a hostile manner COGNISABLE OFFENCE- Cognisable offence means an offence for which a police officer may arrest the offender without a warrant Eg-Murder rape kidnapping HOMICIDE- Homicide means lsquokilling of one individualrsquo as a result of conduct of the other It may be ndash LAWFUL or UNLAWFUL SUICIDE- Suicide means lsquoSelf Murderrsquo Attempted suicide is an unlawful act
INTERPRETATION OF WOUNDS(1) Causative object or weapon
Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument
(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots
(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole
CLASSIFICATION
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
INTERPRETATION OF WOUNDS(1) Causative object or weapon
Imprint abrasion from direct impact with patterned surfaceTrace material in sliding abrasion lacerationStab may indicate shape width length of instrument
(2) Order of InflictionTentative or scattered FIRSTFatal or grouped LATERDistant shots before close shots
(3) Manner of infliction By assessment of Circumstances Scene of death Pattern of injuries as a whole
CLASSIFICATION
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
CLASSIFICATION
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
1 Legal classificationA) simple injuryB) Grievous injury2 Medicolegal classification
(A) Classification of injuries according to causative factors
1) Mechanical or physical injury-
(a) Those caused by blunt force(i) Abrasion(ii) Contusion or bruise(iii) Laceration
(b) Those caused by sharp force(iv) Incision(v) Punctured wound
(c) Caused by firearms(vi) By rifled firearm(vii)By smooth bored firearm(viii) By country made weapons
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
(2) Thermal injury
(a) Due to application of heat(i) Generalised effect Heat hyperpyrexia (heat stroke) Heat exhaustion ( heat collapse) Heat cramps ( minerrsquos cramps(ii) Localized effect of heatbullBurnbullScald
(b) Due to application of cold(i) Generalized effect of cold
Hypothermia(ii) Localized effect of coldbull Frost bitebull Trench foot
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
(3) Chemical injury
(A) corrosions( due to strong acids or alkalis)
(B) Irritation (due to weak acid weak alkalis vegetable or animal extract)
(4) Miscellaneous(a) Electrical injury( due to electrocution)(b) Radiation injury(c) Lightening(d) Blast injury
(B) Classification according to severity of injury
(1) Simple(2) Grievous(3) dangerous
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
C Depending upon the time of infection
(a)Ante-mortem(b) Post-mortem
D Depending upon the manner of infliction sustaining
(c)Suicidal(d)Accidental(e)Homicidal(f) Defence wound(g)Self-inflicted(h)fabricated
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Types of wounds
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Types of woundsAbrasions
Bruises
Lacerations
Incised Wounds
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LEGAL CLASSIFICATION
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
SIMPLE INJURY
bull A simple injury is one which Is neither extensive nor serious which would heal rapidly without leaving any permanent deformity and disfiguration
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
GRIEVOUS HURTAny hurt which endangers life
ORWhich causes the sufferer to be during the space of 20 days in severe bodily pain
ORUnable to follow his ordinary pursuits
ANY DANGEROUS HURT IS GRIEVOUS An act neither intended nor likely to cause death is hurt even though death is caused
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
GRIEVOUS INJURYbull Sec 320 IPC designates grievous hurt1 Emasculation2 Permanent privation(loss) of sight of either eye3 Permanent privation of hearing of either ear4 Privation of any member or any joint5 Destruction or permanent impairing of power of any member or
joint6 Permanent disfiguration of head amp face7 Fracture or dislocation of a bone or tooth or both8 Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuit
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
-It means loss of masculine power-Only applicable to MALES -Loss of ldquomasculine powerrdquo
Causes- a) direct trauma to genitalia- AMPUTATION OF ORGANNOTE- Even if one testis with intact male organ is present it cannot be called as emasculation b) trauma to lumbosacral region- indirect loss of masculine power( 2nd- 4th lumbar vertebrae)
EMASCULATION
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
CASTRATED MALE
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
PERMANENT PRIVATION OF SIGHT OF EITHER EYE
-PERMANENT PRIVATION of sight of either eye--It is the ldquopermanent privationrdquo or ldquoimpairmentrdquo of vision of either eye Even if the vision changes from 66 or 65 to 69 it would be grievous hurt
Example- a) corneal scarring b) retinal detachment etc
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Her eyeballs have been gouged out causing permanent loss of eyesight of both eyes
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
PERMANENT PRIVATION OF HEARING OF EITHER EAR
bull It is the ldquopermanent lossrdquo or ldquoimpairmentrdquo of hearing of either ear
bull EXAMPLE - Rupture of Tympanic Membrane
bull Cause- Blow to the head even if there is PARTIAL hearing loss
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
bull Permanent disfiguration of head or face is referred to as ldquo grievous hurtrdquo
bull It depends on - the nature of the injury on the person associated
bull EXAMPLE - a) a small scar on a young girl may be considered as grievous hurt and even a large scar on an old aged man may not be considered as grievous hurt
b) cutting of nose ear etc
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Her nose amp ears have been cut off by using sharp knife causing permanent disfiguration ( injured ears are being covered by her scalp hair at temples)
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
bull MEMBER - Any organ or tissue of the body capable of performing a DISTINCT function in the body is termed as a ldquomemberrdquo bull It is the ldquoanatomical separationrdquo of any part of body
leading to ldquoloss of its functionrdquo permanently bull EXAMPLE- Privation or anatomical separation of a
leg of an individual during to a road traffic accident
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR JOINT
bull It is any ldquodestruction or privationrdquo to a ldquojointrdquo causing loss of its function permanently
bull There may also damage to any other organ or part of the organ leading to loss of its distinct function
bull The damage should be permanent
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
FRACTURE DISLOCATION OF A BONE OR TOOTH
bull Any dislocation of ldquotoothrdquo or ldquoall fracturesrdquo including HAIRLINE FRACTURES is considered as grievous hurt
NOTE - Even if the fracture is on the outer table of skull it is sufficient for the purpose of law to be labelled as grievous
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LOSS OF LOWER INCISOR TOOTH (LEFT) IN A FORCIBLE BITE
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe bodily
pain or makes him unable to follow his ldquoOrdinary Pursuitsrdquo for a period of
20 daysbull Ordinary Daily Pursuits ndash Means acts which are daily routine in every human beings day to day life bull EXAMPLE - a) Eating food taking bath using restroom etc
NOTE- A simple inability to attend the office or work even for a period of 20 days is NOT considered enough for this clause to categorize injury as grievous
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICO-LEGAL CLASSIFICATION
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MECHANICAL INJURY-BY BLUNT FORCE
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
ABRASIONIt is defined as destruction or damage of the
superficial epithelial covering of skin (epidermis) or mucous membrane due to impact with hard blunt and rough object or weapon
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Types of abrasions
1 Linear abrasions ( Scratches) caused by relative movement of a pointed object on the skin eg nail thorn point of sword or knife 2 Grazed abrasions caused by relative movement of a rough surface on a wide area of skin eg falls a victim being dragged on the ground road traffic accidents 3 Imprint abrasions ( patterned abrasions crushing abrasion) caused by the impact of a rigid hard rough surface over a localized area of the skin without any movement eg fingernail tyre grills bicycle chain bite marks 4Friction abrasions caused by pressure upon the skin with an agent with a smooth surface accompanied by movement eg ligature marks around the neck in hanging lashes with a whip
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
The medicolegal aspect of abrasions include the following important points required in its evaluation-bull Site of impact -It suggests 1)site of external impact 2)possibility of internal injurybull Identification of object-It is obtained by the pattern of injury Eg-Ligature mark in hanging -teeth mark in biting etcbull Cause of injury-It is determined by the lsquosite of an abrasionrsquo Eg-Abrasions are found on neck in lsquothrottlingrsquo around nose and mouth in smothering etcbull Direction of injury-This is surmised on examination with a lsquohand lensrsquobull Time of injury-It is estimated by the age of abrasionsbull Possibility of infection- The abrasions may act as an lsquoentry site for infectionrsquo in surviving
individuals Also indicates the crime scene in some casesbull Confusion with burns- After death abrasions tend to dry and darken therefore confused
with burns
^`
MEDICOLEGAL IMPORTANCE OF
ABRASIONS
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
TIME CHANGES IN ABRASION
FRESH REDDISH amp SWOLLENNO SCAB
8-12 HOURS REDDISH SCAB
2-3 DAYS BROWN SCAB
4-5 DAYS DARK BROWN SCAB
6 DAYS BLACK SCAB STARTS FALLING
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
CAUSATIVE AGENT
Imprint of the muzzle of a shotgun (Abrasion ring)
Imprint of the hilt guard of a knife
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Patterned abrasion
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LIGATURE MARK
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LIGATURE MARK
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LIGATURE MARK
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
BRUISE CONTUSIONbull A bruise signifies haemorrhage into the skin
subcutaneous tissuesbull It is due to an infiltration or extravasation of
blood into the tissues following rupture of small vessels as a result of application of blunt force
bull NOTE- In bruisethere is no breach of continuity of the covering skin but the epidermis may occasionally deupgraded
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
The medicolegal aspect of bruses provide information in regard tobull Identification of object-The external pattern of bruise correspond- to to the object or weapon causing the injury Eg-chains whips canes etcbull Degree of violence- A bruise may prove fatal when it involves important internal
organs of body like heart lung etcMultiple bruises may lead to death alsobull Cause of injury-This is obtained by the distribution of bruise Eg-A bruise around arms or legs in restraint on arms and face during a struggle around in throttling etcbull Time of injury-It is determined by lsquocolour changes in bruisersquobull Possibility of infection- The blood effused serve as a nidus for bacterial infection
MEDICOLEGAL ASPECT OF
BRUISES
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DETERMINATION OF ldquoAGE OF A BRUISErdquo
COLOR OF BRUISE PIGMENT TIME
RED HAEMOGLOBIN IMMEDIATE (24 HOURS)
BLUE DE-OXYGENATED HAEMOGLOBIN
1-3 DAYS
BLUISH-BLACK TO BROWN
HAEMOSIDERIN 4 DAYS
GREENISH HAEMOTOIDIN 5-6 DAYS
YELLOW BILIRUBIN 7-12 DAYS
COMPLETELY DISAPPEARS
- 2 WEEKS
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
bullTRAUMAbullTIME OF TRAUMAbullTYPE OF TRAUMA
multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence
CONTUSION INDICATES-
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Patterned contusion
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LACERATIONSbull In laceration there is breach of continuity of
tissue involving depth more than the covering epithelium of the skin or that of an organ
bull Lacerations are caused due to impact by hard blunt object amp by the rough weapons
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
LacerationCharacteristics
bull Slightly inverted marginsbull Margins are often bruise and abradedbull Ragged wounds caused by crushing and tearing of the skinbull Gape open
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
EXTENT OF LACERATIONS
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPORTANCE OF LACERATION
bull Lacerations are usually 1) Accidental 2)Homicidal 3)Rarely suicidalbull From a lacerationsome idea about causative agent may be found
sometimes the shape amp the design of the weapon may be known from wound The design of a tyre may get deep imprinted when a person is runover by a vehicle
bull Inspection- Foregin substances like dust sand etc present on wound will speak about the site on place where the injury was sustained
bull It leaves a permanent scar which may link the person with an old injury of long time back
bull Gross PM lacerations may be caused by placing the dead body in front of a running vehicle to obliterate the antemortem homicidal injury
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
bull It may also caused by animals like jackals dogs amp other carnivoresbull As lacerations do not have uniform healing pattern amp timing the time of infliction of the wound cant be satisfactorily estimated from the healing porcess of lacerationbullExternal evidence of injury as well as the degree of internal injuries Eg-A forceful impact to the precordial region cause sudden cessation of effective heart beat a punch or kick on the upper abdomen may cause injury to duodenum or pancreas etc
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
The arrow shows the direction of a impact At the point of impact the skin splits cleanly and the torn skin is either everted or inverted
The arrow shows the rolled off edges with hair follicles everted The point of impact is where the bone is seen
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MECHANICAL INJURY-BY SHARP INSTRUMENT
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
INCISED WOUNDbull Incised wounds are cuts or slashes
produced by the sharp edge of aweapon like knife razor sword etc
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPORTANCEbull On examination the type of incised wounds should be carefully identified Eg - 1) Incised wounds may be lsquohomicidalrsquo suicidalrsquo or lsquoaccidentalrsquo identified on bases of situation character circumstances 2) Suicidal incised wounds are usually placed in front and sides of the neck or sometimes in front of thewrists to cut the radial artery to bleed to diebull Presence of incised wound indicates lsquointentrsquobull Incised wound with hesitation cuts indicate lsquosuicidersquo Eg - It involves throat groin elbows wrist etcbull Incised wound without hesitation cuts indicate lsquohomicidal incised woundrsquo Eg- Involves face
neck and genitalsbull Incised wound on palm indicate lsquodefence woundrsquobull Multiple superficial incised wound indicates lsquofabricated woundrsquobull In traffic injuries accidental incised wound caused by broken glass are seen on exposed
parts Therefore these fragments provide valuable forensic evidence bull Direction of application of force ndash From the tailing
and bevellingthe direction of application of force can be knownbull Cause of death ndash In case of incised wound there is excessive external
bleeding Death therefore in many cases occur due to haemorrhage and shock In case of cut-throat injury death in addition may occur due to asphyxia due to choking of the
respiratory passage by blood
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Direction of trauma
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
AGE GROSS FINDING HISTOPATHOGOLICAL FINDINGS
FRESH HAEMATOMA FORMATION
CAPILLARY DILATATIONMARGINATONEMMIGRATION OF NEUTROPHILSSWELLING OF VASCULAR ENDOTHELIUMamp REACTIVE CHANGES IN TISSUE HISTIOCYTES
12 HOURS EDGES RED SWOLLEN ADHERENT WITH BLOOD amp LYMPH
REACTIVE CHANGES IN FIBROBLAST amp MONOCYTE IN EXUDATE
15 HOURS - MONOCYTES UNDERGO MITOTIC DIVISION
24 HOURS CONTINUOUS LAYER OF ENDOTHELIAL CELLS COVER SURFACE WITH CRUST OR SCAB OF DRIED CLOT
ENDOTHELIUM BEGINS TO GROW AT EDGES VASCULAR BUDS BEGIN TO FORM
72 HOURS - VASCULARISED GRANULATION TISSUE FORMATION
4-5 DAYS - FORMATION OF NEW FIBRILS
7 DAYS SCAR FORMATION SCAR FORMATION
AGE OF INCISED WOUND
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
STAB WOUND PUNCTURED WOUND
bull Punctured or stab wounds aredeep wounds produced by thepointed end of a weapon or an objectentering the body
bull Depth is the greatest dimension ofpunctured wound
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
HOMICIDAL STAB WOUNDSbull Homicidal stab wounds are usually more
than one in number all are quite deepmay be located anywhere on the bodyincluding self unapproachable parts
bull In homicidal cases the covering clothesusually bear corresponding cutmarks ortears
bull Defence wounds and marks ofresistance may be present on the body
bullForeign materials like foreign scalp hair orshirt-button etc may be found in the tightgrip of the hand of the victimin a state ofcadaveric spasmThe weapon of offencemay not be available on the spot
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DEFENCE WOUNDSbull A wound sustained when a victim places a
hand arm or other body part to prevent or minimize a blow or slashing by a sharp weapon
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPORTANCE OF
DEFENSE WOUNDbullIf the weapon is blunt bruises and abrasions are produced on the extensor or ulnar surfaces of the forearms wrists backs of the hands and knuckles
bullDefence wounds may be found rarely on the shins and feet if ihe victim was lying on the ground and used his legs to defend himself In the female they suggest sexual assault
bullThe size and shape of the bruises depends upon the attacking object
bullA typical knife defence wound is seen in the web between the base of the thumb and index finger when the blade is grasped
bullDefence wounds indicate homicide
bull Defence wounds are absent if the victim is unconscious or is taken by surprise or attacked from the back or under the influence of alcohol or drugs
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
SUICIDAL STAB WOUNDS Suicidal stab wounds are located
on the approachable parts of thebody more commonly over the leftside front of chest neck and lowerabdomenThe main wound maybe only oneThe coveringclothes may not bearcorresponding cut marks as thatmay be partly removed from thearea whiledoing the act
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPORTANCE
bull In the examination of a stab wound the following essential points are kept into consideration-
1)The effects of stabbing depends upon the lsquodirectionrsquo and lsquodepth of penetration of structuresrsquo involved in it 2)Position of the wound indicates about the position of victim at the time of injury Eg- At the time of attack if an arm was raised in defence then a hole in clothing at the back will be at a higher level 3) In males multiple stab wounds suggests lsquohomosexual assaultrsquo 4) Homicidal stab wounds generally reveal lsquodefence woundsrsquo 5)Sometimes a stab injury is often confused with lsquotherapeutic stab injuryrsquo in autopsy interpretation
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Chopping wounds results from hacking or chopping motion made with a fairly sharp amp relatively heavy weapon like axe hatchet cleaver saber bayonet etc
Margins-sharp abraded or contused Usually the lower end (heel) of the axe strikes the surface first which produces a deeper wound than the upper (toe) end
If extremities are attacked amputation
CHOP WOUNDS
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
bullThe deeper end indicates the position of the assailant In the skull the undermined edge of the fracture defect is the direction in which the force is exerted and the slanted edge is the side from which the force was directed
bullIn case of long bones the bone fragments get loosened on the opposite side of the force
bullMost of these injuries are homicidal and usually inflicted on the exposed amp easily accessible portions of the body like the head face neck shoulders and extremities
bullFew are accidental due to machinery
bullVery rarely suicidal
bullSometimes chop wounds are found on bodies recovered from water
MEDICOLEGAL IMPORTANCE OF
CHOP WOUNDS
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Self-inflicted injuriesSelf-inflicted wounds are those inflicted by a person on his own body Fabricated wounds (fictitious forged or invented wounds) are those which may be produced by a person on his own body or by another with his consent
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Self-inflicted injuries
Cuts are usually superficial multiple and parallel
In right handed people most of injuries are on the left side
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPORTANCE OF
SELF-INFLICTED WOUNDS (I) To charge an enemy with assault or attempted murder (2) To make a simple injury appear serious (3) By the assailant to pretend self-defence or to change the appearance of wounds which might connect him with the crime (4) By policemen and watchmen acting in collusion with robbers to show that they were defending the property(5) In thefts by servants or messengers for the above reason (6) By prisoners to bring a charge of beating against officers (7) By recruits to escape military service (8) By women to bring a charge of rape against an enemy
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
SELF-INFLICTED WOUND
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
PHYSICAL INJURY- FIREARM WEAPONS
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
FIREARM INJURYFirearm injuries are regarded as a special form ofblunt trauma
The damage to the organism is causedby the impact of a single projectile (or a multitudeof pellets) propelled from a barrel by high-pressurecombustion gases and striking the body at a highvelocity
Gunshot wounds in a broader sense arealso lesions caused by blank-cartridge weapons aswell as injuries due to livestock stunners stud gunsused in the construction industry and similar devices
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL ASPECT OF
FIREARM INJURIES
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
The questions the doctor will be suspected to answer are
1 Could the wound have been inflicted with that weapon
2 At what range was it fires3 From what direction4 Could it have been self-inflicted
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
FEATURES SUICIDE ACCIDENT HOMICIDESITE Headside of
temple centre of forehead under the chinover the heart rarely epigastrium
Any area Any area
SHORT DISTANCE Contact or very close range
Close or very close range
Any range Usually distant
DIRECTION Upward or backward
Any direction Usually upwards
NUMBER OF WOUNDS Usually one Usually one Any numberPOWDER RESIDUE OVER HANDS
Present Present Absent
WEAPON Found at the scene
Found at the scene
Not found at the scene
SCENE OF CRIME Usually in his own house with no evidence of disturbance or struggle
Maybe indoors or outdoors in the marriages or parties
Any place amp there is evidence of disturbed scene and struggle
VICTIM Usually males Usually males Any sexCADAVERIC SPASM Present rarely
with weapon firmly grasped
Not so Not so
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
exit inletLarge Small Size
Less More Loss of substance
NO ++++ Powder marks
Everted Inverted Edge
Eternal Internal Beveling
DIFFERENCE BETWEEN INLET amp EXIT
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL ASPECT OF FIREARM WOUNDS
ENTRY WOUND-1) PRESENCE OF ABRASION COLLAR - Indicates that it is entry wound
2) ABRASION COLLAR - indicates the direction of firing
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL ASPECT OF EXIT WOUND
1) DIRECTION OF FIRING2) QUESTION OF VICTIM WHILE FIRING3) NUMBER OF BULLETS THAT ARE REMAINING IN THE BODY
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Medico legal importance of powder marks
1- Diagnosis of fire arm injuries
2- Differentiation between inlet and exit 3- Identification the type of powder used
4- Estimation the distance of firing 5- Determination the direction of firing
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DETERMINATION OF ldquoAGE OF INJURYrdquoThe age of injuries can be obtained from lsquodata of its healing processrsquo Eg- A fresh abrasion is bright red a fresh bruise is red at first then the colour gradually changes etc
The above data itself depends upon-1)Vitality of the injured per son2)Extent of damage 3)Vascularity of the Part4)Infection5)Mobility of the part5)Nutrition6)Diabetes etc
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
IMMEDIATE CAUSES OF DEATH FROM WOUNDS-
Haemorrhage
Injury to a vital organ
Neurogenic shock
Combination of any of these
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Haemorrhage
Site of haemorrhage Cause of death
Extradural subdural or subarachnoid
Cerebral compression
Medulla Failure of vital functions
Pericardial sac Cardiac tamponade
Pleural cavity Collapse of lung amp displacement of mediastinum
Respiratory passages eg in cut throat injury or tonsillectomy
asphyxia
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
INJURY TO A VITAL ORGAN-Extensive damage to vital organs ie brain heart and lungs is usually fatal
NOTE- extensive damage to abdominal viscera may be present without visible marks of injury
NEUROGENIC SHOCK-
It is also known as primary shock or vagal inhibition It is characterized by sudden stoppage of heart amp respiration as a result of reflex stimulation of the vagus nerve amp consequent paralysis of cardiac amp respiratory centres
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
REMOTE CAUSES OF DEATH FROM WOUNDSbull Infection
a) Sepsisb) Infective processes in internal organsc) Necrosis or sloughingd) Tetanus
bull renal failure( crush syndrome)bull thrombosisbull embolism
a) fat embolism b) air embolism
bull secondary shockbull consumptive( disseminated
intravascular )coagulopathy
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPLICATIONS IN RELATION TO
ldquoCAUSE OF DEATHrdquoCAUSE OF DEATH-There are mainly 2 causes of death- 1) IMMEDIATE or DIRECT CAUSE 2) REMOTE or INDIRECT CAUSE
Other causes of death- 1) PROXIMATE CAUSE 2) IMMEDIATE CAUSE
EXAMPLE- A person dies of PERITONITIS two weeks after a STAB in its ABDOMENHere IMMEDIATE Cause of death- PERITONITIS PROXIMATE causeINITIATING cause of death- STAB WOUND of the abdomen
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL IMPLICATION -
bull Under section 300 IPC to substantiate a charge of murder it is necessary to determine-
a)The injury inflicted on the deceased was actually the cause of death b)It was sufficient in the ordinary course of nature to cause death
bull Under section 299 IPC a person can be convicted of culpable lsquohomicidersquo if- a)the bodily injury he caused was likely to cause death and b)the person upon which he caused injury was labouring under a DISORDER DISEASE BODILY INFIRMITY EXAMPLE- Perforation of chronic intestinal ulcer assault resulting in rupture of an enlarged spleen etc bull Under section 299 IPC to substantiate it is necessary to estimate the existence
of disease that cause death from postmortem examination and its relationship to injure that hastened it by showing that-
a) neither the disease nor the injury was the sole cause of death and b) death occurred at that time due to the combined effects of the presence of disease and infliction of injury
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
bull MEDICOLEGAL ASPECT-bull The recognisation of antemortem and postmortem wounds helps in ndash Conviction of the
guilty and acquittal of the suspendedbull EXAMPLE- -A person after a natural death may be run over by a car -The body of a murdered person may be placed on a railway track in order to simulate suicide or accident NOTE- Here if the medical officer fails to recognise that the rail injuries are ldquopostmortemrdquo in nature the ldquoguiltyrdquo person would escape the ldquorigor of lawrdquo THEREFORE - It is necessary for a medical officer to make a detailed observations like- a)Naked eye appearance of wounds b)Histological Timing of wound c)Histochemical Timing of wounds d)Biological Timing of wounds
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Routine histological staining techniques form the basis of a forensic age estimation of human skin wounds and the determination of vitality is aided by the detection of neutrophilic granulocytes which appear earliest about 20-30 min after wounding A clear granulocyte infiltration and a significant increase in the number of macrophages indicates a post infliction interval of at least several hours Macrophages containing incorporated particles such as lipophages erythrophages or siderophages appear earliest at a wound age of 2-3 days similarly to extracellular deposits of hemosiderin whereas the rarely detectable iron-free pigment hematoidin and spot-like lymphocytic infiltrates in the granulation tissue appear approximately one week or more after wounding A complete re-epithelialization of surgically treated and primarily healing human skin lesions can be expected earliest 5 days after wound infliction and the absence of a complete new epidermal layer indicates a survival time of less than 21 days
HISTOLOGICAL TIMING OF
WOUNDS
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
HISTOCHEMICAL TIMING OF
WOUNDSEnzyme histochemical methods allow a wound age differentiation especially in the range of a few hours An increase in nonspecific esterases can be observed earliest approximately 1 hour after wounding followed by other enzymes such as acid phosphatase (approximately 2 h) ATPase (approximately 4 h) aminopeptidase (approximately 4 h) or alkaline phosphatase (approximately 4 h) Positive results however cannot be regularly found Therefore the detection of reactive changes is useful for a wound age estimation whereas negative findings which in general must be interpreted with caution can provide information only in a limited number of histological parameters
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
CHANGES IN ENZYMES AS SEEN HISTOCHEMICALLY IN THE FIRST HOURS OF
WOUNDING
Enzyme histochemical methods allow determination of wound age especially in the range of a few hours and are used to distinguish between postmortem and antemortem skin wounds The methods are based on the determination of the presence and changes of the enzyme reaction in the wound area
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Two zones around antemortem wounds-bullCentral( superficial) zone- it is in immediate vicinity of the wound edgeShows decreasing enzyme activityRegressive phenomenon in this zone- NEGATIVE VITAL REACTIONS( since no such decrease in enzyme activty is observed in the wounds inflicted after death
bullPeripheral zone- It surrounds central zoneIncreasing enzyme activityIncrease in enzyme activity in this zone- POSITIVE VITAL REACTION ( since there are no such changes in postmortem wounds)
DIFFERENCE BETWEEN THE ENZYME ACTIVITY IN ANTEMORTEM amp POSTMORTEM WOUND
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
The ldquoBIOCHEMICAL TIMING OF WOUNDSrdquo depends upon ndash measurement of ldquohistaminerdquo and ldquoserotoninrdquo contents of the INJURED SKIN
In the first period of INFLAMMATION the vascular response is dominated by vasoactive substances including histamine and serotonin
AUTOPSY STUDY-According to autopsy study - ldquo the increase in serotonin content of the injured tissue must be atleast two fold and that in the histamine content 15 fold or morerdquo to indicate that the was inflicted before death NOTE- There is no increase in the serotonin and histamine contents in
the wounds inflicted after death
BIOCHEMICAL TIMING OF
WOUND
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
TIME OF THE WOUND BIOCHEMICHAL CHANGESWound inflicted immediately before death
Great increase in the serotonin content and slight increase in the free histamine content
Wound inflicted 5-15 minutes before death
Relatively higher increase in histamine than in serotonin
Wound inflicted 15-60 minutes before death
Higher increase in serotonin content than histamine
In road accidents Death before the crash ( ie death due to natural cause Eg - signs of coronary artery disease etc)
No changes in the serotonin and histamine content of the severe wounds caused by the crash
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
DIFFERENTIATING SUICIDAL HOMICIDAL
OR ACCIDENTAL WOUNDSbull CIRCUMSTANTIAL EVIDENCEbull THE WEAPONbull THE INJURYbull SCENE OF CRIME
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
CIRCUMSTANTIAL EVIDENCE Circumstantial Evidence prior or after death includes- Actions of deceased immediately prior to death Mental condition of victim his family affairs financial condition etc is an important
indication of suicide Farewell letters such as ldquosuicide notesrdquo ldquo blood stainsrdquo on the body and clothes is an important indication of ldquoposition of the
victimrdquo ldquoPosition of the bodyrdquo and ldquo distribution of lividityrdquo indicate if the body has been
moved after death or not ldquoMud stainsrdquo ldquo superficial injuriesrdquo as evidence of murder and whether the victim has
died where the body has found or not IN ACCIDENTAL INJURIES including firearmsCircumstantial Evidence is ldquo sufficient to show whether they have been accidently inflicted or notrdquo
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
THE WEAPON CONFIRMATORY OF SUICIDE-1)If the weapon is firmly GRASPED in the hand of the deceased by ldquocadaveric spasmrdquo and2) If there is no sign of struggle or other injuries PRESUMTIVE OF ldquo HOMICIDErdquo-1)If the weapon cannot be found and2)Or the weapon is found ldquoconcealedrdquo in the distant place IDENTIFICATION OF THE WEAPON-1)If some ldquobroken fragmentrdquo of the weapon is found in the wound NOTE-ldquo There are some weapons which are NOT used for INFLICTING SUICIDAL INJURIESEXAMPLE- IF THE INJURIES CAUSED BY- a) ldquoLATHIrdquo- Bansdola b) ldquoIRON BARrdquo- fracture of skull or multiple fracturesetc c) AN ldquo AXE rdquo ndash chop wounds
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
THE ldquoINJURYrdquoldquoPREFERENTIAL SITES rdquo or ldquo SITES OF ELECTION rdquo-The certain specific situations selected preferentially by a suicide known as Preferential sitesEg - a) For ldquo Incised Woundrdquo- throat wrist elbow or groin b) For ldquo stab woundrdquo ndash left side of the chest over the heart abdomen c) For ldquo gunshot woundsrdquo ndash precordium right temple mouthNOTE- ldquo Hesitation Woundsrdquo may be present
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
SCENE OF CRIME SUICIDE ndash The suicide will find some secluded place like - ldquo bedroom or locked
bathroomrdquo etcEXAMPLE- When a suicide cuts his throat he will do it in front of the mirror and ldquo blood splashesrdquo will be found on the mirror itself
HOMICIDAL ATTACK ndash In case of a homicidal attack there is a ldquoconsiderable disturbancerdquo at the scene-
bull UNLESS 1)the victim is a child 2) very old and frail or 3) his powers of resistance diminished by drinks or drugs 4) when more than one assailant is involvedrdquoEXAMPLE- Presence of scratches bruises and defence injuries indicate a ldquostrugglerdquo - Presence of ldquofoot printsrdquo of the assailant and ldquoblood stainsrdquo belonging to assailantrsquos blood group indicate CORROBORATIVE evidence
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
Thank you
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
BIBLIOGRAPHYbullParikhrsquos Textbook of Medical Jurisprudence Forensic Medicine amp Toxicology
bull Textbook of Forensic Medicine amp Toxicology- PC Dikshit
bullhttpwwwncbinlmnihgovbullwwwsimilimacombullwwwforensicmedcoukbullwwwmedicinaforenseclswabullwwwforensicscsuacthbullwwwsciencedirectcombullwwwthetruthaboutforensicsciencecombullwwwscribdcombullwwwforensicindiacombullwwwexploreforensicscoukbullwwwdundeeacuk
bullTimes of IndiabullThe Hindustan times
- Slide 1
- INJURY
- INJURIES MEDICOLEGAL ASPECT
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Types of wounds
- Slide 12
- Slide 13
- SIMPLE INJURY
- Slide 15
- GRIEVOUS INJURY
- Slide 17
- Slide 18
- Slide 19
- PERMANENT PRIVATION OF SIGHT OF EITHER EYE
- Slide 21
- Slide 22
- Slide 23
- PERMANENT PRIVATION OF HEARING OF EITHER EAR
- PERMANENT ldquoDISFIGURATIONrdquo OF HEAD OR FACE
- Slide 26
- PRIVATION OF ANY ldquoMEMBERrdquo OR ldquoANY JOINTrdquo
- DESTRUCTION OR PERMANENT IMPAIRMENT OF ldquoPOWERrdquo OF ANY MEMBER OR
- Slide 29
- Slide 30
- FRACTURE DISLOCATION OF A BONE OR TOOTH
- Slide 32
- ANY HURT WHICH ENDANGERS LIFE which causes its suffer severe
- Slide 34
- Slide 35
- ABRASION
- Slide 37
- Slide 38
- DETERMINATION OF AGE OF AN ldquoABRASIONrdquo
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- BRUISE CONTUSION
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- LACERATIONS
- Laceration Characteristics
- Slide 58
- Slide 59
- MEDICOLEGAL IMPORTANCE OF LACERATION
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- INCISED WOUND
- MEDICOLEGAL IMPORTANCE
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- STAB WOUND PUNCTURED WOUND
- HOMICIDAL STAB WOUNDS
- Slide 78
- Slide 79
- Slide 80
- Slide 81
- DEFENCE WOUNDS
- Slide 83
- SUICIDAL STAB WOUNDS
- MEDICOLEGAL IMPORTANCE (2)
- Slide 86
- Slide 87
- Slide 88
- Slide 89
- Slide 90
- Self-inflicted injuries
- Self-inflicted injuries (2)
- Slide 93
- Slide 94
- Slide 95
- Slide 96
- FIREARM INJURY
- Slide 98
- RECONSTRUCTION SUICIDE ACCIDENT amp MURDER
- Slide 100
- Slide 101
- Slide 102
- Slide 103
- Slide 104
- Slide 105
- Slide 106
- DETERMINATION OF ldquoAGE OF INJURYrdquo
- Slide 108
- Slide 109
- Slide 110
- Slide 111
- MEDICOLEGAL IMPLICATIONS IN RELATION TO ldquoCAUSE OF DEATHrdquo
- Slide 113
- MEDICOLEGAL SIGNIFICANCE OF ldquoANTEMORTEM AND POSTMORTEM WOUNDSrdquo
- Slide 115
- Slide 116
- Slide 117
- Two zones around antemortem wounds-
- Slide 119
- Slide 120
- Slide 121
- CIRCUMSTANTIAL EVIDENCE
- THE WEAPON
- THE ldquoINJURYrdquo
- SCENE OF CRIME
- Slide 126
- Slide 127
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