Nobel Medical College & Teaching Hospital

(P.) Ltd.
[ Biratnagar, Nepal ]
12th Batch MBBS
Credit: Sampa Goswami
Nidhi Raj
Reeza Tandukar
1. Defence incised wound over palm:

Manner – Homicidal
Weapon – Sharp
Two type – Active defence injuries
Passive defence injuries

**They are the wound of extremities which result from immediate and initiative reaction of victim
towards an attack.

2. Yellow oleander seed:

Group – Cardiac poison

Active principle – Thevetin
Thevotoxin
Cerberin
Peruvoside
Fatal dose – Seeds: 8-10
Root: 15-20 gm
Fatal period – 2-3 hours
Sign & symptoms – **Burning sensation in mouth, dryness of throat, tingling & numbness of
tongue.
**Vomiting, dirrhoea, headache
**Rapid weak, irregular pulse.

Antidote – **Gastric lavage

**Atropine 1 mg, 2 ml of Adrenaline 1:1000 and 2 mg of noradrenaline to
counteract heart block.
**Symptomatic treatment.
3. Poisonous Mushrooms (food poison group):

Active principle - **Amanita muscaria: Muscarine

**Amanita phalloides: Phalloidin, phalon & B amanitin.
Fatal dose – 2-3 mushrooms.
Fatal period – 24 hours

Sign & symptoms -

Irritant Neurotic
Burning stomach pain Giddiness
Vomiting Headache
Cyanosis Delirium

4. Pattern contusion of tyre (one shoulder)/ Imprint abrasion/ Impact abrasion:

Kind of injury - Patterned contusion

Mechanism - Due to impact with a hard patterned tyre object with ridge and groove.
Manner – **Usually accidental
**Can be homicidal or suicidal
Cause – Blunt injury over chest.
MLI – Bruise may indicate nature of weapon specially when death occurs seen after infliction of
injury.
5. Strychnos Nux Vomica:

Group – Neurotic (spinal poison)

Active principle – Strychnine, Brucine, Loganine
Fatal dose – 50-100 mg or crushed seed.
Fatal period – 1 to 2 hours.
Sign & symptoms – Anxiety, nausea, mydriasis, muscle twitching, convulsion, trismus, risus
sardonicus.
MLI – Accidental poisoning (more common).
Used for killing cattle as arrow poison.
Taken as an aphrodiasiac.
Homicidal in form of alkaloid or powdered.
MOA – Competitively blocks ventral horn, motor neuron, postganglionic receptor of spinal cord.

6. Phosphorus:

Two forms: **White or crystalline

**Red or amorphous
Uses:
Red phosphorus – Used on side of matchboxes
White phosphorus – Fertilizers, Insecticides, rodenticides.
Fatal dose: 60-120 mg of white phosphorus.
Fatal period: within 24 hours.
MOA: Protoplasmic poison and affects cellular oxidation.
7. Abrus Precatorius:

**Organic irritant.
Active compound: **Abrin (toxalbumin)
**Abrine (N-Methyl tryptophan)
**Abralin (Glycoside)
Fatal dose: 1-2 crushed seed orally.
90-120 mg of abrin injected.
Fatal period: 3-5 days.
Sign & symptoms:
On injection – Vertigo, faintness, dyspnoea
On ingestion – Abdominal pain, bloody diarrhoea, weakness, weak rapid pulse, rectal
bleeding, trembling of hands.
MLI: **For homicide, two needles kept between the fingers.
**Seeds are used as an abortifacient
**Used for killing cattle.
**Powdered seeds are used by malingerers to produce conjunctivitis.

8. Semecarpus anacardium:

**Organic irritant.
Active principle: **Semecarpol (0.1%)
**Bhilawanol (15-17%)
Fatal dose: 5-10 gm
Fatal period: 15-24 hours
Sign & symptoms:
**Local application to skin- irritation, painful blisters, itching
**On ingestion of juice- Blisters on throat, dyspnoea, tachycardia, hypotension, cyanosis.
MLI: **Accidental poisoning.
**Juice introduced in vagina as a punishment.
**For criminal abortion.
9. Cartridge of rifle firearm:

Cartridge is one unite of ammunition which consists of:

1. Cartridge case with percussion cap containing primer.
2. Propellant charge (gun powder)
3. Projectile / bullet / pellet.

10. Split laceration over forehead:

Possible weapon: Any blunt weapon (Stick, Iron, Brick)

Site: Scalp, forehead, eyebrow, iliac crest, lower jaw, perineum and chin.
**Occurs when soft tissues are sandwiched between hard objects.
11. Shot gun (smooth bore firearm):

(Firearm injury on temporal area by shot gun)

**It is intermediate mild range
**Irregular central wound of individual pellets.
Signs: Blackening – Absent
Tattooing – Absent
MLI: The debris found within the wound are useful to determine the bore of gun.

12. Macerated foetus:

**Aseptic autolysis
**Earliest sign of maceration is reddening of skin with peeling and slippage.
**Body is soft, flaccid and flatters out when placed on level surface.
13. Tattoo mark over shoulder:

**Special marks designed pictorial diagrams, alphabetical message made or written permanently
on skin of the body.
MLI: **Identification
**Religion (God of worship)
**Indication of lifestyle
**Gang members may wear a tattoo of allegiance and symbolism to indicate status.

14. Burn injury:

**Blackening (due to carbon particle)

Cause: Immediate – Neurogenic shock
Delayed – Septic shock, CO poisoning.
15. Opium:

Group: Cerebral neurotoxin (somniferum)

Active principle (components): Morphine, codeine, thebaine
Fatal dose: 2 gm
Fatal period: 6-12 hours
Sign & symptoms:
Stage of excitement – Euphoria, talkativeness, restlessness, hallucination
Antidote: Naloxone (1.2 mg/kg adult)
(0.4 mg/kg children)
MLI: **Ideal suicidal poison
**Infanticide by breastfeeding women who has smeared nipple with opium

16. Strangulation:

Cause of death: **Asphyxia

**Cerebral anoxia
**Vagal inhibition
**Ligature mark below the level of thyroid cartilage
**Bleeding from nose, ear, mouth more common
**Involuntary discharge of faeces, urine due to relaxation of sphincter.
MLI: **Homicidal
**Accidental in helmet strap
17. Banded Krait:

Group: Organic animal irritant

Family: Elapidae
Sign & symptoms: **Abdominal pain
**Ptosis
**Dysphagia
**Dysarthria
**Chest pain
Treatment: **Control anxiety and fear of patient
**Prevent spread of venom by cleaning the wound, applying pressure over bite and
immobilization.
**Antivenom: 1. Monospecific/Monovalent antivenom when snake is identified
2. Polyvalent antivenom when snake is unidentified
MLI: **Snake bite are usually accidental and can be known occupational hazard.
**Homicidal by throwing snake on sleeping person

18. Saw Scaled Viper:

Group: Organic animal irritant

Family: Viperidae
Sign & symptom: Pain & oozing, local necrosis, parotid swelling, conjunctival edema, sub-
conjunctival haemorrhage, epistaxis etc.
Treatment: **Control anxiety and fear of patient
**Prevent spread of venom by cleaning the wound, applying pressure over bite and
immobilization.
**Antivenom: 1. Monospecific/Monovalent antivenom when snake is identified
2. Polyvalent antivenom when snake is unidentified
MLI: **Snake bite are usually accidental and can be known occupational hazard.
**Homicidal by throwing snake on sleeping person
19. King Cobra:

Family: Elapidae
**Venom produced is neurotoxic
Action: Venom acts on a curare, mainly on motor nerve cells and result in muscular
paralysis. In the order,
Muscle of mouth -> Muscle of throat -> Muscle of respiration
Fatal dose: 12 mg
Treatment: **Control anxiety and fear of patient
** Prevent spread of venom
**Antivenom and general measures.
MLI: **Usually accidental
**Rarely suicidal or homicidal
**Cattle poisoning
20. Root of Aconite (Cardiac poison):

Group: Cardiac poison

Form: Root – conical or tapering, shriveled dark brown with longitudinal wrinkles.
Active component: **Aconitine
**Pseudo-aconitine
**Indaconite
**Picraconite
**Aconine
Mechanism of toxicity:
First stimulate and paralyse nerves of myocardium, smooth muscle, skeletal muscle, CNS
and peripheral nerve.
Fatal dose: Root – 1-2 gm
Fatal period: 2-6 hours
Signs & symptoms:
**GIT – Nausea, vomiting, diarrhoea, numbness, tingling of mouth
**CVS – Hypotension, bradycardia, ventricular arrhythmia, chest pain
**CNS – Headache, vertigo, restlessness, giddiness
**MSK – Weakness of muscles
**Respiratory system – Slow, laboured and shallow
**Ocular – Hippus
Antidote: **Non-specific
**However gastric lavage is done
**Symptomatic treatment
**Atropine (0.5 mg IV)
MLI: **Accidental poisoning
**Used as abortifacient
**Ideal homicidal poisoning
21. Chronic Arsenic poisoning (hyperkeratosis):

Group: Inorganic metallic irritant

Form: Powder
Active component: **Arsenious oxide or arsenic trioxide
**Copper arsenite
**Arsenic sulphide
Mechanism of toxicity:
**Arsenic interferes with cellular respiration by uncoupling mitochondrial enzyme, inhibits
cellular glucose uptake and causes irritation of mucus membrane
Fatal dose: **120-200 mg of arsenic trioxide (adult)
**2 mg/kg (children)
Fatal period: 1-2 days
Sign & symptoms: Nausea, sweet metallic taste, garlic odour, hypotension, rice watery
diarrhoea, ventricular tachycardia, pain during micturition, intense thirst.
MLI: **Homicidal
**Cattle poisoning

22. Intracerebral haemorrhage:

**Hemorrhage found within cerebral parenchyma that is not in contact with surface of brain
Cause: Rarely trauma
Pathological: Hypertension, malformation
23. Aluminium Phosphide:

Group: Agricultural poison

Form: **Tablets (3 mg)
**Pellets (0.5 gm)
Active components: **Phosphine gas (PH3)
Mechanism of toxicity:
**Phosphine gas bind with cytochrome oxidase and causes tissue hypoxia and total
myocardial necrosis
Fatal dose: 150-500 mg for 70 kg adult
Fatal period: 1 hour
Sign & symptoms: Nausea, vomiting, diarrhoea, dizziness, ataxia, cardiac arrythmia,
respiratory distress
Antidote: **No specific antidote
**However gastric lavage is done
**Antacid is used
**IV fluid
MLI: **Mostly suicidal
**Accidental in children

24. Argemone mexicana:

Group: Food poisoning

Active principle: **Argemone plant (alkaloids)– Berberine
Protopine
**Argemone oil (alkaloids)– Sanguinarine
Dihydrosanguinarine
Sign & symptoms: Diarrhoea, marked edema of leg, loss of appetite, myocardial damage
Test: **Nitric acid test
**Paper chromatography test
25. Scorpion:

**Haemolytic factor mimics viperine snake bite with edema, pain and reddening.
**Neurotoxic factor mimics cobra bite or strychnine poisoning with nausea, vomiting, restlessness,
fever followed by convulsion, cyanosis, respiratory depression and death.

Treatment: **Immobilise the limb and apply torniquet above the sting site.
**Pack sting site with ice, incise and use suction
**Wash the site with weak solution of ammonia, borax
**A local anaesthetic (2% novocaine or 5% cocaine) injection at sting site to reduce
pain
**Specific antivenin

26. Cannabis Sativa or Indica:

Active principle: Cannabinoids (delta-9-tetrahydrocannabinol)

Fatal dose: **Charas – 2 gm
**Ganja – 8 gm
**Bhang – 10 g/kg
**THC – 30 mg/kg
Sign & symptom: Detachment, disinhibition, depersonalization, dreaminess, decreased
concentration, fear of dying, increase appetite, slight nausea, dizziness,
restlessness, ataxia, tachycardia, urinary frequency, impaired mental
function.
27. Epidural haemorrhage:

**Bleeding between inner surface of skull and dura-mater

Causes: **Blow over forehead
**Blow over occiput
**Blow on the vertex
**Fracture of skull
**Blow over temporal region
Clinical features: **Lucid interval – Immediate unconsciousness
Person slowly recovers consciousness
Second loss of consciousness
MLI: **Victim may also present with lucid interval
**Victim may be confused for alcoholic intoxication
**Victim may present with volitional activities

28. Ligature mark (Hanging):

**Oblique in direction
**Non-continuous
**Level in neck: above thyroid cartilage
**Base is pale, hard, parchment-like
**Single, simple, slip knot, on one side of neck
29. SKULL:

Feature Male Female

Rounder, smoother and
General appearance Rugged, heavier
lighter
Muscle marking More prominent Less prominent
Supraorbital ridge More marked Less marked
Mastoid process Larger Smaller
Square; set lower on the face; Rounder; set higher in the
Orbits
edges less sharp face; edges more sharp
Higher and narrower; edges Lower and broader; edges less
Nasal aperture
more sharp sharp

30. Effects of H2SO4 in gastric mucosa:

**Black charring of stomach

**Peppery feel
**Perforation of stomach common
31. Effects of HNO3 in gastric mucosa:

**Stomach wall soft, friable and ulcerated

32. Complete hanging:

**Body fully suspended and no part of body touches the ground

**Constricting force is weight of body
**Ligature mark side of neck above hyoid bone runs obliquely backwardsnon continuous upwards
and towards point of suspension
**Cause of death: asphyxia, venous congestions, combined asphyxia andvenous congestion,
cerebral ischemia, reflex vagal inhibition, fracture/dislocation of cervical vertebrae
33. Instruments:

**Needle and Thread: To sew cut section

**Scalpel: For skin incision & reflection of skin, fine dissection
**Dissection and Brain knife: For dissection of solid organ but not for intestine and blood vessels
**Blade saw, Hack saw, Electric saw: For dissection of bone, especially skull
**Metallic scale: To measure injuries or dimension of any organ
**Flexible tape: To measure injury
**Magnifying glass: To see detail of injury
**Hammer & chisel: To remove skull cap
**Scissors: To opening hollow organ
**Bone cutter: To cut or remove bone
** Enterotome: To open intestine
**Tooth forceps: To gripping heavy organ for removal