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3/2/2015 Injuries|ForensicPathologyOnline

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WrittenbyDr.D.Rao

EBookInjuries

Injuries

Awoundor injury isdefinedasdisolutionof thenaturalcontinuityofanyof thetissuesof the livingbody.Mechanical injuriesare injuriescausedto thebodybyphysicalviolence.

MechanismofWounding:Thebodyabsorbsthenaturalforces,likegravity,movement,routinemovementslikesittingandwalkingbytheresilienceandelasticityofitssofttissuesandrigidskeletalframework.woundisduetotheresultforceswhichcrossthelimitsofelasticityorresistance.Thefollowingarethefactorswhichinfluencethewoundingmechanism:

1. TheamountofforceappliedwhichdependsonMassoftheObjectandSquarerootofthevelocitywithwhichitisappliedi.e.Force=1/2M.V.2.Eg.Whenacricketball(200gm) is pressedon thehead itcausesnodamagehowever if the impact isatminimumvelocityof10m/sec itmayendup in fracture.HenceapartfromthemasstheVelocityisthefactorwhichplaysthemajorrole.

2. Thetransferof the force throughthebodyagaina factorwhichcontributes to thewoundingpower. If thewoundingobjectpass throughandthrough(eg.PerforatingBullet)theamountofdamageislessascomparedtoawoundingobjectlodginginsidethebody(Explosivebullet).

3. ThedistributionofForceover theSurfaceof thebody isanother factor, larger theareaofdistribution lesser thedamagesmaller theareaofdistributionmore thedamage(eg.pointedknifecausemoredamagethanbluntweaponwithequalamountofforce).

4. Theforceactingonthesurfaceofthebodysubjectsthetissuetotraction,shearandcompression,hencetheresultantdamagedependsnotonlyonthetypeofthemechanicalinsultbutalsoonthenatureofthetargettissuei.eMuscle,bone,halloworganlikeintestine.etc.

5. AnotherveryimportantfactoristhemovementofthebodyinthedirectionoftheForcewhichaddsuptothewounding.Ifthemovementistowardsthedirectionoftheforcethedamageisleastifagainstthedirectionoftheforcethedamgeisextensive.eg.Catchingacricketballandmovingthehandsinthedirectionoftheforcewillcauseleastdamagethanthecontrarymovmentofthehand.

Classification:

MechanicalInjuries:

1. Abrasions2. Contusions3. Lacerations4. Incisedwounds5. Stabwounds6. Firearmwounds.7. Fracturesanddislocation.

(II)ThermalInjuries:1. (1)Duetocold

(a)Frostbite,(b)Trenchfoot,(c)Immersionfoot.2. (2)Duetoheat

(a)Burns,(b)Scalds.

(III)ChemicalInjuries:1)Corrosiveacids,(2)Corrosivealkalis.(IV)Injuriesduetoelectricity,lightning,Xrays,radioactivesubstances,etc.

Introduction&History PostMortemChanges Injuries Asphyxia SexualAssaults Identification CrimeScene Autopsy Poisons



Legally,injuriesareclassifiedinto(1)Simple,and(2)Grievous.

Others:

SelfinflictedInjuries.

DefenseInjuries.

OffensiveInjuries.

UnintentionalInjuries.

FatalandNonFatalInjuries.

MechanicalInjuriesMechanicalInjuriesareCausedduetoapplicationofMechanicalforceonanypartofthebody,likeBluntForce,SharpForceandFirearms.

ABRASIONS

An abrasion is a destruction of the skinwhich usually involves the superficial layers of the epidermis only. They are caused by a blow, a fall on a roughsurface,bybeingdraggedinavehicularaccident,fingernails,thornsorteethbite.Somemovementandpressurebytheagentonthesurfaceoftheskinisessential.Thesizevariesdependingontheextentofthebodysurfaceexposedtotheabradingforce.Whentheyhealthereisnopermanentscar.TYPES:

1. Scratches:Theyarecausedbyasharpobjectpassingacrosstheskin,suchas,fingernails,pinorthorn.Thereisheapingupofsurfacelayersoftheskininfrontoftheobject,whichleavesacleanareaatthestartandtagsattheend.Fingernailsproduceacurvedscratch,wideatthestartandnarrowattheend.Athornorpinproducesanarrowscratchwhichtailsoff.

2. Grazes:Theyoccurwhenthereismovementbetweentheskinandsomeroughsurfaceincontactwithit.Theyshowlongitudinalparallellineswiththeepitheliumheapedupattheendsoftheselines,whichindicatethedirectioninwhichtheforcewasapplied.Thegroovemaybebroadatoneendandtailawayintheoppositedirection.Theyarethemostcommontypeandseeninroadaccidents.Inopenwounds,directorgritareusuallypresent.

3. PressureAbrasions:Theyarecausedbyacrushingof thesuperficial layersof theskin,andareassociatedwithabruiseof thesurroundingarea. Inthis,themovementisslightandlargelydirectedinwards,e.g.ligaturemarkincasesofhanginganstrangulation,andtheteethbitemarks.

4. ImpactAbrasions:Theyarecausedbimpactwitharoughobject,suchas,whenapersonisknockeddownbyamotorcar.Insuchcasesthepatternofradiator grill or tread of the tyremay be seen on the skin. Impact abrasions and pressure abrasions reproduce the object causing it and are calledpatternedabrasions.

Ondrying,abrasionsbecomedarkbrownorevenblack.

AGE Fresh Brightred.

12to24hours: Lymphandblooddriesupproducingbrightredscab

2to3days: Reddishbrownscab

4to7days: Epitheliumcoversthedefectunderthescab

After7days: Scabdries,shrinksandfallsoff.

Antemortemabrasions:areseenanywhereonthebody,reddishbrownincolour,scabisslightlyraisedandvitalreactionisseen.Postmortemabrasionsareusuallyseenoverbonyprominences,areyellowishandtranslucent,thescabisslightlydepressedandthereisnovitalreaction.

Abrasionsareusuallyseen inaccidentsandassaults.Suicidalabrasionsarerare.Abrasionshavetobedifferentiatedfrom:(1)Erosionofskinproducedbyants.(2)Excoriationsoftheskinbyexcreta.(3)Pressuresores.MedicolegalImportance:

1. TheyIndicatessiteofimpactanddirectionoftheforce.2. Theymaybetheonlyexternalsignsofaseriousinternalinjury.3. Patternedabrasionsarehelpfulinconnectingthecrimewiththeobjectwhichproducedthem.4. Theageoftheinjurycanbeknown.5. Inopenwoundsdirt,dust,greaseorgritareusuallypresent,whichmayconnecttheinjuriestothesceneofcrime.6. Manner of injurymay be known from its distribution: (a) In throttling, curved abrasions due to fingernails are found on the neck. (b) In smothering,

abrasionsmaybeseenaroundthemouthandnose.(c) Insexualassaults,abrasionsmaybefoundonthebreasts,genitals, insideof thethighsandaroundtheanus.(d)Abrasionsonthefaceorbodyoftheassailantindicateastruggle.

CONTUSIONS

Acontusionorbruiseisaneffusionofbloodintothetissues,duetoruptureofsubcutaneousvessels,usuallycapillaries.Theyarecausedbybluntforce,suchas, fist,stone,stick,whip,boot,etc.Usually there isno lossofcontinuityofskinbut theymaybeassociatedwithabrasionsor lacerations.Whena largebloodvesselisinjuredatumourlikemasscalledhaematomaisformed.Afreshbruiseisusuallytenderandslightlyraisedabovethesurfaceoftheskin.Thesizevariesfromsmallpinheadtolargecollectionsofbloodinthetissues.



PatternedBruising:Abruise isusually roundbut itmay indicate thenatureof theweaponused.Ablowfromahammeror theclosedfistusuallyproducearoundbruise.Bruisemadebytheendofathickstickmayberound,butifanylengthofthestickhitsthebodytheyareenlargedandirregular.Ablowwitharod,astickorawhipproducestwoparallellinearhaemorrhages.Theinterveningskinisunchanged.Inbruiseproducedbyalongrigidweapon,e.g.stick,theedgesof thebruisemaybe irregular and thewidthmaybegreater due to the infiltrationof blood in the surrounding tissuesalong theedgesof thebruise.Bruisescausedbyblowsfromwhipsareelongated,curveoverprominences,andmaypartiallyencirclealimborthebodyandareseenastwoparallellines.Bruisesfromstraps,beltsorchainsleaveadefiniteimprint.Patternedbruisingisalsoseeninmotorcaraccidents.

AppearanceofBruises:Asuperficialbruiseappearsatoneasadarkreddiscolouration.Adeepbruisemaytakeseveralhourstooneortwodaystoappear.Therefore,asecondexaminationshouldbecarriedouttwodayslater.

AGE Atfirst Red

Fewhoursto3days: Blue

4thday: Bluishblacktobrown

5to6days Greenish

7to12days Yellow

2weeks Normal

In antemortem bruising there is swelling, damage to epithelium, extravasations, coagulation and infiltration of the tissues with blood and colour changes.Thesesignsareabsentinpostmortembruises.

ProofofBruising:Contusionsinthesubcutaneoustissuesmaybedetectedbyparallelincisionsthroughtheskin.Deepbruisesaredetectedbydeepincisionsmadeintothemuscles.Contusionsofthescalpcanbedetectedbyreflectingthescalpandmakingincisionsfromtheaponeuroticsurface.Whenindoubt,aportionmustbetakenformicroscopy.

Medicolegal Importance:Abruise isasimple injury,but thecontusionof theheartmaycausedeath.multiplecontusionsmaycausedeathfromshockandinternalhaemorrhage.Acontusionmaycontain20to30ml.ofbloodormore.

1. PatternedbruisesmayconnecttheVictimandtheobjectorweapon.2. Theageoftheinjurycanbedetermined.3. Thedegreeofviolencemaybedeterminedfromtheirextent.4. Inthecaseofafall,sand,dustormudmaybefoundonthebody.5. Themannerofinjurymaybeknownfromitsdistribution(similartoabrasions).

Bruisesareusuallyseeninaccidentsandassaults.Selfinflictedbruisesarerareastheyarepainful.ArtificialBruises:Some irritantsubstances,e.g. juiceofmarkingnutorcalotropis,whenapplied toskinproduce injuries,whichstimulatebruises.Theyareseen on exposed accessible parts of the body, colour is dark brown, shape is irregular, margins are well defined and regular and are covered with smallvesicles, ecchymosis is absent, contain acrid serum, itching is present, and vesiclesmay be found on finger tips and on other parts of the body due toscratching.

LACERATIONS

Alacerationisawoundinwhichthetissuesaretornduetobluntforcetothebody.Theyarealsocalledtearsorruptures.TYPES:

1. SplitLacerations:Splittingoccursbycrushingoftheskinbetweentwohardobjects.Bluntforceonareaswheretheskiniscloselyappliedtobone,andthesubcutaneoustissuesarescanty,mayproduceawoundwhichlookslikeanincisedwoundandiscalledincisedlikeorincisedlookingwound.Thesitesarescalp,eyebrows,cheekbones,lowerjaw,iliaccrest,perineumandskin.

2. StretchLacerations:Overstretchingof theskin, if it is fixed,will cause laceration.There is localizedpressurewithpullwhich increasesuntil tearingoccursandproducestheFlap.Itisseeninrunningoverbyamotorvehicleandinfractures.

3. Avulsions:Grindingcompressionbyaweightsuchaslorrywheelpassingoveralimbortrunkmayproduceseparationoftheskinfromtheunderlyingtissues(avulsion)andcrushtheunderlyingmuscles.

4. Tears:Tearingoftheskinandtissuescanoccurfromimpactbyoragainstirregularorsharpobjects,suchas,doorhandleofacar.

Characters:1. Marginsareirregular,raggedandunevenandtheirextremitiesarepointedorblunt.2. Bruisingisseeneitherintheskinorthesubcutaneoustissuesaroundthewound.3. Deepertissuesareunevenlydividedwithtagsoftissueatthebottomofthewoundbridgingacrossthemargin.4. Hairbulbsarecrushed.5. Haemorrhageislessbecausethearteriesarecrushedandtornacrossirregularly.6. Foreignmattermaybefoundinthewound.7. Depthvariesaccordingtothethicknessofthesoftpartsandthedegreeofforceapplied.8. Alacerationisusuallycurved.



9. Theskinonsideofwoundoppositetodirectionofforceisusuallytornfreeorundermined.

Antemortem lacerations show bruising of margins, eversion and gaping of the margins and vital reaction. Lacerations are usually seen in accidents andassaults.Suicidallacerationsareveryrare,astheyarepainful.MedicolegalImportance:

1. Thetypeoflacerationmayindicatethecauseoftheinjuryortheshapeofthebluntweapon.2. Foreignbodiesfoundinthewoundmayindicatethecircumstancesinwhichcrimehasbeencommitted.3. Theageoftheinjurycanbedetermined.

INCISEDWOUNDS

Anincisedwound(Cut,Slash,Slice)isacleancutthroughthetissues,whichislongerthanit isdeep.It isproducedbythepressureandfrictionagainstthetissuebyanobjecthavingasharpcuttingedge,e.g.,knife,razor,scalpel,etc.Characters:(1)Theedgesarecleancut,welldefinedandusuallyevertedandfreefromcontusions.(2)Thewidthisgreaterthantheedgeoftheweaponcausingitduetoretractionofthetissues.

1. Thelengthisgreaterthanitswidthanddepthandhasnorelationtothecuttingedgeoftheweapon.2. Itisusuallyspindleshapedduetogreaterretractionoftheedgesinthecentre.3. Haemorrhageismoreasthevesselsarecutcleanly.4. It is deeper at the beginning because of greatest pressure.This is known as head of the wound. Towards the end of the cut the wound becomes

increasinglyshallow,andfinallytheskinaloneiscut.Thisisknownastailingofthewound.5. Ifthebladeofweaponentersobliquely,oneedgeisbeveledattheexpenseoftheotherifthebladeisnearlyhorizontal,aflapwoundiscaused.

AGE Fresh Haematomaformation.

12hoursTheedgesarered,swollenandadherentwithbloodandlymphleucocyticinfiltration.

24hours Ascabofdriedclotisseenonthewoundvascularbudsbegintoform

36hours Thecapillarynetworkiscompletemitoticactivityinthebasalcells

2to3daysThewoundisfilledwithfibroblastsandcapillarybudsgrowinfromthecutsurfaces

3to5days Definitefibrilsareseenvesselsshowthickeningandobliteration

1to2weeks Scarisformed

MedicolegalImportance:(1)Theyindicatethenatureofweapon.(2)Theygiveanideaboutthesiteofimpactanddirectionoftheforce.(3)Theageoftheinjurycanbedetermined.(4)Positionandcharacterofwoundsmayindicatemodeofproduction,i.e.suicide,accidentorhomicide.Chop Wounds: They are wounds caused by a blow with the sharp cutting edge of a fairly heavy instrument like an axe, butchers knife, and etc. Thedimensionsof thewound correspond to crosssectionof penetratingblade.Themarginsare sharpandmay showslight abrasionandbruisingwithmarkeddestructionofunderlyingorgans.Usually theheelof theaxestrikes thesurface firstwhichproducesadeeperwound than the toewound.Thedeeperendindicatesthepositionof theassailant. If theextremitiesareattackedtheremaybecompleteor incompleteamputationof thefingersorotherparts.Mostoftheseinjuriesarehomicidal.

STABWOUNDS

Staborpuncturedwound iscausedbysharppointedobjects,suchas,knife,dagger,nail,needle,spear,arrow,screwdriver,etc.Penetrating theskinandunderlyingtissues,i.e.,deeperthanitslengthontheskin.Theyarecalledpenetratingwoundswhentheyenteracavityofbody.Whentheweaponentersthebody on one side and comes out on the other side, perforating or through and through puncturedwounds are produced. Thewound of entry is largerwithinvertededgesandthewoundofexitissmallerwithevertededges,duetotaperingofblades.

Characters:(1)Thelengthofthewoundisslightlylessthanthewidthoftheweaponbecauseofstretchingoftheskin.(2)Thedepthisgreaterthanthedimensionoftheexternalinjury.(3)Theedgeofthewoundarecleancut.(4)Shape:(a)Ifawoundwillbetriangularorwedgeshaped,(b)Ifadoubleedgedweaponisused,thewoundwillbeelliptical.(c)Aroundobjectlikethespearmayproduceacircularwound. (d)A roundbluntpointedobjectmayproduceacircularwoundwith raggedandbruisededges. (e)Apointedsquareweaponmayproduceacruciforminjury.(5)Thedirectionisindicatedbyanundercuttingoftheexternalwound,andbythetrackofinjurybytheblade.Theprincipaldirectionshouldbenotedfirstandtheothersnext.

Complications:(1)Externalhaemorrhageisslightbuttheremaybemarkedinternalhaemorrhageorinjuriestointernalorgans.(2)Infection.(3)AirEmbolism.



Concealedpncturedwounds:Thesearepuncturedwoundscausedonconcealedpartsofthebody,suchas,axilla,vagina,rectumnostrils,fontanelle,fornixoftheuppereyelids,andnapeoftheneck.Fatalinjuriescanbecausedwithoutleavinganyexternalmarks.

MedicolegalImportance:(1)Theshapeofthewoundmayindicatetheclassandtypeofweapon.(2)Thedepthofthewoundwillindicatetheforceofpenetration,(3)Directionanddimensionofthewoundindicatetherelativepositionsoftheassailantandthevictim.(4)Theageoftheinjurycanbedetermined.(5)Position,numberanddirectionofwoundsmayindicatemodeofproductioni.e.suicide,accidentorhomicide.(6)Ifabrokenfragmentofweaponisfounditwillidentifytheweapon.Stabwoundsaremostlysuicidalorhomicidal.Accidentalwoundsarerare.

CIRCUMSTANCESOFINCISEDANDSTABWOUNDS:

(1)AccidentalWounds:Theyarecausedby(i)Falluponasharpedgedobject.(ii)Impactbysharpobjects,e.g.,glasspieces.(iii)Unintentionalcutorstabbysharpedgedorpointedinstrument,e.g.,knife,razorblade,householdutensil,etc.(2)Suicidalwounds:

1. Theyaremultipleandparallel,andsuperficialinanyonearea.2. Theyarepresentinseverallimitedaccessibleareasofthebody,suchasneck,wrists,groinandrarelyonbacksoflegsoronchest.3. Hesitationmarksor tentativecutsaremultiple,smallandsuperficial,often involvingonly theskinandareseenat thecommencementof the incised

wound.4. Whenasafetyrazorbladeisusedunintentionalcutsarefoundonthefingerswherethebladehasbeengripped.5. Morethanonemethodmaybeusedforsuicide.6. Inrighthandedpersons,themostseverewoundsareoftenfoundontheleftsideofthebody.

Suicidalcutthroatwoundsareusuallyseenabovethethyroidcartilage,thedirectionisfromlefttoright,theedgesareraggedduetooverlappingofmultiplesuperficialwounds,hesitationcutsarepresent,tailingispresent,theyaremultipleupto20to30,superficialandparallelwoundsmaybeseenonotherpartsofthebody,,theclothesarenotcutandcircumstantialevidencemaybehelpful.(3)Homicidalwounds:

1. Multiplegapingwoundsonanypartofthebodyincludingback.

(ii)Defencewoundsmaybefound.1. Hesitationwoundsareabsent.2. Mutilationofthebody,particularlythebreastsandgenitals,indicatesexualmurder.

PostMortem Wounds: (a) Intentional mutilation: (i) Sex crimes. (ii) Sadistic murders. (iii) Attempted concealment of body by dismemberment. (b)Unintentionalmutilation.

FRACTURES:Fracturesmaybecausedbydirectorindirectviolence.

SKULLFRACTURES:

1. Fissuredfractures: Theseare linear fractures or cracks in the bone involving thewhole thicknessof the boneor oneor other table only. Theyarecausedbyforciblecontactwithabroadresistingsurfaceliketheground,blowswithanagenthavingarelativelybroadstrikingsurfaceorfromafallonthefeetorbuttocks.Thefracturestartsatthepointof impactandrunsparallel tothedirectionoftheforce.If theheadissupportedwhenstruck,thefracturema start at the counter pressure, e.g. in bilateral compression the fracture often starts at the vertex or more commonly at the base. Thefracturelinetendstofollowadeviouscourseandisusuallynomorethanhairsbreadth.

2. Depressedfractures: In this portions of fractured bone are driven inwards into the skull cavity. Their pattern often resembles theweapon or agentwhichcausedit.Theyarecausedbyblowsfromheavyweaponswithasmallstrikingsurface,e.g.,stones,sticks,axe,hammer,etc.

3. Comminutedfractures: In this thebone isbroken into severalpieces.Theyarecausedby fall fromaheight, vehicleaccidentsand fromblowsbyweaponswitha largestrikingsurface,e.g.heavy ironbar,axe, thickstick,etc.Fissuredfracturesmayradiateforvaryingdistancesfromtheareaofcomminution.

4. PondorIndentedfractures:Thisisasimpleinbucklingoftheskull,whichresultsfromtheobstetricforcepsblade,ablowfromabluntobjectorforcibleimpactagainstsomeprotrudingobject.

5. Gutter fractures:Theyare causedwhenpart of the thicknessof thebone is removed soas to fromagutter, e.g. glancingbulletwounds.Theyareusuallyaccompaniedbyirregulardepressedfracturestotheinnertableoftheskull.

6. RingorForamenfractures: It is fissuredfracturewhichencirclestheskull insuchamannerthat theanterior third isseparatedat its junctionwiththemiddleandposteriorthirds.But,usuallythetermisappliedtoafracture,whichrunsatabout3to5cm.outsidetheforamenmagnumatthebackandsidesoftheskullandpassesforwardsthroughthemiddleearsandroofofthenose,duetowhichtheskullisseparatedfromthespine.Theyarerareandoccurafterfallsfromaheightintothefeetorbuttocks.Thisdrivesthevertebralcolumnintotheskull.

7. Perforating fractures: These are caused by firearms and pointed sharp weapons like daggers or knives and axe. Theweapon passes through bothtablesoftheskullleavingmoreorlessacleancutopening.

8. Diasticorsuturalfractures:separationofthesuturesoccuronlyinyoungpersonduetoablowonheadwithbluntinstrument.

Fractureoftheskulloccurringoppositetothesiteofforceisknownasconrtecoupfracture.Thisusuallyoccurswhentheheadisnotsupported.



Braininjury:

Contrecouplesions:Coupmeansthat the injury is locatedundertheareaof impactandresultsdirectlybythe impactingforce.Contrecoupmeansthat thelesionispresentinanareaoppositethesideofimpact.Contrecoupinjuriesaremoreextensive.CerebralContusions:Theymayoccurwithoutapparentinjurytotheskull,butoftenthereisafractureoftheskull.Theymaybefoundonanypartofthebrain,andmayappearasaseriesofsmallpunctatehaemorrhagesaggregatedinbunches,orasadefinitehaemorrhageintothecortex.Thecommonestsiteistheoutersurfaceofparietalandtemporallobesordeepinthebrainsubstance.Infalls,whenmovingheadbrainsubstance.Infalls,whenmovingheadstrikesafixedobject,cerebralcontusionswillbecontrecoupandmoresevere.Ifthefixedheadisstruckbyamovingobject,i.e.ablow,coupinjuriesarecommon.Concussionof theBrain:Concussion isa stateof temporaryunconsciousnessdue to violenceapplied to the skull, comeson immediatelyafter injuryandtendstospontaneousrecovery.Theunconsciousnessmaybemomentaryormaylastforanhourandisusuallyfollowedbyretrogradeamnesia.Thepatienthasnorecollectionofaccidentoninjury,althoughhecanusuallyrecalleventsuptoorwithinafewminutesoftheoccurrence.Aposttraumaticamnesiaoftenextendswellbeyondtheperiodofconsciousness.Autopsymaynotshowanychangebutinsomecases,petechialhaemorrhagesmaybefoundinthecortex,intheroofoffourthventricleandunderthepiamatteroftheuppersegmentsofthecervicalcord.

INTRACRANIALHAEMORRHAGE:1. Extraduralhaemorrhage: It is causedalmostexclusivelydueot trauma.Thevessel injureddependsupon thesiteof trauma.Commonly themiddle

meningealarteryneartheforamenmagnumoranteriormeningealarterynearthecirbriformplateareinjured,oranteriorethmoidalarteryortransverse,sagittalsinusordiploicveinsmaybeinjured.Thesehaemorrahgearecommoninadultsbetween20to40years.Inmostcasestheskullisfracturedandthehaemorrhageisdirectlyunderthefracture.

In a typical case there is a history of head injury, which causes bleeding and temporary unconsciousness. This is followed by a period of normalconsciousness (lucid interval) of one ormore hours duration. As the pressure on the brain increases, the patient first becomes confused and later comaoccurs.

1. Subduralhaemorrhage:Itmayoccurfromrelativelyslighttrauma,ofteninsufficienttocauseunconsciousness,andusuallynotproducingfracturesoftheskull.Itisfrequentlyseenontheoppositesideofimpacttothehead.Rarelytheyarefoundoverbothhemispheres.Itisalmostalwaysproducedbytrauma.Fatalfaemorrhagesareusuallyassociatedwithcontusionsorlacerationsofthebrainandfracturesotheskull.

2. Subarachnoidhaemorrhage:Thisisthemostcommonformoftraumaticintracranialhaemorrhage.Inallcasesofsignificantbraininjury,somedegreeofsubarachnoidhaemorrhageisfound.Itisalsoproducedspontaneouslyduetoruptureofberryaneurysm.

3. Intracerebralhaemorrhage:Thismaybefoundonthesurfaceorinthesubstanceofthebrain.Haemorrhageintothebrainduetotraumausuallyoccursnearthesurface.Asingledeepseatedhaemorrhageisusuallyduetosomedisease.

AgeofeffusionofBlood:Recenteffusionisbrightredwhichbecomeschocolateorbrownaftersomedaysandpalebrownishyellowin12to25days.Asthetimeprogressesthecoagulumbecomesfirmerandlaminated.

Amnesia following head injuries: It is quite common and is usually associated with concussion. Thememory of distant events tends to return before thememoryofmorerecentevents.Permanentretrogradeamnesiamayvaryfromaperiodofsecondsupto7days.Incasesrecoveringfromconcussion,eventswhich occurred just before the injury are sometimes remembered indistinctly during the period of confusion, but there will be complete amnesia for theseeventsafterthereturnofcompleteconsciousness.Assuch,thepatientmaymakefalseaccusations.Retrogradeamnesiamayalsooccurininjuriesinwhichthereisnolossofconsciousness.

PosttraumaticAutomatism:Afteranaccidentthepatientmayspeakandactinpurposivemanner,butdoesnotrememberthemafterwards.

CAUSESOFDEATHFROMWOUNDS:1. ImmediateCauses:

1. (1)Haemorrhage,2. (2)Shock,3. (3)Reflexvagalinhibition.4. (4)Mechanicalinjurytoavitalorgan.

1. Remotecauses:1. Infection.2. GangreneorNecrosis.3. Crushsyndrome.4. Neglectofinjuredperson.5. Surgicaloperation.6. Naturaldiseases.7. Superventionofadiseasefromatraumaticlesion.8. Thrombosisandembolism.9. Fatembolism.

10. Airembolism.

BLUNTIMPACTINJURIESAbluntimpactinjuryisaninjuryinflictedbyanagentwhichisneitherofapenetratingnorcuttingnature.Accordingtotheirexternalappearancebluntinjuriesare



1. Abrasions(i.e.scratches,grazes,imprintorpressuremark)2. Contusions(i.e.Bruises)3. Lacerations

Thetypesofweaponwhichhavebeenusedtoinflictbluntforcetraumaarenumerous,butimportantonceare1. Agentsimplyingintentbutnotnecessarilypremeditationandfrequentlynothomicidal

1. a)Handsb)Footsc)Bootsd)Teeth

2. Agentsimplyingintentbutnotusuallyhomicidal1. a)Whips,canes,ropesetc.b)Knukle,dusters.

3. Heavyagentsoftenassociatedwithhomicidalattacks1. a)Clubbinginstrumentsb)Axesandchoppers

SceneAnassaultwithaclubbinginstrumentmaytakeplaceinalmostanylocalityeitherintheoutdoorsorindoors.Whenitoccursindoorsinaconfinedspace,theinjuriesmaybemodifiedbythelimitationofmovementimposedupontheassailant.Theamountofdisorderatthescenewilldependuponwhetherthevictimwastakenunawaresandrenderedunconsciousi.e.incapableofdefendinghimselforwhetherhehasbeenabletomakeadeterminedefforttoprotecthimself.Inthelettercasegreatdisordermaybefound.Ofthefindingsatthesceneofthiskindthewidespreaddistributionofbloodintheformsofspurts,smearsandpoolsisthemostsignificantfeature.Ifonlyonblowhasbeenstruck,eventhoughanextensivelacerationhasbeeninflicted,nobloodmaybeprojectedfromthewoundbecausetheleadingedgeoftheinstrumentasitstrikesthebodyexpelsbloodfromthetissuebeneathit.theinstrumentitselfmaynotevenbebloodstained.Anysubsequentblowswillforcebloodunderconsiderablepressurethroughthetornvesselsinthewoundpreviouslyinflictedandthisbloodmaybeprojectedmanyfeetinalldirections,striking the walls, furniture, ceiling and of course the assailant. At the scene onemay find blood as spurts or projected droplets from arterial bleeding orrepeatedblows to thebody.Smearsmaybe foundwhere the injuredpersonhasbrushedagainst thewallorotherobject.After the first lacerationhasbeeninflicted, the striking edge for a considerable distance behind, above or to the side of the assailant depending upon how he is using the instrument. Theexaminationof collectionsor poolsof bloodmay revealwhere the injuredpersonwas lyinganddistributionof bloodupon the clothingwill provide valuableinformationastothepositionofbodyaftertheinjurieswerereceived.Anyweaponfoundatthescenemustbehandledwithextremecareitmayhavesomebloodorhairof thevictimadherent to itand itmaybear the fingerprintsof theassailant.Suchaprint isofgreat importance thatmeans thepersonwhosebloodstainedfingerprintispresentontheinstrument,musthavehandledtheweaponaftertheinitialinjurywasinflicted.

IncisedwoundsIncisedwoundsareinflictedbyinstrumentswithasharpcuttingedgesuchasrazorbladeorasharpknife.Thewoundisnormallystraight,butmaybeirregularifinflictedoveranareaoflaxtissue.Themarginsofthewoundarecleanandthereisnobruisingofthewoundedges.Allthetissuesarecleanlydividedeveninthedepthofthewound.Incisedwoundsareofforensicimportancebecausetheirpresenceusuallyimpliesanintentionalact.

SceneThesuicidalpersonfindssomequiteplacewhereheisunlikelytobedisturbed,suchashis/herbedroomoralockedbathroom.Ifthepersonkillsthemselvesoutside,thebodymaynotbefoundforseveraldays.Whenapersoncutshisthroatindoorshewilloftentoitinfrontofamirrorandsplasheswillfrequentlybefoundon theglass itself.Ahomicidalassaultmay lack theprivacyassociatedwithasuicideasregards localityof thescene. Incaseofsuicideonerarelyfindsanyassociatedwithasuicideasregardslocalityofthescene.Incaseofsuicideonerarelyfindsanydisorderatthescene.Asuicidalpersonmaywalkconsiderabledistancesaftercuttinghisthroatorwristandduringthisperiodoflocomotionhemaycollapseandgetupseveraltimesbeforethefinalcollapseandateachplacewherehecollapsesorevenstops,poolsofbloodaretobeexpectedwhereahomicidalattachhastakenplaceorconsiderabledisturbanceat the scene is almost invariable, unless the victim was rendered unconscious before the attach or was very old or where more than one assailant wasinvolved.

ThermalInjuries

BURNSAburnisaninjurywhichiscausedbyapplicationofheatorchemicalsubstancestotheexternalorinternalsurfacesofthebody,whichcausesdestructionof

tissues.Theminimumtemperatureforproducingaburn isabout44oCforanexposureofabout5to6hoursorabout65oCfor twosecondsaresufficient toproduceburns.VarietiesofBurns:Theexternalappearancesofburnsvaryaccordingtothenatureofthesubstanceusedtoproducethem.

1. Ahighlyheatedsolidbodyoramoltenmetal,whenappliedtothebodyforaveryshorttimemayproduceonlyablisterandreddeningcorrespondinginsizeandshapetothematerialused.Itwillcausedestruction,orevencharringoftheparts,whenkeptincontactforsometime.Theepidermismaybefoundblackened,dry,andwrinkled.Thehairmaybesingedordistorted.

2. Burnsproducedbyflamemayormaynotproducevesication,butsingeingofthehairandblackeningoftheskinarealwayspresent.Hairsingedbytheflamebecomescurled,twisted,blackish,breaksofforistotallydestroyed.Roastedpatchesofskinordeeperpartsmaybeseen.

3. Burnscausedbykerosene,oil,petrol,etc.areusuallysevereandproducesootyblackeningofthepartsandhaveacharacteristicodour.4. Burns caused by explosions in coal mines or of gunpowder are usually very extensive and produce blackening and tattooing due to driving of the

particlesoftheunexplodedpowderintotheskin.5. Burnsdue toXrayand radiumvary from rednessof theskin todermatitis,withsheddingofhairandepidermisandpigmentationof thesurrounding

skin.Severeexposuremayproduceburnswitherythema,blisteringordermatitis, orulcerationwithdelayedhealingand illformedscars.Fingernails



mayshowdegenerativechangesandwartlikegrowths.Infraredraysmaycausenecrosisoftheskin.6. Burnscausedbyultravioletrays(thesunormercuryvapourlamp)produceerythemaoracuteeczematousdermatitis.7. Burns fromcorrosivesubstancesshowulceratedpatchesandareusually free fromblistershair isnotsingedand red lineofdemarcation isabsent.

Theyshowdistinctcolorationandareusuallyuniform incharacter.Strongacidsproducedark leatheryburnsupon theskin.Strongalkaliscause theskintosloughandleavemoist,slimy,grayishareas.Hydrofluoricacidandbrominecausenecrosisoftheskinandtissues.

8. Electricalburns.

DegreeofBurns:Dupuytrendividedburnsintosixdegrees,buttheyweremergedintothreedegreesbyWilson.Theprecisedepthofaburncanbemeasuredbyahighfrequencyultrasounddevice.

1. Epidermal:(firstandseconddegreeDupuytren).2. Dermoepidermal:(thirdandfourthdegreesDupuytren).3. Deep: (fifthandsixthdegrees,Dupuytren): In this, there isagrossdestructionnotonlyof theskinandsubcutaneous tissue,butalsomusclesand

bonesaredestroyed,andassuchtheburnsarerelativelypainless.Theappearancesaresimilartothoseoftheseconddegree,but inamoresevereform.Theburntpartiscompletelycharred.

Effects:Theeffectsdependon:1. Thedegreeofheat:Theeffectsaresevere, if theheatapplied isverygreat.Thebodyofanadultdoesnotburncompletely inaburnthouse,as the

temperatureusually doesnot exceed650oC.For purpose of cremation, a humanbody has to be incinerated for one and half hours at 1000oC. Theashesweigh2to3kg.,andcontainbonefragmentswhichcanbeidentifiedashuman.

2. Thedurationofexposure:Thesymptomsaremoresevereiftheheatisappliedforalongtime.3. Theextentofthesurface:Theestimationofthesurfaceareaofthebodyinvolvedisusuallyworkedoutbytheruleofnine,9%fortheheadandeach

upper limb9%for thefrontofeach lower limb9%for thefrontofchest9%for thebackofchest9%for thefrontof theabdomenand9%for thebackofabdomen,99%ofthebody.Theremaining1%isfortheexternalgenitalia.Involvementof50percentofthebodysurfacewillprovefatalevenwhentheburnsareonlyofthefirstdegree.

4. Thesite:Burnsoftheheadandneck,trunkortheanteriorabdominalwallaremoredangerous.5. Age:Childrenaremoresusceptible,oldpeopleless.6. Sex:Womenaremoresusceptible.

Causes of Death: (1) Primary (neurogenic) shock due to pain, etc. (2) More than half of deaths from burns occur within the first 48 hours usually fromsecondaryshock,due to fluid loss fromburnedsurface. (3)Toxaemia,due toabsorptionof variousmetabolites from theburnt tissuepersistsup to3 to4days.(4)Sepsisisthemostimportantfactorindeathsoccurring4to5daysorlongerafterburning.(5)Biochemicaldisturbances,secondarytothefluidlossand destruction of tissue, e.g., hypokalemia. (6) Acute renal failure, due to lower nephron nephrosis occurs on the third or fourth day. (7)Gastrointestinaldisturbances, such as acute peptic ulceration, dilation of the stomach, haemorrhage into intestines. (8) Oedema of glottis and pulmonary oedema due toinhalationofsmokecontainingCOandCO2, if thepersondies inaburnthouse. (9)Accidentoccurring inanattempt toescape fromaburninghouseorbyinjuries due to falling masonry, timber or other structures on the body. (10) Pyaemia, gangrene, tetanus, etc. (11) Fat embolism is rare. (12) Pulmonaryembolismfromthrombosisofveinsofthelegduetotissuedamageandimmobility.

PostmortemAppearances:External:Theclothesshouldberemovedandexaminedforthepresenceofsmellofkerosene,petrol,etc.Theyshouldbeputintoairtightbottlesandsentforchemicalanalysis.Itisdifficulttodeterminethetimeofdeathasbodytemperature,postmortemhypostasisandrigormortiscannotbeassessed.Theburntareaswillbe found reddenedandblisteredorcharred.Blistersmaybepresenteither in themainburnoras islandsbeyond theperiphery.Thewholeof theburnedareamay formone largeblisterorbeconfluenceofblisters.Thedegreeofburning ineachareashouldbeassessed.Hair is singed,or completelyburnt.Inlesserdegreesofburns,endsarebulbousatintervals.Heatrigormaybeobservedinthemuscles.Portionsofthebodywhereclothingistight,e.g.,underthebelt,shoes,brassierorbuttonedcollarareoftencomparativelyunaffected.Sometimes,skinandhair inthearmpitsandthegumsarespared.The

colouroflighthairchangesonexposuretoheat.Atabout120oCfor10to15minutes,brownhairbecomesslightlyreddish.Thereisnochangeinthecolouroftheblackhair.Thefaceswollenanddistorted.Thetongueprotrudesandmaybeburntduetothecontractionofthetissuesoftheneckandface.Frothmayappearat themouthandnosedue topulmonaryoedemacausedbyheat irritationof theairpassagesand lungs. In thehands, theskindetachesasglove,includingthefingernails.Byremovalofthesuperficial layersoftheskinbywipingorrubbing,tattoomarksbecomevisible.TheblistersofaseconddegreeburnscannotbedistinguishedfromblistersseeninCOpoisoning,deepcoma,antemortemandpostmortemgasolineexposureandpeelingoftheskinseenin theearlystagesofputrefaction.When thesevarious typesofblistersburst, they leaveapale,moist, rawsurfacewhichbecomesyellow, tanand finallydarkbrownandleatheryasitdries.

PugilisticAttitude (boxing, fencing, or defenceattitude):Thepostureof a bodywhichhasbeenexposed to great heat is often characteristic. The legsareflexed at the hips and knees, the arms are flexed at elbows andwrists and held out in front of the body, all fingers are hooked like claws, contraction ofparaspinalmusclesoftencausesamarkedopisthotonus, inanattitudecommonlyadoptedbyboxers.Thisstiffening isduetothecoagulationofproteinsofthemusclesanddehydrationwhichcausecontraction.Theflexormusclesbeingbulkierthanextensorscontractmore.Itoccurswhetherthepersonwasaliveordeadatthetimeofburning.

HeatRuptures:Iftheheatappliedisverygreat,skincontractsandheatrupturesoccur,eitherbeforeorafterdeath.Theyareproducedbysplittingofthesoftparts.Thesesplitsmaybeanywhere,butareusuallyseenoverextensorsurfacesandjoints.Theserupturesorsplitsintheskinmaybeseveralcentimetersin length,andsuperficially theymayresemble lacerationsoreven incisedwounds.Theycanbedifferentiatedby: (1)Absenceofbleeding in thewoundandsurroundingtissues,sinceheatcoagulatesthebloodinthevessels.(2)Intactvesselsandnervesareseeninthefloor.(3)Irregularmargins.(4)Absenceofbruisingorothersignsofvitalreactioninthemargins.

Sometimes, thecharredskincrackseasilywhenanattempt ismade to remove thebody fromahousedestroyedby fire.These tearsarecommonlyseen



aroundjoints,especiallytheelbows,shouldersandknees.

Flash burns refer to thermal burns due to sudden, brief exposure to flame. This type of exposure is common in explosions, or ignition of fine particulatematerialoruponignitionofhighlyinflammableliquids.Allexposedsurfacesareburneduniformly.Ifclothingisignited,acombinationofflashandflameburnoccurs.

Humanbodiesburnreadily,especiallywhenthesubcutaneousfatty tissueshave ignited.Often,somepartsof thebodyarepreserved, if theyareprotectedfromtheflames.Insittingpersons,thebuttocksmaybesparediftheheadfallsforwardbetweentheknees,theabdomenisspared.Thehandsandfeetmaydropoff if theburning issuddenand intense,and theymaybepreservedwithslightdamagebecause they fallaway from thesourceof fire.Flexionof thelimbsbyheatmaycause tumblingofaburntbody fromabedorchair to the floor, if thebodywasnotwellbalanced.Partialburningof theabdominalwallassociated with gas expansion within the intestines may produce rupture of the abdominal wall, in the charred burnt victim. The intestines may protrudethroughthisdefect.Flameburnsusuallyhaveapatchydistributionandvaryinsizeandshape.Sometimes,thebodymaybecoveredwithablackorbrownlayerofsmokewhichdoesnotpenetrateintoskincreases.Onstraighteningtheflexedneckorlimb,thepalerskininthecreaseisexposedwhichmaymimicaligaturemark.Insevereburns,theskinmaybestiffened,yellowbrownandleathery.Dryingafterdeathleavesastiff,parchmentlikesurface.Musclesundertheburntareaarepale,brownishandpartcooked.Thisoccursafterdeathduetoheatedenvironment.Black,brittlemassesarefoundinthetissuesmergingintocookeddrymusclebeneath.Bruntbonehasagraywhitecolour,oftenshowingafinesuperficialnetworkofheatfracturesonitscorticalsurface.Thesofttissueofthefacemaybecompletelyburntexposingtheskull.Theoutertablesoftheexposedcranialvaultmayshowanetworkoffinecrisscrossingheatfractures.Iftheflameisunchecked,thebodywillbereducedtoashapless,carbonaceousmassandfinallytoheapofgreyandyellowashes.

EstablishmentofIdentity:Inacharredbody,theweightandstatureareunreliable,astheyaregreatlyalteredduetodryingofthetissues,skeletalfractures,andpulverizationofintervertebraldiscsduetotheheat.Thestaturemaybelessbyseveralcentimetersandweightlossmaybeupto60%.Thefeaturesarechangedduetocontractionsoftheskin.Moles,scarsandtattoomarksareusuallydestroyed.DentalchartsshouldbepreparedandXraysofthejawstaken,whichcanbecomparedwithpreviouschartsof thesuspectedperson.CompleteXraysof thebodyof thevictimareuseful to locatepossibleold fractures,bonyabnormalitiesorforeignbodies.Inabadlycharredorincineratedbody,thesexcanbedeterminedbyfindingtheuterusorprostatewhichresistfiretoamarkeddegree,andbypelvicbones,andagebyteethandbyobservingcentersofossificationinthebonesandtheconditionoftheepiphyses.Ifthewholebodyisdestroyed,personaleffectssuchaskeys,watch,buttons,beltbuckle,cufflinks,etc.,mayhelpinidentity.

Internal: Heat haematoma occurs when the head has been exposed to intense heat, sufficient to cause charring of the skull. It has the appearance ofextraduralhemorrhage,butisnotaccompaniedbyanysignsofinjurybybluntforce.Itconsistsofasoft,friableclotoflightchocolatecolor,andmaybepink,if the blood containsCO. The clot has a honeycomb appearance. The thickness of the clot varies from 1.5 to 15mm, and the volume up to 120ml. Theadjacentbrainshowshardeninganddiscolorationfromtheheat.Thedistributionoftheclotfollowscloselythedistributionofthecharringoftheoutertableoftheskull.Theparietotemporalregionisthemostcommonsiteofsuchhemorrhage.Themechanismofitsdevelopmentisobscure.Possibly,theblood,maycomefromthevenoussinusesorthediploicveinsbytheshrinkageofthebrainduetoheat.

The skull fractures occur most commonly in areas where the skull has been severely burned. There are two types of thermal fractures of the skull. (1)Intracranialincreaseofsteampressurecausesseparationofununitedsuturesoranintracranialexplosionoccurs,producingfractureswithgapingdefectsandwidelyseparatedbonymargins.(2)Thefractureoccursduetorapiddryingofthebonewithcontraction,andonlyinvolvestheoutertableoftheskull.Inthistypethereisnodisplacement,andthelinesoffracturearefrequentlystellate.Skull fracturesareusuallyseenoneithersideoftheskullabovethetemples.Theyconsistofseveral lineswhichradiatefromacommoncentre.Heatfracturesusuallydonot involvethesuturesoftheskulleveninyoungpersonswithununitedsutures.Heatfracturemaycrossasuture line.Peculiar,characteristicallycurvedfracturesareoftenseeninbonesofextremitiesexposedtoveryhightemperatures.

Even incasesofsevereexternalcharring, the internalorgansareusuallywellpreserved,as the tissuesof thebodyarepoorheatconductors.Sometimes,brain,liver,lung,etc.,maybecooked,i.e.,hardenedanddiscoloured.Indeathduetoburns,theCOlevelsinthebloodwillbemorethan10%andmayreach70 to80%, thoughchildrenandoldpersondieat levelsof30 to40%.Theblood ischerryred,whichmaychange tobrownishdue toheat.The levelofCOsaturationof theblood isdependantonconcentrationofCO in the inhaledair, thedurationofexposure, the rateanddepthof respiration, thehaemoglobincontent of the blood and the activity of the victim.COmay be absent in blood due to various reasons, such as rapid death, convection air currents, lowproductionofCO, flash fire (as in theconflagrationofachemicalplant.), inhalationofsuperheatedair resulting indeathbysuffocation, inwarfare,or inanexplosionwhendeathisinstantaneous.Ifdeathhasoccurredfromsuffocation,aspiratedblackishcoalparticlesareseeninthenose,mouth,larynx,trachea,bronchi,esophagusandstomachandbloodischerryred.Suchparticlesareembeddedinfrothymucuswhichcoversthecongestedmucosa.Thepresenceofcarbonparticlesintheterminalbronchiolesonhistologicalexaminationisabsoluteproofoflifeduringthefire.Thesootisbetterseenbyspreadingathinfilmofmucusonacleansheetofwhitepaper.Theamountofsootintheairpassagesdependsonthetypeoffire,themountofsmokeproducedandthedurationofsurvivalinthesmokecontaminatedatmosphere.PresenceofcarbonparticlesandanelevatedCOsaturationtogetherareabsoluteproofthatthevictimwasalivewhenthefireoccurred.Ifthemouthisopen,somepassivepercolationofsootmaybefoundatthebackofthepharynx,butitcannotbecarriedbeyondthe vocal cords, and also it is not found in the lower esophagus and the stomach. In absence of CO in blood and soot in the airways, deathmay resultpossibly due topoisoningwithCO2and/orO2 deficiency.Poisonousgases like cyanide andoxides of nitrogenare produceddue to burning of plastic andsyntheticmaterial.Burningofnitrogencontainingsubstances,e.g.nitrocellulosefilmmayliberatenitrogenoxideandnitrogentetroxide.Burningofwoolorsilkliberateammonia,hydrogencyanide,hydrogensulphideandoxidesofsulphur.Allthesegasescontributetodeath.dependingonthematerialsburninginthefire,variouslevelsofcyanidearefoundintheblood,butthelevelsareusually lessthan0.3mg.%.Cyanidecanbeproducedinsignificantconcentrationbydecompositionofthebody.Bloodshouldbepreservedbyfluorideforanalysisofcyanides.Ifflameorsuperheatedairisinhaled,burnsareseenintheinteriorofthemouth,nasalpassages, larynxandairpassageswithdestructionofvocalcordepitheliumandacuteedemaofthelarynxandlungs.Deathmayoccurrapidlybyshockoracute respiratory insufficiency.The interiorof the larynx, tracheaandmainbronchimaybe thickenedandblanched,or reddened. If thevictimsurvivesforafewdays,inflammatorychangesoccurinthelarynx,withsloughingofmucosa,ulcerationandsecondaryinfection.

Haemoconcentrationispresent,andfrequentlythereissometissueedemaandexcessoffluidintheserouscavities.Thebrainisusuallyshrunken,firmandyellowtolightbrownduetocooking.Theduramatterisleathery.Theduramaysplitandthebraintissuemayoozeout,formingamassoffrothypaste.Thepleuraearecongestedorinflamed.Thelungsareusuallycongested,andshowmarkededematheymaybeshrunkenandrarelyanaemic.Thevesselsofthelungsmaycontainasmallamountoffatduetoaphysicochemicalalterationoffatalreadypresentintheblood.Visceralcongestionismarkedinmanycases.



Petechial haemorrhages are usually found in the pleurae, pericardium and endocardium. The heart is usually filled with clotted blood. There may beinflammationandulcerationofPeyerspatchesandsolitaryglandsintheintestines.Occasionally,ulcersareproducedintheduodenum(Curlingulcers),aboutthetenthdayinextensiveburnsofthebody.Curlingsulcersareusuallysharplypunchedoutmucosaldefects,whichmaybesuperficialordeep.Petechiaeofstomach and duodenum, often with erosions, occasionally acute ulcers, is a more common finding. The large boel may also be involved. The spleen isenlargedandsoftened.The livermayshowcloudyswelling.Fatty liver isnotdue toburns,butdue to treatmentwith tannicacid.Jaundicemayoccur.Thekidneysmay show cloudy swelling, capillary thrombosis and infarction. The adrenalsmay be enlarged and congested.Whenmore than 30% of the skinsurface isburnt,haemoglobinuriaoccurs.Dependingon thematerialsburning in the fire,various levelsofcyanideare found in thebloodbut the levelsareusuallylessthan0.3mg%.

LaryngealOedema:Itmaybecausedbyallergicanaphylacticreactions,infections,tumors,inhalationofflameorsuperheatedair,inhalationofirritantgases,etc.theamountofoedemawilldecreasewithpostmortemintervalandonlywrinklingofmucousmembranemaybepresent.Microscopically,eosinophilsmaybeseen.

Bloodshouldbeobtained from theheartormajorvesselsandplaced ina tightlystopperedcontainer. Itneednotbecollectedorkeptunderoil. Ifblood isclotted,theclotshouldbepreserved.

Age of Burns: The ageing of the burns is very inaccurate and depends upon the agent, the extent, and their depth. Redness appears immediately, andvesication in about an hour. The exudates beings to dry in 12 to 24 hours and forms a dry, brown crust within 2 to 3 days. The red inflammatory zonedisappears in36 to72hours,andpusmay formundersloughs.Superficialsloughs falloff in4 to6days,anddeepersloughswithin twoweeks.After this,granulationtissuecoversthesurfaceandascarisformedafterseveralweeks.Antemortem andPostmortemBurns: In antemortem burns, a zone of hyperaemia (line of redness),which varies inwidth, but is usually 5 to 20mm. ispresentattheedgeoftheburntarea,exceptincasesofimmediatedeath.itisduetooedemaoftissuesandcapillarydilatationandmergeswiththeedgeoftheburnwhichmayshowsblisteringorcharring.It involveswholethicknessoftrueskin.It ispermanentandpersistsafterdeath.ifthewholebodyisburnt,line of rednesswill be absent. The antemortem blister appears as a raised dome and contains gas or fluid. The base and periphery show reddeningwithswollenpapillae.Postmortemblister isdry,hardandyellow.Theproteincontentofserous fluid isnotofmuchvalue todifferentiateantemortemandpostmortemburns.Inantemortemburns,theskinadjacenttoburntareashowsanincreasedreactionforSHgroupsinalllayers,andincreaseinenzymereaction.Acidmucopolysaccharidesarepresent in thesuperficial zoneofburntarea.Burnsproducedshortlybeforeorafterdeathcannotbedistinguishedeitherbynakedeyeorbymicroscopicexamination.

CircumstancesofDeath:Thedistributionofburnsontheclothingmay indicate themanner inwhich itwas ignited, thepostureof thevictimat thetime, thepathtakenbyflamesandtodiscoverthatunburntclothwassaturatedwithsomeinflammablematerial.Splashpatternsburntintothefloorandfloorcoverings,holesinthefloor,particularlyholesofthetongueandgroovetypeandthecharacteristicodourofpetroleumfuelsandsolventsareallusefulindicatorsoftheuseofinflammablematerial.Differentiationismostlyamatterforthepoliceinvestigation.TheinhalationofCOoftencausesseveremuscularincoordination,weakness,andconfusionduetowhichthevictimisunabletoescapeanddiesofasphyxia,thebodybeingburntafterdeath.Accident:Largenumbersofdeathsareaccidental. Infants,children,epileptics, intoxicatedordruggedpersonsorhelpless fromothercausesmayfall intoafire.Whenanintoxicatedpersongoestobedsmoking,anddropsalightedcigarette,hemaydieduetoburns.Lampsorstovesmayexplodeandsetfiretotheclothes.Clothesofwomenmaycatchfireaccidentallywhilecooking.Insuchcases,burnsareusuallyfoundonthefrontofthighs,abdomen,chestandface.Theremaybesevereburningofthehandsduetothevictimtryingtoextinguishthefirebybeatingouttheflames.Thefeetandanklesareusuallynotburnt.Multipledeathsfromburnsmayresult fromplanecrashesorautomobileaccidents.In industry,burnsmaybecausedbyexplosionsfrominflammableliquidsandbyflashesfromfurnaces.Theskinrestingonthesurfaceiswellpreserved.

Suicide:Occasionally,womencommitsuicidebypouringkeroseneontheirclothesbeforesettingfiretothemselvesduetodomesticworries,disappointmentin loveoracuteor chronicdisease.Extensiveburnsare seenover thewholeof thebody only the skin folds, suchas theaxillaeand theperineumbeingspared.Sometimes,apersonmaykeepapieceofclothinhermouthtosuppresshercries.Sometimes,suicidalburningisamodeofpublicprotest.Incasekerosene,petrol,etc.isfoundonthebodyincludingheadhairinhighamounts,itislikelytobeeithersuicideorhomicide.

Homicide:Murderbyburningisrare.Ifaninflammablefluidsuchaskerosene,petrol,etc.,ispouredonapersonlyingonhisbackandthenburnt,therewillbeburningof thesidesof theneck,sides f the trunk,between the thighsandotherareas,especially if theclothing isabsent in thoseareas,as the fluid runsdownwards.Sometimes,fire,hotmetals,boilingwaterandcorrosivesubstancesareusedwithcriminal intent.Adrunkenmanmaypushorthrowhiswifeorchild on the fire, and sometimes lighted lampsmay be used asmissiles.Burnsmay be inflicted on the pudenda ofwomenas a punishment for adultery.Attemptsmay bemade to burn a body after homicidewith the object of concealing the crime. In such cases, the body should be examined formarks ofviolence,e.g.,stabwounds,bullets,strangulation,etc.IncasesofIndividualdyingduetoExtensiveburnsunderAlcohol intoxication/influenceofdrugsnoaccidentalnatureshouldbespecificallyruledout.

SelfinflictedBurns:Burnsaresometimesselfinflictedinordertosupportafalsecharge.

CONFLAGRATEDHUMANREMAINSUNBURNTANDBURNTBONESInsomeinstances,burntbonesandashesareforwardedtotheforensicpathologistforinspection,ifthepolicesuspectsomefoulplayafterabodyispartially

or completely burnt. In an ordinaryhouse fire, the temperature seldom exceeds 1200oC. It is, therefore, unlikely that the body of an adult will burn socompletelyas to leaveno trace. If thebody isnot completelyconsumed, fragmentsofbones leftwouldaffordsufficientevidence to indicatewhether theywerehumanornot.Thecombustionofabodyisrarelysocompleteastoreduceittoashes.Hence,byshiftingtheashesthroughsieves,fragmentsofbonescanbecollectedandidentifiedbyacarefulstudy.

Incinerationofanadulthumanbodyforthepurposeofcremationrequires1hourat16001800oC,andtheresultantashesweighabout46kg.Suchhumanashcontainsbonepieceswhichmaystillbeidentified.

ToddandKrogmanworkingonabodyburnedinanauto,concluded:



When the soft tissue around the bones are small in amount (thin) the bones show sharp heat induced fractures of the skull and limbbones (usuallytransverse),charring,calciningandsplintering,whilewiththicksofttissue,e.g.,infemur,pelvisandnuchalareasofskullthesubstanceofthebonesshowsthemoltenorgutteredconditioncharacteristicoffusionbyheat.

Abone iswhite in appearancewhenburnt in theopen, andblackor ashgreywhenburnt in the closed fire.Aburnt bonepreserves its shape, but falls topowderwhenpressedbetweenthefingers.Itissaidthatitwillbereducedtocharcoaliftreatedwithhydrochloricacid,butthisisnotnecessarilytrue.Ifit isburnt tosuchanextent thatorganicmatter isdestroyed,nocharcoalwillbe leftonaddingacid.Whenexposed toveryhigh temperature,characteristicallycurvedfracturesmaybeproducedinlongbonesandskull.Abonebecomessobrittleandfriableonprolongedexposureofthefirevictimtosuchintenseheat,thatitisreadilyfracturedduringtransportofthebody,oritsbeingmoved,orduringexamination.Ahyoidbonemaysimilarlybreakonmanipulation.Aforcefulstreamfromafirehosecanfragmentabonelikethefemur,renderedbrittlebyexposuretosuchhightemperatures.Theskullburstsduetotheformationofsteamwithin theskull cavityasa resultof intenseheat.Suchexplosivepostmortem fracturesareaccompaniedbygapingdefectsandseparationofnonunited sutures and protrusion of brain matter. Intense heat can lead to desiccation of skull, with the production of postmortem thermal linear fracture,commonlylocatedoneithersideoftheskull,abovethetemples.Theyusuallyconsistofseverallineswhichradiatefromacommoncentre.Iftheappearanceisnottypical,distinctionfromanantemortemskullfracturemaybedifficult.Besides,postmortemmechanicalfractureofanybone,duetothefallofawallorabeamcanalsooccur.Itisimportant,therefore,todistinguishbetweenpostmortemthermalfractureandpostmortemmechanicalfracture.

In casesof suspectedpoisoningbysomemineral, eg,arsenic,all theavailableashesandburntbonesshouldbepreserved for chemicalanalysis.This isbecause,despiteitsvolatility, it ispossibletodetectarsenicinlargepiecesofburntbonesmixedwithashesincasesofarsenicpoisoning,forthefollowingreasons.

1. Muchofthearsenicinbonesisconvertedintoarsenates,partiallyreplacingthephosphatesofthebones.Arsenatesarenonvolatilehencearseniccanbedetectedinthebonesevenafterstrongheatingforalongtime.

2. Evenifallthearsenicwerepresentinthebonesintheformofarsenictrioxideorsomeothervolatileform,allthearsenicisnotlikelytobelostduringtheprocessofcremation,ascompletecombustionofabodydoesnot,asarule,occurinIndia.Hence,someofthevolatilizedarsenicis liabletobecondensedonthecoolerpartsoftheunburntfuneralpyre,whereitspresencemaybedetected.

Whenarsenictrioxideisheatedwithsaltsofsodiumorearthgroup,partofthearsenicisconvertedintoarseniteandbecomesnonvolatile.

BurnsThemedicolegalinvestigationofadeathfromburnsshouldbeaimedatansweringthefollowingquestions.

1. Wasthepersonalivebeforefirestarted?2. Didtheburnscausedeath3. Ifdeathwasfromcausesotherthanburns,didtheburnscontributetodeath?4. Werethereanynaturaldiseasesorinjuriesthatcouldhavecauseddeathorcontributedto5. Weretheburnssustainedaccidentallyordidthepersoncommitsuicide?6. Wasthedeathofcrime?7. Wasthereanyattempttoconcealcrime?8. Whatwasthecauseoftheonsetoffire?9. Whatevidencewasfoundtoidentifythedecedent?

Occasionally,withmultiplefatalities,onemaybeaskedwhodiedfirst.Examinationofscenemayrevealinformationregardingthecauseoffireandmayalsointhesiteoforiginofthefire.Theoverallstudyofthecircumstancesofdeathatthescenemayinformationconcerningthemannerofdeath.Fromthesceneofdeathallpersonalbelongingssuchaskeys,watchband,bellbuckle,buttoncufflinksandpiecesofunburnedclothingshouldbecollected.Thesecanbehelpfulinestablishedtheidentityofthedecedent.

HEATThreeclinicalconditionsanyresultfromexposuretohighenvironmentaltemperature:(1)heatcramps,(2)heathyperpyrexia,and(3)heatprostration.

1. HeatCramps:(minerscramps,stokerscramps,or firemanscramps):Theyarecausedbyarapiddehydrationofbodythroughthe lossofwaterandsalt in the sweat. It is seen in workers in high temperature when sweating has been profuse,. The onset is usually sudden. Severe and painfulparoxysmalcrampsaffecting themusclesof thearms, legsandabdomenoccur.The face is flushed, thepupilsdilatedand thepatientcomplainsofdizziness,tinnitus,headacheandvomiting.Intravenousinjectionofsalinegivesrapidrelief.

2. HeatHyperpyrexia orHeatStroke:Heat stroke is a condition characterized by rectal temperature greater than 41oC and neurological disturbances,suchaspsychosis,delirium,stupor,coma,andconvulsions.Thetermthermicfeverorsunstrokeisusedwhentherehasbeendirectexposuretothesun.High temperature, increasedhumidity,minor infections,muscular activity, and lack of acclimatization are theprincipal factors in the initiation.

Where there is 100%humidity, a temperature of 32oC in the environmentmay lead to heat stroke.Other factors are old age, preexisting disease,alcoholism,useofmajortranquilizers,obesity,lackofairmovementandunsuitableclothing.Failureofcutaneousbloodflowandsweating,thefactorswhichcontrolbodytemperature,leadstoabreakdownoftheheatregulatingcentreofthehypothalamus.

Clinical Features: The onset is usually sudden, with sudden collapse and loss of consciousness. In some cases, prodromal symptoms of headache,

dizziness,nausea,vomiting,weakness,mentalconfusion,musclecramps,restlessnessandexcessivethirstoccur.Thetemperaturerisesto40oCto43oCormore.Theskin isdry,hotandflushed,withcompleteabsenceofsweating.Thepupilsarecontracted,.Thepulse israpid(usuallymore than130p.m.)andlaterbecomesirregular.Thebreathingisrapid,(usuallyabove30breathsp.m.)deepandofKussmaultype.Bloodpressureislow.Convulsionsoccurandthepatientbecomesdeliriousorcomatose.Thefatalperiodis5minutesto3days.

PostmortemAppearances: They are not specific. The temperature remains high after death.C.N.S: The brain is congested and edematous and petechialhemorrhages are seen in the white matter . cerebral hemispheres are increased in weight and show flattening of the convolutions. Cellular changes with



pyknotic nuclei, swollen dendrites, chromatolytic changes, degeneration of neurons and diffuse proliferation of mocroglia are seen. Changes occur incerebellumrapidlywhicharemorestrikingandconsistentandconsistofoedemaofthePurkinjelayerandswelling,disintegrationandreductionofthePurkinjecells. If the person survives for 24 hours, complete degeneration of the Purkinje layer and gliosis are seen. Rarefaction of the granular layer occurs withprolongedsurvival.Hypothalamusshowsoedemaof thenuclei.Respiratory system:Tracheaandbronchi contain frothyhemorrhagic fluid.The lungs showoedema, congestion and hemorrhages. Heart: Dilation of right auricle, flabbiness of muscle, petechial or confluent subepicardial and subendocardialhemorrhagesanddegenerationofmyocardium.Liver:Congestionandcentrilobularnecrosis.Kidneys:Congestion,oedemaandincreaseinweight.Incaseoflonger survival, haemoglobinuric nephrosis is common. Adrenals: Pericapsular hemorrhages, engorgement of sinusoids and cortical degeneration.General:Petechialandconfluenthaemorrhagesareseeninmostorgans.

1. Heat Prostration(heat exhaustion heat syncope, or heat collapse):Heat prostration is a condition of collapsewithout increase in body temperature,which follows exposure to excessive heat. It is precipitated bymuscular work and unsuitable clothing. There is extreme exhaustion and peripheralvascularcollapse.Thepatientfeelssuddenlyweak,giddyandsick.Hemaystaggerorfall.Thefaceispale,theskincold,thetemperaturesubnormal.Thepupilsaredilated,thepulsesmallandthreadyandtherespirationsighing.Thepatientusuallyrecoversifplacedatrest,butdeathmaytakeplacefromheartfailure.

SCALDS

Ascald isan injurywhichresults fromtheapplicationof liquidabout60oCor fromsteam.Thedestructiondoesnotextendasdeeplyas inburns.Rednessappearsatonceandblisteringwilltakeplacewithinafewminutes.Ifblisteredskinisremoved,itwill leaveapinkrawsurfaceandlatertheexposeddermisbecomesbrownish,hardanddry.Scaldsshowsaddeningandbleachingbutdonotsinge thehair,anddonotblackenorchar theskin.Superheatedsteamsoddenstheskinwhichbecomesdirtywhitecolour.

DegreesofScalds:(1)Erythemabyvasoparalysis,(2)Blisterformationduetoincreasedpermeabilityofthecapillaries,(3)Necrosisofthedermis.

Theinjuryislimitedtotheareaofcontactandismoresevereatthepointoftheinitialcontact.Scaldingcanoccurthroughclothing.Scaldedareasareusuallylarge,butmaybesmall ifcausedbysplashing.Streaksof liquidrundownwardsfromthemainareacausing linesofblisters.Sticky liquids.Suchassyrup,oilsand tar causemoreseverescalds thanhotwater.There isusuallya sharplydemarcatededge, corresponding to the limitsof contactof the fluid.Thescaldedskinmayswellandexudeserum.Scarsofscaldsaremuchthinnerthanthoseofdeepburnsandcauselesscontractionanddisfigurement.Blistershaveanhyperaemiczonearoundthem.Thereisareddeningandswellingofthepapillaeintheflooroftheblister.Theblisterfluidcontainswhiteandredcells.Apostmortemblisterdoesnotshowhyperaemiainthesurroundingareaandthefloorisnotred.Ifinflammablefluidsareused,signsoftricklingoftheburningfluidwillbepresentonsomepartsofthebody,e.g.ifkeroseneissplashedonabodylyingonitsbackandthenignited,runsofburningliquidwillbeseenonthesidesof theneck,sidesof the trunk,between the thighs,etc. Inhalationofsteammaycause thermal injuryof the respiratory tract,producingdeathbyasphyxia due to obstruction to airway by the oedematous mucous membrane. Death usually occurs from shock, fluid and electrolyte disturbance andsecondaryinfection.

Occurrence:Scaldsareusuallyaccidentaldue toburstingofhotwaterbottles,burstingofboilers,splashingof fluid fromcookingutensils,orpullingoversaucepansorkettlesbychildren,etc.Occasionally,childrensuck thespoutsofkettles,whichcausesseveresteamscaldsof themouthandairpassageswithoedemaoftheglottis.Suicidebyscaldingisrare.Boilingwatermabethrownwithintenttoinjure.Murderscaldingisrare.

Spontaneouscombustion:Spontaneouscombustionofthehumanbodynotoccur.Abodycanneverbeconsumedwithouttheapplicationoffireorflameanditcannotbereducedtoasheswithoutthesurroundingobjectsbeingsetonfire.

PreternaturalCombustion:Thisisveryrare.Duringputrefaction,

inflammablegasesareproducedinabdomenduetotheactionofmicroorganismsuponorganicmatter.Thesegasesareignitedifaflameisnearby,andcausepartialburningoftheneighbouringsofttissues,butcompletecombustionofthebodydoesnottakeplace.Itisnotavalidscientificphenomenon.

Duringlife,inflammablegases,suchashydrogen,hydrogensulphideandmethanemaybeformedinthealimentarytract.Suchgaseswhenbelchedorletofffromtheanus,maybeignitedontheapplicationofaflameandcauseaburnatthesite.

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