VIRGINITY, PREGNANCY, DELIVERY AND LEGITIMACY

Definitions:

Virginity: a virgin is a woman who has never had any sexual intercourse.

Defloration: loss of virginity

SIGNS OF VIRGINITY

• Breasts: hemispherical, firm and rounded.
• Nipple: small, undeveloped, areola is pink.
• Labia majora: firm, elastic, rounded & completely.
• Labia minora: soft, smooth, small, sensitive & pink in color.
• Fourchette & posterior commisure: intact.
• Vaginal wall: closely approximated.
• Vaginal mucosa: rugose, reddish, sensitive to touch.
• Hymen: intact, deeply situated in children & superficial after puberty, soft to firm in consistency & usually annular or semilunar in shape.

Different types or shapes of hymen:

• Annular or circular (with a central aperture)
• Cresentic or semi lunar
• Fimbriated or notched
• Septate (divided into two openings by a septum)
• Cribiform (with several openings)
• imperforate

Difference between fimbriate & torn hymen

Fimbriate

• Notches are symmetrical
• Notches occur anteriorly
• Do not extend to vaginal wall
• Mucus membrane intact
• No signs of inflammation

Torn Hymen

• Irregular
• Usually posteriorly
• Extend to vaginal wall
• Damaged
• Signs of inflammation present

Signs of defloration:

• Carunculae myrtiformes: several small, granular tags or knobs of tissues (remnants of hymen).
• Labia majora & vagina: lose of tone and rugosity.
• Labia minora: leathery and hard.

Conditions causing ruptured hymen before coitus

• Accidents
• Masturbation
• Instrumentation by doctors
• Artificial dilatation of vagina by foreign bodies for prostitution
• Passage of large blood clots

True virgin

• Hymen is intact & the woman has had no sexual intercourse.
• It only admits tip of little finger in vagina.

False virgin

• Hymen is intact but the woman has had sexual intercourse
• It can easily admit two fingers in vagina.

MLI of Virginity

• Divorce
• Defamation (chastity)
• Rape

Signs of prgenancy in living:

Subjective

• Cessation of menstruation
• Morning sickness
• Sympathetic disturbances (salivation, altered taste, irritable temper)
• Quickening (movement of fetus felt by mother) – after 14-18 weeks
• Frequency of micturation

Objective

• Breast changes
• Skin changes
• Vaginal changes
• Changes in cervix
• Hegar’s sign (softening & compressibility of lower uterine segment from 2nd to 5th month)
• Progressive enlargement of abdomen
• Braxton Hick’s sign: intermittent contraction & relaxation of uterus after 4th month
• Uterine souffle (soft blowing murmur heard by 3rd or 4th month)
• Ballottment

Breast changes:

• 2nd month: breast becomes full & tender, increase in size, veins become prominent, nipples enlarged, areola wider & darker, Montgomery’s tubercles (ENLARGED SEBACEOUS GLANDS)appear.
• 3rd month: colostrum can be squeezed out of the nipples.
• 6th month: lines like linea albicantes appear on breast due to stretching.

Skin changes:

• Pigmentation of abdomen, axillae, pubis & vulva.
• A dark line extends from symphysis to umbilicus called linea nigra.

Vaginal changes:

• Pressure of the gravid uterus >> increased vascularity >> mucosa becomes purple or bluish purple >> Jacqueimier’s sign.
• 4th month- pulsation of vaginal arteries is felt by placing a finger in vagina (osiander sign)

Changes in cervix:

• 4th month- cervix becomes soft like lips (goodell’s sign)

Location of uterine fundus:

• 4th month- just above symphysis pubis.
• 5th month- midway b/w symphysis pubis & umbilicus.
• 6th month- umbilicus.
• 7th month- midway b/w umbilicus & xiphoid.
• 8th & early 9th month- at xiphoid process.

Classification of signs of pregnancy in living:

A.Presumptive signs

• Suppression of menstruation
• Morning sickness
• Sympathetic disturbances
• Breast changes
• Pigmentation of skin
• Quickening
• Vaginal changes
• Urinary disturbances

B.Probable signs

• Changes in abdomen
• Softening of lower segment and os
• Presence of cervical mucus plug
• Braxton Hick’s sign
• Ballottment
• Uterine souffle
• Biological tests

C.Positive signs of prgnancy:

1. Fetal movements (after 5th month,at 24 weeks )
2. Recognition of fetal parts (by abdominal examination)
3. Fetal heart sound (160 bpm at 5th month, 120bpm at term),heard between 18-20 wks for first time.
4. Radiograph of fetus (can be taken after 4th month)
5. Ultrasound-G.S seen by 6th week

Pseudocyesis

-Spurious or phantom pregnancy

-Seen in women near menopause or those who are much desiring pregnancy

-All subjective symptoms of pregnancy including increase in abdominal size by abnormal fat deposition,or ascites occur

-even lady seen to have started labour like pains

Signs of prgenancy in Dead (on PM examination)

• Presence of an ovum or fetus
• Uterine changes
• Presence of corpus luteum in one of the ovaries

Uterine changes:

• Uterus thickened and enlarged
• Length, breadth, & weight are increased
• Chorionic villi are seen on microscopic examination

Posthumus child

• -born after the death of father

MLI of pregnancy:

• To escape hard labor or punishment
• To avoid court attendance
• In cases of property
• In divorce cases
• Black mailing
• If a woman is charged of unchastity
• Identification

Superfecundation-fertilisation of two ova which have been discharged by two separate acts of coitus commited at short intervals.

Superfoetation –fertilisation of second ovum in a woman who is already pregnant.

DELIVERY

Signs of recent delivery in living

• General appearance- pale, exhausted & ill looking sunken eyes, slight increase in pulse and temperature.
• After pains – intermittent contractions of uterus for the first 4-5 days after delivery.
• Breasts- enlarged, contain colostrums, surface veins dilated & prominent, striae & Montgomery’s tubercle present
• Abdomen- flaccid, wrinkled, striae gravidarum present
• Fourchette- ruptured, posterior comissure destroyed
• Vulva- bruised, tender & gaping
• Vagina- lax, capacious, rugae begin to reappear about the third week

Uterus- enlarged, easily felt, palpate as a cricket ball

Soon after delivery- 2.5cm below umbilicus

10th day- on level with pelvic brim

2-3 weeks- returns to pelvic cavity

6 weeks- returns to normal size and position

Cervix- soft, patulous, may be lacerated. Internal os closes in first 24 hours, external os in two weeks.

Lochia- discharge from uterus and vagina for about 2-3 weeks.

• Has a peculiar disaggreable odor
• 1st 4-5 days- bright red with large clots- lochia rubra
• Next 4 days- serous and pale in color- lochia serosa
• After 9th day- yellowish grey or turbid- lochia alba until its final disappearance
• If the blood or urine gives positive pregnancy test, strong evidence that pregnancy has been terminated recently. (likely to disappear in a week or 10 days)

Signs of recent delivery in dead:

• Breast when cut open, may show milk
• Uterus flabby and enlarged
• Ovaries and fallopian tube congested, on section may show corpus luteum

Animal Poisoning

Classification of snakes

-Poisonous

Poisonous

A. Colubridae

Elapidae

Kobra

Krait

Mamba

2. Hydrophidae

Viperadae

Rattle snake

Pit vipers

Russel viper

Elapids: (Cobra, Krait)

• Secrete neurotoxin- leads to local burning pain, muscular weakness, spreading paralysis, slow labored breathing, death is usually due to respiratory failure
• Head is small
• Pupils are round
• Fangs are short, fixed and grooved
• Cobra is found everywhere except Europe
• Cardiotoxin found particularly in cobra venom is toxic to heart
• Cobra has a hood which on the dorsal side often bears a double or single spectacle mark
• Cobra grows to a length about 2 m.
• Cobra venom fatal dose- 15 mg
• Krait has a single or double white bands across the back and a creamy white belly
• Kraits are nocturnal in habit
• Kraits venom fatal dose- 6 mg

Vipers

• Secrete vasculotoxic venom- intense local pain, swelling, ecchymosis and discoloration of surrounding tissue, oozing of bloody serum rapid feeble pulse, hemorrhage from natural orifice, cold and clammy skin, loss of consciousness, death from shock
• Consists of pit vipers and pit less vipers
• Pits are situated between the eye and nostrils
• Head is big and triangular
• Pupil is vertical
• Fangs are long, movable and canalized
• Can bite through clothes
• Pit vipers are seldom dangerous but the russel viper, which is pitless viper, is dangerous.

Sea snake

• Secrete myotoxic venom- generalized pain and stiffness, brown colored urine due to myoglobinuria, hyperkalaemic symptom, death due to respiratory failure
• Small head and flat tail
• Found in the vicinity of sea coast
• Most of them do not bite

Difference

Poisonous

• Belly scales are large and cover entire belly
• Fangs are hollow like hypodermic needles
• Tail is compressed
• Two long fangs are present
• Usually nocturnal
• Head scales are small with enlarged central row of scales on back

Non-poisonous

• Small, do not cover the entire belly

• Fangs are short and solid

• Tail is not much compressed
• Several small teeth
• Not so
• Head scales are large

Delirient poison

Dhatura (thorn apple)

• Solanaceae family- flowers are bell shaped, fuits are spherical with spinous projections
• All parts of plants are poisonous, but seed and fruits are more
• Active principle is hyoscine, traces of atropine, so it paralyses the parasympathetic system
• S/S- dry mouth, dry face, restlessness, confusion, delirium, patient may become noisy or violent, hallucination (usually visual), amnesia, convulsion and death, tachycardia, dysrrhythmias, raised body temperatures.
• Treatment- stomach wash with warm water and KMnO4, oxygen, catheterization for urinary retention, cold water sponging for pyrexia, i/v diazepam for convulsion, physostigmine
• MLI- is a stupefying agent used for robbery, rape, and kidnapping; may be accidental, suicidal and homicidal
• Fatal dose- 100 to 150 seeds crushed, 60 mg alkaloid
• Fatal period within 24 hours

Atropa Balladona:

• Also called deadly night shade
• All part of plant are poisonous
• Contain alkaloids, atropine, and hyoscymine
• Treatment, sign and symptoms and postmortem findings same as dhatura
• Fatal dose 10-15 berries, 100-125 mg atropine by mouth, 3mg by injection
• Fatal period 24 hours

Cannabis indica or sativa

• All parts are poisonous
• Drug is used as “Bhang” (dry leaves and fruiting shoot, least potent), “Ganja” (flowering top of the female plant), “Charas or Hasis” (exudates obtained from leaves and stem)
• First stimulates and depresses the vital centre
• 
  
• never causes death and its dangers are denied by many, though long-term users may develop psychotic states
• and there is some evidence of genetic defects in the offspring of users
• 
  
• S/S- anxiety, excitement, euphoria, talkativeness, laughter, increased appetite, hallucinations, unproductive cough, dry mouth, run-amock (homicidal tendency),finally stage of narcosis (drowsiness, staggering gait, dilated pupil, rarely death)
• Treatment- stomach wash, saline purgatives, symptomatic treatments
• MLI- dangerous when driving, stupefying agent, run-amock, sadhus and pujaris use it
• Fatal dose- Charas: 2gm/kg, Ganja: 8gm/kg, Bhang: 10gm/kg
• Fatal period: 12hrs to 19 days

Cocaine:

• Derived from the dry leaves of cocoa plant
• Colorless, odorless, crystalline substance with a bitter taste
• Administered through the oral mucus membrane, injection, inhalation
• Ulceration of the nasal septum is always recorded as a complication of long-term nasal abuse of cocaine but this is, in fact, a rare phenomenon.
• Cocaine produces hypertension, which (like amphetamines) may lead to cerebral bleeding. Dilated pupils hyperpyrexia, marked sweating and confusion may lead to coma and death from either respiratory depression or cardiac arrhythmia.
• more potent form of cocaine called ‘crack’ has appeared
• S/S- numbness of mouth, pyrexia, dilated pupil, increased sexual desire, happy and euphoric, delirium, tachycardia, tachypnoea, nausea, vomiting, muscular twitching, convulsion, collapse and death.
• Treatment- stomach wash with warm water and KMnO4, symptomatic treatment
• Postmortem finding- lungs edematous, signs of asphyxia or cardiac failure
• MLI- aphrodisiac, used by prostitutes to constrict vagina, accidental, drug of addiction
• Fatal dose- 1gm orally,
• Fatal period- 2min to 4 hours

FORENSIC TOXICOLOGY

Definition

• Toxicology-science dealing with properties,actions,toxicity ,fatal dose,detection,estimation of and the interpretation of result of toxicological analysis and treatment of poisons
• Forensic toxicology deals with medical and legal aspects of harmful aspects of chemicals on human beings
• Poison is a substance (solid,liquid or gas)which if introduced into the living body,or brought into contact with any part thereof,will produce ill health or death,by its constitutional or local effect or both.

CORRHOSIVE

• Strong acid
• Strong alkali

IRRITANT

1.Inorganic:

• Non-metallic-phosphoros, chlorine, bromine
• Metallic- arsenic, mercury, lead, zinc, copper

2.Organic:

• Vegetable- castor seed, croton oil, aloe
• Animal- snake bite, insect bite, cantharides

3.Mechanical:

• Diamond dust
• Powdered glass

SYSTEMIC

1.Cerebral:

• Somniferant- opium and other alkaloid
• Inibriant- alcohol, ether, chloroform
• Deliriant- dhatura, balladona, cannabis

2.Spinal: nuxvomice

3.Cardiac: digitalis, tobacco, aconite

4.Asphyxiant: war gas, coal gas, sui gas

5.Peripheral: curare

Symptom characteristic of a particular poison

• Violent convulsant
• Quick death
• Hallucination and delusion
• Drowsiness
• Colic and pronounced diarrhoea
• Paralysis ,unconsciousness
• Coffee brown vomitus with garlic odour
• Bluish green vomitus
• Black vomitus
• Yellow vomitus
• Strychinine
• Cyanide
• Dhatura or atropine
• Opium, tranquiliser, hypnotic
• Arsenic, lead
• Carbolic acid, nicotine
• Phosphorus,
• Cuso4
• Sulphuric acid
• Nitric acid, chromic acid

Treatment of poisoning

1.Stop further administration

2.Removal of unabsorbed poison

• Emesis
• Gastric aspiration and lavage
• Whole gut lavage

3.Check further absorption with antidote

• Mechanical or physical example- oil, fat, milk, banana
• Chemical- to neutralize poison, e.g. weak acid, weak alkali
• Universal antidote like activated charcoal, milk of magnesia, tannic acid

4.Prevent further action of absorbed poison with chelating agent

• BAL (Bristish, Anti-Lewisite for heavy metal poisoning)
• EDTA for lead
• Penicillamin for copper, lead and mercury
• Dicobalt edetate for cyanide
• Desferrioxamine for iron

5.Elimination of absorbed poison

• Diuresis,
• Sweating
• Dialysis
• Hemoperfusion, exchange transfusion

6.Treat general symptoms

CORRHOSIVE- H2SO4, HNO3, HCl, oxalic acid, acetic acid, caustic potas, NH4CO3

Suicidal ingestion of a corrosive substance (Lysol). Spillage around the mouth has run down the neck and onto the chest.

• The symptoms are obvious and immediate, with pain at the sites of exposure, usually the mouth and on the skin, difficulty in swallowing, chest pain, abdominal pain, vomiting, difficulty in breathing, choking.
• If the amount ingested is significant, there will be signs of shock, with collapse, a weak and rapid pulse, hypotension and possibly death, even if treatment is available straightaway.
• Avoid gastric lavage

Sulphuric acid:

• Colorless, oily liquid, damages the tissue by dehydration
• Signs and symptoms- burning pain in mouth, throat down to stomach, nausea, vomiting, dark brown or black vomitus mixed with blood, chalky white teeth, swollen or excoriated lips, difficulty breathing if larynx involved, weakness and collapse
• Treatment with- neutralisation with milk of magnesia, milk or lime water, analgesia for pain, corticosteroid, fluid replacement
• Gastric lavage is contraindicated
• Fatal dose- 10-15 ml, fatal period is 12-24 hours.
• MLI- used for suicide, mostly accidental, abortificent,vitriolage(throwing acid)
• Cause of death-circulatory collapse,spasm or oedema of glottis,collapse d/t perforation of stomach

Nitric acid/Aqua Fortis:

• Yellowish liquid, choking odor, colorless irritating fumes on exposure to air
• S/S- like H2SO4 except tissues stained yellow, abdominal distension due to gas formation, lacrimation and conjunctivitis, death may occur d/t pulmonary edema.
• MLI- used for suicide, accidental, homicidal (rare).
• Fatal dose- 15-20 ml, fatal period- 12-24 hours.

HCl / Muriatic acid:

• Pungent, colourless fuming liquid, less corrosive ,is in stomach. destroys mucosa.
• S/S- as H2SO4, HNO3 but milder & more respiratory symptoms being volatile
• PM findings- skin and mucus membrane whitened, ashy grey or black; errosive esophagitis; stomach is red, perforation is less common.
• Fatal dose- 15-30 ml, fatal period is 18-30 hours.

Oxalic acid:

• Although not as corrosive as the mineral acids, oxalic acid and potassium quadroxalate are very toxic, death often occurring within a hour or so if the solid or concentrated solution is taken.
• They are used extensively as bleach for stain removal and in many other trades and industries .
• Natural constituent of many plants e.g.spinach,cabbage
• Colorless, prismatic crystals, rapid poison
• S/S- sour taste, burning in throat, stomach
• rarely damage skin but readily corrode the mucosa;
• purging & tenesmus; stools contain blood; low BP; skin cold & clammy
• Treatment- give chalk in water; gastric lavage; gastric purgatives; i/v calcium gluconate and calcium chloride(antidote of any oxalate is calcium which binds and forms,calcium oxalate); i/m morphine for pain; inj. coramine to elevate BP
• Fatal dose- 15 gms, fatal period is 1-2 hours.

Carbolic acid/ phenol:

• Long, colorless, prismatic needle shaped crystal
• Largely used as antiseptic and disfectant
• Turns pink on exposure to light and air, intense penetrating odour
• S/S- hot burning sensation from mouth to stomach, corroded lip, mouth, tongue; nausea, vomiting; pulse small, BP low; greenish appearance of urine k/a carboluria; death from respiratory paralysis as phenol is a respiratory depressant.
• T/t- milk, vegetable oil or any demulcent; stomach wash; inj. morphine for pain; artificial respiration for shock; antibiotic prophylaxis of pneumonia
• Fatal dose- 15 gms, fatal period is 3-4 hours.

Aspirin/ Acetyl salicylic acid:

• White crystalline powder for headache and pyrexia
• S/S- n/v, subconjunctival hemorrhage; petechiae over face and eyelids; gum bleeding, GIT and urethral bleeding; tinnitus and deafness; deep and rapid respiration; pulse rate increased; delirium, agitation, confusion, coma and convulsion; death due to respiratory failure
• T/t- gastric lavage; KCl to treat hypokalaemia; milk as demulcent; Vit. K for bleeding; oxygen for cyanosis; hemodialysis in very severe cases
• PM findings- petechial hemorrhage on face and neck; frothy fluid from mouth and nose; cyanosed; erosion of GIT

Heavy metal poisoning:

• The literature of nineteenth-century European forensic medicine is full of notorious cases of murder by arsenic, antimony and mercury.
• Arsenic
• Metallic arsenic,black is not toxic
• It is the compounds of arsenic, particularly arsenious oxide and the various arsenites of copper, sodium and potassium, that are toxic to humans, inteferes with cellular respiration.
• Vascular endothelium appears to be particularly susceptible to the toxic effects of arsenic.
• In acute poisoning, if sufficient chemical is ingested, there may be initial burning in the mouth and then, after an interval, signs of intense gastroenteritis develop: abdominal pain, nausea, burning regurgitation and vomiting. Diarrhoea ensues and this, together with the sickness, leads to prostration, mainly from dehydration and electrolyte imbalance. death in 1 to 3 hrs in severe ac. Poisoning due to shock and peripheral vascular failure.
• In chronic poisoning, a classic state of ill-health develops, Loss of appetite, mild nausea, some vomiting, jaundice, loss of weight and anaemia are relatively non-specific symptoms.

• More specific signs can be seen in the skin, where chronic arsenical poisoning causes hyperkeratosis of the palms of the hands and soles of the feet produce band of opacity in the nail k/a MEES-ALDRICH line.
• A speckled pigmentation of the general skin surface sometimes described as a ‘raindrop’ appearance (finely mottled brown change especially over eyelid,temples,and neck).
• loss of hair, brittle nails and a peripheral neuritis with itching, tingling and paraesthesia of the extremities
• The fatal dose is variable, but 200–300 mg of arsenious oxide are likely to be needed for acute fatal toxicity.
• At autopsy, little may be found in acute deaths apart from a haemorrhagic gastritis. The stomach mucosa has been likened to red velvet, due to the bleeding
• Subendocardial bleeding may be seen in the left ventricle, though this is not specific to arsenic and can be seen in any death when there has been a precipitous drop in blood pressure due to ‘shock’.
• 
  
• T/T-stomach thoroughly washed with fluid,BAL is given,penicillamine may be used in place of BAL.Demulsant decrease the irritation.glucose –saline helpful to combat shock.

Lead

Lead can be administered by oral,inhalation,through skin,mucous membrane,I.V

Causes spasm of capillaries and arterioles

Toxic effects results from fixation of lead into tissues

S/S-

acute poisoning -sweet,metallic taste,burning in throat,V/N,jaundice,feeble pulse,drowsiness,insomnia,headache,convulsion,numbness.

chronic poisoning- anorexia,metallic taste in mouth,constipation,colic,Burton s line(blue pigmentation on gingival margin),anemia and punctate basophilia,peripheral neuritis(foot drop and wrist drop)arthralgias

Management-EDTA as chelating agent,diazepam for convulsion,morphine and pethidine for pain,physiotherapy for paralysis.

MLI-mostly accidental d/t use in utensils,lead pipes.

FD=20-40mg, fatal period =uncertain,2-3 days

Mercury

• Mercury is usually an industrial or environmental poison.
• Although historically some deaths occurred from its use in medicine, mercurial diuretics and antiseptics are now almost a thing of the past.
• Acute poisoning resembles that of arsenic and antimony: gastrointestinal symptoms are common,
• But there are also excessive salivation and signs of renal failure.
• Chronic mercury poisoning is almost wholly industrial in nature and
• The clinical hallmarks are gingivitis, loose teeth, salivation, black gums, mandibular necrosis, peripheral neuritis, encephalopathy and renal failure.

SEXUAL OFFENSES

Classification:

Natural offenses- rape, incest, adultery.

Un-natural offenses- sodomy, tribadism, bestiality, buccal coitus.

Sexual perversions- sadism, machochism, necrophilia, transvestism, exhibitionism, masturbation, voyeurism, frotteurism.

RAPE

It is an unlawful sexual intercourse by a man with a woman against her will, without her consent, with her consent by putting in fear of hurt or death, with her consent when at the time of consent she is unable to understand the nature & consequence intoxicated or given any stupefying substance, with or without her consent if she is a minor.

• Even if his wife, even with consent, if she is under 13,
• Of any woman under 14 years, not his wife, even with consent,
• Of any women above 14 years, against her will.
• Penetration is sufficient to constitute sexual intercourse necessary to the offence of rape.

Punishment:

1. U/S 376 P.P.C:

It may be imprisonment for 10 years to life imprisonment with or w/o fine (unlimited).

2. Under Islamic Penal Code:

HADD means punishment ordained by Holy Quran or Sunnath.

• Muhsan- be stoned to death at public place
• Not muhsan- whipping numbering 100 stripes at public place.

3. Zina: If a man & a woman, not husband & wife, both not insane, have sexual intercourse, they said to commit Zina.

4. Tazir: means punishment other than HADD

Examination of Victim:

• Includes:

a.Signs of local violence to body

b.Signs of local violence to private parts

c.Presence of spermatozoa

• The victim should not be examined w/o requisition from investigating police officer or the magistrate. The court or police has no power of forcing a woman for medical examination against her will.
• Consent has to be taken.
• Examination should be performed in the presence of a third person (female).
• General details of patient with identification marks & statement should be collected.
• Examine the clothes for signs of struggle like tears & for stains.
• Marks of violence on body like scratches, bruises.

Genitals:

• Pubic hair should be sent for chemical exam for semen & blood.
• Stains on thighs should be examined.
• Examine vulva for swelling, bruising, tenderness.
• Examine hymen (ruptured or not, if yes- recent or remote)
• Two vaginal swabs should be sent for chemical examination.

Presence of spermatozoa:

• Motile sperms in vagina- upto 100 hours.
• Non-motile sperms in vagina- upto 17 days.

Rape on children:

• Signs of struggle are less marked.
• Tearing of vulval & vaginal tissues.
• Infections are more common.
• Hemorrhage.
• Hymen is usually intact.

Accidents following Rape on Children:

• Convulsions or epileptic fit.
• Mental derangement due to psychic trauma.
• Death from shock due to fear & tear.
• Syncope due to excessive bleeding.
• Death due to septic infection.
• Death due to asphyxia.

Examination of Accused:

• Should be done as soon as possible.
• General development & mental condition of accused.
• Signs of struggle of victim, like scratches on face and private parts.
• Clothes for signs of struggle, seminal or blood stains.

• Local examination of genitals include:

a.Development

b.Potency

c.Any abnormality

d.Blood or seminal stains

e.Vaginal epithelial cells or penis

f.Smegma (absent in uncircumcised men)

g.Any injury to penis.

• Pubic hair should be sent for examination.

Incest:

• Sexual intercourse b/w close blood relations, b/w whom marriage is prohibited e.g. father, brother or uncle of a woman.
• Occurs b/w mental defectives where alcohol removes the natural inhibition etc.

Un-natural Sexual Offenses:

• Sexual intercourse against the order of nature with any man, woman or animal.
• Types:

A.Sodomy

B.Bestiality

C.Triabadism

A. Sodomy

Sodomy: Un-natural or anal intercourse b/w two men (homosexual sodomy) or b/w a man & a woman (heterosexual sodomy). It was practised in a town called Sodom.

Peaderasty: If the victim is a small or a young girl/boy, it is k/a paederasty. The accused is usually the pedophile.

Catamite: Passive agent is called catamite.

Sodomite: Active agent is called sodomite.

Buccal coitus: Intercourse b/w penis of a man & oral cavity of another man, a woman or a child. It is also known as coitus per os/sin of Gomorrah.

Examination of Passive Agent:

Non-Habitual

• Anal orifice dialted, irritable, inflamed & tender to touch.
• Abrasions of the skin are seen.
• Radial fissure of mucus membrane is seen.
• Defecation may be painful
• Blood stains may be seen on anus, perineum / clothes.
• Lubricant may be present.
• Signs of struggle may be present.

Habitual

• Usually hijras or eunuchs.
• Shaved anal regions.
• Funnel shaped anus.
• Muscles of anus lose tone.
• Loss of rugosity of mucosa or disappearance of radial folds.
• Prolapse of rectal mucosa.

Examination of active agent:

• Presence of smell transferred by anus.
• Traces of feces on penis.
• Abrasions & bruises on glans.
• Tearing of frenulum of penis.
• Stains of semen, blood or feces on penis.
• Examine for potency.
• Elongated & constricted penis (habitual sodomite).
• Presence or absence of smegma indicates time since last intercourse (in uncircumcised).

B. Bestiality: Sexual intercourse b/w a human being with a lower animal, either anus, vagina or any other opening.

Accused

• Fecal matter of animal may be seen.
• There may be an injury to penis.
• Blood, seminal or fecal stains may be seen on body or clothes.

Animal

• Semen may be seen in vagina or anus.
• Human hair may be seen on animal body.
• Injuries may be found on the anus of the animal.

Sexual perversions: are persistently indulged sexual acts or fantasies in which complete satisfaction is sought and obtained w/o sexual intercourse.

1.Tribadism- Homosexual connection b/w two women & consists of mutual friction of external genitals. (Lesbianism)

2.Masturbation- Sexual gratification by a person w/o external help in the form of self-indulgence. Mild masturbatory exercises are common and are of little importance.

3.Sadism- Sexual perversion in which sexual gratification is obtained by inflicting pain on opposite partner. In extreme cases of sadism, murder serves as the stimulus for sexual act leading to erection, ejaculation and orgasm called “Lust Murder”.

4.Masochism- Sexual perversion in which sexual gratification is obtained on receiving a painful stimulus from opposite partner (opposite of sadism). Named after Von Sacher Masoch, an Austrian novelist.

5.Fetichism- It is the sexual gratification produces by the sight of some part of woman’s body or their articles. E.g. shoes, stockings, underclothing.

6.Exhibitionism (Indecent exposure)- Sexual gratification is obtained by exhibition of genitals in presence of opposite sex.

7.Transvestism or eonism- Sexual pleasure is obtained by wearing the dress of the opposite sex.

8.Uranism- Sexual gratification obtained by fingering, folding or licking of genitals.

9.Necrophilia- Desire for sexual intercourse with dead bodies. Said to have sadomasochistic foundation and that decomposition, foul smell, coldness serve as stimulus for intercourse.

10.Voyeurism or scoptophilia- Sexual gratification obtained on watching genitals of other people indulged in sexual act.

11.Frotteurism- A compulsion to rub the genitals against other persons usually in buses etc. to obtain sexual satisfaction. It is punishable under IPC with fine upto Rs. 200.

12.Urolangia (coprophilia)- Sexual excitement is obtained by sight or odor of urine or feces.

MISCARRIAGE OR ABORTION

Definition:

Expulsion of product of conception at any time before full term.

After a pregnancy is apparent, the loss of the fetus up to 24 weeks is usually called a ‘spontaneous abortion’ or ‘miscarriage’; from 24 weeks to full term, it may be called a ‘premature birth’.

The punishment- 3 years imprisonment to transportation for life.

Classification:

1. Natural:

Spontaneous

Accidental

2. Artificial:

Justifiable

Criminal

Criminal abortion

• A criminal abortion is the deliberate ending of a pregnancy outside any legal provisions that have been made by the state for this act. A criminal abortion is a serious criminal offence

Methods of performing illegal abortion:

• Drugs and toxins have been used for millennia to try to remove unwanted pregnancies, but most of them are quite ineffective.
• In South-East Asia, unripe pineapple is alleged to produce miscarriage. However, none of these substances is known to have any predictable or significant effect on the uterus
• Other substances that have a contractile effect on smooth muscle have a better theoretical chance of success and these include ergot, pituitary extracts and quinine.

• Other substances normally used in obstetrics, particularly prostaglandins, are also used to induce abortions and are potentially more potent .
• Another group of chemicals is the strong purgatives such as colocynth, croton oil or jalap, which simply cause general debility to the woman, but they are highly unlikely to cause an abortion.
• Instrumentation is commonly practised, involving a wide variety of devices from surgical probes and bougies to the crudest implements made of metal or wood, as well as bicycle spokes, metal coat-hangers or even twigs from trees.
• The dangers of instrumentation are perforation and infection.

• The fundus may be perforated and the instrument pushed up into the intestines or even the liver.
• General violence in an attempt to induce a ‘spontaneous’ abortion may still be encountered on rare occasions.
• Other methods that are thought to be capable of inducing a ‘spontaneous’ abortion include the taking of very hot baths, ingestion of large quantities of alcohol, vaginal douches with many substances, and violent exercise such as skipping, jumping and even riding horses or bicycles over rough ground.
• Syringe aspiration is a method used by both legal and criminal abortionists.

Drugs for abortion

Mechanical Violence for Abortion

General:

1. Violent exercise like jumping, cycling, horse riding, heavy weight lifting, driving on rough roads.
2. Severe pressure on abdomen- blow, kick, jumping over abdomen.
3. Cupping on hypogastrium
4. Hot and cold bath alternatively

Local:

1. Dilatation of cervix- instrumentation, abortion stick, curettage, electricity.
2. Local irritation by abortifacient

Legal termination of pregnancy

Many countries now have legal provisions for the medical termination of pregnancy. This is often called ‘therapeutic abortion’,

RULES

• The termination must be performed by a registered medical practitioner.
• It must be carried out in a Health Service hospital or a place specifically registered for the purpose.
• Two registered medical practitioners must examine the woman (not necessarily together) and certify that grounds for termination exist.
• Neither of these doctors needs to be the doctor who actually performs the operation.
• The termination must be notified to medical officers of the appropriate government department.

Consent to termination of pregnancy

• The only consent that is required for termination of pregnancy is from the woman herself, provided she is competent to make that decision.
• The consent of a husband or permanent partner (if he accompanies the woman) may be obtained as good clinical practice; however, the woman’s wishes are paramount and a husband’s or partner’s objections are not relevant in English law.
• Any competent young girl may seek medial advice and may consent on her own to an abortion, although for girls under 16 the doctor should seek to encourage them to discuss the matter with their parents or carers

A photograph of only historic interest in the UK. This

woman had died of air embolism after attempting to induce an

abortion with a Higginson syringe, which can be seen below her

right foot.

Autopsy appearance of a septic uterus following an

illegal abortion.

Differences b/w criminal & natural abortion

Natural

• Cause- natural
• Genital tract- not injured
• Foreign body in genital tract- not present
• Sepsis- not usually
• Signs of violence- nil
• Toxic drug effect- nil
• Fetal injury- nil

Criminal

• May be injured
• May be present
• Frequent
• Usually present
• May be present
• May be present

Complications of criminal abortion

1. Shock
2. Haemorrhage
3. Air or fat embolism
4. Perforation of uterus
5. Sepsis
6. Poisoning by drugs
7. Sub-involution of uterus
8. Death