Forensic Medicine & Toxicology Textbook PDF

 Section 1 FORENSIC MEDICINE CFMT-01 (3rd Proof).p65 1 8/12/07, 9:24 AM CFMT-01 (3rd Proof).p65 2 8/12/07, 9:24 AM  +0)26-4  Definition and History of Forensic...

 Section 1 FORENSIC MEDICINE CFMT-01 (3rd Proof).p65 1 8/12/07, 9:24 AM CFMT-01 (3rd Proof).p65 2 8/12/07, 9:24 AM  +0)26-4  Definition and History of Forensic Medicine DEFINITIONS King of Egypt. Some of the important landmarks in this context are as follows: The specialty of Forensic Medicine is known by 1. Code of Hummurabi of Babylon (2000– various names like Forensic Medicine, Legal 1000 B.C.) is the oldest medico-legal code Medicine, Medical Jurisprudence and State given by King of Babylon in 2200 B.C. It Medicine, etc. Although all the names carry describes punishment for medical different meanings they are related to each other. practitioners in case of improper treatment. The word “Forensic” means “of court of law”. 2. Code of the Hittite (1400 B.C.) describes Forensic Medicine is defined as application of compensation for personal injuries medical knowledge in the administration of justice. sustained. Medical Jurisprudence deals with the legal 3. Roman Law (451 B.C.) contained a lot of aspects of medical practice and knowledge. It provisions related to medico-legal matters. brings doctors in contact with laws. 4. Hippocrates (460–377 B.C.) described State Medicine is application of medical lethality of wounds, medical ethics, sudden knowledge in prevention of diseases. It defines the deaths, etc. duty of a doctor in relation to notification of all births, deaths, notifiable diseases and food Around the beginning of the Christian Era, poisoning. It deals with the legal mandatory duties many public laws relating to public health, sexual of medical practitioners and personnel. matters and eugenics were made in India which are popularly known as laws of Manu. HISTORY OF FORENSIC MEDICINE 5. Justinian Code (A.D. 529–564) described penalties for medical practice and principles The history of Forensic Medicine is quite old. of regulation of medical profession. Documents related to medico-legal work have been 6. The Barbarian Statute described the role found dating back to 4000–3999 B.C. in Egypt, of medical experts in evaluating injuries. Sumer, Babylon, India and China. A document The first Medico-legal autopsy was conducted dated around 3000 B.C. has been found in China by Bartolumeo De Varignana in A.D. 1302 in that describes poison. Imhotep (2730–2900 B.C.) Bologna, Italy. Guidelines on how to conduct is considered as the first medico-legal expert. He investigations into the cause of death was prepared was the personal physician and Chief Justice to the in China in thirteenth century. In sixteenth century, CFMT-01 (3rd Proof).p65 3 8/12/07, 9:24 AM  4 Concise Textbook of Forensic Medicine and Toxicology the Penal Code of the Bishop of Bamberg and the of medical ethics. Sushruta Samhita written by Caroline Code emphasised on the role of medical Sushruta in 200–300 A.D. refers to poisons, snake evidence in court trials. The famous book on signs and treatment of poisoning. Sushruta is Medico-legal questions, Questiones Medico-legales, considered to be the Father of Indian surgery. Unani was written by Paolo Zacchia in 1621 in seven system of medicine was introduced in India by volumes. He was the principal physician to Pope Mughal rulers when Ayurveda was flourishing in Innocent X and Alexander VII. India. Coroner’s Act 1811 was introduced by British Towards the end of the sixteenth century, in Kolkata and Mumbai and police investigations medico-legal autopsies started becoming frequent began in India then. The first chair of professor of at various places around the world. The first book Medical Jurisprudence was established in 1857 at on Forensic Medicine was written in 1602 by Madras Medical College. Fortunate Feedele, an Italian physician. Famous The Indian Penal Code (I.P.C.) came into existence works on medico-legal scenario by Zacchia was in 1860 and Criminal Procedure Code in 1861. The published in seventeenth century. In eighteenth Indian Medical Council Act came in 1933 and century, professorship in legal medicine was created established the Medical Council of India at New Delhi. in Germany. Orfila (1737–1853) was the professor The most outstanding contribution in medico- of chemistry and legal medicine in Paris and is legal field in India was made to modern regarded as the founder of modern toxicology. dactylography. Sir William Herschel of the Indian Civil Service in 1858 used dactylography as a method of identification, which was later improved FORENSIC MEDICINE IN INDIA by Sir Francis Galton. The modern Forensic Medicine in India was Manusmriti (3102 B.C.) is the first treatise on various started by Dr Jaising P. Modi. For the first time in laws written by King Manu. It prescribed code of India in 1920, he was the one who wrote a book on conduct for society and had many medico-legal laws Forensic Medicine and toxicology. It was titled, about marriage, punishment for rape, adultery, etc. Medical Jurisprudence and Toxicology. He is called Vedas (2000–1000 B.C.), especially the Father of Forensic Medicine in India. He Atharvaveda, furnish details about how to cure described the Indian medico-legal experience for wounds, poisoning and snake bites. The first Indian the first time in his book. In the last fifty years, the book on medicine, Agnivesha Charaka Samhita specialty of Forensic Medicine has grown all over was written by the famous physician Charaka. It India and is a part of curriculum in all medical describes training, duties, privileges and social schools. Now, various organisations are working status of physicians. It is considered as Indian code in this field for improvement of the specialty. CFMT-01 (3rd Proof).p65 4 8/12/07, 9:24 AM  +0)26-4 2 Legal Procedures INQUEST evidence. He prepares a detailed report called panchnama in presence of public witnesses Inquest means ‘to seek’. It is an enquiry into the (panchas) who had some knowledge of the crime. cause of death. It is conducted where there is This panchnama is called inquest papers. He then suspicion regarding cause of death or cause of death forwards the dead body to the medico-legal expert for is to be ascertained. There are four types of inquests: a post-mortem examination. On reaching the police station, a first information report (FIR) is lodged by 1. Police Inquest him under relevant sections of the Indian Penal Code 2. Coroner Inquest and investigation into the circumstances of the crime 3. Magistrate Inquest begins. 4. Medical Examiner system Coroner’s Inquest Police Inquest Previously, it was held in Mumbai and Kolkota It is held all over India and conducted by a under Coroner Act of 1871. It was first abolished competent and authorised police officials. The in Calcutta, later in Mumbai. It is of historical value inquest is held under Section 174 of Cr. P.C. The in India but coroner’s inquest is still prevalent in police officer who conducts this is called an many parts of the world. The coroner’s inquest is Investigating Officer. The police receives held in following cases: information from village chowkidars (guards), public informers, hospitals, and various agencies. 1. Sudden death where cause of death is not On receipt of information about the crime, it is known. noted in a daily diary register. This entry is 2. Suicide, homicide and infanticide. commonly called a Daily diary (DD) entry. Once 3. Accidental death, poisoning, traffic the DD entry is made, an investigating Officer is accidents, drug mishap, industrial accidents. deputed on the scene of crime to conduct inquest. 4. Death occurring while in treatment like The Investigating Officer reaches the scene of the under anaesthesia. crime and takes the stock of the situation. If a person 5. Custodial deaths like death in prison, police is injured or needs medical assistance, he is rushed station, mental asylum, etc. to the hospital. If the victim is dead, the The coroner used to be of the rank of a First Investigating Officer seals the scene of crime and Class Magistrate. He had the powers to order a post- if needed sends requisition for a photographer, mortem and exhumation. He had the power to fingerprint experts, ballistic experts, etc. to collect summon a doctor to depose in his court. He had CFMT-02 (3rd Proof).p65 5 8/14/07, 3:51 PM  6 Concise Textbook of Forensic Medicine and Toxicology the powers to summon witnesses and record 1. The Delay in Information: Police is unable statements and if he suspected foul play he used to to act on time as information regarding give a verdict of foul play and then assign the case crime reaches the police quite late due to to the concerned magistrate for trial. When the lack of communication facilities like accused was not found he used to return an open telephones, etc., especially in villages or verdict which means that the inquest was postponed remote areas. indefinitely and could be opened on receipt of new 2. Decomposition: As police reaches late, the information. In a coroner’s court, the presence of signs of decomposition may have already the accused was not essential. set in and vital evidence may be lost. 3. Lack of Medical Knowledge: As majority Magistrate Inquests of police officials are ignorant about medical knowledge, they experience difficulty in It is held under Section 176 Cr. P.C. and is conducted correlating injuries with circumstances. by an executive magistrate like Subdivisional or 4. Rapid Disposal of Dead Bodies: As per District magistrate. It is considered to be superior to religious customs, cremation is done in police inquest. It is held in following cases: Hindu and Sikh communities, if the body is 1. Death in prison cremated before arrival of police, vital 2. Death in police custody evidence may be lost. Even in cases of 3. Death due to police firing burial, rapid decomposition may cause loss of evidence as the permission for 4. Dowry deaths under Sec. 304B of the Indian exhumation may take some time. Penal Code 5. Any case where the government orders that inquest needs to be conducted by a magistrate. COURTS IN INDIA Magistrate can order exhumation. Earlier, a coroner also had the power to order exhumation. As doctors have to appear in various courts of law, In any case of death, magistrate can hold inquest it is better for them to get familiar with different even if the police has already made the inquest. courts in India and their powers (Table 2.1). There are two types of courts in India: (1) civil and (2) Medical Examiner System criminal. The courts in India are of four types: This system is prevalent in the United States of 1. The Supreme Court: It is located in New America where a forensic pathologist is appointed Delhi, and is the highest judicial tribunal in as a medical examiner. He conducts the post- India. It can pass any sentence prescribed mortem and usually visits the scene of crime. Being by the law and supervises all the courts in a doctor, he is able to easily correlate injuries with India. The law declared by it is binding on circumstances. He submits his report to the district all courts. attorney for further action. This system is 2. The High Court: It is usually located in considered superior to a police inquest. the capital of every State, and is the highest tribunal of the state. It can try any offence and pass any sentence prescribed by the law. DIFFICULTIES IN DETECTION OF CRIME IN 3. The Sessions Court: It is located at district INDIA headquarters, and can pass any sentence authorised by the law but the death sentence The following are the difficulties which are passed by it must be confirmed by the High commonly faced in detecting crime in India: court. CFMT-02 (3rd Proof).p65 6 8/24/07, 3:42 PM  Legal Procedures 7 4. The Magistrate Courts: The magistrate under penalty threat on a specified day, time and courts are of following types: place for giving evidence. It may also ask him to (a) Chief Judicial Magistrate or Chief produce any book, document or case records Metropolitan Magistrate can pass supposedly under his control for the inspection by imprisonment for up to 7 years, and can the court. The witness can be excused from also impose fine without limit. He can attending the court only if he has some valid and order solitary confinement as well. urgent reasons. (b) First Class Magistrate or Metropolitan Noncompliance of summon may render a person to pay damages in a civil case, or pay fine Magistrate can pass a maximum of 3 or sustain imprisonment in criminal cases. Criminal years sentence, fine up to Rs. 5000/- and courts have priority over civil courts. If a person can also order solitary confinement. has received two summons for the same day, one (c) Second Class Magistrate can sentence of which is from a criminal court and the other from up to one year, and fine up to Rs. 1000/-. the civil, he should attend the criminal court and Also, he can order solitary confinement. should inform the civil court. Higher courts have priority over the lower courts. If summoned to two Cognisable Offences courts, both civil and criminal, he should first attend the higher court. If he is summoned by two courts It is an offence where a police officer can arrest a of the same status he should attend the court from person without a warrant from the magistrate, e.g. where he has received the summons first, informing rape, murder, grievous hurt, etc. the other court. The sentences authorised by law are: (a) death, (b) imprisonment for life, (c) rigorous impris- onment, and/or solitary confinement, (d) simple Conduct Money imprisonment, (e) forfeiture of property, (f) fine, In civil cases, a reasonable sum that would be and (g) detention for treatment, training and incurred as travelling expenses is usually tendered rehabilitation of young offenders under the age of at the time of serving of summons. This is known 16 years. as ‘conduct money’. It is paid by the party who has called him to give evidence. If the fee is not paid, Subpoena or Summons (Sub means under, doctor can ignore the summon or, if he feels it is poena means penalty) insufficient, he can bring it to the notice of the court which will decide whether it is reasonable or not. It is a document issued by the court commanding If the court feels it is insufficient, it may direct the the attendance of the witness to appear in the court party who has called the doctor to give evidence or Table 2.1 Powers of different courts Court Death sentence Imprisonment Fine 1. Magistrate Court (a) Second Class Magistrate No One year Rs. 1000/- (b) First Class Magistrate No Three years Rs 5000/- (c) Chief Judicial Magistrate No Seven years No limit 2. Sessions Court Yes Life sentence No limit (but to be confirmed by High Court) 3. High Court Yes Life sentence No limit 4. Supreme Court Yes Life sentence No limit CFMT-02 (3rd Proof).p65 7 8/14/07, 3:51 PM  8 Concise Textbook of Forensic Medicine and Toxicology to pay more. In criminal cases, no fee is paid at the Re-examination time of serving summons. However, usually the court gives travelling charges and daily allowance The counsel who has first conducted examination- after the doctor has deposed in the court. in-chief, has the right to re-examine the witness with the aim to explain any ambiguities, to correct COURT PROCEDURE any mistake the witness has made during cross- examination. But the witness should not introduce The evidence of the witness is recorded as follows: any new fact without the consent of the judge or 1. Oath the opposing counsel, lest he would be liable to 2. Examination-in-chief cross-examination. 3. Cross-examination 4. Re-examination Questions Put by the Judge 5. Questions put by the judge The judge may ask any question at any stage to clear its doubts. Oath Before starting the procedure, witness has to take PERJURY an oath. The format is: “I swear by God that I shall Perjury means willful utterance of falsehood by a speak truth, the whole truth and nothing else but witness under oath. He is liable to be prosecuted truth.” If the witness is an atheist, he has to make for the same. solemn affirmation instead of swearing by God. Medical Evidence Examination-in-Chief It is of two types: The first examination is done by the counsel who 1. Written or documentary evidence has called the witness to the box. In this 2. Oral evidence. examination, no leading questions can be asked. A leading question is defined as the question, which Documentary Evidence suggests some answer, e.g. “whether on the day of murder you were wearing a red shirt or not?” The This refers to all documents produced for the purpose of the examination-in-chief is to place on inspection of court, e.g. (a) medical certificate, (b) record, all the information the witness has about medico-legal report, and (c) dying declaration. the case. In case of medical witness it is the public Medical Certificate: It refers to ill health, insanity, prosecutor who examines him first. birth and death. It has to be signed by a registered medical practitioner. In giving certificate of ill Cross-examination health, the doctor should mention the exact nature of the illness, and take the signature (preferably) It is considered to be the most reliable procedure or thumb impression of the patient. of testing the value of an evidence and is held by the counsel for the accused, or the opposite party. From April 1, 1969, under the Registration of The witness may be asked any question including Births and Deaths Act, the registration of births and the leading question. There is no time limit fixed deaths is compulsory. It is obligatory for a medical for cross examination. practitioner who has attended the last illness of the However, the court reserves its right to disallow deceased person to issue a death certificate. The any question it deems unnecessary or insulting to medical practitioner is not entitled to charge any the witness. fees for issuing a death certificate. CFMT-02 (3rd Proof).p65 8 8/14/07, 3:51 PM  Legal Procedures 9 Table 2.2 Differences between dying declaration and dying deposition Dying declaration Dying deposition 1. Recorded by Anyone Only magistrate 2. Oath Not necessary Necessary 3. Presence of the accused Not essential Accused/lawyer is allowed 4. Cross-examination Not allowed Allowed 5. Value Less value as compared to More value as compared to dying dying deposition declaration Medico-legal Reports: These documents are Dying Deposition: It is the statement of a person prepared by the doctor on the request of police or on oath before a magistrate, in the presence of the investigating agencies in criminal cases like assault, accused or his counsel, who in turn, is allowed to rape, murder, poisoning, etc. The reports consist cross-examine the witness. The doctor should first of two parts: (a) facts observed on examination, certify whether the person is capable of making a and (b) opinion drawn from the facts. The report is statement or not (compose mentis). It means court not admitted unless the doctor testifies in the court. by the bedside, and has greater value as compared Exhibits like clothing, weapon, etc. sent for to dying declaration (Table 2.2). examination should be described in detail after examination and should be handed over after it is Oral Evidence properly sealed. It includes all statements made before the Court, by the witness, in relation to the matter under Dying Declaration: It is a statement, written or investigation. The oral evidence must be direct. Oral verbal, of a person who is dying as a result of some evidence is much more important than documentary unlawful act, relating to facts of cause of his death evidence as it allows cross-examination. or any of the circumstances resulting in death. Documentary evidence is accepted by the court If there is time, a magistrate should be called. If only on oral evidence by the person concerned. The there is an emergency, the doctor himself should following are the exceptions: record the statement. But before recording, he should 1. Dying declaration certify that the person is compose mentis, i.e. he is 2. Expert opinion expressed in a treatise may conscious and his mental faculties are normal. The be proved in court by producing such a statement can be recorded by police or any other book, if the author is dead or cannot be person. The statement should be noted down in the found or called witness without man’s own words without any alteration. Leading unreasonable delay or expenses. question should be read over to the person and his 3. Evidence of doctor recorded in a lower court signature or thumb impression should be taken at is admissible in a higher court, provided it the end. If the person is able to give only partial was recorded by a magistrate in the presence statement, and then he becomes unconscious, only of the accused. the partial statement should be recorded. The dying 4. Evidence given by a witness in a previous declaration is admissible in court as evidence even judicial proceeding, is admissible in if the person was not under expectation of death at subsequent judicial proceedings when the that time. It is accepted as evidence at the time of witness is dead or cannot be found, or is trial if the person dies. If the declarant survives, the incapable of giving evidence, or cannot be declaration is not admitted and the person is called called without undue delay or unreasonable to provide oral evidence (Table 2.2). expense. CFMT-02 (3rd Proof).p65 9 8/14/07, 3:51 PM  10 Concise Textbook of Forensic Medicine and Toxicology 5. Evidence of mint officer. CONDUCT AND DUTIES OF A DOCTOR IN 6. Reports of certain government scientific THE WITNESS BOX experts like: (i) Chemical Examiner, (ii) Chief Inspector of Explosives, (iii) Director, The following are general principles a doctor Fingerprint bureau, (iv) Director, Haffkine should observe while giving evidence: Institute, Mumbai, (v) Director, Central Forensic Science Laboratories, and (vi) the 1. He must attend court punctually and serologist, can be asked for. The court has produce all the documents asked for. His power to summon and examine these dress should be consistent with his dignity. experts. 2. He should be well prepared with the details 7. Public records: Routine entries, operative of the case, anticipate likely questions, study notes, discharge summaries are admissible the literature and stand up straight. without oral evidence. But the cause of 3. He should never attempt to memorise. He disease/death is not accepted without oral should speak slowly and distinctly with testimony. confidence. He should address the judge as “Sir” or “Your Honour.” 4. He should use simple language, avoid TYPES OF WITNESS superlatives and exaggeration. He should Witness is of two types: not fumble while reporting for records or literature. Avoid discrepancy between 1. Common witness record and testimony. 2. Expert witness 5. The doctor should be pleasant and polite to the counsel or the accused. He should not Common Witness try to evade a question and should not lose He is the person who gives evidence about the facts his temper. within his knowledge and perception. He states 6. He should retain independence of his mind. what he has actually observed. He provides a first He should be honest, impartial and truthful. hand knowledge. 7. He should avoid long discussions. Express an opinion from his own knowledge and Expert Witness experience. 8. Text books of repute can be offered in He is the person who has been trained or is skilled evidence. Before answering, he should read in a technical or scientific subject, and is capable out the complete passage, as the lawyer of inferring opinion from the facts observed by him might have read only the statements that as a doctor, fingerprint expert, etc. favour him. A doctor can be both, a common and an expert 9. A medical man does not have the witness. When he describes the injuries on the body professional privilege and therefore, must he becomes a common witness. But when he tells answer all questions. how the injuries may have been produced he acts 10. The doctor should volunteer information if like an expert witness. Hostile witness is the one he thinks injustice would result if he does who gives false evidence because of some interest not make a statement. The response should or motive or by concealing the truth. not exceed beyond the expert’s knowledge. CFMT-02 (3rd Proof).p65 10 8/14/07, 3:51 PM  +0)26-4 ! Identification Identification is recognition of a person based on 6. Anthropometry certain characteristics which may be (a) complete, 7. Dactylography and footprints i.e. exact fixation of personality, and (b) incomplete 8. Deformities like determination of age, sex, race, stature, etc. 9. Scars The doctor is called upon to establish the identity 10. Tattoo marks of a dead body or a person brought to him. 11. Occupation marks Identification of a living person is required in 12. Handwriting criminal cases like, absconding soldiers, person 13. Miscellaneous methods of identification accused of assault, murder, rape, interchange of such as: newborn babies, disputed paternity, etc. and in case (a) Clothes and personal articles of impersonation. In civil cases, identity of a living (b) Speech and voice person is required in cases like marriage, (c) Gait inheritance, disputed sex, etc. The identification of (d) Ticks, manners and habit (e) Mental power, memory and education. dead bodies is required in cases of sudden and unexpected deaths, fire explosions, railway or aircraft accidents. At least two identification marks Race should be noted by the doctor and mentioned in all It can be determined by following characteristics: medico-legal reports. 1. Complexion: The skin is brown in Indians, fair in Europeans and black in Negroes. It THE CORPUS DELICTI is of limited value. 2. Eyes: Indians have dark eyes, Europeans The corpus delicti means body of offense or essence have blue or grey eyes. of crime. In case of a murder, it is the fact that a 3. Hair: Indians have black, thin hair; person has died from unlawful violence and Europeans have fair or light brown or includes the body of the victim and other facts like reddish hair. Indians, Mongolians and bullet, knife or clothing. Europeans have straight or wavy hair while The following points are usually seen for the Negroes have woolly hair (arranged in purpose of identification: spirals). Mongolian hair is coarse and dark 1. Race and usually circular on cross-examination 2. Sex and has dense uniform pigmentation and 3. Age dark medulla. Negro hair is elongated, oval 4. Complexion and features on cross-section and has dense pigment with 5. Hair an irregular distribution. CFMT-03 (3rd Proof).p65 11 8/12/07, 9:25 AM  12 Concise Textbook of Forensic Medicine and Toxicology Table 3.1 Cephalic index in relation to different skulls and races Types of skull Cephalic index Race 1. Dolicho-cephalic (long headed) 70–75 Pure Aryans, aborigine Negroes 2. Mesati-cephalic (medium headed) 75–80 Europeans and Chinese 3. Brachy-cephalic (short headed) 80–85 Mongols Caucasian hair has oval shape in cross- characteristics become prominent only after section with uniform distribution of fine or puberty. coarse pigment. The difficulty arises when there is ambiguity 4. Skeleton: The cephalic index or index of of external genitalia and the secondary sexual breadth of skull is very important: characters are unable to confirm the sex. Maximum breadth of skull Cephalic index = × 100 Investigations Maximum length of skull The measurements are made with callipers (Table 3.1). There are investigations for sex determination Characteristics of Hindu males are that they are which are as follows: not circumcised, sacred thread, necklace of wooden 1. Sex Chromatin Study: The Barr body is beads (Rudraksh), caste marks on forehead, tuft of present in females and absent in males. It can be hair on head and pierced ear lobes. The Hindu easily demonstrated in buccal smear. The females may have vermilion on scalp, silver toe chromosome in the males is fluorescent to ornaments, tattoo marks, nose ring aperture in left quinacrine and can be demonstrated easily. The nostril, few openings for ear rings along the helix. determination of sex is quite important in Muslim females may have nose ring aperture in connection with inheritance, marriage, divorce, septum only, several openings in ears along the sexual offenses, participation in sports, etc. helix. All Muslim males are circumcised. Intersex: It is intermingling of one sex into another. It can be divided into two categories: Sex (a) Gonadal agenesis: In this condition the testes or ovaries have never been developed. Sex of individual can be determined either by The nuclear sex test is negative. It is quite clinical method or investigations. rare. Clinical Method (b) Gonadal dysgenesis: It is mainly of four types: It is by observing secondary sexual characters of (i) Klinefelter’s syndrome: In this, the the individual. In males, presence of a well- chromosomal pattern is XXY (47 developed penis and testes, hair on upper lip, chin, chromosomes). The anatomical structure is chest, pinna, pubic hair extending towards naval, of male but nuclear sex is that of a female. underdeveloped breasts and lesser thyroid angle There is delay in puberty, behavioural (about 90°) are main characteristics for identi- disorders and mental retardation. Axillary fication. In females, a well-developed vagina along and pubic hair are absent and hair on chest with labia major and minor with clitoris, well- and chin are reduced. Gynaecomastia, developed breasts, greater thyroid angle (about azoospermia, low level of testosterone, 120°), pubic hair being horizontal covering only sterility, increased urinary gonadotrophins, mons pubis, are the few features which help in signs of eunuchoidism and increased height identification of the females. But these are usual characteristics. Testicular CFMT-03 (3rd Proof).p65 12 8/12/07, 9:25 AM  Identification 13 dysgenesis and hyalinisation of semini- 2. Concealed Sex: Criminals may try to ferous tubules is reported. Incidence is 1: conceal their sex by dress, or by some other 500 and increases with advanced maternal methods to avoid getting caught. It can be age. detected easily by clinical, histological, (ii) Turner’s syndrome: The chromosomal chromosomal or hormonal studies. In pattern is XO (45 chromosomes). It can be advanced stage of putrefaction, sex of the recognised at birth by oedema of dorsum of dead bodies can be detected by the presence hands and feet, loose skin-folds in the nape of uterus or prostate, which resist of neck, low birth weight, and short stature. putrefaction. 3. Skeleton: If skeleton is available, it is quite In adults, primary amenorrhoea, sterility, useful in the determination of the sex. The lack of primary and secondary sexual bones of adult females are usually smaller characteristics, increased gonadotrophins and lighter than that of adult male, and have excretion, short stature, pigmented navel, a less marked ridges and processes for short fourth metatarsal, webbed neck, shield muscular attachments. The frontonasal chest, midset Mongols nipples, high arched junction is not prominent. The orbits have palate, low set ears, slow growth, spina sharp margins and are rounded. The adult bifida, coarctation of aorta, septal defects, female skull is lighter and smaller. Its cranial renal defects, Cushing’s syndrome and high capacity being 10 per cent that of adult male. incidence of diabetes mellitus are usual The protuberances are less prominent. The features. The gonads do not show primordial female thorax is shorter and wider than that follicles. of the male. The sternum of females are (iii) True hermaphroditism: It is a very rare shorter and its upper margin is at the level condition, where testes or ovaries co-exist of the lower part of the body of the third in the body, with external genitalia of both thoracic (dorsal) vertebra while in males, it sexes. The gonads may be present in is at the level of lower part of the body of abdomen, inguinal canal or labio-scrotal the second. The sternal body is less than position. There may be uterus or phallus twice the length of manubrium in females may be penile or clitoral. The labia may while it is more than twice its length in the be bifid as in the females or fused male. It is due to the fact that manubrium in resembling scrotum of the male. They are the male is somewhat smaller than that in usually sterile. the female. The ribs are thinner and have (iv) Pseudohermaphroditism: In this, external greater curvature and the costal arches are characteristics of one sex may be there with larger in females. gonads of the opposite sex. The pelvis provides most reliable chara- A. Male pseudohermaphroditism: cteristics for distinguishing sex in over 90 per cent of individuals. The female pelvis Nuclear sex is XY but sex organs and is shallower, wider, smoother and less sexual characteristics are of female massive than the male pelvis. The ilium in form. There is testicular feminisation. females are less sloped, their posterior B. Female pseudohermaphroditism: borders are more rounded and the anterior Nuclear sex is XX but deviation of sex iliac spines are more widely separated and organs and sexual characters towards the great sciatic notches are much wider, male are seen because of adrenal forming almost a right angle, than in the hyperplasia. male. A female sacrum is short and wide, CFMT-03 (3rd Proof).p65 13 8/12/07, 9:25 AM  Identification 15 Temporary teeth: They are also known as milk Each tooth has a crown, a neck and a root teeth or deciduous teeth. They are 20 in number—4 embedded in the jaw bone. It is composed of dentin, incisors, 2 canines and 4 molars in each jaw. the crown is covered by enamel and the root by Permanent teeth: They are 32 in number—4 cementum which is attached to the alveolar bone incisors, 2 canines, 4 premolars and 6 molars in by periodontal membrane. It is observed that dental each jaw. The permanent teeth erupted in place of and skeletal ages correspond in males, but in temporary teeth which start shedding from about females the skeletal age is generally one year more sixth or seventh year (Table 3.3). than the dental age (Fig. 3.1). Table 3.3 Differences between temporary and permanent teeth Features Temporary teeth Permanent teeth 1. Size Small Large 2. Colour Porcelain white Ivory white 3. Constriction at Present Absent crown-root junction 4. Edges Sharp Serrated 5. Cusps Few and small More in numbers and highly developed 6. Number (Maximum) 20 32 Table 3.4 Sequence of appearance of centres of ossification and union of bones and epiphysis Age Appearance of centre Union of bones and epiphysis of ossification 5th year Head of radius, trapezium, Greater tubercle of humerus fuses with scaphoid head 6th year Lower end of ulna Rami of pubis and ischium unite 6th to 7th year Medical epicondyle of humerus — 9th year Olecranon — 9th to 11th year Trochlea of humerus — 10th to 11th year Pisiform — 13th year Separate centres in triradiate — cartilage of acetabulum 12th to 14th year Lesser trochanter of femur — 14th year Crest of ilium, head and Medial epicondyle of humerus, patella tubercles of ribs complete 15th year Acromion Coracoid with scapula 16th year Ischial tuberosity Lower end of humerus, olecranon to ulna, upper end of radius, metacarpals, 17th to 18th year head of femur, lesser and greater trochanter of femur, acromion, lower end of ulna 18th to 19th year Inner end of clavicle Lower end of femur, upper end of tibia and fibula, head of humerus, lower end of humerus 18th to 20th year Iliac crest 21st year Inner end of clavicle, ischial tuberosity CFMT-03 (3rd Proof).p65 15 8/12/07, 9:25 AM  16 Concise Textbook of Forensic Medicine and Toxicology Gustafson’s Method: It is used for age Males: At 14 years, fine hair begin to appear estimation in adults above 21 years of age. It depicts on pubis, the testes become large in size and penis the physiological changes in each teeth with begins to grow. At 15 years, hair growth on pubis progression in the age. The important changes are is moderate and also starts in axilla. At 16 years, periodontosis, attrition, secondary dentin, hair on pubis is fully grown and genitals acquire cementum apposition, root resorption and an adult appearance. Between 16 and 18 years, hair transparency of the root. Of all these, transparency begin to grow on the face and voice becomes of root is most reliable. hoarse. The four pieces of the body of sternum fuse Females: At 13 years, breasts begin to develop with each other from below upwards between the and fine, pale, downy hair appear on mons pubis. age group 14 and 25 years. The xiphoid fuses with The labia develops and menstruation starts. At 14– the body of sternum at about 40 years. The 15 years, growth of pubic hair is good and starts in manubrium fuses with the body in very old age or axilla too. sometimes does not fuse. The greater cornuea of the hyoid bone fuses with body in 40–60 years of Medico-legal Importance of Age (Table 3.5) age. In skull, the anterior fontanelle closes and two The following is the medico-legal importance of age: halves of the mandible unite during the second year 1. Criminal Responsibility: Under Section (Table 3.4 and Fig. 3.2). 82 of the I.P.C., any act done by a child Secondary Sexual Characters: The sequence under 7 years of age, is not an offense. of appearance of secondary sexual characters in Under Section 83 of the I.P.C. a child males and females are as follows: between the age of 7 and 12 years is 50–60 years 20 years 30 years 40–50 years 50–60 years 50–60 years 60–90 years 40–50 years Fig. 3.2 Closure of cranial vault in years. CFMT-03 (3rd Proof).p65 16 8/12/07, 9:25 AM  Identification 17 presumed to be capable of committing an 4. Rape: According to Section 375 of the offense if he has attained sufficient maturity I.P.C., sexual intercourse by a man with a of understanding to judge the nature and girl under 15 years, even if she is his wife consequences of his conduct on that or with any other girl under 16 years even occasion. This maturity is presumed in a with her consent, is an offense. child unless proved otherwise. 5. Kidnapping: Kidnapping means taking 2. Consent: Section 89 of the I.P.C. states that away a person illegally from a lawful a child under 12 years cannot give a valid custody. It is an offense to (a) kidnap a child consent to suffer any harm which may occur with the intention of taking any moveable from an act done in good faith and for his property dishonestly, if the age of the child benefit. Section 87 of the I.P.C. states that a is under 10 years (Section 369 of the I.P.C.), person above 18 years of age can give valid (b) kidnap a minor from lawful guardianship consent to suffer any harm which may result if the age of the boy is under 16, and that of from an act not intended or not known to a girl is under 18 years (Section 361 of the cause death or grievous hurt. The child I.P.C.), (c) push a girl for prostitution, if her below 12 years cannot give valid consent age is under 18 years (Section 366A of the for medical examination. I.P.C.), and (d) import into India from a 3. Juvenile Punishment: According to the foreign country, a girl for purposes of illicit Juvenile Justice Act 1986, Juvenile means intercourse, if her age is below 21 years a boy who has not attained the age of 18 (Section 366B of the I.P.C.). years or a girl who is below 18 years. The 6. Employment: A child below 14 years of law has established separate courts for the age is not allowed to work in any factory or juvenile and, instead of jail they are sent to mine or any other hazardous work. juvenile home or Borstal school where there However, a person completing 15 years is are facilities for education, vocational allowed to work in a factory as an adult if a training and rehabilitation. fitness certificate is granted by a doctor. Table 3.5 Medico-legal importance of age Age in years Medico-legal relevance 0–1 year Infanticide Less than 7 years Criminal immunity 7 years Criminal responsibility 10 years Kidnapping for valuables 7–12 years Guilty of offence if maturity present 12 years Can give consent for medical examination except for procedures 14 years Factory employment 15 years Wife can give consent for sexual intercourse 16 years Girl can give consent for sexual intercourse 16 years but less than 18 years All offences to be tried under Juvenile Act 18 years Attain majority. Right to vote. Consent for any surgery, marriage age for girls, kidnapping charges for girls 21 years Attain majority when under guardianship of court Marriage age for boys 25–35 years Age for entering government service 60–65 years Age for retirement from government job CFMT-03 (3rd Proof).p65 17 8/12/07, 9:25 AM  18 Concise Textbook of Forensic Medicine and Toxicology Under the Factories Act, 1948 an adult is of the features regarding the eyes, nose, ears, lips, defined as a person who has completed his chin and teeth should always be carefully noted. 18th year. An adolescent is defined as a The colour of irises, size of ear lobule should be person who has completed his 15th year, noted. In certain individuals, lips may be thin or but has not completed his 18th year; and a thick. The chin may be round, square, protruding child is defined as a person who has not or double (due to excessive fat). Expression of an completed his 15 years. individual changes after death. 7. Attainment of Maturity: A person attains maturity on completion of 18 years. Hair However, if a person is under the guardianship of the court of law or is under guardian appointed by the court, he attains Hair plays an important role in establishing identity maturity on the completion of 21 years. as it resists putrefaction for a longer time. The hair 8. Evidence: The competence to depose does of Indians is generally dark and fine, that of Chinese not depend on age but on understanding. If and Japanese is dark and coarse, while that of the court is satisfied that the child is truthful, Negroes is curly and wooly. Some people in order any child of any age can give evidence in to disguise their identity, might colour hair with the court (Section 118, Indian Evidence henna, dyes or cosmetics. The hair may change Act). colour in individuals working in certain trades like 9. Marriage Contract: A girl under 18 years copper melters and indigo workers. To find out the and a boy under 21 years cannot contract chemical use of dyeing, a few strands of hair should marriage (Child Marriage Restraint Act, 1987). be removed and they should be diluted in 10. Infanticide: In a court of law the charge of hydrochloric or nitric acid to dissolve the matter infanticide cannot be sustained if it is proved and then appropriate test should be done. that infant was under the age of 6 months Medico-legal Importance of Hair intrauterine life. 11. Criminal Abortion: A woman who has Hair is important in a crime investigation, as it already passed the age of child bearing, sometimes remains on the body of the victim or cannot be charged of having criminal on the alleged weapon. In rape and sodomy, pubic abortion. hair of the accused may be found on the victim or 12. Impotence and Sterility: A woman vice versa. Stains on the hair may sometimes becomes sterile after attaining menopause. indicate the nature of assault, for example, seminal However, a boy can be sterile although not stains in sexual offenses and salivary stains in impotent before puberty. asphyxial deaths. In chronic poisoning of heavy metals, the metal can be detected in the hair even after a long time. Singeing of the hair indicates Complexion and Features burning. The complexion may be fair, wheat coloured, dark, Anthropometry brown or shallow. The colour of an individual ranges from one area to another and depends upon This system is used primarily for the identification race, patterns and weather conditions. The details of veteran criminals. It is also called Bertillon CFMT-03 (3rd Proof).p65 18 8/12/07, 9:25 AM  Identification 19 system. It is applicable only to adults, as it is based on the principle that after 21 years of age no change occurs in the dimensions of the skeleton and ratio of the size of different parts to one another remains constant. Usual parameters which are taken are height of the person while standing, length of the head, width of the head, length of the right ear, (a) (b) width of the right ear, length of out-stretched arms, height of the trunk while sitting, length of the left foot, length of the left middle finger, length of the left little finger and length of the left forearm and hand. These measurements are recorded and kept. Certain peculiarities like the colour of irises or scars are also mentioned in the record. This system (c) (d) requires the employment of special instruments and Fig. 3.3 Various types of fingerprints: (a) arch, large number of staff. This system has now been (b) loop, (c) whorl, and (d) composite. replaced by a better system called dactylography. Poroscopy Dactylography It is a further modification of fingerprints, made This is also known as the fingerprint system and by Locard. The ridges on fingers and hands are consists of taking the impression of the pulp of the constituted of microscopic pores formed by fingers and thumbs with printer’s ink on an openings of ducts of sweat glands. Each millimetre unglazed white paper. It is seen that individual of a ridge contains 9–18 pores. These pores are peculiarities of the pattern formed by the permanent, and do not change throughout life. This arrangement and distribution of the papillary or method of examination is useful when only fragments of fingerprints are available. epidermal ridges on the finger tips are absolutely constant and persist throughout life (from infancy Technique of Investigating Fingerprints to old age) and, that patterns of no two hands resemble each other. The fingerprints of even The hands are first washed, cleaned and dried. The identical twins are different. The chances of two fingerprints are recorded on an unglazed white paper using printer’s ink. There are two types of persons having identical fingerprints is about one prints which are taken: (a) plain fingerprint—is in thirty times the population of the world. taken by applying ink to the tips of the fingers and This system was first used in India in 1858 by placing the fingers directly on paper. In this, the Sir William Herschel but it was Sir Francis Galton whole contour of the pattern does not appear; who established it. Fingerprints are classified in four (b) rolled fingerprint—is taken by rolling the groups, namely, loops (about 67 per cent), whorls fingers on papers so as to obtain impression of the (about 25 per cent), arches (about 6–7 per cent) and whole tip. composite form (about 1–2 per cent). They are Fingerprints on paper, wood and fabric can be further classified into subgroups since arches can developed by treating them with sulphur nitrate be plain or tented; loops can be radical or ulnar; and solution, and then fixing them with sodium composite can be central pocket loops, twinned thiosulphate. Fingerprints can also be developed loops, later pocket loops and accidental (Fig. 3.3). exposing it to the vapours of iodine. CFMT-03 (3rd Proof).p65 19 8/12/07, 9:25 AM  20 Concise Textbook of Forensic Medicine and Toxicology Criminals sometimes attempt to mutilate the in 3–4 months. Some scars located in the chest and patterns of fingerprints by inflicting wounds or limbs grow in size with the natural development of burns, application of corrosives but they are not the individual, if the injury has been inflicted in obliterated unless true skin is completely destroyed. childhood. Certain diseases like leprosy may modify the finger- prints. Electrical injury and radiation may also Tattoo Marks cause impairment. In criminal cases, impression of all the 10 fingers are taken, but for civil purposes Tattooing is prevalent all over the world and is more the left thumb impression is taken in case of males common among persons of low socioeconomic and right thumb impression in case of females. status, persons involved in crime, prostitutes, Footprints: The skin pattern of toes and heels religious fanatics and punks. Tattooing is done are as distinct and permanent as those of fingers. mostly by puncture in which tattoo particles of In case of maternity hospitals, footprints of new- insoluble pigments are introduced into the dermis born infants are taken to prevent exchange. Some (such as vermilion, cinnabar and ultramarine). individuals have also advocated the use of palate- Designs of various kinds from initials to Gods of prints and lip-prints in the identification of worship, and sometimes tattoo posture of sexual individuals. activity are seen. It has been observed that tattoo marks may disappear during life without leaving Deformities any trace on the body after a considerable time, namely, in years. It is mostly seen in cases where They may be congenital or acquired, and are quite the pigment used is vermilion or ultramarine and if useful in the identification of individuals. it is perforated deep into the skin. Tattoo marks Deformities like cleft palate, hare-lip, may be removed artificially by (a) surgical methods, supernumerary fingers of toes, supplementary (b) electrolysis, and (c) application of corrosives. mammae, web fingers or toes and muscles are Small pox and chronic eczema have been shown congenital. Clear or acquired deformities, such as to cause obliteration of tattoo marks (Fig. 3.4). ununited or malunited fractures are quite useful in the identification of the individual. Scars A scar is a fibrous tissue covered by epithelium formed as a result of the healing process of a wound or injury in which there has been a breach of continuity. It does not contain hair follicles, pigment or sweat glands. Generally, a scar assumes the shape of the wound causing it. A scar resulting from an incised wound is usually straight. Broad and irregular scars are caused by lacerated wound. A scar appears in 4 or 5 days after healing under a scab. It is difficult to tell the exact age of a scar. When first formed, a scar is light, tender and covered by a scab. Subsequently, it turns brown and finally white. These changes are generally seen Fig. 3.4 Tattoo mark. CFMT-03 (3rd Proof).p65 20 8/12/07, 9:25 AM  Identification 21 Occupational Marks 1. Clothes and Personal Articles: They do not form any special basis for evidence in They are quite useful in identification of unknown identification of living persons, as the dead bodies as certain trade practices leave marks. individual may change them at will. But they For example, horny and rough hands are observed are very useful in establishing the identity in individuals doing hard manual labour. Kahars of a dead body, particularly in a mass and dooly bearers usually have a hardened callous disaster. The clothes can be identified by the on their shoulders. Callosity on the hypothenar presence of marks of a dhobi (washerman) eminence and right palm is seen in persons involved or that of a tailor. 2. Speech and Voice: Certain peculiarities of in weighing goods. speech like stammering, stuttering, hissing Callosity on the right middle finger distal and nasal twang are characteristics of certain interphalangeal joint, where the pen usually rests, individuals. However, speech can be affected is seen in clerks, and depression in the lower part in many nervous diseases and trauma. Also, of the sternum is found among shoe-makers. Tailors many cases have been reported in which the have marks of needle punctures on their left index impersonator has been successful in keeping finger. Engineers, dyers, chemists and the exact patterns of speech. photographers generally have their fingers stained 3. Gait: Individuals can be recognised from a with dyes or chemicals. These occupational marks distance by watching their gait but this are quite useful in the identification of an individual. evidence is far from conclusive as the gait may be altered by an accident or disaster. Handwriting 4. Ticks, Manners and Habit: These are usually hereditary, e.g. left-handness. A person may be identified by his handwriting. But However, repetitive jerky movements of to identify a person from handwriting requires shoulders or the muscles of face may be an highly skilled experience. However, handwriting individual characteristic. 5. Mental Power, Memory and Education: experts are not at all infallible and their evidence Certain individuals have described various may be conflicting. It is observed that mental and methods of identification based on the fact nervous diseases, especially those causing tremors, that no two electrocardiograms (ECG) are may alter the character of writing by producing the same. Some have used lip-prints for more or less irregularities in the formation of letters. identification. Some have compared X-rays of frontal sinuses after the age of 15. Some Miscellaneous Methods of Identification individuals have advocated the use of footprints and palatoprints for identification. The following are the miscellaneous methods of But all these methods are not standardised, identification of an individual: so cannot be relied upon. CFMT-03 (3rd Proof).p65 21 8/12/07, 9:25 AM  +0)26-4 " Post-mortem Examination The post-mortem examination is a legal not be possible to bring the bodies to the mortuary; requirement when the cause of death is not known. in such cases the doctor conducts the post-mortem The objectives of a post-mortem examination are: on the spot. Also, in cases that require exhumation, the post-mortem is conducted on the spot. 1. To establish the identity of an individual Before a post-mortem examination, the doctor 2. To know the cause of death should read all the inquest papers. The inquest 3. In case of a newborn whether the foetus papers contain brief facts of the case, statements of was viable or not. witnesses, a map of scene of crime, medico-legal The cause of death is defined as disease or report, death report, etc. He should also go through injury which results in death. The manner of death the enquiries made by the investigating officer. The explains how the cause of death came into being. post-mortem should preferably be conducted in The manner of death may be natural or unnatural. daylight. Although there is no bar to conduct a When a person dies because of some disease, the post-mortem examination at night, there should be manner of death is natural. If he dies because of adequate light if post-mortem is conducted after some injury, the manner of death is unnatural, sunset. It is advised that if a post-mortem which may be homicidal, suicidal, or accidental. examination is carried out after sunset, necessary The mode of death is the physiological process permission from appropriate authorities may be which causes death like asphyxia, coma, and sought. The post-mortem examination should be syncope. complete and thorough. All the great cavities and organs should be examined thoroughly. A partial CONDUCTING A POST-MORTEM post-mortem is not allowed. EXAMINATION The post-mortem report consists of following components: The post-mortem examination is conducted only 1. Preamble: The name of the deceased, the on the written request of the police or magistrate. gender, address, time of arrival of the body, In normal circumstances, a police officer or a date and place of examination, name of the magistrate brings the dead body, along with the police officer who brought the body and inquest paper, to a mortuary for post-mortem name of the relative who identifies the body, examination. But sometimes, if it is not possible to should be noted. bring the dead body to the mortuary, the doctor 2. The Body of the Report: It consists of may be asked to go to the scene of the crime and complete account of external and internal conduct post-mortem examination. This is examination. All the injuries on the body sometimes seen in hills where a vehicle may fall are described. Marks of identification should into a deep trench resulting in death, and it may be recorded. CFMT-04 (3rd Proof).p65 22 8/12/07, 9:26 AM  Post-mortem Examination 23 3. Opinion: This is the most important aspect 3. If ligature material is seen around the neck, of the report. An opinion regarding the its position, manner and application of the cause of death is provided after careful knot should be recorded accurately. consideration of all the findings. The opinion 4. A rough estimate of age should be made should be brief, clear and honest. It should from general body, teeth examination or be based on scientific facts and terms like other physical appearances. probably, nearly, etc., should be avoided 5. All the natural orifices like mouth, nose, while expressing opinion regarding the cause ears, anus, urethra and vagina should be of death. inspected for injuries, discharges, or foreign After expressing his opinion the doctor should bodies. Swabs should be taken in suspected put his signature, complete name, designation and cases of sexual assaults. address below the signature. It is better to put the 6. The signs of decomposition and post- official seal. No unauthorised person should witness mortem changes should be carefully noted. a post-mortem examination. The doctor should Extent of rigor mortis, post-mortem staining, preferably write the report immediately after the changes in cornea, and dripping of saliva should post-mortem examination and hand it over to the be noted. police official or the magistrate. The copy of the After cleaning the body, all the injuries present report should not be given to any unauthorised on the body should be noted. All the injuries should person. be described in detail. The length, breadth and depth should be exactly noted. If the injuries are External Examination deep, the distance of each injury from two fixed Before starting external examination, height and points on the body should be noted. Fixed points weight of the body should be taken. Observation of the body include bony prominence, median regarding nutrition, physique should be made. In plane, etc. The description of the injury should be case of unknown bodies, fingerprints along with made in such a manner that the doctor is able to photographs should be taken. Marks of reconstruct the same in a court of law, if requested. identification like moles, scars, tattoos, deformity, Injection marks present on the body should be etc. should be noted. carefully noted. If required for testing purposes, a The following procedure should be followed portion of skin (2.5 cm × 2.0 cm) containing for external examination: injection mark with subcutaneous tissue and muscles 1. The body must be identified by police should be preserved. A similar piece from the constables who brought the body and it opposite side should also be taken as control should be cross-checked with relatives of specimen. The length, breadth, direction and colour the deceased. This is necessary especially of bruises and abrasions should be noted. All bruises in burn cases and when the body is highly should be incised to confirm infiltration of blood decomposed, since facial features of the beneath the skin so as to confirm their status as person may have been obliterated due to ante-mortem or not. No probe should be introduced burns or decomposition. in deep or penetrating wound till the body is opened 2. The clothes on the body should be examined up. In case of fire-arm injuries, blackening around carefully for stains and tears as these may the entire wound should be carefully noted. In case indicate struggle before death. The pockets of of burns, exact size, portion and extent should be the clothes should be checked and any item noted. In case of an infant, the condition of the found should be noted in the post-mortem umbilical cord should be inspectedæwhether it is report. tied, torn or cut. CFMT-04 (3rd Proof).p65 23 8/12/07, 9:26 AM  24 Concise Textbook of Forensic Medicine and Toxicology Examination of Head The head is opened by giving first a transverse incision across the vertex from ear to ear and flaps are reflected anteriorly up to orbits and posteriorly below the occipital protuberance. The inner surface of the scalp should be examined for extravasation of blood, petechial haemorrhages or injuries. The skull bones should be examined for any fracture or separation of sutures, after the periosteum is denuded and temporal muscles cut. The skull cap is removed by making a circular cut by a saw around the cranium just above eye bridges keeping within reflected caps. The inner surface of the cap should be inspected for fracture of inner plate and any haematoma present. Any extra-dural haematoma may be noted once the skull cap is removed and condition of the dura should be noted. The dura is removed by cutting longitudinally along both the sides of the midline, and any subdural and sub- arachnoid haemorrhage should be noted. The brain is removed by raising the anterior lobes with fingers of left hand and cutting the nerves at its base and the medulla as low as possible. The brain should be examined for any injuries, embolism, or petechial haemorrhages. Different sections of the brain should be cut to inspect carefully. The dura mater should be removed from the base of the skull Fig. 4.1 Types of incisions for opening the body. at last, and fractures should be examined if present on the base of the skull or around. Internal Examination Examination of Thorax and Abdomen All the three cavities, head, thorax and abdomen The thorax is opened by giving longitudinal incision should always be opened. There is no fixed sequence from above the middle of the sternum to the pubic of opening these cavities, but in case of alleged bone, avoiding any wounds present in the line. The infanticide, the head should be opened first so that skin and muscles are reflected. The abdominal the contents of the skull can be examined before cavity should be examined first, before the thorax blood is drained out by opening other cavities. In is opened. The position of the diaphragm, any normal cases, thorax and abdomen are opened first presence of blood, pus, or foreign body in the and head later on. The spinal cord is normally not abdomen should be noted. The thorax is opened opened up. Only in cases of suspected spinal injury by dividing the ribs at their cartilages and the or poison it is opened up. In all other cases it is sternum at the sternoclavicular junction with a opened last (Fig. 4.1). cutter and lifting up the sternum in such a way that CFMT-04 (3rd Proof).p65 24 8/12/07, 9:26 AM  Post-mortem Examination 25 it does not injure the underlying parts. The pleural In case of suspected poisoning, the entire cavities should be examined for the presence of stomach along with its contents is preserved. any blood, pus, or injury. 2. Intestines: Both small and large intestines The heart is examined by opening the should be inspected by cutting the mesentery pericardium. The lungs and heart should be and examined for congestion, ulcer & removed and examined. The condition of the heart perforation. In cases of suspected poisoning should be seen for enlargement or any injury a small part of the upper intestine is present. All the chambers of the heart should be preserved. examined for an