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FORENSIC MEDICINE

By Dr. Naveen
FORENSIC MEDICINE

 In absolute terms, the phrase ‘forensic science’


means science that is applied to legal matters.
 The word ‘forensic’ itself originates from the
Latin word ‘forum’ which during the Hellenistic
and Roman times was the general assembly
where all facts of criminal or disturbing
behaviour were discussed in the open and
verdicts were reached regarding the suspects
involved.
What is forensic medicine
 Forensic medicine, which is also known as
legal medicine, relates to application of
medical knowledge for dispensation of
justice in a court of law.
 Thus this subject teaches a person how to
use his knowledge of
medicine,biology,chemistry etc, to clarify
or solve legal problems or issues
Branches of forensic medicine;
 Forensic pathology
 Forensic toxicology
 Forensic ballistic
 Forensic serology
 Forensic radiology
 Forensic dactylography
 Forensic psychiatry
 Forensic obstetrics
 Forensic odontology
 Forensic Criminology
Why doctors needs
knowledge of forensic
medicine?
 Often doctor is the chief source of evidence
upon which legal decisions are made.FM
prepares the doctors to face such situation with
efficiency.
 A doctor of any speciality may be asked at any
time to give medicolegal opinion in case of
death.FM helps them in such case
 Fair knowledge of FM is needed to safeguard a
doctor himself from criminal cases.
 A doctor come to know his own code of conduct
what to do and what not through FM.
THE DOCTOR & THE LAW
The legal system:

 Civil law :
It concerns a dispute between two individual or
parties which do not amount to offence.
eg.land dispute,divorce case etc.
 Criminal law :
It concerns offence w/c are considered to be
against general public’s interest.
eg. Murder,theft,rape etc.
 Defendant:
The accused person is called defendant
 Plaintiff:
The other party bringing the action is
called the plaintiff.
Role of a doctor??

 As a defendant
 As a witness
-ordinary witness
-professional witness
-expert witness
Inquest:

 “An inquest is an inquiry or investigation


into the cause of unnatural death or
sudden and suspicious death.”
Types of inquest

 Police inquest
 Magistrate inquest
 Coroner’s inquest
Police inquest:

 Here the officer incharge of the police


station conducts the inquest.
 Invastigating officer Should not be below
the subinspector
Procedure :
 When officer incharge of the police office recieves the information
 Inform about the incidence to the nearest executive magistrate
 Go to the place where the body of such person is
 Makes an investigation in presense of 2 or more respective
persons ( Panchas)
 Prepare reports ( panchanamas)
 Signed by the police officer and the witness
 If no foul play is suspected, dead body will be handed over to the
relative & if there is any suspicious about the foul play then will be
sent for PM examination.
 Body should be sent with the copy of inquest report and chalan
,and one report is forwarded to the magistrate.
Magistrate’s inquest

 It is conducted by the district


magistrate,subdivisional magistrate or any
other executive magistrate
 Done in case of:
Death in prison,police custody,death due
to police firing ,dowry death,Exhumation
etc.
Difference between police
inquest and magistrates
inquest
Police:
 Cannot hold inquest in case of death in
prison ,police custody,jail etc.
 Gets help from the witness
 Have to inform nearest magistrate
 Cannot issue warrant
 Cannot order exhumation of the dead
body
Witness:
 “ The person who saw,heard or know the
incident and is called upon by the court to
give evidence is known as witness.”
Types of witness:
 Common witness:
“common witness is the person who give
evidence about the facts observed by him.”
 Expert witness:
“expert witness is a person who is capable of
giving opinion about the cases.” or
“Expert witness is a person who has been
trained or is skilled in technical or scientific
subject.”
###
 Subpoena or summons:
“It is a document compelling the attendance of a
witness in a court of law under penalty on a
particular day or time for the purpose of giving
evidence.”
 Conduct money :

“It is the fee offered or paid to a witness,in civil


cases at the time of serving the summons to
meet the expense towards attending the court.”
Medical evidence:
 Evidence:
“All legal means which will help to prove
or disprove any matter in question is
called evidence.”
Types of medical evidence:
 1. Oral
 2. documentary
Documentary evidence:
 “It includes all the documents,written or
printed which may be produced for the
inspection of the court during the course
of trail.”
 3 types:
1.medical certificates
2.Medicolegal reports
3.dying declaration
 1.medical certificates:
- fitness certificates,death
certificates,health certificates etc.
- NMC / PMDC registered
- signature or left thumb impression of
the person should be taken
- Don’t take fee in case of death
certificate.
 2. Medicolegal reports:
“these reports are prepared by a medical
man in response to a requesition from a
magistrate or a police officer.”
eg.post mortem report,injury
certificate,certificate in response to sexual
offence- rape etc.
 3.Dying declaration:
“it is the oral or written statement of a
person,who is dying as a result of some
unlawful act.”
-magistrate should be called if there is
time
-oath is not administered.
‘dying persons tells the truth.’
###
 Dying deposition:
“It is a statement made by a dying person
on oath in a sound state of mind and
recorded by the magistrate in the
presence of the accused or his lawyer
who has an opportunity to cross examine
the dying person.”
- In other word called “bed side court.”
Oral evidence:
 Here the doctor has to attend the court
when summoned.
Procedure:
 Summon
 Conduct money
 When turn comes stand inside the witness box
 Take oath
 Now the question will be asked in the following manner:

i) Examination in chief- done by the lawyer on behalf of that party or


who called him
ii) Cross examination- question is put by the lawyer of the opposite
party
iii) Re-examination- again done by the laywer of the same side to
correct any mistakes
iv) Question by the judge- can ask in any stage in case of doubt
###
 During cross examination_
 Opposite lawyer may say“I object yr
honour”,
 “objection over ruled” – doctor has to
answer.
 “Ruling on the object”
Roles/duties of doctor in a
witness box
 Should be well prepared
 Take all reports,relevent records
 Be well dressed and modest
 Do not discuss the case with anyone in court except the lawyer of yr
own
 Stand up straight
 Be relaxed and calm
 Speak slowly,distinctly and audibly
 Be confident but not over confident
 Use simple language
 Address the judge by his proper title
 Say ‘In my oponion’ don’t say I think
 Never attempts to memorize
IDENTIFICATION OF THE
LIVING AND DEAD
Identification:
 “Identification means establishment of
exact individuality of a person - living or
dead.”
 Types :

- Complete or absolute
- Incomplete or partial
 Complete Identification:
“It means the absolute fixation of the personality
of an individual and determination of the exact
position occupied by him in the society.”
 Incomplete Identification:

“It means certain data have been ascertained


about a person but,other relevant particles
necessary for the establishment of his
personality are unknown.”
When a doctor should identify a
living person??
 Marriage ,Passport,Admission into the
institute,Insurance,pension claims,missing
person
 Assault, rape, sodomy,murder,interchange
of newborn babies in hospital
Dead body???
 Sudden and unexpected death
 Railway,RTA,aircraft accident
 Hidden dead bodies
 Skeleton of isolated bones
 Partially burned dead bodies
Identification data:
 1.Race
 2.Religion
 3.Age
 4.Sex
 5.General configuration- height/wt
 6.Hair
 7.Finger prints and foot prints
 8.External pecularities eg.moles,scars,tattoo marks
 9.Teeth
 10.Handwriting
 11.Speech and voice
 12.Gait,trick of manner and habit
 13.Memory and education
 14.Personal effects – clothes,pocket contents,jewellery etc.
1.Race:
 “It may be defined as the biological concept
denoting the different breeding of origin of
human being ( living in different or same zone
with different characteristics) united by common
hereditary.”
 Mainly 3 types:
- Caucasion- europeans, part of US,australia
- Mongolian- east asia ( china,japan, indonesia)
- Negro- Africa,US,
Distinguishing Points between 3
races:
 Skin
 Hair
 Eyes
 Forehead
 Face
 clothes
2.Religion :
 Hindu/ Muslim
Why you are a Hindu or a
Muslim??
Male :
 Circumcision
 Callosities : a thickened hard mass of a skin occurs in
the area w/c undergoes excessive use
 Clothes

Female:
 Vermilion mark
 Artificial spot
 Tattoo marks
 Position of nose ring aperture
3.Sex:
 3 methods:
- Physical examination
- Gonadal biopsy
- Sex Chromatin ( Nuclear sexing)
 3 types of body:

- fresh body
- Decomposed body
- Mutilated fragments
 1.Fresh body:
- quite easy
- by doing local and physical examination
 2.Decomposed body:
- see for the presence of prostate or
uterus
- resists long after decomposition
- If you can’t find it histological
examination of the suspected t/s.
 3.Mutilated fragments:
- study in details in class of “Autopsy”.
Histologically how we determine
the sex??
 Here we examine the suspected ovarian or
testicular t/s microscopically in case of
decomposed body.
 In cells of a women:
-“Barr body” tiny nodules of chromatin attached
to the inner surface of the nuclear membrane
-“Davidson’s body” small drum stick like nuclear
attachment in WBC
Inter-sex
 “This is the condition in which male and
female characteristics coexist in varying
propertion in same individual.”
--True Hermophrodism: internal sex organ
of both sex present
-- False Hermophrodism:external genitalia
is of opposite sex
4.Age:
 Medicolegal Aspects:
- Identification of an individual both in the
living and dead.
- Rape, Kidnapping,prostitution,Criminal
abortion
- others: Employment,marriage contract
Age determining factors:
 Examination of teeth
 General development
 Ossifications of bones and joints
 Secondary sexual characteristics
Medicolegal aspects:
 7 years : child below 7 years of age cannot be convinced to crime.
 15 years: sexual intercourse with one’s wife below the age of 15 –
rape
- can work in a factory
 16 years: age of consent of sexual intercourse in female

- offenders under 16 – juvenile offenders


- taking away a boy under 16- kidnapping
 18 years: marriageable age of female

- age of entering into government service


- Taking away a girl under 18 – kidnapping
 21 years:
- attainment of majority
- marriagable age of male
5.Dactylography:
 “It is the system for taking the impressions of the
bulbs of the fingers and thumbs with pointed ink
on an unglazed white paper which is examined
by the magnifying lens.”
 Characteristics:
-Present from birth
-Remains constant for whole life
-Absolutely different from individual
Classifications:
 Loops : 67%
 Whorls: 25%
 Arches: 6-7%
 Composite: 1-2%

“LWAK”
Medicolegal Importance:
 100% individuality denotes by dactylography
 To established the identity of criminal by
detecting chance impression left on the scene of
the crimes eg.weapons,glasses.
 To maintain identity record
 Useful in banks,other finantial institutes
 Identification of servants,soldiers,sailors.

‘1 in 64 thousand millions’
6.External Pecularities:
 Deformities:
congenital: cleft lip,cleft
palate,supernumery fingers
acquired: malunited # bones,unilateral
wasting of muscles
 Scars :
These are simply the fibrous t/s covered by
epithelium without hair follicles, pigments or
sweat glands.

Medicolegal importance:
1.Identification of person living or dead
2. shape of scar nature of weapon used
3. Linea albicans : previous pregnancy
Occupational marks:
- Dye in dye workers
- Depression in lower part of the sternum
shoe makers
Medicolegal importance:
Identity
social position
 Tattoo marks:
“These are the designs imprinted in the skin of
some individuals by multiple puncture wounds in
the true skin with needles or similar penetrating
tools dipped in a dye.”
 Dyes commonly used:

Indigo/ cobalt/ carbon/ Vermilion/ prussion blue/


indian ink etc
 Medicolegal importance:
- May help in identity by special design
- may indicate religion or god of worship
- may indicate social status
- may indicate behavioral characteristics
 Natural disappearance??
vermilion,cinnabar,ultramarine disappears after a
minimum of 10 years.
carbon never disappears
Artificial procedure to remove
tattoo marks:
 Surgery
 Applying chemical subs,carbon dioxide
snow,silver tannate
 Galvanocautery
 Lesser beam
7.Handwriting :
 “It is the characteristic of individual
speciality,if it is written rapidly.”
 May be changed in :
-Gradual increasing in age
-some mental or nervous disease
-when person becomes insane
-before the time of death
????
 A criminal removed his tattoo surgically
Forensic Pathology
 By dr. Naveen
DEATH:
Death:
 Extinction of life
 “The permanent cessation of all the vital
functions of the living body is known as death”
 Medicolegal defination:

“Death is permanent and irreversible cessation


of functions of the 3 interlinked vital systems of
the body ( the tripod of life), namely the nervous,
circulatory and the respiratory systems.”
 Crucial situation :
“consult”
 Ordinary circumstances:
-wait for 10 minutes
- no evidence of function of the tripods>
declare death.
Types of Death:
 1.Somatic Death ( systemic death)
 2.Cellular death ( Molecular death)
 1.Somatic Death: it is permanent and irreversible cessation of the
functions of nervous, circulatory and respiratory systems, also
known as clinical or systemic death.

 2.Cellular death: means the cessation of respiration and metabolism


of body t/s which is soon followed by autolysis and decay.
Brain cells: 10 minutes
blood cells/cornea: more than hrs

more the organ needs blood supply ~ more quickly they die
Brain death:
 “Brain death means that the patient is
dead, whether or not the function of some
organs, such as a heart beat is maintained
by artificial means, and all the function of
the brain must have permanently and
irreversibly ceased.”
 Medicolegal importance:

Brain death = legal death


 For applied purposes, brain death has been
classified into three types
 i) Cortical death
 ii) Brain-stem death
 iii) Both cortical and brain stem death.
Diagnostic test for brain death:
 Absence of corneal reflex,fixed pupils unreactive
to light
 Absence of vestibulocochlear reflex when ice
and water is introduced into ears.
 Painful stimuli – no motor response
 Gag reflex - absent when a catheter introduced
into the larynx and trachea.
 No respiratory movements when the patient is
disconnected from the ventilator
Death certification:
 Should certify if:
you are registered medical practitioner
you know the cause of death
Issuing the certificate:
 ‘WHO’ system:
1st part: condition which led directly to the
death
2nd part : other condition which also
contributes to the death
Modes of death:
 1.Coma: failure of nervous system
 2.Syncope: failure of circulatory system
 3.Asphyxia: Failure of respiratory system
1.Coma:
 “It means insensibility resulting in death from different causes which
involves the vital centres of the brain stem.”
 Causes:
Head injury, encephalitis, meningitis, certain poisoning like opium,barbiturates
etc.
 C/F:
.Initially person in a condition from where he/she can be aroused
.Reflex still present
.complete unconsiousness
.pupils dilated, insensible to light
.pulse full and bounding but usually slow
.Breathing slow/irregular
.Perspiration occurs
2.Syncope :
 “It is sudden cessation of action of the heart leading to death.”
 Cause :

- any heart disease


- Anaemia
- over exercise or exertion
- severe hypoxia
 C/F:

.pallor of face, lips, finger nails


.Dilated pupil
.skin cold and clammy
.nausea, vomitting
.hypotension
.pulse slow and weak
3.Asphyxia:
 “It may be defined as a state in which body lacks oxygen because of
some mechanical interference with the process of breathing.”
 May be due to hypoxia or hypercapnia
 Cause:

mechanical obstruction : hanging ,strangulation


disease; pulm.oedema,pneumonia,COPD
poisons
 C/F:

congestion of face
cyanosis
oedema of face
Stages of asphyxia:
 Total duration : 3 – 5 minutes
 1. Stage of Dyspnoea
 2.Stage of convultion
 3.stage of exhaustion
Death trance/Suspended
animation:
 It is the condition in which all signs of life
or vitality are seems to be absent although
the individual still remains alive which can
be detected by ECG
 Even, the functions of the nervous system,
circulatory system or the respiratory system
may not be perceived by conventional
methods, though the person may actually not
be dead and the functions of these systems
“return “ after sometime, either as such or after
proper resuscitation. Such a death-like state is
known as suspended animation or apparent
death.
 The state of suspended animation or apparent
death is said to be practicable . Its practice is
popular among the Indian “yogies’ (persons
who follow lives of strict principles with
physical and mental exercise and restraint).
Such people demonstrate their outfit by being,
Voluntarily buried alive, under the earth for
hours.
 Actually, the circulation etc. do not completely
stop but is being maintained in their minimum.
When it is practiced voluntarily as by yogis, it
is called voluntary suspended animation and
when it occurs spontaneously as in cases of
drowning or electrocution , it is called
involuntary suspended animation.
Possibilities:
 A new born infant
 Drowned person
 Electrocutation
 Thunder
 Snake bite
 Head injury
 Anaesthetic shock
 Severe narcosis
 Severe hypothermia
 Prolonged starvation
 Practitiener of YOGA
“”ECG””
postmortem appearance
 CHANCES AFTER DEATH OR
DIFFERENT SIGNS OF DEATH
 Some of the changes which occur after death
are related to somatic death and some are
related to molecular death. Accordingly, some
of them are conspicuous immediately, some
come early and the rest appear late
Immediate changes
 (a) Stoppage of function of nervous system
 (b) Stoppage of respiration
 (c) Stoppage of circulation
Early changes-
 (a) Facial pallor
 (b) Loss of elasticity of the skin with
decrease in the facial crease
 (c) Primary relaxation of the muscles
 (d) Contact pallor and contact flattening
 (e) Changes in the eye
 (f) Cooling of the body
 (g) Postmortem staining
 (h) Rigor mortis or postmortem rigidity
Late changes
 (a) Putrefaction or ordinary decomposition
 (b) Adepocere change- a modified form of
decomposition
 (c) Mummification- another form of
modified decomposition
Immediate changes
 Stoppage of function of nervous system-
 With death all functions of the nervous system
ceased. The subject has no sense. There loss of
both sensory and motor functions. There is
loss of reflaxes, no response and no tonicity of
the muscles. Pupils are widely dilated.
 Stoppage of respiration
 Stoppage of circulation
Early Chances after death
 1 Facial pallor- After death, due to stoppage of
circulation, blood drains from the capillaries
and small vessels to big ones. This is why,
generally the face appears pale and bloodless,
but in case of agonising death and where there
is obstruction of venous return due to
compression over the neck or below, as in case
of strangulations etc., the face is congested
and cyanotic.
 2 Loss of elasticity of the skin with ironing of
the facial creases –
 these occur due to loss of tonicity of the skin
muscles including those of the face. The face
looks younger.
 3 Primary relaxation of flaccidity of the
muscles
 After death muscles loose their tonicity and
become flaccid. Joints are loose and the chest
wall flattens .During this stage of relaxation
the muscular tissues are still alive; their
chemical reaction is still alkaline and they still
respond to electrical stimuli.
 4 Contact flattening and pallor –During the stage of
primary relaxation of muscles of the body, the areas
which remain in contact with the ground, become flat
and the blood from vessels of these areas are pressed
out. During the stage of rigor mortis, the areas
continue to be flat, as rigor appears in those muscles
in their flattened state and the drainage of blood from
the vessels of the areas make the areas pale which
continue to be so even after formation of postmortem
staining in the surrounding areas.
Medicolegal importance-
 From the contact flattening and pallor, the
position of the body in which it stayed for
some time after death can be understood.
5 Changes in the eye
 (a) With death, the corneal and pupillary
reflexes are lost.
 (b) With death, the eyelids usually close due
to loss of tone of the muscles of the eyelids.
 (c) Haziness of the cornea
 (d) Shape of the pupils – Ordinarily, they are
circular. But ,as after death, there is loss of
tone and elasticity of the ciliary muscles, the
shape of the pupil can be changed which may
persist during the stage of rigor mortis of the
muscles.
 As the nervous control over the pupils is lost
after death, the sizes and shapes of the pupils
of the two sides may be different. The pupils
respond to the application of the miotic and
mydriatic agents for an hour or two after
death.
 (e) Loss of ocular tension
Somatic and molecular deaths
 Death commonly refereed to with the
cessation of the functions of nervous,
circulatory and respiratory systems , are also
known as somatic deaths or clinical or
systemic deaths.
 With somatic death further supply of oxygen
to different organs stop. Due to lack of
oxygen supply, individual cells of the different
tissues or organs die. This death of the
individual cells is known as cellular or
molecular death .
 In the absence of circulation and respiration,
molecular death occurs in a series, death of
brain cells stand first.
 Within five minutes of stoppage of circulation
and respiration, brain cells are to die.
Molecular death in muscles starts by the end
of the first hour of somatic death and it takes
some more hours for all muscle tissues to die.
 Blood cells and cornea may remain alive for
more than 5 hours. organs like , liver, kidneys
and heart die comparatively early. Death of the
fibrous tissue occurs late . As a general rule,
organs which receive or need more blood
supply during life, die early in absence of
circulation .
organ transplantation from dead bodies

 This gap between the somatic and the molecular deaths has
helped the process of organ transplantation from dead bodies .

 For the purpose., tissues like blood or cornea may be removed


form a body soon after somatic death. But those organs which
are highly vascular, cannot be left, till circulation and
respiration stop, as lack of oxygenated blood-supply will soon
make them unsuitable for the purpose of transplantation.
 Thus , for transplantation purposes, heats, liver
and kidney have to be removed before
stoppage of circulation i.e., before occurrence
of the “ somatic death”, The organ of brain can
not be used for transplantation , where cells
die within a few minutes of stoppage of
circulation or respiration , even though their
stoppage may be taken as to have occurred
permanently before brain death.
 Further, if the brain can be kept transplantable or
alive by maintaining circulation and respiration ,
there is no reason why the subject should be taken as
going to face inevitable death . But if it becomes
certain that brain has stopped functioning
permanently and irreversible, then by maintaining
circulation and respiration artificially, transplantable
organs can be suitably removed from such a donor.
This possibility gave rise to the necessity of
understanding the conception of “ brain death”