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

MEDICO-LEGAL AUTOPSY

Autopsy, necropsy and post-mortem examination are synonymous, although post-mortem examination can have a broader meaning encompassing any examination made after death, including a simple external examination.

In general terms, autopsies can be performed for two reasons: clinical interest and medico-legal purposes.

The clinical autopsy is performed in a hospital mortuary after consent for the examination has been sought from and granted by the relatives of the deceased. The doctors treating the patient should know why their patient has died and be able to complete a death certificate even in the absence of an autopsy.

These examinations have been used in the past for the teaching of medical students etc. and for research.

The medico-legal autopsy is performed on behalf of the state.

A poor autopsy is worse than no autopsy. In medico-legal autopsy, often the history is absent, sketchy, doubtful.

The aims of these examinations are much broader than those of the clinical autopsy and include:

to identity of the body;

• to estimate the time of death;

• to identify and document the nature and number

of injuries;

• to interpret the significance and effect of the injuries;

• to identify the presence of any natural disease;

• to interpret the significance and effect of the natural disease present;

• to identify the presence of poisons; and

• to interpret the effect of any medical or surgical treatment.

Taken at its broadest, autopsies can be performed by any doctor, but ideally they should be performed by a properly trained pathologist in mortuary at day-time, without the presence of any unauthorized person.

Rules for medico-legal autopsy:

1. The body should be labeled as it arrives the mortuary.
2. Conducted never in a private room, only in mortuary.
3. However, autopsy is done at the site when advanced level of putrefaction, causing difficulty in transportation.
4. Conducted only when official order from police or magistrate.
5. Done without undue delay after receiving the order.
6. M.O. should read the inquest report carefully to know the apparent cause and circumstance of the death.
7. Conducted in day light as far as possible.
8. The body must be identified by the police constable who accompanies it.
9. In unidentififed bodies, marks of identification, photographs and finger prints should be taken.
10. No unauthorized person should be present during autopsy.
11. The investigating police officar may be present.
12. The details are noted and sketches are made.
13. Both positive and negative findings should be recorded.
14. After autopsy, the body should be handed to the police constable.
15. The PM report should not be handed to the party.

Autopsy Report:

Consists of

1.The pre-amble: mentions the authority ordering the examination, date and place of the examination, name and sex of the deceased.

2.The body of the report: consists of detailed external and internal examination, focusing nature, direction, exact situation and dimension of the wounds, diagrams are of value.

3.Conclusion: as to the cause of death should be concise in clear language and honest. It should be followed by signature and qualification of the doctor.

External examination:

• The clothing should be listed and examined, type of garment, colour, tears, loss of button indicating a struggle is explained as each item is removed from the body. Blood stain, grease, seminal stain, poison, vomit should be kept for analysis. Clothes should be placed in clean separate bags.
• Nail scrapping- any visible fiber or other matter at the hand should be removed and placed in envelope. Ten small envelopes are labeled, one for each finger.
• Height and weight, general state, body built.
• General condition of the skin- rash, petechiae, colour.
• General description- age, sex, colour, race, nutrition, hair, scar, tatoo, moles, circumcision, pupils.
• Vaginal and anal swaps, pubic hair should be combed through. Matted pubic hair should be cut with scissors and the samples of pubic hair should be taken.

• The stain of mud, vomit, faeces, gun powder described.
• The presence of signs of disease eg., edema of legs, surgical emphysema, skin disease etc.
• The time since death should be noted from rectal temperature, rigor mortis, post-mortem hypostasis, putrefaction.
• The face examined for frothy fluid at the mouth and nose, cyanosis, petechiae, pallor etc.
• The eyes examined for conjunctiva, opacity of the cornea and the lens, petechiae. The ears for leakage of blood or CSF.
• The neck examined for bruises, finger nail abrasion, ligature mark.
• The abdomen, thorax, thyroid, breast, back, external genitalia and the natural orifices should be noted.
• The position of limbs should be noted. Hands examined for injuries, defense wounds, electric mark etc. and anything grasped in the closed fist.

Internal examination:

• Skin incison-

‘I’ shaped from the chin to symphysis pubis.

‘Y’ shaped incision from acromial process down below the breast to xiphoid and down to the symphysis pubis.

Modified ‘Y’ shaped incision- incision made in the midline from supra sternal notch to the symphysis pubis. The incision extends from the suprasternal notch over the clavicle to its centre on both sides and then passes upwards over the neck behind the ear.

• Abdomen- The recti muscle of the abdomen are divided about 5cm above the symphysis pubis, peritoneum is cut upto xiphoid, the condition of abdominal cavity and the organs is observed. Blood, pus if seen in the abdominal cavity, should be measured.

• Neck- a block should be placed under the shoulder to extend the neck, the skin dissection carried out immediately deep to skin to the lower border of lower jaw, sternomastoid muscle is freed from its attachments, the trachea, larynx, pharynx are pulled away from the pre-vertebral tissue by blunt dissection.
• Mouth- a knife inserted under the chin through the floor of mouth, cut along the sides of the mandible, to the angle of mandible dividing the neck muscles attached to the jaw. The soft palate is then cut to include the uvula and tonsils with tongue and neck organs to be removed. The knife is turned backwards and laterally to divide the posterior pharyngeal wall. The larynx and pharynx are pulled down, the dissection is then carried distally through the prevertebral muscles on the anterior surface of the cervical vertebra.

• Chest- pneumothorax should be noted by creating a pocket filled with water before the proper chest dissection. The wall is punctured with the knife under the water. The chest is opened by cutting the costal cartilage beginning from the second cartilage near the costo-chondral junction. The pleural cavity should be examined. Note the lumen of the main pulmonary vessels, right atrium and ventricle for embolism, distension or collapse of lungs, pleural cavity for fluid, pus, adhesions. Note the pericardium for cardiac temponade, collect blood sample from the heart for toxicological examination.
• Air embolism- in the heart can be found by cutting the pericardium anteriorly and grasping the edge with hemostat on each side. The pericardial sac is filled with water and the heart is punctured with scalpel and twisted few times to release escape of bubbles of gas.

• Fat embolism- if suspected the pulmonary artery should be dissected under water and the escape of fat droplets noted.
• There are two distinct methods of removing the viscera from the abdominal cavity and thoracic cavity:

1.Virchows method- removing each organ seperately

2.Rokitansky method- removing all the organs ‘en masse’.

The organ should be described based on size, shape, surface, consistency, cohesion, cut surface.

• Esophagus: the esophagus is cut open from the posterior surface up to the cardiac end of the stomach. If death occurred due to rupture of esophageal varices, the break in the lower end should be noted.

• Lungs: look for thrombi, emboli. The lung organ is crossed across from the apex to the base with a large brain knife, producing an anterio-posterior slice and examined for consolidation, edema, emphysema, tumor, infarction. The smaller bronchi are examined for mucosal thickening, infection and blockage.
• Aorta: whole length of aorta is cut on its posterior surface from the iliac vessels, around the arc upto the aortic valve to note chronic aortitis, obstruction of coronary arteries.
• Heart: is held at the apex and lifted upwards and the vessels are cut as far away as possible. This isolated heart is opened in the direction of the flow of blood. The right atrium is cut between the opening of superior and inferior venecava. Through the right atrium and through the tricuspid orifice, the right ventricle is opened along the lateral margin.

• Note whether the content of right ventricle and auricle is fluid blood, currant jelly clot or chicken-fat clot. The left atrium is cut along the lateral wall, extending through the mitral orifice and passes along the lateral margin of the left ventricle upto the apex. After the blood clots in the cavities are removed, the measurements of the valves, circumference and thickness of ventricles are taken. The coronary arteries are examined by making serial cross sections along the entire course of vessel about 2-3mm apart.
• Agonal thrombi: seen in case of persons dying slowly with circulatory failure, a firm tough pale yellow thrombus, usually on the right side of the heart, filling the right auricle and ventricle and pulmonary artery. It branches like a tree like cast. In the left ventricle, agonal thrombi are not so big.

Post mortem clots: 2 types-

• Black currant jelly: soft, lumpy, uniformly dark red, moist clot formed when the blood clots rapidly.
• Chicken-fat clot: when red cells sediment before the blood coagulates. The red cells produces a clot similar to the first type. Above this a pale or bright yellow layer of serum and fibrin is seen called chicken fat. It is soft, elastic jelly like.
• Usually a mixture of the two is found. Post-mortem clots are moist, smooth, shiny, homogenous, rubbery, not attached to the underlying wall, and there are no fine white lines of fibrin (striae of zahn).

• Stomach: opened along its greater curvature from the cardiac to pyloric end. The contents are examined for food, digestion, smell, colour. In massive hemorrage, the stomach is filled with large soft clots which may take the form of a task of gastric outline.
• Intestine: the superior mesenteric vessels are examined for thrombi, emboli. The small intestine is opened along the line of mesenteric attachment.
• Liver: weight, size, colour, injury are noted. It is cut into slices 2cm thick which run in the long axis. Amoebic abscess are usually single large and confined to the right lobe. Pyogenic abscess are multiple. In fatty liver, cut section is greasy. In portal cirrhosis, the liver is sturded with nodules, 1-3mm in diameter (micro nodular).
• Spleen: removed by cutting through its pedicle. Note the size, weight, rupture.

• Pancreas: sliced by a series of cuts at right angle to the long axis which gives the best exposure of ductal system.
• Kidney: renal artery ostia are examined. The capsule of the kidney is stripped, the kidney is sectioned longitudinally to split in half and open the pelvis to see calculi and inflammation.
• Female genitalia/uterus: the tube, the ovaries and the uterus are freed from the pelvis and are removed. If the uterus contains a fetus, its age should be determined.
• Head: head is fixed by head rest. A coronal incision is made in the scalp from the mastoid process just behind ear and carried over the vertex to the opposite mastoid. The scalp is reflected forwards and backwards. The saw line is made in slightly ‘V’ shaped direction so that the skull cap will fit exactly back into the correct position. The meninges are examined and the brain is examined.

MECHANICAL INJURY

ML Classification of Injury:

MEDICAL

1.Mechanical

A)DUE TO BLUNT FORCE

Abrasion

Contusion

Laceration

Fracturew and dislocation

B)DUE TO SHARP FORCE

a)Incised wound

b) Chop wound

c)Stab wound

C.FIREARM WOUNDS

a) Firearm wound

2.Thermal

DUE TO COLD-frost bite ,immersion foot

DUE TO HEAT-burns,scald

3.Chemical corrosive acid ,corrosive alkali

4.physical- electricity .lightning,Xray.

5.explosions

LEGAL

1.SIMPLE

2.GREVIOUS

MEDICOLEGAL

1.SUICIDE

2.HOMICIDE

3.ACCIDENT

4.FABRICATED

5.DEFENCE

Contusion:

• Surface injury to the skin and sub-cutaneous which leads to an effusion of blood into tissues
• usually caused by blunt trauma.
• Appears 1-2 hours after injury.
• may take the shape of weapon eg railway tract appearance.
• Children, old, obese women bruise easily.
• Mongolian spot shouldn’t be confused with bruise.
• Contusion may be also in the internal organs
• Gravity shifting of bruise may occur in late occuring bruises

Color changes in a bruise:

• 1st day- red
• 2nd day- 3rd day -bluish
• 4th day- brown day(haemosiderin)
• 5th-6th day- green(haematoidin)
• 7th-12th day- yellow(bilirubin)
• 13th-15th day ,2 weeks – normal
• Subconjunctival Hage donot undrego colour change

ML aspect of contusion:

• Patterned bruise-Identification of weapon,ligature,vehicle
• Degree of violence from size
• Time since injury
• Purpose of injury
• Homicidal, suicidal, accidental .position of assylant while arms are grasped

Difference between antemortem and postmortem bruise:

Antemortem contusion

• Swelling present
• Color changes present
• Epithelium abraded
• Clotted blood in tissue present

Postmortem contusion

• Not present
• Not present
• Not present
• Not present

Difference b/n artificial and true bruise

Artificial bruise

• By juice of marking nut,calotropis or plumbago
• At exposed accessible site
• Dark brown colour
• Shape irregular
• Margins well defined and regular
• Itching present
• Positive chemical test

True bruise

• Trauma
• Anywhere
• Typical colour changes
• Usually rounded
• Not well defined,diffuse,no vesicles
• Absent
• negative

Patterned intradermal bruise on the forehead due to a

fall onto ribbed ceramic tiles.

Bruising of the upper arm. The pattern of these bruises

is typical of forceful gripping. Small abrasions from fingernails are

also seen.

Typical ‘railway-line’ bruises caused by a wooden rod.

Note that the centre of the parallel contusions is unmarked.

Recent bruising of the abdominal wall and scrotum due

to kicking.

Abrasion:

• destruction of only superficial layer of epidermis,thickness of skin is 1.6mm.
• Bleed very slightly
• Heal very rapidly
• Leave no scar

Types of abrasions:

• Scratch or linear abrasion-has length but no significant width.eg by pin, thorn, nail etc. very sharp objects
• Graze(sliding,grinding abrasion)-longitudional parallel lines. by rough surface in contact with a broader surface of skin, eg. RTA
• Patterned abrasion (pressure and impact abrasions)- thumb mark in strangulation, ligature mark in hanging, wheel mark of tyre,teethbite mark.

Age of abrasion by color change: exact age cant be determined

• Red color- fresh
• Red scab- 12-24 hours-by dryind of blood and lymph
• Reddish brown scab- 2 to 4 days
• Healing from periphery- 4 to 7 days,dark brown
• Complete healing- 10 to 14 days
• Seperation of scab- 10 to 14 days

ML importance:

• Identification of object
• Direction of injury
• Time since injury
• Possibility of internal injury
• Somtime erosion by ants look like abrasion.d/d-ants produce abrasion that are brown,irregular margin,commonly at mucocutaneous junction about eyelids,nostril,mouth,axilla,by hand lens show multiple cresent shaped,sand like bite marks

Difference

Antemortem abrasion

• has Moist surface
• Bleeding present
• On drying scab formation,scab slightly raised
• Blurred margin
• Inflammation present
• Intravital reaction and congestion seen

Postmortem abrasion

• Dry surface
• No bleeding
• No scab
• Sharply defined margin
• Inflammation absent
• Not seen

Abrasions from scraping against a rough surface

during a fall.

Extensive abrasions caused by stumbling, drunk and

naked, against furniture. The dark leathery appearance is due to

post-mortem drying of the damaged areas of skin

Incised wound:(cut,slash,slice)

• Clean cut through tissues ,usually skin and subcut. By sharp edged or cutting weapon, eg. knife, sword, glass.
• Edges are smooth, clean cut and everted.
• Broader than the edge of weapon
• Length is greater than depth and breadth.
• Bleed profusely
• Superficial towards the end of wound k/a tailing
• Edges may be inverted in case of underlying muscle attached to skin, eg. scrotum.

ML importance:to find homicidal,accidental or suicidal

• Homicidal, anywhere in the body, deep
• Suicidal- multiple, superficially, usually in the left hand
• Accidental- anywhere
• Edges of the wound indicate: antemortem or postmortem, sharp or blunt weapon.

Difference between incised wound

Antemortem

• Bleed freely and profusely
• Arterial spouting present
• Blood is clotted
• Edges gape
• Inflammation present
• Serum serotonin and histamine increased

Postmortem

• Very slight or no hemorrhage
• Not present
• Not clotted
• Edges closely
• Not present
• Not raised

Difference between suicidal and homicidal cut-throat wounds

Suicidal

• Left side of neck,passing across the throat,usually in rt handed
• Level above thyroid cartilage
• Multiple no ,superficial,rarely single
• Edges usually ragged,due to overlapping
• Hesitation cuts present
• Defence wound absent
• Weapon usually present
• Clothes not torn or damaged
• Circumstancial evidence, quite place

Homicidal wounds

• Usually on both sides
• On or below thyroid cartilage
• Multiple .cross each other at a deep level
• Sharp and clean cut,bevelling may be seen

Incised wound to the flank; it is clearly longer than it

is deep

A complex stab wound where all three injuries are

caused by a single action. The first entry is in the right breast; there

is an exit wound in the middle and a re-entry wound over the centre

of the chest.

Stab or punctured wound:

• Type of incised wound whose depth is greatest in dimension.
• Eg. Knife wound, dagger

Types of stab wound:

• Penetrating wound- has only wound of entry
• Perforating wound- has both entry and exit wound

Features of stab wound:

• Aperture is usually smaller than the weapon due to elasticity of the skin
• Depth is greater than breadth and length.
• Very little external hemorrhage but profuse internal hemorrhage

• Shape- Wedge shaped with knife, elliptical with dagger, rounded with needle, slit-like opening with screw driver,
• Margins of entry wound are clean and inverted,
• Margins of exit wound are small and everted
• Direction determined by line joining entry and exit wounds or X-ray after radio-opaque dyes.

ML(medical legal ) importance:

• Nature of weapon
• Direction of wound
• to find Suicidal, homicidal or accidental

Lacerated wound:

• Wound in which skin and underlying tissue is turned due to blunt force application

Classification:

• Split laceration
• Stretch laceration
• Avulsion
• Tears (caused by irregular sharp object)

1.Split laceration (incised looking wound)

• Usually found overlying the bones
• caused by blunt perpendicular impact
• Skin splits between 2 hard objects and simulate an incised wound

2.Stretch laceration:

• Overstretching of skin produces a flap
• Caused by blunt tangential impact
• Also by sudden deformity of bone after a fracture

3. Avulsion:

• Caused by horizontal crushing impact
• Commonly truck, bus wheel, muscles are crushed
• Also known as degloving of skin

Multiple lacerations from a blunt steel bar. These were

initially mistaken by the police for axe wounds. The abraded or

crushed margins can be easily seen.

Laceration of an arm of a pedestrian struck by a car.

The impact has been oblique, causing a flap of skin to tear away

to the right.

Nature of injuries- simple, grievous, dangerous

1.Simple injury:

• Neither serious nor extensive
• Heals rapidly w/o leaving permanent deformity or disfigurement

2. Grievous injury:

• Emasculation
• Permanent loss of sight of either eye
• Permanent loss of hearing of either ear
• Destruction of joint or any member of body eg. Limb
• Permanent disfigurement of head or face
• Fracture or disfigurement of bone or tooth
• Any hurt to be in hospital for 20 days

3. Dangerous injury:

• Compound fracture of skull
• Injury to vital organ eg. spleen, liver
• A wound of large artery eg. radial femoral

INJURY DUE TO HEAT AND ELECTRICITY

The heat source may be dry or wet; where the heat is dry, the resultant injury is called a ‘burn’, whereas with moist heat from hot water, steam and other hot liquids it is known as ‘scalding’.

Burning

1 first degree – erythema and blistering (vesiculation);

2 second degree – burning of the whole thickness of the epidermis and exposure of the dermis;

3 third degree – destruction down to subdermal tissues

Where the burnt area exceeds 50 per cent, the prognosis is poor even in first-degree burns.

Clinical conditions due to high heat exposure

1.Heat cramp- miner’s cramp, fireman’s cramp due to rapid dehydration through loss of water and salt in the sweat, severe and painful paroxysmal cramp of muscles of leg, abdomen, arms.

2.Heat prostration- heat exhaustion, heat syncope, heat collapse.

• Is a condition of collapse without increasing body temperature, which follows exposure to excessive heat.
• Precipitated by muscular work and unsuitable clothing
• Patient usually recovers if placed at rest but death may occur from heart failure.

3.Heat hyperpyrexia or stroke- characterized by rectal temperature more than 41 degree centigrade and neurological disturbance as psychosis occurs.

• Term sunstroke used when direct exposure to sun is there.
• High temperature, increased humidity, muscular activity and lack of acclimatization are the principle factors in initiation of stroke.
• Failure of cutaneous blood flow and sweating, the factors which control the body temperature, lead to breakdown of heat regulating centre of hypothalamus.

Burns in a victim of a house fire.

Scalds:

• Runs or dribbles of hot fluid will leave characteristic areas of scalding – these runs or dribbles will generally flow under the influence of gravity and this can provide a marker to the orientation of the victim at the time the fluid was moving.
• Scalding is seen in industrial accidents where steam pipes or boilers burst and it is also seen in children who pull kettles and cooking pots down upon themselves.

The examination of bodies recovered from fires

• The findings of soot in the airways and carbon monoxide in the blood indicate that the person was breathing after the fire began.

Post mortem findings

A.External:

• Burnt fabrics
• Smell of kerosene, petrol over fabrics
• Postmortem hypostasis and rigor mortis can not be assessed
• Face is swollen and distorted,
• Tongue protruded and swollen and may be burnt
• Froth at mouth and nostril due to pulmonary edema due to heat irritation of air passage and lungs
• Pugilistic attitude (boxing, defense attitude)- characteristic of great heat exposure; the flexor muscles being bulkier than extensor contract more.
• Heat rupture in severe burning or charring, skin contracts and heat ruptures occur
• Flash burn due to sudden ignition or explosion of gases

B.Internal:

1.Heat hematoma- has the appearance of extra dural hemorrhage

• Clot has honey comb appearance
• Parieto-temporal region is the most common site of such hemorrhage

2.Thermal fracture of skull-

3.Laryngeal edema

Scalds of the buttocks and feet on a child who had been dipped into a bath of extremely hot water as a punishment.

Trachea showing soot and mucus following inhalation of fire fumes and smoke.

Skin splits in the victim of a house fire. These splits were initially thought to be incised wounds.

ELECTRICAL INJURY

• Usually, the entry point is a hand that touches an electrical appliance or live conductor,
• The exit is to earth (or ‘ground’), often via the other hand or the feet.
• In either case, the current will cross the thorax, the most dangerous area for a shock because of the risks of cardiac arrest or respiratory paralysis.
• When a live metal conductor is gripped by the hand, pain and muscle twitching will occur if the current reaches about 10 mA.
• If the current in the arm exceeds about 30 mA, the muscles will go into spasm, which cannot be voluntarily released because the flexor muscles are stronger than the extensors; the result is for the hand to grip or to ‘hold on’.
• This ‘hold on’ effect is very dangerous as it may allow the circuit to be maintained for long enough to cause cardiac arrhythmia, whereas the normal response would have been to let go so as to stop the pain.

• If the current across the chest is 50 mA or more, even for only a few seconds, fatal ventricular fibrillation is likely to occur.
• The victims of such an arrhythmia will be pale.
• Even more rare are the instances in which the current has entered the head and caused primary brainstem paralysis, which has resulted in failure of respiration.

The electrical lesion

• Where the skin is wet, there may be no signs at all, as the entrance and exit of the current may be spread over such a wide area that no focal lesion exists.
• Usually, however, there is a discrete focal point of entry.
• The focal electrical lesion is usually a blister, which occurs when the conductor is in firm contact with the skin and which usually collapses soon after infliction, forming a raised rim with a concave centre.

• The skin is pale, often white, and an areola of pallor (due to local vasoconstriction) is a characteristic feature. The blister may vary from a few millimetres to several centimetres.
• The skin often peels off the large blisters leaving a red base.
• The other type of electrical mark is a ‘spark burn’, where there is an air gap between metal and skin.
• Here, a central nodule of fused keratin, brown or yellow in colour, is surrounded by the typical areola of pale skin.

The electric mark (Joule burn):

• It is specific and diagnostic of contact with electricity
• It is found at the entry point.
• These are round or oval, shallow craters, 1-3cm in diameter, and have a ridge of skin of about 1-3 mm height.
• The crater floor is lined by pale flattened skin
• When the contact is prolonged, there may be charring.
• Produced by conversion of electricity into heat within the tissue.

Exit mark:

• Variable feature, but have some of the features of entrance mark
• May be more damage of tissue
• Often seen as splits in the skin, continuous or interrupted
• Ante mortem electric burns can not be distinguished from postmortem electric burns

Multiple minute electrical marks on the hand caused by contact with a faulty electrical drill.

Extensive electrical burns with scorching and blistering.

Electrical mark from a mains wire wrapped around the neck. There is marked hyperaemia and adjacent pallor, with evidence of blistering.

Hyperaemia from a defibrillator paddle, caused during

attempted resuscitation.