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FORENSIC
MEDICINE AND
TOXICOLOGY medpgnotes
FORENSIC MEDICINE AND TOXICOLOGY
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1 GENERAL FORENSIC MEDICINE
CONTENTS GENERAL FORENSIC MEDICINE ..................................................................................................................................... 5
IDENTIFICATION ........................................................................................................................................................ 5
PRIMARY TEETH ........................................................................................................................................................ 5
SECONDARY TEETH ................................................................................................................................................... 6
DENTITION ................................................................................................................................................................ 6
ESTIMATION OF AGE ................................................................................................................................................. 7
ESTIMATION OF SEX .................................................................................................................................................. 7
ESTIMATION OF RACE ............................................................................................................................................... 8
ESTIMATION OF STATURE ......................................................................................................................................... 9
DEATH AND POSTMORTEM .......................................................................................................................................... 9
DEATH AND CHANGES AFTER DEATH ....................................................................................................................... 9
AUTOPSY ................................................................................................................................................................. 10
POSTMORTEM TEMPERATURE CHANGES ............................................................................................................... 11
POSTMORTEM STAINING/POSTMORTEM LIVIDITY ................................................................................................ 12
RIGOR MORTIS AND CADAVERIC SPASM ................................................................................................................ 12
MUMMIFICATION ................................................................................................................................................... 13
ADIPOCERE .............................................................................................................................................................. 13
PUTREFACTION ....................................................................................................................................................... 13
MAGGOTS ............................................................................................................................................................... 14
ANTEMORTEM AND POSTMORTEM BURNS ........................................................................................................... 14
ASPHYXIA .................................................................................................................................................................... 14
CAFÉ CORONARY ..................................................................................................................................................... 14
HANGING ................................................................................................................................................................ 14
DIFFERENT FORMS OF ASPHYXIA ............................................................................................................................ 15
DROWNING ................................................................................................................................................................. 16
FIREARM INJURIES ...................................................................................................................................................... 17
TYPES OF FIREARM .................................................................................................................................................. 17
TYPES OF BULLET .................................................................................................................................................... 17
TYPES OF FIREARM INJURIES .................................................................................................................................. 18
WOUND AND INJURY .................................................................................................................................................. 19
GRIVEOUS INJURY ................................................................................................................................................... 19
INJURIES .................................................................................................................................................................. 19
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FRACTURES ............................................................................................................................................................. 19
WOUND ................................................................................................................................................................... 20
LAW IN RELATION TO MAN ......................................................................................................................................... 21
COURTS ................................................................................................................................................................... 21
EVIDENCE ................................................................................................................................................................ 21
OFFENCE ................................................................................................................................................................. 22
IPC, CrPC AND IEA ................................................................................................................................................... 22
INQUEST .................................................................................................................................................................. 23
EXHUMATION ......................................................................................................................................................... 23
TORTURE ................................................................................................................................................................. 23
CRIMINAL RESPONSIBILITY...................................................................................................................................... 23
CONSENT ................................................................................................................................................................. 24
MEDICAL LAW ......................................................................................................................................................... 24
MEDICAL NEGLIGENCE ............................................................................................................................................ 24
TESTS AND RULES ........................................................................................................................................................ 25
SEXUAL OFFENCES ...................................................................................................................................................... 26
RAPE ........................................................................................................................................................................ 26
OTHER SEXUAL OFFENCES ...................................................................................................................................... 27
INFANTICIDE AND FETAL DEATH ................................................................................................................................. 28
FETAL DEATH ........................................................................................................................................................... 28
BATTERED BABY SYNDROME .................................................................................................................................. 28
TOXICOLOGY ............................................................................................................................................................... 29
GENERAL FEATURES OF POISONING ....................................................................................................................... 29
POISONING BASED ON PHYSIOLOGICAL STATE ...................................................................................................... 30
HYDROGEN SULPHIDE ............................................................................................................................................. 30
ARSENIC .................................................................................................................................................................. 30
LEAD ........................................................................................................................................................................ 31
PHOSPHORUS .......................................................................................................................................................... 32
MERCURY ................................................................................................................................................................ 32
COPPER ................................................................................................................................................................... 33
ZINC ......................................................................................................................................................................... 33
CADMIUM ............................................................................................................................................................... 33
ALUMINIUM PHOSPHIDE ........................................................................................................................................ 34
CYANIDE .................................................................................................................................................................. 34
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PARACETAMOL POISONING .................................................................................................................................... 34
SALICYLATE POISONING .......................................................................................................................................... 34
COPPER SULPHATE POISONING .............................................................................................................................. 35
ACID POISONING ..................................................................................................................................................... 35
SULPHURIC ACID ..................................................................................................................................................... 35
NITRIC ACID ............................................................................................................................................................. 35
CARBOLIC ACID ....................................................................................................................................................... 35
OXALIC ACID ............................................................................................................................................................ 36
KEROSENE POISONING ............................................................................................................................................ 36
CARBON MONOXIDE ............................................................................................................................................... 36
CHLORAL HYDRATE ................................................................................................................................................. 36
METHYL ALCOHOL ................................................................................................................................................... 37
BARBITURATES ........................................................................................................................................................ 37
ACONITE .................................................................................................................................................................. 37
DHATURA ................................................................................................................................................................ 38
STRYCHNINE ............................................................................................................................................................ 38
OPC ......................................................................................................................................................................... 38
PRESERVATIVES FOR POISONING ............................................................................................................................ 39
SNAKES .................................................................................................................................................................... 40
MUSHROOM POISONING ........................................................................................................................................ 40
PLANT POISON ........................................................................................................................................................ 41
GENERAL FEATURES OF MANAGEMENT OF POISONING ........................................................................................ 41
HEMODIALYSIS ........................................................................................................................................................ 41
ALKALINE DIURESIS ................................................................................................................................................. 41
SALINE DIURESIS ..................................................................................................................................................... 42
GASTRIC LAVAGE ..................................................................................................................................................... 42
BAL .......................................................................................................................................................................... 42
EDTA ........................................................................................................................................................................ 42
METALLOTHIENES ................................................................................................................................................... 43
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4 GENERAL FORENSIC MEDICINE
KEY TO THIS DOCUMENT
Text in normal font – Must read point.
Asked in any previous medical entrance
examinations
Text in bold font – Point from Harrison’s
text book of internal medicine 18th
edition
Text in italic font – Can be read if
you are thorough with above two.
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5 GENERAL FORENSIC MEDICINE
GENERAL FORENSIC MEDICINE
IDENTIFICATION
Superimposition technique is used in Skull
Cheiloscopy is the study of Lips
Palatoprints are taken from Anterior hard palate
Study of fingerprinting Dactylography
Dactylography is also known as Galton system, dermatoglyphics Majority of fingerprints in Indians Loop
MC type in Dactylography Loop
Least common type of finger printing Composite NOT a type of fingerprinting Circle
System of Dactylography first used in India
First finger loop bureau established in Kolkatta
Disease permanently altering fingerprints Leprosy
Identical twins may NOT have Same fingerprinting
Most sensitive and specific for identification Dactylography
To make a positive identification with the help of a partial fingerprint, the points of similarity should be
16
Most reliable method for identification of person Galton method
Tattoo is useful in identifying Decomposed body
Blackening and tattooing of skin and clothing best demonstrated by
Infrared photography
Faint letter mark can be made visible by Infrared photography
Identity in convict established by Anthropometry
Bertillon system is used for Identification
Bertillon system Identification based on body measurements
PRIMARY TEETH
TEETH ERUPTION
Lower Central Incisor 6 months Upper Central Incisor 7 months Upper Lateral Incisor 8 months Lower Lateral Incisor 9 months First Molar 1 year
Canine 1 ½ years Second Molar 2 years
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SECONDARY TEETH
TEETH ERUPTION
First Molar 6 years Central Incisor 7 years Lateral Incisor 8 years First Premolar 9 years Second premolar 10 years Canine 11 years Second Molar 12-14 years Third Molar 17-25 years
DENTITION
Natal teeth Present at birth, usually 2 incisors of mandibular teeth, need not be removed in all cases
Hardest part of the tooth Enamel
Best method to determine age up to 14 years Dentition
Charting of left lower canine 33 in FDI, 43 in modified FDI, -3 in Haderup
Dental numbering is done by FDI two digit system, Anatomic and diaphragmatic charting, Palmer notion
Dental numbering is NOT done by Acrogram
Stack formula for age estimation from dental pattern in Infants
Gustafson method is used for Age estimation
Most reliable criteria in Gustafson’s method of identification
Transparency of root
Gustafson method Estimation of age in adults over 21 years, transparency of root is not seen until 30 years, error in estimation is + 4 to 7 years
Most reliable criteria in Boyde’s method Incremental lines Eruption of tooth Canine is the second last to appear in primary dentition,
Hypothyroidism delays dentition
First incisors to erupt in an infant Lower central
All milk teeth are erupted by 2 years
Eruption of temporary teeth completed at 2-2 ½ years
Number of deciduous teeth 20
Period of mixed dentition 6-11 years
First permanent tooth to appear First molar
First Permanent tooth Maxillary molar
Second molar erupts at 12 years
Number of teeth in 3 years 20
No of tooth at 7 years 24
No of permanent tooth in 8 year old child 12
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No of tooth at 10 years 16, 8
20 permanent and 8 temporary teeth seen at 10 years
No of tooth at 12 years 24
Precocious dentition in newborn is associated with
Ellis van Crevald syndrome, Hallerman Streiff syndrome
Dentition occurs earlier in Syphilis Dentition is delayed in Rickets Delayed eruption if no teeth at age of 13 months
Permanent staining of teeth Tetracycline
Teeth typically grown in 20 – 30 months Second molar
Least medicolegal importance given to Second bicuspid Early loss of primary teeth Hypophosphatasia
Commonest morbidity in school Dental caries
Complication of Xerostomia Dental caries
MC tooth to be impacted Lower third molar
Impacted wisdom tooth produce referred pain via Branch of auriculotemporal nerve
On tenth day of a teeth being knocked out, the local clinical finding will be
Tooth socket is filled by tissue
Pantomogram is useful in visualization of Caries, Dental cyst, Temporomandibular joint
ESTIMATION OF AGE
Age assessment Clinical examination and Radiological evidence
Number of carpal bones seen in newborn X ray None
Number of carpal bones in skiagram of hand at the end of 1 year
2
X ray site for age determination of 16 year old female Lower end of radius and ulna
Attainment of 16 years of age best diagnosed on X-ray by
Elbow
X ray site for age determination of 21 year old female Iliac crest and clavicle
Most successful age estimation in skull Sagittal suture (lateral view) Metopic suture closes at 3 years Coronal, sagittal and lambdoid suture closes on inner side by
25 years
Closure of coronal suture starts by 30-35 years
Xiphoid process fuses with body of sternum at 40 years
Best bone to assess age between 20-50 years Skull
If the angle of mandible is obtuse, it means that the bone belong to
Young female child, Elderly
Mental foramen in older age Near upper border of mandible Two halves of mandible unite at 2 years
ESTIMATION OF SEX
Best bone for sex determination Pelvis Best criteria in pelvis Sciatic notch index Chilotic line Line on hip bone for sex determination
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Ischiopubic index is more in Females
Pubic arch in male pelvis 70 – 75* Pubic arch in female pelvis 90 – 100* Female pelvis Obtuse and U shaped subpubic angle, Broad greater
sciatic foramen, Broad lesser sciatic foramen, Pre and post auricular sulcus is prominent, Ischial tuberosity is everted and obturator foramen small and triangular, C shaped pelvic cavity
Male skull Muscular markings over occiput are more marked, Capacity greater than 1500 cc, Orbits square, Frontal eminence small
Skull of male from female Capacity > 1500 cc, Square orbit, Frontal eminence small
Features of male skull U shaped palate, steeper forehead, prominent zygomatic arch
Preauricular sulcus helps in determination of Sex
Corpobasal index is useful for determination of Sex
Corpobasal index is more in Males Corpobasal index of sacrum in females Less than 42 Sacral index in females Greater than 114 Scapular glenoid height in females Less than 36 mm Bicondylar width of femur in females Less than 72 mm Knogman table for Sex Sex differentiation from pelvic bone upto 95% accuracy from
Greater sciatic notch, Pre auricular sulcus, Obturator foramen, Sub pubic arch
Best bone for sex determination Pelvis
Female pelvis Wide sciatic notch, Shallow and wide symphysis pubis, Obtuse sub pubic angle, Light and graceful structure, Preauricular sulcus is larger
NOT useful for sex determination Clavicle
ESTIMATION OF RACE
Most reliable bones for purpose of medullary index Humerus, Tibia, Radius
Craniofacial angle 130*
AP diameter of skull is minimum in Brachycephaly
Cephalic index Maximum breadth/maximum length * 100 Cephalic index of Indian population 70-75
Cephalic index is used for determination of Race
Pure Aryans have Dolicocephalic
Rounded nasal opening, horse shoe shaped palatte, round orbit cephalic index above 80
Mongols
Squared orbit and rectangular palate with cephalic index 75,broad nose
Negroes
Fragmented medullary hair Negroes
Kidney shaped cross section of hair Negroes